CHINA and MODERN MEDICINE and Body Sick Unto Death ; but the Science O F L Hea Ing Was Unknown , While Its Native Practice Was Discredited , and Indeed Discreditable

C HINA AND MODERN MEDIC INE

A S T U D Y I N ME D I C A L MISSIONARY DEVELOPME NT

HAROLD BALME

(ENG J . D. P. H .

' Presi dent (formerly Dean of th e of Meaz cz /z e) S ﬁan tu n Ckristzan Un v rsz t Ta rz an Clzz na g i e y, ,

WITH PREFAC E BY

S IR DONAL D MA AL ISTER M C , K . C . B . D .

' Pres z denf of ﬂze General Co uncil of Medical E ducati on an d R egistration of th e Un ifed K angdam Prmczpal and Vi ce-Ch ancellor of tile Umvers z fy of Glasgow

LONDON

UNITED CO UN CIL FOR MISS IONARY EDUCATI O N

EDINBU G OUSE 2 E ON G E S w l R H H , AT AT , . . 1 9 2 1 Fi t Edit on J un 921 rs i , e 1

S ec nd Edition November 1921 o ,

PREFAC E

LD MACAL I S TE R . . B Y S IR DONA , M D

I f times faith N these unrest ul , when is apt to f c o ld st o r f aint and love to wax , the y un olded in this book will come to many a perplexed Ch rist ian as a stimulus and a challenge . The social and religious dispeace in Western Christendom is to ” many hearts a burden almost not to be borne . Ev en the brave are daunted and the wise are f ba ﬂed by the outlook . The believer in the Fatherhood o f God and the Brotherhood o f Man is hard put to it to vindicate his creed . He knows that fo r lack o f that vision the peoples are perish

fo r f ing about him, but the time he eels powerless f to reveal or revive it . He shrinks rom pessimism , but he has to admit that the pessimist ’ s gloom is not without a cause . It is the dark hour indeed, and he wonders whether any dawn is at hand . Let him turn fo r a while from his misgivings fo r Europe to the history o f Christian medical f f w missions in China , as it is set orth in the ollo ing pages , and he will take heart again . A hundred years ago no human enterprise could have seemed more hopeless than the physical and spiritual

f o ul trans ormation f China . Millions were in so 5 6 CHINA AND MODERN MEDICINE and body sick unto death ; but the science o f l hea ing was unknown , while its native practice was discredited , and indeed discreditable . Dis interested service and sacriﬁce fo r the sake o f Christian ideals was a motive scouted by the ul r ers and unthinkable by the masses . The vast

’ o f l ness China s territory and popu ation, the

o f antiquity her traditions , her inveterate social

fo r habits, and her stolid contempt western in

o f novation , made the project the ﬁrst adventurers fo r the uplifting o f China seem to the worldly

h O e f wise merely fantastic . The p o the little o f band Christian pioneers , that their effort s would one day raise the mighty mass o f China to a higher level , that their teaching and practice would in the end leaven the inert lump o f its pride and prejudice, was regarded even by many f western Churches as a ond illusion . f The task set be ore these pioneers , inspired as they were by trust in God and compassion fo r men , was indeed harder and less promising than that o f reconstructing European Christendom to f f f day . But in aith they aced it , and their aith

fo r has not been belied . This book shows , our example and encouragement under stress o f evil

s f o f day , the huge di ﬁculty their undertaking ,

o f ff the spirit and method their e ort , and the measure and promise o f their triumph . Two points in the method I would lay stress upon . They are set out in the statement PREFACE 7 o f the original Medical Missionary Society in

China by its ﬁrst President , Thomas Richardson M D . Colledge , . Aberdeen Among its aims were these

1 . To encourage Western Medicine among the

ff fo r Chinese , and a ord an opportunity

Christian philanthropy and service .

2 . To educate Chinese youths in Western

Medicine .

Firs t , then , western medicine was mediated to

China by the Christian medical missionary . As ’ an apostolic envoy, his Master s commission enjoined him to preach the Reign o f God and ” to cure the sick . His mission was twofold : a

o f ff O mission healing, a ording him an pportunity o f Christian philanthropy and service and a

o f mission teaching , whereby he proclaimed the true motive o f such service to be that beﬁtting a

o f son o f God and a follower f Christ . His aith and his works had to be o f a piece ; they had a f common groundwork, and each rein orced the other . It is o f high importance that the blessings o f medical and hygienic science shall continue to be associated in the mind o f China with the Christian

o f ideals brotherhood and service . Corporate

fo r f o f responsibility the wel are individuals , the duty o f each to safeguard the public health o f the community, are still novel conceptions in Chinese 8 CHINA AND MODERN MEDICINE

f li e . It is necessary to real progress that they shall be assimilated and become operative .

S econdl y, no medical mission is complete which does not provide fo r training Chinese practitioners

fo r as well as treating Chinese patients . Scientiﬁc medicine in China must not continue indeﬁnitely f ” to be a oreign doctrine . The medical pro fessio n o f China must become national if it is to be universally accepted . To build up , on the f best and surest oundations , a Chinese medical profession which shall be instructed in the soundest knowledge o f the West and capable o f advancing it , and which at the same time shall be

o f imbued with the spirit and ethics Christianity, has become the conscious aim o f the foremost

o f Christian Medical Schools China . From small beginnings they have grown in some happy in stances into great institutions . These vie with the best o f other countries in the scope and

o f standard their instruction , and they are able, if at this juncture they receive fuller support and f sympathy rom Western Christendom, to render a unique service not only to China but to civili i f z at o n . Barely hal a century ago Japanese medicine was simply receptive o f what the West could teach ; it is now making valuable con t ribut io ns o f its own to the common stock .

There is no doubt whatever that Chinese medicine, guided into the true path by the devotion o f men f like Pro essor Balme and his colleagues , will in PREFACE 9

due course enrich the science o f the world with ’ new discoveries in China s own immense and un f explored ﬁelds . The time is there ore opportune fo r helping the Medical Colleges o f China to fulﬁl

o f their high mission sowing the good seed ; and , fo r earnest that the harvest will be plenteous on

o f such a soil , the growth and development the scantily- furnished medical missions here recorded

should be more than enough . The labourers are o f f still too few . But the promise the uture is

theirs , and they have shown abundantly that they have in their hearts the courage and the

faith that overcome . Let us strengthen their hands .

D. M . AUTHOR ’S PREFAC E

THE privilege o f introducing the beneﬁts o f modern medicine to the Chinese people during

fo r the past century has been shared, the most

o f part , by the representatives medical missions , and this book is a humble attempt to sketch some o f the main lines o f development which have been followed in connection with that enterprise . It does not claim to be a history o f ff modern medicine in China , nor does it o er a comprehensive review o f the various activities which have been connected with medical mis sio nar ff o f y work in di erent parts the country . Limitations o f space have made it impossible to do more than refer to some o f the leading features which have characterized this effort and as a result a large number o f interesting f acts have had to be omitted . Moreover, the

fﬁ ul di c ties under which the book has been written , owing to a temporary absence from China and

o f - to the constraints an inexorable time limit , have still further increased the possibility o f serious omissions : a sincere apology is offered if such have occurred . The book could not have been produced at all had it not been fo r the generous assistance afforded by the Secretaries o f the various Mission

Boards in Great Britain , Canada and the United 10 AUTHOR ’ S PREFACE 11

States , in placing their publications on this ’ subject at the author s disposal . Special thanks

C B A o f are due to Mr . H . Fahs , . Librarian the

fo r New York Missionary Research Library, his indefatigable effort s in procuring sources o f f in ormation ; to Mr Lionel Colledge , fo r his kindness in supplying details o f the life o f his distinguished grandfather and in granting ’ permission fo r the reproduction o f Chinnery s f f amous painting to Miss E . J . Haward , ormerly Matron o f the Peking Union Medical College

o f Hospital , and Miss Batty, Secretary the ’ o f fo r Nurses Association China , their generous assistance in the preparation o f material fo r the chapter on nursing ; to Drs A . C . Hutcheson

L . . f r f . J r o v and J Maxwell , , aluable in ormation regarding the progress o f medical research in

China ; to Rev . William Paton, Rev . Nelson

Mo o rsh ead H Bitton , Dr R . Fletcher and Dr .

fo r f Melville Churchill , their help ul comments

’ and suggestions ; . to the Women s Foreign Missionary Society o f the Methodist Episcopal

o f Church, and the Master Emmanuel

fo r College , Cambridge , permission to reproduce

o f T photographs ; and, most all , to Mr . R . W . o f f Lunt , late editor the United Council o r Mis sio nar fo r y Education , his invaluable literary

criticism and inspiring counsel . H . BALME

LONDON Ap ml 1921 C ONTENTS

EF S D LD MA ALISTER MD R CE B Y m O c . P A NA , .

’ A UTHOR S PR EFA CE

CHA PTER I THE RATIONALE OF ME DICAL MIS S IONS — Th e characteristic features of mo dern medicme Its demand for exact — — scientiﬁ c truth Its emphasis on prmmple of trusteeship Ch inese medi cme — - in o lden time Its limitatio ns t o day o wmg t o i gnorance of heme sc iences — Its failure t o develo p sense of trusteeship Co ns equent Wides pread suffering — — in China Th e special c o ntribution of medi c al missions Their obj ective and th e metho ds of attainment

CH APTER II

THE COMING OF THE WES TERN PHYS ICIAN

Th e ﬁrs ioneers ol e e and Par er—S ri in success of eir work t p , C l dg k t k g th — — Their conception o f content of medical miss io nary pro gramme Foundation — — o f Medic al Missio nary S o ciety in Ch ina Loc khart and R obson First trans — latio n of medi cal bo o ks into Ch mes e Extens mn of medi cal effo rt al ong sea — — co as t provinces Extension inland Co o peration of general medical practi — tioners Th e ﬁrst women ph ysiCians

CHAPTE R III METH ODS OF APPROA CH

m ca i n — Problems confronting th e edi l p o eers Th e redemption of th e medical - — reputation Th e overc oming of hostility and prej udice D isabilities from men —Th e m o — inadequate staﬁ and equip t eth ds of th e pioneer doctor Th e f th e ut- a ien e ar ment—H w i — functi on o o p t t d p t o t should b e c onducted Th e — vastness o f th e untouched territo ry Methods of reaching new sections of

CH APTER IV

THE EV OLUTI ON OF THE HOS PITAL

— - m - Treatment of Sick in China Th e o ld ti e hospital and its handicap Its — a f o dwﬂl—S ur ica su — v al ue Th e cultiv tion o g o g l cc esses Spiritual mﬁ uence — m n f ia os i a s—Th e rue un i Develo p e t o spec l h p t l t f ct on of a miss IOD hospital - — — Its educative side Th e Chi na Medi cal Miss ionary Asso mation Evo lution m ern i a — na ua a i of th e o d h osp t l I deq te f cil ties in many mission hospitals 12 CONTENTS 13

CHAPTER V

T HE NE w PR OFES S ION IN CHINA — — Early attempts at medi cal educati on Apprentice metho d Classes for — — student assistants First Medic al Coll ege Devel o pment of union effort in — — medical education Medi cal co lleges for wo men Th e founding of th e China — — Medical B o ard Medical instruction in Mandarin Th e Gounod o n Medi cal — — Education Th e ques tio n o f a double standard Premedical instructio n — Preparation of a scientiﬁc literature Attitude of th e Chines e Government

CHAPTER VI THE ADV E NT OF THE CHINES E NURS E

’ — The old-time hos pital from th e nurs e s standpomt Problems facing th e — — pioneer nurse Ward o rderlies and their limitations E arly attempts at — — — traini ng Recent develo pments Characteristics of Chinese nurse Th e ’ — ’ — Nurses Association of China Male nurses work Maternity training

CHA PTER VII

RES EAR CH AND PUB LI C HEALTH — — Difficulties of research in China Th e attitude o f th e people Lack of — — — facfli ties o r leisure Early effo rts Historical investigati ons Chi nese — — Materi a Medica An atomi cal and ph yswlogical investigatio ns Clinical and — — p atho lo gical research D iseases preval ent in Ch ina Th e imp ortance of — — public health measures Metho ds employed Th e fi eld fo r preventive medicme

CHAPTER VI I I

THE OUTL O OK T O -DAY — — Effect of western medicme in China Quantitative results meagre In —l- ﬂuence of western physician far- reachi ng New attitude towards foreigners — — Extensio n of Christian inﬂuence Awakeni ng o f social conscience Oppor - — — tumties for co o peratio n with Ch inese Th e p o licy of th e future Chinese — — leadership Th e medical missio n as a model What th e new policy requires

APPENDICES L OG AP Y I . B IB I R H R TI N E D L II . i NFO MA O R GAR ING MEDICA MI SSION SERVIC E IN CHINA D L Y III . CHINA ME ICA MISSIONAR ASSOCIATION TIO AL EDICAL CI TI o r C I Iv. NA N M ASSO A ON H NA EDIC L CURRICULUM C I v. M A IN H NA ’ E A T F vi . NURS S SSOCIA ION O CHINA

INDEX

End Pap er en we ance ac war at the isto r o f me icine Wh gl b k d h y d , o se mi in me ica art and science t o u o n ea th ghty d l , h gh l g d d, us a ass m A are co n ure u e o re nd o n as a ano ra a. j d p b f , p p grave - lo o kingChinaman seems t o take the lead th e shado wy o rm o f so me E ian ries s and so me Grecian riests f gypt p t , p ea e Aescu a ius scarce ess s a o w o o w t en h d d by l p , ly l h d y, f ll ; h co me th e silent and deeply co ntemplative Pyt hago ras and his isci es ne t co me the Cni ians and the Asc e ia es wit d pl ; x d l p d , h

Hi o crates at t eir ea . So crates P ato and Aristo t e pp h h d , l , l f u A t erwards co me the is ci bringup th e rear o this gro p . f d ples o f the A e an rian sc o o s wit o se o f Per amus— Ga en l x d h l , h th g l , Ara ia s wi Ce sus et c . T en o o w the n t Rhaz eres at l , h f ll b , h

eir ea in th e nint centur . th h d, h y It is a stran e and mo e arra c o w e riests S o rt g tl y y ; l d p , h ro c e a -men and ar ers o o e wo men o wne and f k d b th b b , h d d , g d e ar e necro mancers wit the s m o s o f Astro o and b d d , h y b l l gy Th e an ram Christianity o n their banners . p o a mo ves o n i a a ile Baco n esa i Har e i t e ns to wn . G o V us l gh b g d l , , l , v y, S en am Hunter and J enner wit o t er names as ami iar yd h , , , h h f l , a ear o n the scene w i e intermin e wi t ese reat pp ; h l , gl d th h g and o o men co me Ro sicrucians and reten ers A c emists g d , p d , l h and Humo ra ists So i ists and Chro no thermalists mesmerists l , l d , , i er f all s rts and fantast c dream s o o . — MD. J AMES HENDERSON, . , 1864 . CHAPTER I

THE RATI ONALE OF ME D I CAL MIS S I ONS

That H e might be th e ﬁrs tbo rn o f a great bro therh o od. ’

R iii 29 Mo ffatt s Versio n . OMANS v . ( )

IT may not be possible to speak with exact pre cisio n as to what we would all imply by Mo dern

Medicine ul o f , or as to the partic ar number years during which western medicine , as practised to day, can claim a modern origin, but there is one important criterion which will help us in drawing the dividing line . The distinguishing mark which characterizes modern medicine all over the world to -day is its ﬁght fo r exact truth in the investiga

o f tion and treatment disease, and its employment o f every known form o f science in the attainment o f that ideal . It is easy fo r us to smile at the queer fantastic

s o f notion the Chinese physician, with his strange ideas as to the causation o f bodily disorders and

o his ingenious classification f diseases . But we are apt completely to forget the equally unscientific theories which filled our own medical text -books less than a century ago . Open any treatise on o f w r physiology that time , or any o k on the 15 16 CHINA AND MODERN MEDICINE

o f o f etiology disease, and you will ﬁnd a medley

empirical observation and superstitious theory, with many an amusing reference to the various humours which a ffect the functions o f the

body . But no sooner did physicians learn to yoke to the chariot - wheels o f medicine the vital forces o f

fo r natural science, with its insistent demand the

Old truth , than the order began to pass away,

o f and the era modern medicine was ushered in . It was no longer o f any avail to indulge in plausible theories as to the functions o f the different organs o - o f f the body . The test tube the chemist and the experimental observation o f the physiologist f were hence orth to be sole arbiter and judge . It was idle to draw fancy pictures as to the

o f o f supposed location artery and nerve, viscus

fo r o f and gland, the keen scalpel the dissector f was laying each structure bare . It was utile to

o f speculate as to the processes disease, based

’ upon an alleged interpretation o f a patient s f f eelings and ancies , when the expert pathologist could unfold the whole story by autopsy and hl C microscope , and rut essly xpose every incorrect deduction . What a tremendous change has been brought about ! How wonderful is the new conception o f the growth and development o f the human body since ﬁrst we summoned bio -chemistry and physical chemistry to our aid , and were taught

18 CHINA AND MODERN MEDICINE

o f their expression in the League Nations . But the application o f this doctrine had a much earlier origin in respect to individuals . It sprang into being on the ﬁrst occasion that a physician taught that all medical discovery, and all knowledge as

o f to the causation and treatment disease, were the common heritage o f every practitioner o f

o f medicine , and not the private monopoly the f discoverer himsel . And when one begins to consider the implications o f that teaching particularly against the background o f those countries where no such doctrine has ever been — taught the immense potentiality o f such a truly Christian conception at once seizes the imagination . Think fo r a moment where medicine would be to - day if Jenner had set up a private consulting

fo r o f room the practice vaccination , and had never made it possible fo r others to share in

o f un his discovery . Think the appalling and necessary suffering that hundreds Of thousands would have endured if Morton and Simpson had appropriated to themselves the sole right to the

o f ae o f administration an sthetics , the secret which might well have died with them . Where would surgery be if Joseph Lister had not made his antiseptic principles freely accessible to one and ? all Where , indeed, could we point to any

o triumphs f modern medicine , had it not been fo r the fact that this conception o f trusteeship RATIONALE OF MEDICAL MISS IONS 19 has been the dominating ideal o f every medical investigator o f modern times Nor was it only in the realm Of medical dis

r c o ve y that this new ideal became operative . In

o f spite certain regrettable exceptions , the sense o f trusteeship has gradually become the funda mental conception governing the attitude o f physician and nurse towards their patient , with the result that everything connected with the

S — f ick man his health, his li e , his very conﬁdence

- fo r is regarded as a sacred trust , which his f doctor is answerable to God and to his ellows . It is around this central thought that the whole o f our modern system o f medical and nursing l ethics has been bui t up . Hospitals and dis

ensaries a p , Red Cross Societies and asylums , h ve all alike been organized as an embodiment o f this creed . And the faithful work o f every conscientious physician and nurse has been an exposition o f this underlying sense o f personal

’ r f responsibility fo the patient s wel are .

II It is as one comes to study the civilization and

o f progress other lands , and to appreciate the appalling loss , both to health and to general o f knowledge , which the absence these two domin ating ideals means , that one ﬁrst learns to estimate

o f them at their true worth . No close observer Chinese life and thought can fail to be astonished 20 CHINA AND MODERN MEDICINE that a country o f such magniﬁcent history and such ancient civilization , and a people with such

fo r ul f far reverence scholarship , sho d be le t so behind by the nations o f the West in all matters o f science . It is startling to realize that a nation whose schools and colleges have been in existence almost from time immemorial should have failed until very recent years to organize any system o f scientiﬁc medical education ; that a land where benevolence has been held up as a primary virtue should be devoid o f hospitals and that a people who have set so great a store upon knowledge S hould have regarded the physician as in very much the same category as the astrologer and

- the fortune teller . Yet that was exactly the condition up to a very few years ago . In China there was no f medical pro ession , as we understand the term ; there were no restrictive regulations to safeguard

o f the practice medicine , and no authority which could prevent any illiterate adventurer who ’ f S wished to do so rom hanging out a doctor s ign , 1 and preying upon the credulity Of the public . How may this be accounted fo r ? May it not

1 Th e ro es sio n o f medicine is c ons idered an exc ellen co ndui p f t t, o r was e i e t o c arr o ff all th e li erar ac h elo rs wh o c anno t p p , y t y b t a a t o th e su erio r rades o r re end t o th e mandarina e tt in p g , p t t ; a hina is c o ns e u en l s warmin Wi h do c o rs e en wi h ou nd C q t y g t t , v t t in th e almos innumera le ama eu rs fo r almos e er c o unt g t b t , t v y se h as a s ma erin o f medi c al no wled e and th e smalles Chine tt g k g , t ” ’ — Abbé c l r i M. L Hu as s s e eral ro essio na ac i o ners . village b o t v p f p t t ,

s iani t i n Chi na Tartar and Thi bet v o l. iii. . 209. Chri t y , y , p RATIONALE OF MEDICAL MISSIONS 21 all be explained by the lack o f those two great ideals , which , as we have seen , have done so much to build up the tradition o f medicine in western ? o b countries Centuries ago , when a shrewd servation o f human nature and an empirical knowledge o f the use o f drugs formed practically the only stock- in -trade o f the physician in any

o f f r part the world , China was not a behind any — in f other country in medical knowledge act , in some respects she was actually leading the way . Two thousand years before the birth o f Christ the Chinese medical teachers were accurately

o f describing the symptoms cholera . Seven hundred years before the value o f inoculation against smallpox was recognized in this country

f o f it was reely practised in China . The uses

Of o f Of mercury, arsenic , rhubarb , and numberless

k fo r other medicaments , have been nown centuries among the Chinese . And even such essentially

o f modern ideas as the importance clean , airy,

- o f and well lighted rooms , and the value quietness , are referred to by Lew -Ian in the regulations which he drew up fo r the treatment o f smallpox nearly two hundred years ago , and which were published

Go lden Mirror o Medical Practi in the f ce. o f But in spite this promising beginning , the application o f natural science to medicine never f reached China , and even so undamental a physio logical fact as the circulation o f the blood was

not even guessed at by a Chinese practitioner . 22 CHINA AND MODERN MEDICINE The superstitious ideas regarding the dead body

o f made the practice dissection an impossibility .

These things , together with complete ignorance as to the use o f the microscope or the principles o f

ul chemistry and physics , necessarily res ted in the most erroneous ideas becoming current as to what took place within the human organism ; whilst

o f o f the absence any system examinations , or

fo r other qualiﬁcations medical practice , made the widespread exploitation o f the profession not only possible but inevitable . Perhaps it was due f 1 249—1 1 22 to this act that in the Chou dynasty,

B C . . , the public were warned against swallowing the medicine o f any physician whose family had not been in practice fo r at least three generations Whilst at the same time it was decreed that all medicine administered to a ruler o f the state must first be tasted by the Prime Minister 1 A fo r new use that influential statesman , and pos ‘ sibly a novel means o f removing him from o fiic e Such conditions made the formation o f a real f medical pro ession an utter impossibility, with the result that any knowledge accumulated in course Of years by a practitioner o f experience was handed down from father to son as a jealously guarded secret , and never passed into general currency . There is no doubt whatever that many o f th ose

O d o f l Chinese physicians , by dint careful observa

1 Hi ric i a b es s to Ch n . A. Gil . 10 . y H , p . RATIONALE OF MEDICAL MISSIONS 23

o f o f tion, gathered together in course time a mass valuable information as to the symptoms o f various

o f f diseases , and the action the chie drugs in the

o pharmacop eia . Their knowledge may have been

f o f o f empirical , and di ﬁcult explanation in terms

o f dl modern science , but much it would undoubte y

o f be accurate , and great beneﬁt to the patient . Unfortunately most o f this information has been

fo r lost to the world , the reasons above stated , and such secrets as still remain are exceedingly

f l o f di ﬁcu t discovery . f O ten , too , the Chinese physician compensated fo r his ignorance o f exact science by a ruminating

l f o f phi osophy and a pro ound study human nature . An amusing instance o f this left me with a very deep admiration fo r the manner in which the experienced Chinese practitioner understands and handles his patients .

It happened , in my early days in China , that I had as a patient a member o f the bodyguard o f Of one the provincial governors . He was a

Of magniﬁcent specimen physical strength , a man who , when carrying important despatches to and f u o rom Peking , wo ld think nothing f riding sixty or eighty miles a day on the relay o f ponies pro

ided fo r hi v m. He was a member o f the Christian

Church , and a man who was looked up to by all who knew him . But , alas , he became a victim to

o f cancer the stomach, and by the time he con sult ed h i s s m t c z me about y p giﬁ alllmp ep f effecti ng 24 CHINA AND MODERN MEDICINE

f a cure had gone . A hard tumour had ormed ml which was ﬁr y ﬁxed, and already giving signs o f wt secondary gro hs , whilst the poor man could

o f barely retain any kind nourishment . He would not consent to any operation which did not promise to eradicate the whole disease , and one was helpless to do anything beyond attempt ing to alleviate his symptoms .

He was usually extremely bright , but on one f occasion, on visiting him, I ound him looking thoroughly depressed and worried , and enquired as to the cause . He glanced round the room anxiously, to make sure that we were alone , and

o f then, with an expressive jerk his ﬁnger towards the next apartment , gave me to understand that f there were domestic troubles afoot . His wi e was

o f S o f a little bit a thing , but the harpness her tongue was proverbial 1 She had never had any ’ sympathy with her husband s attitude towards

Of Christianity , and had thoroughly disapproved his consulting a foreign doctor about his com plaint ; and the trouble on this occasion had arisen from her insistence that he S hould call in a Chinese physician . o f On ascertaining the state the case , I urged f him to do as his wi e suggested, and stated that I would be only too glad to meet such a physician in consultation . The matter was accordingly

few arranged , and a days later the doctor was summoned .

26 CHINA AND MODERN MEDICINE

1 the dual principle , the Yin and the Yang . When

we inspire , we take in the good air ; that is the

Yang element . When we expire , we breathe out

the bad air, the Yin . When we need nourishment , our body takes in the good food —the Yang which sustains and nu rtures it whilst the noxious

elements , the Yin , are excreted . Now this patient looks to me as though he had done a great deal o f horse - riding (this with f an enquiring glance at the wi e , who beamed her

o f approval such insight and intelligence) , and I fear that in the course o f his travels he has been

subjected to a severe strain , which has caused an

internal twist . The result is that the Yang and

S O Yin elements have been reversed , that now the

f Of good ood that he takes , instead passing into the body, is immediately rejected as soon as swallowed Who could wish fo r a clearer explanation than that ? How far more convincing than all that

o f stupid talk about a carcinoma the pylorus , and reversed peristalsis ! The lady ’ s face was a study in vindicated prophecy ! I would have done well to leave the matter f there , but un ortunately, in my ignorance , I 1 Th e p o wers o f th e Yin and th e Yang are po pularly supposed in China t o underlie th e c rea i e rmCI leS o f the uni erse and t v p p v , by th eir interactio n t o h ave pro duced and to c o ntro l th e fo rces in na u re Chinese me a h sics o f the las h o s o perating t . t p y t t u and years h ave been bas ed u pon th e suppo s edly univers al Operation t an eo manc and s iri ism as ell a o f th e Yin and h e . w s Y g G y p t , h emis r h a e h ad his elie at h eir o unda i o n medicine and c . t y, v t b f t f t RATIONALE OF MEDICAL MISSIONS 27

innocently enquired as to whether, in the great

Chinese pharmacopoeia, there did not exist some “ ” drug which would undo the twist and enable

the Yang and Yin to resume harmonious relations .

The reply was immediate and crushing . Oh

certainly ; we have such drugs , and that is just

what I shall prescribe . But as this patient has

o f already taken a great deal foreign medicine , I greatly fear that the efﬁcacy o f the remedy may be impaired and interfered with in this particular case ” ! fo r That evidently was so , the poor patient died within ten days Of taking the ﬁrst dose o f the

medicine (mainly Opium) which was sent him . But I greatly fear that the widow ascribed his death to the unfortunate circumstances which prevented her from calling in that Chinese physician earlier Certainly he had left me with the reﬂection that he was a very shrewd student o f u h man nature, and that modern medicine had little or nothing to teach him as to the best means ’ fo r impressing one s patients and inspiring con

ﬁdence !

III But if the scientiﬁc ideal has been lacking

o f amongst Chinese practitioners , the conception trusteeship has been even more conspicuous by f its absence . Owing in part to the ailure to develop any real guild - spirit amongst Chinese 28 CHINA AND MODERN MEDICINE

physicians , and owing even more to the attitude which the educated classes Of China have adopted towards a profession which unfortunately in cluded so many quacks and illiterate Charlatans w ithin its ranks , the Chinese doctor, except in 1 f rare instances, never becomes a amily physician . He attends a case when summoned to do so ; he ’ feels the patient s pulse ; he tenders his advice ;

and he writes out his prescription . But there the

matter ends , and he never visits the house again l f un ess perchance the amily summon him to do so . He recognizes no responsibility to see the patient through his illness and he knows quite well that unless his prescription has given immediate relief a second and perhaps third physician will be f called in a ter him, almost as soon as his medicine has been sampled . In exactly the same way this lack o f any

o f — conception trusteeship and, may we not add , the lack Of the impelling constraint o f Christian service- led to a complete failure to develop any

o f o f fo r system hospitals , or other institutions the ’ reception and care o f the sick . It was nobody s responsibility to do such a thing , nor was it any ’ body s responsibility to institute measures fo r the prevention Of disease or fo r the health o f the community .

1 Th es e e ce ions are c ieﬂ the c as es o f no a le amilies x pt h y t b f , usuall elo n in t o th e O ﬁ cial class wh o re ain th e s er ices o f a y b g g f , t v medic al rac i io ner Such an a o in men ma ec o me h eredi ar p t t . pp t t yb t y, ein h and d o n r er b g e f o m fath t o s on . RATIONALE OF MEDICAL MISSIONS 29

In times o f serious epidemics the Chinese have

di f o f often improvised special expe ents , in the ace

an immediate and pressing danger, but this has

o f been merely a temporary nature , and inspired

- by motives o f self protection . There has been no systematic attempt to organize works o f public

eﬁ c ence b en , because China has lacked a religious dynamic o f sufﬁcient vitality and positiveness to give to her public and social life a sense o f cor p o rat e responsibility . This state o f things resulted in the widespread suffering and disease o f which writers on China have constantly spoken— suffering and disease which are all the more pathetic because o f the numerous instances in which they are due to entirely preventable causes . There is no sadder sight in China to - day than the collection o f suffering humanity which gathers at every hospital clinic , and which always includes a number o f patients who might easily have been cured had they been able to secure proper attention in time, but upon whom those terrible words TOO late have now to be pronounced .

fo r o f Here , example , is a group children, totally blind , who have lost their sight during o f a l an attack measles or sm l pox , simply because there was no o ne at hand with the requisite know ledge and skill or the requisite sense o f responsi bilit y to bathe their poor inflamed eyes . Here is a fine young man with an utterly useless limb 30 CHINA AND MODERN MEDICINE useless from no more serious cause than an ordinary dislocated joint , which all the pullings and twistings o f the Chinese bone - setter have failed to reduce . Here are inoperable tumours that might easily have been removed— and with — every h Op e o f success if the patient had only been in a position to receive S killed help last year f or the year be ore . And here is a strong , healthy looking workman whose axe slipped one day last week whilst he was at work in the fields and in

ﬂict ed a deep cut on his ankle ; but, alas , his friends used the common soil in their well - meant efforts to stop the bleeding , and now he is in the iron grip o f tetanus . — So it passes o n this ceaseless procession o f sufferers— until at last the physician feels perfectly desperate to do something which will stop this

o f f f awful wastage li e and use ulness , and bring health and comfort in place o f needless pain and disease . IV It was from sentiments such as these that the work o f medical missions had its birth in China ; f but , as we shall see in the ollowing chapter, the men who laid the foundation o f the enterprise were men who longed not only to stem this tide o f

Off human sorrow, and to er to the Chinese those great ideals Of truth and trusteeship which f l Chinese medicine had ai ed to contribute , but also to use the art o f healing as a handmaid o f RATIONALE OF MEDICAL MISSIONS 31 that higher religious truth which China so sorely

needed . They realized that they were in contact with a country where pitiable superstition held

f o f S o f sway, where ear evil pirits lay at the root much o f the hostility to western science and

progress , where the social conscience rarely passed beyond the limit o f family and clan and was insensible o f civic and national Obligations ; and where the moral beauty Of the Confucian ethic “ ” was not commuted into the pure religion o f

- riﬁ i self sac c ng service . These great pioneers o f modern medicine in China desired above all else that they might be able to make a worthy con t ribut io n o f to the physical needs the Chinese , whilst at the same time pointing them to the Fountain Of all true life and the Inspiration Of true brotherhood . This purpose has never perhaps been expressed in choicer language than that which was used by f those ounders themselves , in their ﬁrst published paper, when they wrote

Altho ugh me dical truth canno t resto re the sic k and a ﬂicte to th e a o ur o f Go d et erc ance the s f d f v ; y , p h , pirit o f uir a o u it o nce awa ene wil no t s ee till i enq y b t , k d, l l p t enquires “ after th e S o urce o f truth and he wh o co mes with the blessings o f health may pro ve an angel o f mercy t o po int to th e Lamb

o f Go d .

At an ra e is seems th e o n o en y t , th ly p do o r ; let us enter it ; lo athso me disease in e very ho pe less fo rm has uttered h er cry fo r relief fro m every co rner o f th e land ; we have heard it and wo u and must essa its a in e . A ai , ld y h l g f th that r et no t ma wait fo r t wo k h y o her do o rs . No ne can deny that 32 CHINA AND MODERN MEDICINE

t is is a wa o f c ari at wo r et no ill and o ur u to h y h ty th k h , d ty a a and im era i e 1 w lk in it seems pl in p t v .

Such men as these could never be content merely to relieve the external conditions which u fﬁ they saw around them . Nothing wo ld su ce ’ but to bring the whole message o f God s love and

compassion , as Jesus taught it , to bear upon this f barren situation . With this be ore them they f deliberately set about the two old task, to alleviate suffering and wretchedness wherever it

f fo r was ound , and thereby to prepare a way ’ o f S O the whole gospel God s goodness . In doing nl they quickly proved, not o y that they were

fo r blazing a trail the preacher, but that their ministry Of healing was itself an exposition o f the Christian message which even the dullest or l most hosti e could understand . Every missionary doctor and nurse goes to this work with the primary purpose o f bringing the blessings o f the Gospel to those who have never

o f o f before heard the coming Jesus Christ . They would not call themselves missionaries if it were i fo r . t not this Sim larly, every hing that is done in the mission hospital or Christian medical college is done with the single Object Of rep re senting and interpreting the Christian message to

far those who have never understood it . But so from the work o f healing being regarded as a

1 Original su gges tio ns for the fo rmatio n of a Medical Missionary

t i n ina 1836 . S o cie y Ch .

344 CHINA AND MODERN MEDICINE stated as being nothing less than an attempt to

Off fo r o f er, in the Name and the sake Jesus Christ , all those blessings to body and soul which have f come to us through His Example , His Li e and His

AS f rest o r Death . He gave per ect healing and a tion to health and activity, so the medical mis sio nary o f to - day seeks to carry with him the very

Off best that modern medical science has to er, in th e careful investigation and treatment o f all f manner o f disease . As He mani ested a new

o f o f o f spirit , gentleness , concern , willingness to touch the most loathsome , so the medical man who calls himself by His Name seeks to act as

He did , and so to represent Him . As He trained f His ollowers in service , so the missionary doctor and nurse regard as one o f their chief tasks the training o f their Christian helpers in a like con ce tio n o f f-sac riﬁ ce p disinterested service and sel .

o And, just as He taught that the greatest need f — man was not physical but spiritual the rest o ra tion o f a fellowship with God which sin had — broken so the medical missionary conceives it to be his greatest privilege and duty to lead men into that fellowship with God which Christ has

r made possible fo all . It is in the quest o f this Objective that medical missions have been the pioneers o f modern

o f medicine in every part China . It is this aim which has led to the establishment o f medical ’ colleges and nurses training schools , to the under RATIONALE OF MEDICAL MISSIONS 35 taking o f scientiﬁc investigation and the trans

- o f lation o f medical text books , to the initiating public health reforms and the education Of public Opin ion in the prevention o f disease ; as well as to those other activities o f which subsequent i chapters w ll treat . The new conception o f communal service and

f o f responsibility, so notable a eature student life

- h O e fo r in China to day, and bursting with p the f o f uture the East , has its roots in little mission W schools and hospitals all over China , here the young people Of that ancient nation are learning at last the true meaning and Obligation o f brother hood and the Signiﬁcance and the joy o f unselﬁsh service. CHAPTER II

THE C OMING OF THE WE S TE RN PHYS I CIAN

The wo rld is a who le : and as the human race appro xi ma e s t o th e er ec io n w ic it is estine to reac the t p f t h h d d h , principle o f unio n and fe llo w -feeling will beco me mo re and o re ﬂu m in entia . A Baco n a New o n o r a Fran in is no t t l , t kl o m no i e Suc men e o n no t mere to the natio be o po l z d . h b l g ly n t at a e t em ir but t o th e w o e wo r . U o n h g v h b th , h l ld p tho se wh o ﬁrst enj o yed th e bo o n rests the o bligatio n to extend uni ersa l eir rinci es w ic a e re o utio ni e th e v l y th p pl , h h h v v l z d i o so and science o f Euro e and w ic w ene er er ph l phy p , h h, h v p imi ar resu mitted ree in ress wi ro uce s ts in C ina. f g , ll p d l l h th e rinci e is a mit e t at o ur race is o ne en the If p pl d t d h , th remo teness o f th e empire fo r which we plead canno t neutralize — K N M N th e o i atio n. COLLE GE AR R A D BRIDG A A ril14th bl g D , P E , p ,

1838 .

IN the days , nearly a century ago , when the trading adventurers o f all Europe were contending fo r Of the markets the Far East , and competing to “ develop the limitless resources o f East India and China, an old Rugby schoolboy was pushing his way along the streets o f a busy Chinese sea f port . He had studied medicine a ter leaving school at Leicester Inﬁrmary and St Thomas ’ s

Hospital , and it was a strange accident that had

ﬁrst taken him out to the Far East . A doctor had failed to report fo r duty on the ship to which he was attached , and in the emergency Sir Astley

f s h ad Cooper, the amous urgeon, conﬁdently 36 COMING OF WESTERN PHYSICIAN 37

f recommended this avourite student , Thomas

fo r few Richardson Colledge, the post . A years later he had joined the Honourable East India

Company, whose trading operations extended to

China . Now he was attached to their trading station at the port o f Macao and in contact with the seething masses Of Asiatic humanity which crowded the busy streets . ’ It was an extraordinary Sight that met Co lledge s

o f eyes . But it was not the strangeness the f Chinese dress , nor their un amiliar language , which most o f all impressed him ; it was the appalling spectacle o f suffering which confronted

o f f him on every side . Every kind pain ul disease ff seemed to be represented , and what a ected him most o f all was the pathetic helplessness o f the — blind the Old man tapping his way along with

o f his stick, the procession beggars guiding one ’ f l another s ootsteps , the chi dren clinging to the S hadows to avoid the painful glare o f the strong

S eastern sun . Such ights stirred his very soul , and though there was but little he could do , he resolved there and then to devote as much o f his time and money as he could to the relief o f these sufferers . With characteristic energy he pro c eeded at once to make enquiries as to the possi bilit o f f y opening a hospital in the port , and be ore — long -in the year 1 827 h e had succeeded in founding the ﬁrst institution ever opened in China fo r the purpose o f bringing the beneﬁts o f 38 CHINA AND MODERN MEDICINE western medicine to the suffering Chinese— the 1 Macao Ophthalmic Hospital . The hospital thus established was the fore

Of Of misslo nS runner the great adventure medical , which represents the most beneﬁ c ent gift which the white man has ever had to Offer to the most

o f ancient civilized nation the world .

NO ﬁft - wonder that y two years later, looking

f o f f l back over a long li e use u service , Thomas

o f — o r Colledge said the hospital , more parti cularl Of y, the Medical Missionary Society which followed it ten years later : That was the one ” o f f good thing my li e . And Dr Joseph Thomson , the careful American historian o f medical work

o f in China , regarded Colledge as the originator 2 medical missions in that country . 1 828 In , the British Factory being stationed

O in Canton , Dr Colledge pened a dispensary in that

: city also . A visitor thus describes the scene At an early ho ur in the mo rningo ne may daily witness the sic th e lin and the ame o f all a es and o t se es cro w k, b d , l , g b h x , d h e o f h e e s r e a e seen e ess ingaro und t do o rs t disp n a y . W h v h lpl c i ren ro u t ere in th e arms o f t eir nurses o r more h ld b ght h h , c o mmon acco r in to the custo m o f th e co un r as e u o n ly, d g t y, l h d p c o a n ser a t a ee ld in ecre it the a f o u n . We e s n o b k y g v h v , bl d, d p

1 This was no t h o we er ui e th e rs in ro duc i o n o f wes ern , v , q t ﬁ t t t t t o hina In th e ear 1 Dr Alex ander Pears n ed cine C . 05 m i y 8 , o , sur eon t o th e Eas ndia Co m an had in ro duced th e rac ice g t I p y, t p t o f acc ina ion whils in 1820 R o ert Mo rris on and Dr Li in s o n v t , t , b v gt , also o f th e Eas ndia Co m an h ad s ar ed a dis ens ar in t I p y, t t p y Can on fo r the Chinese o o r c o nduc ed fo r th e mos ar owe er t p , t t p t, h v , hinese rac i i oners and wi h Chines e dr s by C p t t t ug . 1 C ina M i J urnal 1 8 41 h ed cal o , 88 , p . . COMING OF WESTERN PHYSICIAN 39 men wit staff in an led t i er t eir it e ran chi ren , h h d, h th by h l tl g d ld , w i e o t ers wh o were in etter circumstances were ro u t in h l h , b , b gh t e a s Th e num er o f t o se wh o a e co me fo r aid has h ir sed n . b h h v ee a s o fe 1 n er re t and the cure n t a w. b v y g ,

I Colledge was not a medical missionary in the

o f o f ordinary sense the term , but he was a man great devotion and piety, eager to employ his talents in the service o f humanity and in the

o f o f extension the Kingdom God . Thus it was

o f 1 8 3 4 that when , in the October , there landed in Canton the ﬁrst medical missionary ever appointed as such by a Mission Board— Peter

r Of o f Pa ker, the American Board Commissioners — fo r Foreign Missions Colledge extended to him the warmest welcome , and the two men became f fast friends . They ormed a remarkable com f bination , and their riendship was a happy augury

o f c o - O o f o f the peration Briton and American ,

v l f ci i servant and missionary, which the uture development o f the medical missionary enter

prise in China was to manifest . Peter Parker was a Yale graduate and a 2 man o f striking ability and inexhaustible energy .

o f Within a year his arrival in China he opened ,

1 i R o si r v ol u h n s e e to . . 2 6. C e p y, . , p 7 1 — Th e biography o f Peter Parker wh o in later years played a l ar r l f a a— will well a e in th e e a ions o S A. nd Chin very not b p t t U. is i s d . wr en b th e R v e D re a u e . G o . B . S e ens D p y t y It tt y t v , , and publish ed byth e Congregatio nal SundayScho ol and Pu blishing B U Socie os on . S . A. ty, t , 40 CHINA AND MODERN MEDICINE

ath 1 8 3 5 on November , the ﬁrst Medical Mis — sio naryHospital o f the Far East the Ophthalmic f Hospital , Canton , a terwards known as the

Canton Hospital . His success was immediate f and sweeping . He himsel thus describes these days

It was after a lo ng effo rt that a place was fo und fo r a o s i a and w en at en a suita le ui in was rente h p t l , h l gth b b ld g d and re io us no ice h ad ee n i en o n th e rst da no atien s p v t b gv , fi y p t enture to co me o n th e seco n da a so li ar ema e afflic e v d , d y t y f l t d wit auco ma o n th e ir da a a o z en and so o n t e h gl , th d y h lf d , h y I is dif cu t e c ame in cro wds . t fi lt o co nv y t o a perso n wh o isi e the o s i a a us t i ea f m He nee s to h as no t v t d h p t l j d o the . d be resent o n a da fo r recei in new atien s and e o p y v g p t , b h ld respe ctable wo men and c hildren assemblin g at the do o rs the re io us e enin and sit in all ni in th e s reet t at t e p v v g, t g ght t h h y in time to ain an earl tic e fo r a missi n He might be o bt y k t d o . nee e o in th e mo rnin th e o n ine o f se ans e ten in d b h ld g l g l d , x d g far in e er irectio n see the o cers wi t eir atten ants v y d ffi , th h d ; o bserve th e dense mass in the ro o m belo w ; stan d by during the e amina io n and i in o ut o f ic ets o f a missio n x t , gv g t k d , ur ent cases ein a mitte at o nce w i e o t ers are directe g b g d d , h l h d ain at s e ci e im um ers ro m o t er t o co me ag a p fi d t e . N b f h pro inces ro m Nan in and Pe in who were resi ent at Canton v , f k g k g, d , 1 have called . But Colledge and Parker both saw from the

if o f very ﬁrst that this enterprise medical missions , so happily inaugurated , was to be placed upon f f a permanent and satis actory oundation, and possess a deﬁnite and clear policy, it must be related to a proper organization . They accord ingly proceeded to draw up plans fo r the fo unda

o f tion a Medical Missionary Society, and to issue

h ar 1 M i n o c . 22 The edicalMissio nar n Chi a b . L . y , y W k t, p

42 CHINA AND MODERN MEDICINE character o f the founders and their broad outlook

o f upon the task medical missions . We do well to study the splendid conception which these men held as to the aim and content o f the medical missionary enterprise , which is shown by the emphasis they laid on the following points in their ﬁrst manifesto

1 . To encourage western medicine amongst the

ff fo r Chinese, and a ord an opportunity

Christian philanthropy and service . To extend to the Chinese people some o f i those beneﬁts which science, patient n

v esti at io n - o g , and the ever kindling light f f ” discovery, have con erred upon the West . f To cultivate conﬁdence and riendship , and thus introduce the Gospel o f Christ in

place o f heathenism . To provoke enquiry into truth by the opposing o f exact science to superstitious

ignorance . To make a contribution towards the relief o f

ff o f human su ering, and the cure loathsome

diseases . To educate Chinese youths in western

medicine . To advance general medical knowledge by the reﬂex beneﬁts which will accrue from

scientiﬁc discoveries in China . Parker ’ s immediate success established his COMING OF WESTERN PHYSICIAN 43

o f reputation , and patients all classes entrusted

o f themselves in his hands . Within two months — the opening o f the Canton Hospital in pre

— h e anaesthetic days , let us remember is removing a huge and dangerous tumour weighing a pound and a quarter from the temple and face o f a Chinese

o f girl thirteen , the child bearing the operation wi f l f th wonder u patience and ortitude, and the

wound healing by ﬁrst intention . A year later he is performing the ﬁrst amputation ever attempted on a Chinese patient (a disart icula tion through the shoulder - joint fo r osteosarcoma o f f m the humerus , which he per or ed in exactly one f minute , and rom which the patient recovered and was walking about in six days In 1 8 3 8 he is successfully operating upon a large scirrhous f cancer, whilst rom another patient he removes an extraordinary growth which grew from beneath — the chin and had to be support ed in her lap an operation which won fo r him the undying gratitude

o f the relatives , who presented him with a most 1 eulogistic tablet . In 1 8 4 4 Parker is doing his ﬁrst lithotomy

fo r operation , and the ﬁrst time on record is able to give complete and permanent relief to one o f those many sufferers from calculus who are found

1 On visitin g England in 1 841 Parker brought with him a mos t s t o f i interes ting e pa ntings o f s o me o f th e su rgical c as es which h e h ad succ ess ull rea ed in Can on i en t o him b f y t t t , gv y a Chinese ’ ar is . Th es e h e resen ed t o u s Hos i al wh ere he t t p t G y p t , t y may s illb e s een in th e o rdo n Muse m t G u . 44 CHINA AND MODERN MEDICINE

in such great numbers in the Canton area . In 1 8 47 he is rejoicing in being able to introduce the

o f a n blessings an esthesia to the Chinese, and withi a few months has gained such a reputation fo r the newly discovered anaesthetic that Chinese with nothing the matter with them are asking to be put under ether just to see what it is like

o f The gratitude and conﬁdence all classes, from the Imperial Commissioner down to the humblest coolie, were extended to Parker on every side, and nothing perhaps bore more picturesque testimony to the affection with which he was regarded by his patients than the pathetic appeal o f one old Chinese gentleman whose sight Parker f l had been success u in restoring . He begged to be allowed to send a native artist to paint Parker ’ s portrait in order that he might be able to bow before it every morning . It is no wonder that Beadle said o f him : Dr Parker opened the gates o f China with a lancet when European ” cannon could not heave a single bar . During 1 84 0 and 1 8 4 1 Parker had a most successful tour through the United States and f Great Britain , preaching be ore Congress at

Washington , addressing large and enthusiastic meetings in London, Edinburgh , Glasgow, and

fo r Liverpool , and receiving strong support the newly formed Medical Missionary Society from

o f such prominent leaders as the Duke Wellington, o f h Sir Robert Peel , the Lord Provost Edinburg , COMING OF WESTERN PHYSICIAN 45

o f and the Archbishop Canterbury . It was as a result o f this V isit that the Edinburgh Medical Missionary Society was ﬁrst founded (though under a different name at that time) on November 3 oth 1 84 1 , , with the celebrated Dr Abercrombie its as ﬁrst president .

II Meanwhile other medical men had been arriving in China to take up missionary work, the most conspicuous being William Lockhart , in

1 8 3 8 MB . 1 8 3 9 , and Benjamin Hobson , in , the ’ former a graduate o f Guy s Hospital and the

o f o f latter University College , London, and both them members o f the London Missionary Society . f Like Colledge and Parker be ore them, they were exceptional men . William Lockhart was a born

f fo r i pioneer . A ter working a short time n Macao f and Hongkong he proceeded arther north, and in 1 8 4 4 he opened the ﬁrst hospital in Shanghai and laid the foundations o f one o f the most successful medical missions in China . The Tai f Ping Rebellion ound him still at his post, and there he remained throughout the siege and capture o f the city in 1 853 rendering con spicuo us service to the hundreds o f wo unded fo r

o whom no sort f medical provision had been made .

1 was the Triads a sec ion of the Re olu ionaries wh o ac uall It , t v t , t y c a ured Sh an h ai pt g . 46 CHINA AND MODERN MEDICINE

f 1 8 57 He le t Shanghai in and returned to England .

f Of But our years later, on the ratiﬁcation the Treaty o f Tientsin which opened up Peking fo r f oreign residence, the old pioneering instinct again f asserted itsel , and he immediately returned to China and Opened the ﬁrst mission hospital in the national capital . The great contribution Of Benjamin Hobson lay

ff f o f in rather a di erent sphere rom that Lockhart . f He, too , did most success ul medical work, ﬁrst in Hongkong and subsequently in the new hospital which he opened in the western suburbs o f Canton

- - fo w . (Kum li ) , and in Shanghai But he soon

’ recognized that the great problem o f China s suffering could never be properly solved until some systematic attempt was made to train up a new and enlightened medical profession in the country by giving them, in their own tongue, the beneﬁts o f a modern medical literature . His own ff words best describe this e ort . Writing on this 1 8 5 8 subject in , he says

It seemed very desirable to attempt to intro duce the well a is e rinci es and acts o f western me ica science t o est bl h d p pl f d l , resent s stem o f prepare th e way fo r changes in th e p y China. Under this co nvictio n a wo rk was prepared in Canton eight a o n h e su ect o f anato m and sio o a o i in years go t bj y phy l gy, v d g i T is h as een e tens i e rea and all theo retical Op nio ns . h b x v ly d er a o ura recei e and has ro e a o o o un atio n v y f v bly v d, p v d g d f d fo r what was to fo llo w . The ne t treatise was o n the ro erties o f air i t eat x p p , l gh , h , and elec ricit and the e ements o f astro no m and na ura t y, l y t l is o r esi ne as an in ro uc io n t o ese arie ranc es h t y, d g d t d t th v d b h COMING OF WESTERN PHYSICIAN 47

This has een succee e a wo r o f natural pheno mena. b d d by k o n the principles and practice o f surgery ; by ano ther o n midwifery and the diseases o f children ; and by a fift h o n th e ractice o f me icine and materia me ica o et er wit a p d d , t g h h medica o ca ular in En is and C inese t o e ain and l v b y gl h h , xpl Th e i ustratio ns s o w at o nce th e sub fix th e t erms used . ll h ects reate o f and I a e s are no ains the aid o f an j t d , h v p d p , by inte i ent assistant t o ma e ese wor s accurate ers icuo us ll g , k th k , p p , e and us ful. A t o u atten e wit difi culties it is sti uite rac l h gh d d h , ll q p ticable to make every subj ect with which we are o urselves ac uainte as c ear and e ressi e in C inese as in En is q d l xp v h gl h . Bo re i io us and scienti c wo r s s o u o we er o n be th l g fi k h ld , h v , ly ma e erso ns who a e een so me time in th e co untr d by p h v b y, o r Th e rea i e and co nversant with Chinese auth s . g t des d ratum fo r a trans lato r is a go o d and fixed no menclature o n every ra c f ci e The an ua e a mits o i b n h o s enc . l g g d f a sat sfacto ry and distinct explanatio n o f mo st new t erms ; where it do es 1 no t t ese must be trans erre . , h f d

’ The magnitude o f Hobson s task becomes the more apparent when it is remembered that in 1 850 when he produced his ﬁrst book there was no scientiﬁc background amongst the Chinese medical

o f practitioners that day, nor was there any

scientiﬁc nomenclature in Chinese , such as he speaks Of as the great desideratum o f every trans In lator . many instances he had ﬁrst to create

and explain the very terms that he needed to use . But so successful was he in carrying out this work that his books were actually republished by the

o f Viceroy Canton , who had the illustrations recut ,

printed separately, and made up into rolls , in f Chinese ashion . Each volume , as it came out,

Mdical Missio nar in China b Lo The e W. c har . 155 y , y k t , p . 48 CHINA AND MODERN MEDICINE

fﬁ s was republish ed in this way, Government o cer ,

o f physicians , and people every rank reading f o f them, whilst the oreign merchants Shanghai contributed the sum o f towards the pre

paratio n o f a larger edition . The years that followed saw a steady extension

o f medical work to other centres , led by a suc

o f cession men as remarkable , in many instances, f as the ﬁrst four pioneers already re erred to . ACAO Commencing , as we have seen , with M , ON ON CANTON and H GK G, the movement soon spread northward and by 1 8 42 had reached

o f MOY the important seaport A . Here Dr

f- W . H . Cumming , a sel supporting American

f few physician , led the van , to be ollowed a

o f months later by Dr J . G . Hepburn the American

i — Presbyter an Mission the most versatile ﬁgure,

perhaps , who has yet been seen in the Far East . Compelled to leave China on grounds o f health f ’ a ter two years work in Amoy , Dr Hepburn practised successfully as a physician in New

fo r York thirteen years ; then , again hearing the call to the Orient , he turned his back on the promising career that had opened to him an d

fo r - sailed Japan , where , in the next thirty three years , he became known throughout the whole country as pioneer medical missionary, compiler

Of - the ﬁrst great Anglo Japanese dictionary,

Bible translator and educationalist , winning dis tinctio ns f and honours rom the Japanese Emperor,

50 CHINA AND MODERN MEDICINE at Ningpo was the special course Of lectures to Chinese practitioners o f the city which Dr f Macgowan used to give rom time to time , aided by plates , models , and a skeleton . He also published a monthly scientiﬁc magazine in which he attempted to relate the work o f the hospital

f o f to the li e the city . From Ningpo the new enterprise soon reached

HAN HAI . S G There , as we have already seen, f l 1 8 4 4 it ell to Wi liam Lockhart , in , to make

f few the ﬁrst advance , ollowed a years later by Dr Charles Taylor Of the American (Southern)

s MD Methodist Mission , and by Bi hop Boone , f . . Of and his son Dr H W Boone , ounders the important medical work connected with the

American Protestant Episcopal Church .

S O the work spread, British and American , physicians vying with one another in friendly rivalry, leading the pioneer movement in new

OOCH OW re re centres . Down in F it was a p s e t ativ e o f n the Church Missionary Society, 1 8 50 Dr W . Welton , who was ﬁrst in the ﬁeld , in , and the old temple which he secured as his

Of ﬁrst dispensary, in the teeth ﬁerce opposition ,

o f o f quickly became the resort crowds patients , and in the end Opened the way fo r the remarkable developments o f all branches o f missionary work in that neighbourhood in later years . Similar foundations o f a great future were surely

WAT OW ORMOS A 1 8 6 3 laid in S and F , in and COMING OF WESTERN PHYSICIAN 51

1 8 6 5 W - Of , by two ell known pioneers the English l Presbyterian Mission , Dr William Gau d and Dr James Maxwell— men who subsequently made noteworthy contributions to the cause o f medical missions in Great Britain . During this period medical work was also spreading to the most northerly provinces o f E IN the Empire , commencing in P K G under William Lockhart in From a humble beginning in some buildings belonging to the

O British Legation , with nly two or three patients ’ a day, he was able in two years time to report a total attendance o f over separate cases f be ore he handed on the work to Dr John Dudgeon .

It was that same American physician , Dr

Mc Cart ee , whose varied career has been briefly sketched above , who first brought the benefits Of modern medicine to the people Of the sacred

o f HANT N province S U G, whilst a young Irish man , Dr Joseph M . Hunter , blazed the trail in

C RI MAN H U A . Hunter had been deeply moved

o f by the last appeal that great Scotsman , William

Chalmers Burns , uttered as he lay dying in his lonely inn at Newchwang . It was this appeal

1 It is interesting to rememb er that this was not th e ﬁrs t timc h a es e edi ine as r is d in Pe In 16 t t t w t rn m c w p act e king. 92 h e em ero r an -Hs i du rin a se ere a ac o f e er was induc ed p K g , g v tt k f v , b th e esui missionaries t o a e uinine whic h e were y J t t k q , h t y i i This emplo ying w th success fo r similar c ases 111 th e c ty. proved e fic acious and in ra i ude fo r th e cure the em ero r a e em f , g t t p g v th i th re s f t la a ho use with n e p c inc t o h e pa ce . 52 CHINA AND MODERN MEDICINE

which led to t h e commencement o f the work o f the Irish Presbyterian mission in Manchuria, and thus paved the way fo r the great medical service rendered there during the last thirty or forty years by members o f that mission and o f

o f the United Free Church Scotland, with which ’ all readers o f Dr Dugald Christie s interesting f 1 book will be amiliar .

III

Up to this period the opening o f medical work had been almost entirely conﬁned to the chief commercial centres on the coast and the treaty f ports , and indeed it was not until a ter the treaty o f Tientsin in 1 8 58 that foreigners were permitted ’

l . f to travel in and But rom the sixties onwards, the great advance into the interior provinces began, led in most instances by members o f the China nl I and Mission . For years before the doors had Opened James — Hudson Taylor most romantic o f dreamers and — most practical o f saints had been poring over the map o f China and praying fo r its untouched provinces . He had also been increasing his medical knowledge and practising his skill in f success ul dispensaries at Ningpo and Hangchow, and had been training a band o f men whose highest ambition it was to preach the Gospel in the most inaccessible regions . Thus when the

1 Thirt a M uk ie rs in M. G. e o den Du a C ris C. y Y , by g ld h t , COMING OF WESTERN PHYSICIAN 53

l gates swung back, the China In and Mission was ready to take instant advantage o f the Opportunity and was the ﬁrst to occupy many o f the inland

provinces . f AN OW f . o In H K it ell to Dr F Porter Smith,

the Wesleyan Missionary Society , to introduce

modern medicine to the people , and his zeal as a f missionary, coupled with his gi ts as a doctor, m e inently ﬁtted him fo r pioneer work . In an ’ interesting review o f Porter Smith s life Dr Max well thus describes the early stages in Hankow

Ver so on two sma o uses were rente as a o s ita y ll h d h p l , the wo rk at which to uched befo re lo ng all grades o f life at a cials t ci i and mi itar ries ts and o H n o w. O o e e k ffi , b h v l l y, p p pl ’ mi s assi an e n f h c a i e so u t Dr S st c . O e o t e ie o f cia s l k , gh th h f fi l in the pro vince o f Hupeh sent his little daughter fro m Wuchang t o reside near th e ho spital in o rder that sh e might o btain th e t r A mi itar man arin o f i siti ser ices o f the o c o . o o n v d l y d h gh p , a t er his reco er a eare o ne da in his o ffi cia isitin f v y, pp d y l v g ro es and at en e his ul retinue o f ser ants and at en an s b , t d d by f l v t d t , in o rder that perso nally and publicly he might thank th e o cto r T ere was no o n in in t o se a s fo r western science d . h l g g h d y , but rather an utter sco rn fo r everyt hing and e very perso n ro mthe est and it is a tri u e t o me ica missio ns at e f W , b t d l th ven under such co nditio ns the pro udest was willing in the day ’ f his is ress to co me and recei e at the o cto r s an o d t v d h ds . In 1866 the first hospital ever erecte d in Central China r the re ie o f the sufferin was o ene Dr Smi fo l f g p d by th . Sanita tion a so and iene fo r the mil io n were ea t wit l , hyg l , d l h by means o f trac s written the o cto r and istri ut t by d , d b ed bro adcast the enero sit o f th e Co mmissio ner o f Custo ms by g y . A wo rk o n th e Materia Medica and Natural History of China laid th e fo undatio n o f a go o d deal that h as been written in later r D years by o the pens . r Smith became the trus ted friend o f man o f the nati e o cto rs ten i y v d . Of m ght he be fo und ’ seate e in the co unter o f a na i e o c o r s s o r d b h d t v d t h p , p e 54 CHINA AND MODERN MEDICINE scribing native drugs in conj unction with an enlightened ati e o cto r 1 n v d .

By the year 1 8 8 0 the north - westerly province

o f HAN S I . . . S is being invaded, another C I M pioneer,

h o ﬁ eld l S c . Dr Harold , leading the assau t He was , in some respects , the most remarkable man who had volunteered fo r medical work in China up ’ to that time . Educated at Owen s College , f Manchester, and at London and Ox ord Uni v ersit ies f , he had carried everything be ore him, securing scholarships to a total value o f and on one occasion needing to requisition a

o f cab in order to carry home his load prizes . ’ At Owen s College he Obtained the Victoria

Scholarship in classics , and was elected an associate

o f . the College At London University, where he B B A . S . . c took his . and degrees , he was ﬁrst in the Honours List in ! oology and third in honours in geology, paleontology, and classics . At Oxford O he btained an exhibition to Lincoln College , secured the Greek Testament prize o f the Uni

ﬁ rst - versity, graduated with class honours in

Natural Science , and was awarded the Radcliffe

’ Travelling Fellowship . At St Bartholomew s

Hospital he won no less than ﬁve scholarships , including the coveted Brackenbury and Lawrence honours , completing his course by securing the

Of o f Fellowship the Royal College Surgeons, in addition to Obtaining degrees in arts and medicine

1 m nd A r ad. ne 1 1 1 4 Ho e a b o u 9 0 . 3 at . Medical Missio ns J , p COMING OF WESTERN PHYSICIAN 55

f o f at Ox ord . At the conclusion his work in London he did post - graduate study in Vienna and

Prague , and served with the Serbian and Turkish armies . At this stage in his career almost any

O o f post was pen to him, and a senior member the staff o f his own hospital was just approaching him with a request that he would collaborate with him in the preparation o f a new work on physiology when he startled all his confreres by the announce ment that he was going out to China to engage in medical missionary service .

fo r f There three brie years he laboured , until — typhus fever that deadly enemy o f medical men — in North China claimed him fo r a victim ; but during that short period o f service he made an impression on the people o f Shansi that time can never efface . With all his brilliant successes he was one o f the most modest o f men and most

o f fl earnest evangelists , and his in uence over 1 individuals was deep and lasting .

So the work extended , until , one by one , each o f the remaining provinces was Opened up to the f work o the physician . By the year 1 8 87 more than one hundred and ﬁfty medical missionaries had worked in China f since Parker led the way sixty years be ore . Although these men had been the pioneers in

O every new centre that was pened up , it must be remembered that they were not the only means by

1 R Ha ld M mo rials o . ro A S Vide e . cho eld b Dr A T Sch ofi l f fi , y . . e d. 56 CHINA AND MODERN MEDICINE which the benefits o f modern medicine were being introduced to China . With the development o f foreign trade which followed upon the various treaties entered into between China and foreign

o f powers , a number western physicians settled f — down at the chie ports notably at Hongkong, — Shanghai , Hankow, and Tientsin and though fo r the most part their practice was conﬁned to the

European and American population , several o f them took a keen interest in the relief o f the

i c O - O Ch nese, and perated most generously with the medical missionaries working in their midst . During some years while the Chinese General Hospital in Shanghai— founded by the London Missionary Society— was without a medical mis sio nar - y superintendent , non missionary doctors o f the Shanghai European community took complete

o f o f charge the medical side its work .

IV A new and a most important chapter in the history o f medical missions in China was opened with the arrival (in 1 8 7 3 ) o f the ﬁrst woman

f o f physician , and the ounding special hospitals fo r women and children . Although China has no f purdah system, and her emale population has never been secluded in the same rigid fashion as is the case in India or in Moslem lands , there was never complete freedom o f approach fo r a male physician, and it is certain that a large percentage

58 CHINA AND MODERN MEDICINE

o f ment . Week by week, as the members the mission met in prayer, this urgent need was made

o f a matter o f special intercession . At the close one o f these meetings a courier arrived to request

Dr Mackenzie to accompany Dr Irwin, a British ’ practitioner in Tientsin, to the Viceroy s palace , to see if western medicine could effect a cure where Chinese physicians had pronounced a case hopeless . The treatment which they employed, and the after - treatment subsequently carried out at their request by Miss Howard , proved entirely

f o f success ul . Thus , by a happy combination all f o f orces , a great wall prejudice was broken down, and the conﬁdence o f the highest ofﬁcial in the country secured . The immediate result was the founding o f a

o f new mission hospital in Tientsin, the cost which was borne by the Viceroy, and this subsequently led to the establishment o f the ﬁrst medical school ever attempted on western lines in China, ’ and the full recognition o f women s medical work . Women ph ysmlans were soon welcomed every where, and the entrance which they secured into the best homes o f the Chinese did much to estab lish fresh contacts and to win new conﬁdence and f riendship . 1 900 Thus the work spread until the year , when occurred the great Boxer uprising, that last and most despe rate attempt to exclude from China — o r at least from its northern provinces all that COMING OF WESTERN PHYSICIAN 59

savoured o f the West . Medical missions shared in the common turmoil : no less than twenty - two hospitals were burnt to the ground and four

Of h f others stripped their contents , w ilst our medical men were counted among the martyrs ,

. o f Drs G . Yardley Taylor and Cecil V R . Hodge

Pao tin fu the American Presbyterian mission at g , and Drs W . Miller Wilson and Arnold

o f Lovitt Shansi . This great tragedy proved but the prelude to an extraordinary awakening and advance in the

f . ff years that ollowed The medical missionary sta , which in 1 902 totalled slightly over a hundred men and women , more than quintupled its numbers by 1 91 7 ; and o f the three hundred mission h OSpitals at work tod ay in China full eighty per cent have been erected during the last two decades . CHAPTER III

ME TH ODS OF APPROACH

We canno t expect th e Chinese t o grasp with eagerness at o ur im ro emen s et the cure o f iseases set o wn at o nce p v t y d , d as a a in t eir e erience mus be li e to aci i ate the in f t l h xp , t k ly f l t tro ductio n o f o ur no w e e and add mo st umane to t eir k l dg , h ly h co mfo rt and ci i iz atio n — SIB HENR HALFOR President o v l Y D , f the Co lle e o Ph sicians London 1834 . g f y , ,

THE introduction o f western medicine to the various classes who compose the three hundred and sixty million inhabitants o f China has followed

o f two deﬁnite lines approach .

In the ﬁrst place , there have been those pioneer efforts which have been made since the days Of

- Colledge and Parker, and still are made to day, in order to bring the blessmgs o f the art o f healing to the service o f the people throughout the length

o and breadth f the land .

Secondly, there are those new impacts which are being brought to bear upon different sections o f the community through the medium o f the out - patient dispensary and other agencies o f every hospital . In any attempt to study this

f o f subject, there ore, both these sides must be considered . 60 METHODS OF APPROACH 61

I It is quite impossible to understand the work o f the medical missionary pioneer in China, to appreciate his methods , to sympathize with his fﬁ f di culties , or to estimate his success or ailure , unless one ﬁrst has a clear idea o f the problems f which have aced him, and their underlying causes .

d M d a Re a i The Re em tion o the e ic l ut t on . 1 . p f p

The ﬁrst , and in some respects the most serious , o f these problems arose from the attitude which the Chinese people, especially the educated classes , adopted towards medicine in general . This was due on the one hand to their tendency to associate

Of sickness with the inﬂuence evil spirits , and on the other hand to the low standard o f medical science in China until quite recent times . A

ro ession o medical p f could not , by any stretch f imagination, be said to exist . Still less was there

e o f any recogniz d standard practice . The better educated o f the Old-fashioned practitioners had a certain general acquaintance with the action o f drugs , and a rough and ready knowledge o f the o f treatment some conditions , yet on the other hand the most enlightened o f them had never had the advantage Of the most rudimentary study o f f — the undamental sciences chemistry, biology,

anatomy, physiology, etc . Thus it is clear how

’ much justiﬁcation there has been fo r the people s 62 CHINA AND MODERN MEDICINE

attitude , seeing that medicine was looked upon

o f as very little more than a mixture quackery,

commercial exploitation, and superstition . Dr 0 . L . Kilborn has well described the position

T ere are no medica Anyo ne may be a do cto r in China. h l

co e es no e aminatio ns and no i o mas . NO licence is ll g , x , d pl rac ic A man ma es u his min t o ractise re quired fo r p t e . k p d p

edicine and an s o ut his si n . He u s a o o o r two m , h g g b y b k ,

d e ins t o rea . As so on as h e can et a a ien h e wil an b g d g p t t , l ia o se his co m aint wri e a res cri tio n and acce the d gn pl , t p p , pt fee ic is i en to the e inner A er a very small wh h gv b g . ft v rying ” ort unes fo r a ear o r two he ma es a mar e lo us cure f y , k v l ,

sur risin no o ne ro a so muc as hims e . Li e as p g , p b bly, h lf k ly no t his cure was effected by th e metho d by which pins saved ’ a great many lives in th e small bo y s co mpo sitio n Bypeo ple ’ ’ ” llo in o em The medicines w ic ro u no t swa w f . h h b ght abo ut ’ the cure were entirely harmless ; nature s metho ds were not inter ere wit and a cure was effecte uic and we l f d h ; d q kly l . ’ No w the new o cto r s ame o es u his atients increase d f g p , p , 1 and his fees also take a rise . It is one thing to introduce modern medicine in a country where medical science has already ’ won its way, and the doctor s position is thoroughly assured it is quite another thing to try to do so

in a country where medicine is held in disrepute , and the physician looked down upon by the f educated classes . Yet such were the di ﬁculties which the pioneers o f medical missions were called o f upon to overcome in every province China . o f They had to prove , by the solid merit their a work, that modern medicine does rest upon

basis o f exact science , at the same time as they

1 S ick b O L Kil o rn 86 Healthe , y . . b , p. . METHODS OF APPROACH 63

f were exhibiting, by li e and precept, that great — message Of redemption physical, moral , and — spiritual which they had come to proclaim . — The Winnin o Go odwill 2 . g f The second pro blem which faced the pioneer is one which happily

o f we can now begin to speak in the past tense . The traditional Chinese policy o f isolation and f f exclusion , which expressed itsel in suspicion, ear, and prejudice towards everything and everyone from the West, engendered a deep antipathy towards the mission hospital , just because it was

NO O foreign . sooner was a hospital pened, parti ’ arl cul y in the inland provinces , than the doctor s motives became at once the object o f discussion

and criticism, and in many cases the most extra ordinary rumours were circulated as to ' the horrible practices which he was supposed to be

. o indulging in secretly There was a time, f r

o f example, in the province Hunan, when an in

flu ential f o ficial , Chouhan by name, published a series o f inflammatory pamphlets declaring that the missionary doctors took the eyes from infant children fo r medicinal purposes and were guilty Of the most flagrant crimes in their operations

o upon women . And this was typical f the reports that were often spread abroad concerning the o f work the hospitals . It must not be thought fo r a moment that the success which crowned Parker ’ s efforts in Canton followed so inevitably or so rapidly in th e more 64 CHINA AND MODERN MEDICINE

o f remote portions the country, where the dreaded f oreigner was less well known . In such places

the pioneer had to proceed with great caution, f care ully picking his cases , and avoiding, as far

o f f as was possible, all risk ailure . At the same

time he sought , by every means in his power, to cultivate the friendship and win the conﬁdence o f

the people around him, and especially o f such patients as were bold enough to entrust them

selves to his care . But there was always with him the serious thought that he carried in his hands the lives o f his colleagues and the reputation o f f his profession, and that any alse step might jeopardize the prospects not only o f his own work but also o f the whole mission fo r which he stood .

3 The Overcomin o Limitations — . g f The third great difﬁ culty arose from the lack o f proper facilities fo r u p -to - date medical work : no suitable premises to work in : no apparatus nor equip ment : no nurses nor trained assistants , possibly not even an educated Chinese helper willing to be trained fo r such a work not the least semblance

o f o f san itation, nor intelligent measures to prevent the spread o f disease . The pioneer doctor had nothing but a limitless mass o f human suffering

few s and ignorance around him, a instrument o f and drugs in his hand, an unshakable sense f fﬁ vocation, and a dauntless aith in the su ciency o f God .

66 CHINA AND MODERN MEDICINE

ro m all kin s o f dis eases mo st o f t em simi ar to t f d , h l hose met wit at o me but in a far mo re a ra ate co n i io n ue h h , gg v d d t , d to the e o ra e co nse uences o f na i e trea m In d pl bl q t v t ent . a ast num er o f cases suc as skin iseases o a mia urns v b , h d , phth l , b , u cers wo un s and all in s o f O en so res the utter irra io na l , d , k d p , ly t l metho ds o f native treatment o nly perpetuate and aggravate the c i o ndit o n . Tho us ands o f such cases present them se es to the me ica missio nar and w i e no t er a s lv d l y, h l p h p articu ar interestin fro m a ro essio na o int o f view p l ly g p f l p , h e may co ntinually re j o ice that h e is affo rde d abundant o o rt unit o f curin is eases a e ia in a as amo unt o f pp y g d , ll v t g v t suf erin and winnin t ere th e rea affectio n and o o wi f g, g h by l g d ll o f his atien s to sa no in o f th e i er ri i e e sti o f p t , y th g h gh p v l g ll ’ daily carrying o ut Christ s two fo ld co mmand t o heal the sick and preach th e go spel . ’ The C inese o c o r s i no rance o f ana o m te s o f co urse h d t g t y ll , , very serio usly in cases o f fracture o f bo nes and dislo catio n o f o ints and o ur trea ment o f a few suc c ases in o ur ear j , t h ly a s ins ire a mo st enco ura in co n ence resu in in man d y p d g g ﬁd , lt g y min t o us e en ro m o n distances s uc cases co . Ca es s h g , v f l g o f inj ury o r disease necessitating amputatio n o r th e remo val umo urs are his o wn co n essio n e o n the o wer o f o f t , by f , b y d p ati e o cto r but co min t o the o s i a as a ast o e th e n v d ; g h p t l l h p , and there being Operated upo n under all the advantages due ro o rm and antise tic rea men th e re utation to chlo f p t t t , p u s rea t o reat is ances so at it was no t o n grad ally p d g d t , th l g befo re we were able t o ﬁ t up acco mmo datio n and undert ake

- in patient surgical wo rk . Ano ther impo rtant branch o f the wo rk was th e curin g o f h o us e as a ru e t o s a wi us fo r a mo atients w n . o pium p , d, l , t y th th s f o un men o f so un c o ns i utio n we o un th In the ca e o y g d t t , f d e best results were gained by an immediate and entire withho lding um in an o rm and the treatment o f s m to ms as o f o pi y f , y p The e i erance ro m the O ium cra e was us they aro se . d l v f p v th uic ef ecte t o u fo r th e rst few a s the the mo re q kly f d, h gh, ﬁ d y ,

ica istress was so metimes c o nsi era e . In o er men phys l d d bl ld , wea co nstitutio n o r er ea smo ers ex o r men o f k , v y h vy k , ience tau t us t at a es s rastic me o was re era e p er gh h l d th d p f bl , and such wo uld fo r two o r three weeks be treate d with medicine i diminis in uantit o f O ium i at co ntaining a stead ly h g q y p , t ll METHODS OF APPROACH 67

the end o f that perio d no o pium was being taken . Many s f ese asse ro u o ur an s and in nearl hun dred o th p d th gh h d , y all instances were able t o return ho me freed entirely fro m t his terrible crave and the demo raliz ingeffects o f the o pium habit es o f all man ro e eir a er i es a e were no t b t , y p v d by th ft l v th t th y l e i ere ro m the o n a e o f O ium but h ad en ere in o o n y d l v d f b d g p , t d t il the liberty o f the ch dren o f Go d. To ma e o ur medi ca wo r mo re wi e no wn and t o k l k d ly k , ins ire th e eo e wi co nfi ence we were a to a ai o ur p p pl th d , gl d v l selves o i the Chinese custo m o f acceptingfro m grateful patients h e wea ier c ass the ar e an s o me h o no rifi c ta ets o f t lth l l g h d bl , o n whic h th e do no r ins cribes in letters o f go ld his name and cia o si io n the isto r o f his dis ease and n a in Offi l p t , h y fi lly, r flo wer an ua e his un o un e rati u e t o the o cto r ve y y l g g , b d d g t d d

h o has so success u un er a en his case . In a few ears w f lly d t k y , mo re an ten o f t ese so me as ar e as an a era e inin th h , l g v g d g ro o m ta e h ad een resente and a o rne th e stree bl , b p d, d d t fro ntage o f o ur ho spital and th e walls o f the dispens ary and

- r m waiting o o . The resen atio n o f ese a ets as is custo mar in China p t th t bl , y , s a wa s th e o ccasio n fo r a so mew a im o sin ceremo wa l y h t p g ny . Th e ra e ul atien acco m anie a o z en o r mo re o f g t f p t , p d by d his riends marc e ro u th e s ree s in ull o f cia dress f , h d th gh t t f fi l , acco m anie a an o f musicians and in the ro cessio n an p d by b d , p o no ure lace was assi ne t o the ta et carrie ear r h d p g d bl , d by b e s s r i and festo o ned with ca let s lk. The o rma resen a io n and s eec es o er the ta et as f l p t t p h v , bl w un in the ace a o e to it and the u es s were in i e h g pl ll tt d , g t v t d t o a eas a er w ic a enera ins ectio n o f th e o s ita f t , ft h h g l p h p l and any o bj ects o f interest usually o ccupied their attentio n fo r an ho ur o r two ; thus was affo rded a fresh o ppo rt unity fo r fri endly interco urse between th e missio nary co mmunity and ese re resenta i es o f the iterar and o f cia c ass th p t v l y fi l l , w ic es e cia l in o se a s was the mo st i fi cu t c ass h h , p l y th d y , d f l l S uc o ccasio ns na ura a e s co e fo r c n to reach . h t lly g v p o versatio n as to o ur rea ur o se in co min t o eir an and o n ea in l p p g th l d , l v g, each guest was presented with po rtio ns o f th e S criptures and i o ther Christ an bo o ks .

Concurrently with the Op ening o f out - patient 68 CHINA AND MODERN MEDICINE

dispensary and hospital, as described by Dr

Wilson, attempts were also made in many centres to extend the work o f the medical mission over a o f Im wider area by means itinerating tours . portant cities and market towns were thus visited on regular days , usually once a month or there abouts , and on each visit patients were seen and evangelistic addresses given . This work, whilst not very satisfactory from the professional stand f point, certainly helped to amiliarize the people Of the district with the Objects and work o f the medical mission hospital , and probably encouraged some patients , who would not otherwise have done so, to take the journey to the medical mission

fo r o f in - station purposes patient treatment . From such humble beginnings many a branch o f the Christian Church in China has sprung .

III

It is not only in the more remote parts o f China that contacts are made with new sections o f the community in the manner described

- above . Hardly a day passes in the out patient clinic o f any mission hospital but there are

a fo r h el included , mongst those who come p , numbers o f men and women who have never before been brought into touch with western medicine, and who have not the slightest acquaint

o f ance with the teachings Christ . They have e o f c ome becaus their physical need, which METHODS OF APPROACH 69

f hitherto they have ound no one able to relieve . But away back in their village or country town ff they have met another patient , possibly su ering f f rom some a ﬂiction very similar to their own, who has told them o f the relief that he has already obtained at this particular hospital ; and this is what has led them to take the journey and make

- their way to the out patient department . Readers o f missionary publications are s ome times so impressed with the progress that has been made at particular stations that they are apt to lose sight o f the enormous mass Of untouched population which forms the hinterland o f each f and all such centres . It is rom this teeming hinterland that these patients come , and it is just this fact which invests the out - patient dis p ensary o f every mission hospital with all the

Of importance a great Extension Department . It is here that ﬁrst impressions are going to be formed— impressions which in many instances will never have the opportunity o f being corrected or ampliﬁed by subsequent residence in the

hospital wards , or by closer contact with those who profess to represent and s erve the Greatest o f

all Physicians . It is here also that the patient

will make up his mind, not merely about the western doctor and his methods o f investigation

and treatment, but also about the new truths

as which, he learns , the hospital is intended to

promulgate . 70 CHINA AND MODERN MEDICINE

It is no small matter fo r the doctor to stand up before men and women o f this kind and to reﬂect that he and his assistants represent- ii one dare — to use the term the only manifestation o f the

o f Great Father that some , at least, these patients will ever meet . A discourteous reception ; dry, perfunctory preaching ; slipshod methods o f diagnosis ; impatient or hurried treatment these things , which might under ordinary circum

o n o f stances be easily excused grounds pressure, take on a new signiﬁcance when it is remembered that these are the impressions which it will take

o f ff e ffe tu longest all to e ace, and that they will c ally distort the image Of the Christ which the doctor would fain have presented to the patient ’ s

V iew . There is only one deduction that can be drawn from this the out - patient work must be treated — very seriously far more seriously than is some

- times the case in hospitals to day, where the f doctor, overburdened as he o ten is with the pressure o f the wards and o f the countless other f duties that all to his lot, is apt to relegate his out - patient department to the care o f a poorly trained Chinese assistant and evangelist . Here in the West emphasis is being increasingly laid upon the importance o f senior members o f the leading hospitals taking an actual share in the treatment o f out - patients ; and the same is true in China . Even where a qualiﬁed doctor is METHODS OF APPROACH 71 single - handed it is a great question whether he would not , in the long run , be doing a bigger and better service to China by deliberately limiting himself to such numbers (in - patients and out

s patients) as he could do real justice to . This doe not mean that he should concentrate all his time

f few and attention on a avoured , whose cases should be investigated with greatest minuteness but it does mean that he should organize the work so as to safeguard the impression which is being made on the patients , and prevent the possibility o f anyone who has been received in the out - patient department going away with the f ft eeling that he has not been properly looked a er, or his case not thoroughly investigated . Nothing is more difﬁ cult than to curtail the

o f number patients , especially in a country where terrible suffering and disease abound on every f side , but it must never be orgotten that, in any case, western doctors are not able to do more than

f o f touch the barest ringe the work . It is Often

fo r stated, instance , that in some particular pro vince or district there is only one fully qualiﬁed

f o f physician to hal a million or a million people, as if forsooth he were able in some way to be o f some service to such a number . The probability is that not one in every hundred ever come near h him when t ey are sick, nor could he possibly if attend them they did . There are four points in connection with the 72 CHINA AND MODERN MEDICINE

out - patient side o f the work which are specially

o worthy f notice .

1 o f im rtance . It is the utmost pp that patients

ues s be should always be regarded as g t , and received with courtesy and kindness by the gate

is keeper o r registrar whom they ﬁrst meet . He the ﬁrst representative o f the hospital to come in

contact with the new patient, and ﬁrst impressions go a long way to determine the patient ’ s attitude

to the institution .

2 . Any evangelistic service which is conducted fo r the patients should be o f a character worthy

o f the great cause which is to be proclaimed , and calculated to emphasize the winsomeness and

graciousness o f the Message . It must never be forgotten that the patient has not come to the hospital fo r the sake o f attending a religious service . He has come because he is sick, possibly he is in pain, and he wants to be helped . He will not as a rule object to listen to an evangelistic address while he is waiting fo r the hour at which the clinic is due to open ; but if that address is f to grip him it must be presented thought ully, earnestly, and with every possible consideration

r o fo the condition f the hearers . A V ery good plan that has been tried with success in at least one hospital in China is as follows As the out -patients begin to gather th e evangelist

o f and his helpers , instead keeping up a continuous

74 CHINA AND MODERN MEDICINE

ff e while he o ers up an intercession on their b half.

Prayer concluded , an earnest address is given, usually on some incident in the life and teaching d o f Jesus Christ , and a strong appeal is ma e to all

r o f to study fo themselves the truths the gospel . As the hour fo r the opening o f medical work strikes , a second bell is rung, and at this signal the evangelist and his helpers leave the platform and mingle once more with the people . The early comers , whose registration number will entitle ﬁ them to be seen rst, are directed to the proper door, while the evangelist sits with those who have some time to wait, explaining in more detail ff what has been said during the service , o ering

o f fo r portions the Scriptures or other books sale, and attempting to draw them into conversation . In this way he soon learns to recognize those who

fo r are coming regularly treatment , and in some cases is able to obtain an invitation to visit them f im in their own homes , there to ollow up the f pression that has been ormed .

3 o f . The investigation the patients , prior to

o f o f the adoption any particular line treatment , f should be as care ul and complete as possible . Superﬁcial medical practice ill accords with a

If o f fervent religious service . the work a mission hospital out - patient department is to be properly f done, both the religious and the pro essional sides

o f should be treated as the utmost importance, and neither should be sacriﬁced fo r the sake o f METHODS OF APPROACH 75

lve the other . It would be better to g up the evangelistic service or the medical work alto gether than to treat either so carelessly as to convey the impression that it was only o f very secondary importance . To do real justice to the medical care o f th e

- o f out patients , the enthusiastic work the doctor f himsel is essential , and he needs to have a

- st aff~ and well trained adequate equipment . In a country like China , where parasitic and blood f in ections abound, the more modern hospitals are ﬁnding that they need not only well - ﬁtt ed exa mination and dressing - rooms in their out - patient departments , but that a small clinical laboratory in constant use is also an indispensable adjunct fo r thorough investigations . Fortunately the

Chinese make excellent technicians , and it is not difﬁcult to train them in laboratory methods .

4 human o f . The side the work is the supreme thing and must always be paramount . It may

fo r f not be very easy the doctor himsel , in the rush

r o f o f his work, to spend a la ge amount time talking with individual patients , but his attitude towards them and the attitude o f his helpers will

fo r t . fo r count every hing Here , example, is a poor old man who has tramped ﬁfty or a hundred

o f miles in the hope recovering his sight, because he has heard o f someone else who was operated

fo r f on cataract with most success ul result . But a f glance is su ﬁcient to show that his trouble, 76 CHINA AND MODERN MEDICINE

f ff un ortunately, is due to a very di erent cause .

o f fo r His is a case absolute glaucoma, which nothing can possibly be done . It is a bitter dis

fo r Old appointment the man , and very hard fo r him to understand ; but it is going to make all the difference to him if the doctor spares a few moments to talk to him sympathetically about it, and then perhaps leads him to one Of the nurses or other helpers , who will explain more fully

. f why his case is incurable And a ter all, it is these human impressions which are the most potential . Some years ago a Chinese patient suffering from

f o f cataract consulted a riend mine, and was successfully treated . Subsequently there came

o f from his district a procession seven blind men , walking one behind the other, each touching the f shoulder o f the one in ront . They had tramped

h O e o f fo r many days across the mountains , in p a similar cure . When they reached the hospital it was immediately evident that no cure was possible in any o f their cases . But they were received and treated as guests , and their conﬁdence and friendship were won . For very many years one o f those blind men was an untiring and successful wh o evangelist, not only to the blind but to those were more fortunate than he ; this all resulted from his stay in that hospital . It certainly pays to treat the human factor as the most important o f all . METHODS OF APPROACH

China is sometimes spoken o f as a country which is now well covered with missionary agencies o in f every description, and which mission hospitals f and dispensaries abound . It is not di ﬁcult to demonstrate how completely fallacious such a statement is . Throughout the whole country there are not yet more than three hundred mission f if hospitals (possibly three hundred and ﬁ ty, branch dispensaries are included) , and the majority o f these are situated in the large cities and towns near the coast . It must also be remembered that mission hospitals are small ; the largest in China would not contain more than three hundred beds . A f care ul estimate has recently been made , based

o f o f on the records two hundred these hospitals , in order to ascertain how much accommodation they are able to provide fo r the needs o f the com f munity . This has revealed the act that there is but one mission hospital bed at present to every i 1 o f the p Opulat o n . To this should be added the relatively small aggregate number o f beds provided by the Chinese government and private hospitals which are just coming into ex ist nce fo r e , and also the accommodation Chinese

1 An Enquiry into the S cientiﬁc Eﬁiciency of Missio n Hospitals rin ed rom China Medical J urnal No em er in China. Re o 1920 p t f , v b , , m t Hospital S upple en . 78 CHINA AND MODERN MEDICINE

afforded by the Community hospitals o f the 1 Roman Catholic Church . In this connection the statistics o f the individual

provinces are most enlightening, revealing, as

o f they do, the tremendous stretch unoccupied line which the more remote portions o f China f still present . They are as ollows

Pro vince o f Fu kien 1 bed per o f po pulatio n Kiangsu Chekiang Kwangtun g Manchuria

These ﬁgures will be appreciated if it is re membered that in the United Kingdom there is a

1 According t o the statistics given in the appendices t o The i Cat i C ur h in C na b v Ber r m Wo lferstan S . J . ho l c h c h R e . a , y t , , u lish ed in 1 909 th e Ro man Ca h o lic Church was su o r in p b , t pp t g 82 h o s i als and 328 dis ens aries in China in th e ear 1 907 in p t p y , o h ts ari s ra h es Mo s o f h ese ins i u io ns c nnec ion wi i o u nc . t t v b t t t t t , h o we er a ear t o h a e een in c h ar e o f Ca h olic ries s la v , pp v b g t p t , y ro h ers o r sis ers o f merc o nl a small ro o r i o n o f th e a ien s b t , t y, y p p t p t t ein a ended b ali ed wes ern h si ians b g tt y qu ﬁ t p y c . METHODS OF APPROACH 79 bed in a voluntary hospital fo r one in every six

o hundred f the population, and this does not include the large number o f additional beds 1 provided by the Poor Law inﬁ rmaries How is the territory to be covered ? There are three principal methods that are worthy o f careful consideration

1 B ranc Dis sa i — . h p en r es In order to widen the area served by existing hospitals , as many branch dispensaries should be established as it is possible adequately to man . The distance from the main hospital at which such dispensaries can be effectively worked must

f o f depend upon the acilities communication, as

o f ff well as the strength available sta , as it is essential that they should be administered from the central institution and be visited regularly . Well - trained Chinese workers should reside at

o f these outposts , capable dealing with the spiritual needs as well as the minor physical ills o f the people . Such dispensaries will not only make provision fo r the large number o f patients who

o do not require prol nged hospital treatment, but will also act as collecting stations fo r the more serious cases who need to b e transferred to the central hospital . The success o f this method depends upon the main hospital and its branch dispensaries being

1 In En land and Wales h ere is a h o s i al o r inﬁ rmai bed , g t p t y e l fo r o ne in e very 320 p o p e . 80 CHINA AND MODERN MEDICINE

o f organized as a single unit, under the control a ff fully qualiﬁed and experienced medical sta .

Peill o f s The late Dr Arthur D . T ang Chou was a

f - o f li e long advocate this policy, which has since 1 been developed by his brothers and many besides .

2 New M d a M e r s — t im e ic l issi C nt e . I . on is possible to study a map o f the unoccupied territory in China without realizing the urgent call fo r the

Of opening up new medical mission centres . Men and women are needed tod ay who will take the

f o f torch rom the hands the pioneers , and will carry the new light into the remote and backward

o portions f the country . This will not be easy work . It will entail loneliness and isolation in a land where other missionaries are enjoying the stimulus o f professional comradeship and the

o f facilities adequate equipment . But the thing is worth doing, and it has compensations which

wh o h ave f those only tried it can ully appreciate . And in face o f the limitless mass o f human suffering

t o f which these neglected par s China represent, and o f the unique gift which the science o f medicine

Of Off and the evangel redemption have to er, no one worthy o f the profession can resist such a call if it comes to him . D 3 . The evelo ment o Chinese Leadershi p f p . Upon the nations o f the West has been placed the great responsibility and privilege o f carrying to

1 Vide The Belo ved Ph sician o Tsan Chou edi ed b Rev y f g , t y .

J . Peill.

CHAPTER IV

THE E V OLUTI ON OF THE HOS PITAL

All the ar er ro o ms l g , Lo and are e ma e eir o s i a fty b , th y d th h p t l, In whic h by night and daythey ministered Un o t eir sic t h k ; and these were always full . And allo f them had diligently learnt Th e art o f ea in and amo n em were h l g, gth S o m sur e s a sicians uc r e g o n nd phy m h e xpe t . But mo s o se w o m t e recei e wi in tly th , h h y v d th , ere s ric en iseases tedio us mo re W t k by d , T an mo r a nee in ten erness and care h t l, d g d

And all as ret ren t e co m assio nate b h , h y p ly

aite u o n and ten e . W d p , d d A ho use o f ho ly service and o f peace Was this they dwelt in livingin o ne bo nd Of urit and ro t er o o o f o e p y , b h h d l v S ea in but i e ra in raisin Go d p k g l ttl , p y g, p g f s ic f th eart s an With j o y ul erv e o e h d hands . HARRIE T ELEANOR HAMILTON KING Di i 1 he sc les 2 . T p , 87

P RIOR to the introduction o f modern medicine into China there was nothing in the whole country that was at all analogous to the western hospital .

few There were, it is true , a certain Chinese

Benevolent Associations , but they were chieﬂy concerned with the distribution o f food to the

o f f . indigent, or the care oundlings , etc There 82 EVOLUTION OF THE HOSPITAL 83 was no Chinese institution that undertook to receive and treat the sick poor . What happened then in case o f serious illness

In the ﬁrst place, the local physician was called if f in, and his prescription ailed to give immediate

o f relief a selection others would be summoned ,

o f limited only by the ﬁnances f the amily . The next step was usually the invocation o f f religious aid . All over China are to be ound

o f o f temples medicine , mostly created in honour

o f f celebrated physicians prehistoric ame . Many an ancient tree outside a Chinese town or village — has a similar shrine o f healing the abode o f some

o f f mythical animal abulous powers , or other supernatural being . These trees are favourite

o f resorts in times sickness , and their gnarled branches present a strange appearance o f dilapi date d splendour from the worn -out banners — suspended from them the votive offerings o f grateful worshippers . I well remember a visit I once paid to the

o f Temple Medicine in an inland city . A care worn woman was entering the outer court as I

few approached, and a minutes later, having

Off o f made her ering money to the priests , she was admitted to the innermost precincts o f the f building . There the chie idol was enthroned, and having placed her sticks o f lighted incense f be ore the grotesque ﬁgure , down she knelt low, knocking her head on the hard stones , and giving 84 CHINA AND MODERN MEDICINE

voice to her petition . A cylindrical box was handed to her containing several bamboo slips , each bearing a different number ; and as she f swayed backwards and orwards , calling upon the idol in a low crooning voice , so she shook the open

o f f . box, until one the slips ell to the ground The priest, who had been watching her, at once f stepped orward and picked it up then, glancing at the ﬁgure which it bore , he walked across to f f the other side o the temple, and tore down rom the wall a paper with a corresponding number .

This he handed to the poor suppliant, with a

' brief word o f instruction as to the way in which it was to be used . A moment later she was speeding

ff o f homeward, there to try the e ect this new

cure upon her loved one . In some cases such a paper would contain a

fo r few o prescription medicine, or a words out f a sacred book . In one instance that came under my notice the priest gave orders that the paper was to be soaked in water and the inky ﬂuid — drunk by the patient an old man suffering from dysentery . On another occasion a Chinese lady,

fo r f o f who was pleading the li e her husband ,

f r evidently drew an unlucky number, o the notice that was handed to her contained a declara tion that the sick man had offended against the gods , and could not recover . (He did , though, thanks to the splendid nursing o f a Christian f Chinese riend, who came to the rescue ! ) And EVOLUTION OF THE HOSPITAL 85

ff this was all that the temple had to o er . Where there was extreme poverty, even this meagre consolation could not be sought , and the poor f f invalid was le t untended , and o tentimes alone .

It was to conditions such as these that the pioneers o f western medicine in China addressed themselves , and they set to work immediately to establish hospitals wherever they could secure a 1 8 50 footing . By the year there were at least 1 8 8 9 ten such institutions , by the number had

- grown to sixty one . Since that date the increase has been still more rapid . In those early days there was considerable and frequent discussion as to the relative value o f medical itineration work or o f centralization in

v hospitals , but experience early con inced the large majority o f medical men o f the superior

o f value an intensive policy, with the result that the work o f the medical missionary has increasingly become centred in the mission hospital .

It must not, however, be imagined that the hospital in China in former days bore much resemblance to the type o f institution which we associate with that name in Europe or

o f - America , nor do many them to day . Far from

o f - it . The buildings the old time hospital , which 86 CHINA AND MODERN MEDICINE fo r the most part consisted o f adapted Chinese premises , were most primitive in character, and the organization was still more so . Under the arch o f an ornamental Chinese

o f gateway, at the side which a small room

d - o r ' accommo ated the gate keeper registrar, the visitor passed into an open courtyard where the f patients and their riends assembled . Ranged round the court were several one -story buildings

- fo r fo r rooms the hospital employees , a shed

- fo r sedan chairs , a stable the temporary shelter o f the animals which brought patients from long distances— whilst on the further side there was

- i usually the out patient d spensary, with its

- fo r waiting rooms men and women , its preaching

- chapel and consulting rooms .

Similar courtyards opened out beyond , some

fo r fo r reserved male patients , and others women . Each consisted o f a series o f one - story rooms arranged in rows or around a central square . These rooms measured approximately eleven feet by ten , but in many cases three or more would be

built side by side without partition walls , so as to ” make a long ward .

o f The walls were either porous brick or adobe,

o f and the ﬂoors beaten mud , Chinese concrete

or brick tiles whilst the windows , at any rate in

o f the quite early days , were invariably paper . These windows were seldom made to Open ff f n e ectually, and it must be con essed that either EVOLUTION OF THE HOSPITAL 87 ventilation nor cleanliness was a marked feature o f these old hospitals . The furniture o f the ward was o f the scantiest

o f description , and probably consisted nothing more than a few Chinese beds (wooden or bamboo) , t a table or two , and some chairs . Every hing else was provided by the patient , who brought his own clothes to sleep in, his own bedding to lie on, f f and his own riends to nurse and eed him . It is perhaps well to draw a veil over that bedding and clothing, and to bury its entomological contents in a decent silence !

- A small lean to shed , with a primitive stove , ’ f served as a kitchen . Here the patient s riends , or the hospital cook, prepared whatever the sick

fo r man fancied . It was almost impossible the medical staff to maintain adequate control over ’ the patient s diet , and, as likely as not, a man suffering from severe dysentery would surrep titio u sl o f y procure a solid meal dumplings , or slake his thirst with a hard pear . if Even the hospital possessed a bathroom , it was hardly o f such a sort as would tempt an unwilling patient to make experiment with soap and water .

- f - An ill urnished, but well kept operating room, where some remarkably successful operations were f per ormed , usually completed the hospital plant .

- Such was the old time hospital , and such its — o f handicap the lack trained nurses , the absence 88 CHINA AND MODERN MEDICINE o f im o ssi any real control over the patients , the p bilit o f y ensuring ordinary cleanliness , to say

o nothing f asepsis . But as we read the records o f the work that was successfully accomplished we cannot withhold a tribute Of admiration fo r

o f in the courage and skill the medical men, and “ ” c ident ally fo r the efﬁ ciency o f the anti - bodies o f the average Chinese patient It is Obvious that such a building was not a

o f th e hospital at all , in the modern sense term .

It was really a hostel or inn , in which the patient resided with his friends whilst attending the and doctor, where he was always accessible to

S medical treatment and piritual inﬂuence . But whilst not possessing any o f those accessories

o f - which go to make up the hospital to day, and which have proved to be indispensable to the

o f modern investigation and treatment disease, the old - time hospital had a value which should never be underrated . One great advantage o f such a building in the early days was that its unpretentious appearance soothed the suspicions o f would - be patients and

f V their riends . This was a ery important matter in times when the mental attitude o f the patient was the most difﬁcult o f all Obstacles to be overcome . A hospital which looked exactly like their own Chinese house and in which they could live and eat and sleep very much as they did at home could not after all be such an uncomfortable

90 CHINA AND MODERN MEDICINE

o f f sphere use ulness rapidly grew, and though it was not possible to do very much fo r cases that required skilled nursing or elaborate medical treatment, he generally succeeded in building up

O an extensive surgical practice, and in btaining some very striking results . Probably it is due to this fact as much as to anything else that western surgery has obtained a far wider reputation in China than that which has hitherto been accorded to western medicine but with the advent o f the m dern o f u - o hospital , and the employment p to

o f date methods investigation and therapeusis , the foreign physician o f to - day has every prospect o f securing the same measure Of conﬁdence as is f accorded to the oreign surgeon . But the value o f the old hospital did not merely rest upon the opportunity which it afforded fo r

NO a wider use o f medical and surgical skill . sooner did the missionary begin to grapple with ’ the immense problem o f China s suffering than he realized that he was engaging in a much f sterner conﬂict than appeared on the sur ace .

far o Deeper, deeper, than the physical ills f the Chinese patient was a problem o f mind and spirit which medical science alone could never relieve . To make provision fo r disease and suffering and turn out a series o f cures with the regularity o f so many Ford cars , whilst it might go a long

o f way towards the alleviation distress , was never ’ o f m going to solve the whole China s proble , nor EVOLUTION OF THE HOSPITAL 91 provide that full restoration to health o f which the Chinese people stood in such dire need . Psychologists o f those days knew considerably less than they do now o f the intimate connection which exists between mental and spiritual out d look and physical disease . And to ay , looking backward over the years , we can see that the founders o f those old -time hospitals built more n wisely than they k ew . Perhaps the very limita tion o f buildings and professional equipment under which they had to work helped to preserve their sense o f proportion and to emphasize the further function which the mission hospital must fulﬁl in ministering to minds diseased or souls in pain . Certain it is that every mission doctor set out to carry a spiritual message to the patients who entrusted themselves to his care ; and so wisely and considerately was this done that in most instances men and women who came into the wards with no thought beyond their bodily ailment became glad and eager listeners to the Story which f was there un olded to them . Various were the methods employed in carrying out h t is purpose . In many hospitals a quiet hour was set aside each day when every patient who cared to do so was taught to read, and in that way became familiar with passages o f Scripture and verses o f hymns which have brought new life and power to men and women all the world over . In others special classes were 92 CHINA AND MODERN MEDICINE

arranged fo r convalescent patients who were anxious to enquire more deeply into the truths o f

the Christian revelation . But the most commonly used method was the simple service conducted daily in the hospital

if s chapel, uch existed, or more commonly in one ” o f f descri or other the wards . The ollowing p tion o f such a gathering may be taken as typical o f what occurred in other parts o f China (the original account has been slightly amended)

The c an o f the o n w ic h as ust reso un e sen s the l g g g, h h j d d, d wor men o me fo r th e ni and the e l we ear so s ort k h ght , b l h h ly a c fter is alling patients and he lpers alik e to Evening S ervice . Presently we see a little stream o f peo ple wending their way o war s o ne o f the war s e mi t as we o in the ro t d d . W gh ll j p cessio n behind this o ld man limping alo ng o n a crutch and a a - int and see w ere it rin s us c s to . b k pl , h b g We enter a so mew at ro u - o o in war th e e s cro w e h gh l k g d, b d d d u to et er wi a amenta e isre ar fo r the Lo n o n p g h , th l bl d g d d ’ Co unty Co uncil (o r any o ther authorities ) demands fo r air s ace w i s in the centre are a num er o f o rms arran e p , h l t b f g d in ro ws co n ertin the war for th e time ein into a sort , v g d b g

o f Missio n Hal . Th e o ccu ants o f the e s sit o r lie in ar in l p b d , v y g c sce c Here are t o o r e s stages o f sickness o r o nvale n e . w po f llo w wh o were o n o era e o n t is mo rnin and so far a e but ly p t d h g, h v m T ere u i it e in eres in w at o es o n aro un e . n the l tl t t h g d th h , p co rner is an o ld man who h as us arri e in fo r o er , j t v d, bl d v ten ears u o n w o m we are o in to O era e fo r o u e y , p h h p g p t d bl O o site t o him is a o un man wh o h as een c ataract . pp y g b sufferin at the an s o f un ua i e o c o rs and w o se mal g h d q l ﬁ d d t , h unite racture h as h ad to be re - ro en and wire o e d f b k d t g ther. T ese and man i e t em are the ro er a ients o f the h , y l k h , p p p t war but atients ro m o t er arts o f the o s ita are a s d, p f h p h p l l o ere to et er wi o ur o wn e ers and no t o n are all the h , g h th h lp , ly o rms o ccu ie but se vera ﬁnd sea s u o n the end o f a nei f p d, l t p gh ’ s be One o r two o rmer a ien s a so are wit to - i bour d. f p t t l h us n ght h e ser ice and we a a s ive a s cia e o fo r t w e w c m t suc . v , l y g p l l e o h EVOLUTION OF THE HOSPITAL 93

end o f the war un erneat a. ar e rawin At th e furt her d , d h l g d g amari an is arran e a tin ta e and c air fo r o f the Go o d S t , g d y bl h

- is m i th e ea er wh o t o ni t is o ur ea ass an . A n s l d , gh h d t t hy given o ut and sung (with po ssibly mo re vigo ur than melo dy) to a well -kn o wn tune ; a sho rt prayer is o ffered fo r blessing upo n the service ; and then the o ld sto ry o f the Lo st Sheep Th a o es o n for near is slo wly read and explained . e t lk g ly al an o ur wit a rie ause e er no w and a ain to h f h , h b f p v y g emphasiz e a po int o r to as k a questio n o f so meone wh o appears s i So metimes th e a ress is en i ene to be pec ally dens e . dd l v d ario us un e ecte inci en s as for e am e w en a by v xp d d t , , x pl , h particularly intereste d hearer gives vent to audible co mments the sermo n o r w en th e ser ice is ein co n ucte a o n , h v b g d d by ri very o ginal perso n . One such man gave an address a little time ago o n the sto ry h m o en Man at the Po o o f B e es a A t er o f t e I p t t l th d . f exhaust in the mo re o rdinar a ica io ns o f th e mirac e h e sai g y ppl t l , d No w o u no w t is sto r h as ano t er er im o rt ant es y k , h y h v y p l so n o earn S o me o f o u a e co me ere t for y u to l . y h v h o ho spital e xpecting to have yo ur sicknes s treated o r yo ur o peratio n er o rme the er da o u co me and o u ma e e er suc p f d v y y y , y k v h uss if o u a t o wai a da r o Yo u u a f y h ve t y o tw . o ght to try ’ and co is man s atience fo r h e waite t irt -ei py th p , d h y ght years befo re he had his disease attended to It was at same s ea er wh o o n ano t er o ccasio n a ter th p k , h , f watching us set a fracture fo r a po o r beggar with a bro ken t i wh o had craw e to th e o s i a in a s o c in c h gh, l d h p t l h k g o nditio n o f emacia io n and so res ra e in u ic o n th t , p y d p bl e fo llo wing evening that Go d wo uld us e th e means which the do cto r ” as em o in to a e th e man to ea en w pl y g t k h v . But meanw i e we are o r ettin alla o ut the ea assista h l f g g b h d nt , w o mwe e t i in the a ress . it sim e o rci e an ua e h l f gv g dd W h pl f bl l g g , i ustrate ro m the ai wo r o f th e o s ita he e ll d f d ly k h p l, t lls the patients o f th e fuller life t o which the Savio ur o f men is calling them ; then an earnest prayer is o ffere d that they may o ne and all be fo und o f the Go o d Shepherd and bro ught back to the true o and the ser ice is o er fo r the ni 1 f ld ; v v ght .

1 A uiet Evenin in a Missio n Ho s ital Vide M Q g p . edical Miseio ns Abr 1 908 1 65 at Home and oad, , p . . 94 CHINA AND MODERN MEDICINE

II In the earliest hospitals accommodation was provided fo r any type o f case that sought admission , and the only distinction that was

o f made was in the matter sex, male and female patients being housed , as a rule, in entirely ff di erent buildings and compounds . But as the work developed , special hospitals were opened in various cities fo r the reception o f particular classes .

Of With the coming women physicians , hospitals fo r women and children were established, many o f which developed important maternity depart fﬁ ments . It is di cult to do adequate justice to the remarkable service rendered by these insti t utio ns in a country where so little is known o f ’ o f the scientiﬁc treatment women s diseases , and where indescribable suffering too Often ac c o m

- If panics child birth . reliable statistics could be secured as to the prevalence o f puerperal septi c eemia and tetanus neonatorum in China they would undoubtedly startle the whole medical ’ world . The Women s Hospitals have a splendid record to show o f work accomplished in combating these and similar diseases . The leper is another unfortunate class o f sufferer fo r whom special provision has been made . Leprosy has existed in China from time im memorial , and there , as in other countries all over EVOLUTION OF THE HOSPITAL 95

the world , the disease has been regarded with s ff ’ dread , and the u erer s lot has been a most f unhappy one . Prevented rom living at home , or in their native village , lepers usually join the

o f overcrowded ranks mendicants , and hundreds o f them have doubtless ended their lives o f misery

o f O with an overdose pium . The ﬁrst Leper Hospital in China was estab lish ed at Pakhoi in 1 8 90 in connection with the

o f work the Church Missionary Society, Dr E . G . i t it Horder being the do ctor in charge . This ns u f tion rapidly grew, and one hundred and ﬁ ty patients— men and women— are now aecom mo dat ed there . At the same time other centres

Siao kan also developed , notably at (Hupeh pro

o f vince) , where Dr Henry Fowler the London Missionary Society has been making a lifelong

o f study this subject , and at Hangchow, where the Chinese gentry have subscribed generously to wards the erection o i the splendid Leper Asylum 1 91 5 which Dr Duncan Main built there in . Other refuges are being Opened up fo r these u n f ortunate people , whose number is estimated at f f not less than our hundred and ﬁ ty thousand . The Mission to Lepers has now appointed Dr Fowler as its special representative fo r the Far f East , with a view to the urther development o f o f this branch service . At the same time it is hoped , in connection with the newer medical

ls es s schoo in China, to tabli h departments fo r 96 CHINA AND MODERN MEDICINE

o f scientiﬁc research in the treatment this disease . In this connection it is interesting to note that the drug upon which greatest reliance is placed by modern leprologists in their efforts to cure this terrible complaint , namely Chaulmoogra Oil , has

fo r been known to the Chinese years past, and was successfully employed by Dr Hobson as long ago 8 4 as 1 5 .

f fo r - Re uges the blind, such as those associated with the honoured names o f David Hill o f Hankow

o f and Hill Murray Peking, have as a rule been connected with the general work o f the missions rather than with the medical branch o f the enter

o f fo r prise . The same is true special institutions

f o f f the dea and dumb , which the Home at Che oo o f under the able superintendence Mrs S . R . Mills is the most conspicuous example .

o f afﬁ ict ed In the care the mentally , however, it has been the medical missionary who has led the

- o f way, and the well known name the great

American physician, Dr J . G . Kerr, will always be remembered in China in connection with this

fo r development . The Hospital the Insane which 1 8 7 2 he ﬁrst advocated in , and which was actually 1 8 98 opened in Canton in , was the ﬁrst ever established in China, and as such has won the admiration o f all classes o f the people . It now

o r h as accommodation f six hundred patients , and is largely subsidized by Chinese Ofﬁcials who make themselves responsible fo r the support o f

A WAR D IN A N O L D - T IM E MIS S IO N H O S PIT AL

(S e e page 87)

A WA R D IN A MOD ERN MISSION H OSPIT AL

(S ee p age 1 0 6) EVOLUTION OF THE HOSPITAL 97 patients whom they constantly send to the f re uge . Refuges fo r victims o f the opium habit were established from earliest days in connection with

o f unfo r mission hospitals , and hundreds these

tu nat e f creatures have , in them, ound deliverance

and happiness . Another development o f more recent years has been the provision o f sanatoria fo r tuberculosis

in several centres , notably at Kuling and Hang

o f chow, the latter being one the many institutions connected with the work Of the Church Missionary Society which owes its origin to the enterprise

o f and administrative ability Dr Duncan Main . These institutions are breaking ground which it is hoped the Chinese themselves will be able to f develop and cultivate in the uture .

III

Of - f The style the old ashioned hospital , originally

dictated by the conditions under which it arose , f continued long a ter these conditions had passed , and even to this day a large number o f mission

hospitals in China, especially in the interior, are operated on the same primitive lines as those

o f o already described . The causes this are f two

o f kinds . First , the ﬁnancial stringency mis

nar l sio y budgets , incessant y crippling plans fo r necessary development, tends in the long run to cramp the initiative o f the missionary organiza D 98 CHINA AND MODERN MEDICINE

. s tions in the ﬁeld Secondly, the way to progres is constantly barred by the lack o f imagination on

o f the part committees and supporters at home , or by that inadequate conception o f the medical missionary enterprise which regards it merely as f a means to an end , and not as an end in itsel . The difﬁ culties created by this point o f V iew have

been well expressed by the veteran missionary,

Dr James L . Maxwell . Writing on this subject

sixteen years ago, he said

All are a ree at the reat end o f me ica missio ns as o f g d th g d l , all missio ns is th e e a in and c o mmen in o f C rist as th , x lt g d g h e But all are n t a r e o n th e in es n Savio ur o f men . o g e d l o whic h missio n o s i a is t o be wro u so as t o acco m is is a h p t l ght pl h th . r r i i eas In the main there a e two p eva ling d . One idea is that it do es no t matter very much in what kind o f ui in o ur me ica and sur ica wo r is er o rme b ld g y d l g l k p f d, pro vide d it gives yo u an o ppo rtunity o f preac hing th e go spel t o o ur a ients and ur er a seein t at the s iri ua y p t ; , f th , th t g h p t l sul s are the c ie in ere is no s ecial call to la o urs re t h f th g, th p y y elf t be r a t ea i i cu case uc o ut fo r and o e dy o d l w th d ffi lt s . S h cases wi a e u a lo t o f ime and wi i e the me di ca missi ll t k p t , ll gv l o nary o o ea o f an iet and tro u e ere o re it wo u a g d d l x y bl ; th f , ld be we ll to cultivat e o nly tho se cases that can be easily and quickly T o se wh o o l is iew— and ere managed . h h d th v th are no t a few o n missio n bo ards and amo ng th e Christian public who do — ho ld it are perfectly satisﬁed that in this way the greater

gain is to be reached . The o er i ea t at w ic re ai s t o u not uni ersa l th d , h h h p v l , h gh v l y, amo n me ica missio naries emse es and eir co lea ue g d l th lv th l g s, is that a missio n ho spital o ught to be laid o ut o n the very best lines fo r securing th e healing o f the sick ; that the medical ssio nar s o u be read to the er utmo s o ssi e mi y h ld y, v y t p bl , t o mee and ea wi the mo st di cu t cases and a a o t d l th fﬁ l , th t l ng t ese ines we ma e ec the ar es u ima e s iri ua resu ts h l y xp t l g t lt t p t l l . It will be manifest at o nce that the missio n hospital idea

100 CHINA AND MODERN MEDICINE

ﬁnd a response in the heart o f every medical missionary still

e saw no s iri ua resu ts if we saw no co n er s ro u If w p t l l , v t b ght medi ca missio ns if we saw no o o rs o ene eir o ut by l , d p d by th means it wo u s i be the o un en u o f C ristian eo e , ld t ll b d d ty h p pl t o do what they can with this western science which Go d h as i en t o a e iate miser and wret c e ness ain and isease gv ll v y h d , p d , i 1 wherever t may be fo und .

This emphasis upon the qualitative aspect Of the work o f the hospital is entirely in line with those two important axioms upon which students o f missions tod ay are more and more basing their

o f policy . The ﬁrst these is that no country can be truly evangelized— nor set free from ignorance — and disease e xcept through the efforts o f its — own sons and daughters . The second and it is — the obvious corollary o f the other that the work o f every missionary in China, no matter what branch he or she may be engaged in, is primarily and essentially educative . ’ The permanent value o f the evangelist s work cannot be expressed in terms o f the number o f people to whom he has personally preached , or given tracts ; it can only be truly expressed in terms o f men and women in whom the Message

- has become self operative . The greatest service he can render China is to call out and train a band o f disciples o f Christ whose passion is the

f o f saving and upli ting their country .

1 M rc and Truth Churc Missionar Socie Feb 1 e . 90 y ( h y ty) , 0, 41 p. . EVOLUTION OF THE HOSPITAL 101

The same rule applies to hospital work . It is not enough that we regard our hospitals merely as a palliative fo r the immediate ills o f a certain

o f number patients , nor even solely as an object

o f lesson kindness and sympathy, great as that

o may be . The permanent work f medical relief is ultimately a matter o f education even more

o than f curative treatment . We in the West escape the untold sufferings o f so many thousands o f o Chinese patients , not because f the number o f physicians at our doors to cure us , but mainly because o f the great hygienic measures that have

fo r Of been adopted the prevention disease . We escape the horrors Of typhus because we have learned to appreciate the vital importance o f ridding our persons and our clothing Of typhus f bearing vermin . Our children are saved rom the blindness which so often accompanies small in pox the Orient , because they are protected

f f - against smallpox itsel . Our in antile death rate

c is beginning to de rease because, at long last, the

o f f o f o f blessings resh air, suitable diet, and skilled nursing are beginning to be appreciated . Such considerations should be in our minds as we ’ f o f ff o f ace the problem China s su ering, which so large and terrible a proportion is entirely preventable .

s if Even our mallest hospitals , they are to be o f worthy that name, should be a demonstration to the Chinese patients and a training - ground to 102 CHINA AND MODERN MEDICINE their own helpers in those simple lessons o f cleanliness and hygiene and the kindly care o f the sick, which have had such an enormous educative value in our own countries , and which are so d desperately needed in China to ay . In that way forces will be generated which should have a permanent and increasing inﬂuence in promoting

o f the health the community . Another reason which has led to the increased thought that is being given to this matter is the fact that mission hospitals are now no longer the only h OS pit als known to the educated classes

O in China . Hundreds f students and merchants who have travelled in Europe, in America , or in

o Japan, have had personal experience f modern hospital treatment in those countries , and are increasingly conscious o f how far many mission hospitals fall short in scientiﬁc equipment and

few modern nursing methods . The last years have also seen the starting by the Chinese them

Of Of — selves several hospitals , one which the — Central Hospital, Peking was erected at a cost Of nearly and has been ﬁtted out and equipped in the most modern manner . The graduates o f the new medical schools in China likewise learn to appreciate the value o f those special diagnostic methods which we associate with modern medicine , and to depend upon skilled

o nursing fo r the treatment f their patients . If f , there ore, the mission hospital is not to

104 CHINA AND MODERN MEDICINE

No a -u -to - ate me o s o f wo r fo r the C inese less . h lf p d th d k h His aim was ua i ra er an were allo we d by him. q l ty th th uanti and h e saw t o it a his directio ns and in es o f rea q ty, th t l t t rrie u He has raise a s an ar o f ment were stric tly ca d o t . d t d d me dical wo rk in Central China the inﬂuence o f which will be 1 felt fo r years t o co me .

o f o f The inﬂuence Hodge , and medical men

o f f and women his type , gathers orce as the years

o f go by . No question is exercising the minds medical missionaries in China more deeply to - day than that o f making their hospitals a real object

ro fessmnal lesson to the Chinese , in p standards and

f S scientiﬁc e ﬁciency as well as in piritual power .

The China Medical Missionary Association,

f 1 8 8 6 o which was ounded in with Dr J . G . Kerr f

Canton as its ﬁrst president, and which now has a membership o f nearly six hundred medical men 2 o and women , has continually lent the pages f its

o f journal to a discussion this topic . It was made the main subject fo r discussion at the last

f o f Con erence the Association, held in Peking in

1 920 o r February . In preparation f that confer ence a somewhat exhaustive questionnaire , dealing with every aspect o f the scientiﬁc efﬁciency o f mission hospitals in China, had been prepared during the preceding twelve months , and this was sent out to every medical mission station in the

1 S dn Ru rt H d b th Re ill e o e J K . e e v . . H . 59 and 1 y y p g , y , pp 00. 2 Memb ers h i p o f th e As s o ci atio n is no t c o nﬁned t o medi cal missionaries but is o en t o all h sicians wh o are in s m a , p p y y p thy wi h s ar o r S ee A end ix I o t mis io n y w k. pp II f r a fuller acc o unt o f his im rtant ss o i a io n t m A c t . EVOLUTION OF THE HOSPITAL 105

o f country . It is signiﬁcant the interest which

o f this subject is arousing that , in spite the lengthy

o f f and detailed character the enquiry orm, returns were received from no less than eighty

it als per cent o f the h OS p . The enquiry brought to light the very difﬁcult conditions under which many hospitals even in important towns and cities still have to carry on

o f f fo r their work, owing to the utter lack acilities modern medical treatment . This is clearly shown in the following summary o f some o f the evidence which appears in its pages

34 per cent o f th e ho spitals who se repo rts were received a e no nurse w ate er o rei n o r C inese and 60 h v h v , f g h , r cent no t mo re t an o ne raine nur pe h t d se . ’ 37 per cent depend entirely o n the patients friends fo r all nursin w i st 62 er cen a e no ni t - ur i n s n . g, h l p t h v gh g 37 er cen o ssess no e in o r o n su cien fo r a er p t p b dd g, ly fﬁ t v y i s few pat ent . 58 per cent are unable to c lo the their patients in clean

ho spital garments . 8 er cent o n a e a ure water su and 6 er c p ly h v p pply, p ent o nly have running water laid o n thro ugho ut the

ho spital . 50 er ce nt se o m o r ne er a e t eir atien s and p ld v b th h p t , 43 er cen a e no aun ries o r o n ina p t h v l d , ly dequate acco mmo atio n fo r ea in wit the o s ita in n d d l g h h p l l e . 34 per cent do no t po ssess a pressure steriliz er fo r their ressin s and 73 er cen a e no means o f steri i d g , p t h v l zing r s s beddingo r matt es e . 37 per cent have no pro te c tio n whate ver against ﬂies o r mo s uito es and 65 er cent a e no i q , p h v so latio n blo ck ar o r c o urty d . 3 1 er cen do no t o ssess a a o rato r o f an in i p t p l b y y k d, wh lst 82 per cent have no bacterio lo gical incubato r 87 er cen do no t o ssess an X -Ra p t p y plant . D3? 106 CHINA AND MODERN MEDICINE

It will be seen from the above table h o wmuch leeway there is yet to be made up before these

r hospitals are worthily equipped fo their work . At the same time there is solid ground fo r en c o uragement in the progress that has already

fo r been made, and in the new plans advance which many mission boards are now contem ff plating . There are already, in di erent parts o f China, nearly a hundred mission hospitals which are being Operated on approximately

u - - modern standards , with p to date equipment , f f skil ul nursing, care ul and thorough investigation f ff o disease , and above all , a determined e ort on the part o f every worker to manifest and proclaim the S pirit o f Christ in the whole work o f the insti t ut io n f f o . This represents a orce in the li e f China f r- n whose a reaching i ﬂuence no one can estimate .

108 CHINA AND MODERN MEDICINE o as f the Medical Missionary Society, which we f 1 83 8 have seen they ounded in , but already, in the preceding year, Parker had commenced to train three assistants in his hospital at Canton . Naturally enough such training consisted almost entirely o f oral instruction o f a practical char acter, on very much the same lines as in the old

o apprenticeship days in this country, f r there were no Chinese medical text - books that could be

f fo r employed, nor any acilities laboratory work . But the clinical teaching which Parker gave these

f o f men was so success ul that one them, Dr Kwan tao, subsequently obtained a reputation as surgeon and oculist that was almost as widespread as that

r o f his teacher . On one occasion he was sent fo o f by the Viceroy Szechuan, nearly miles

O fo r away, upon whom he perated cataract . He f also per ormed various major surgical operations , one o f which was the removing o f a tumour which is said to have measured some three and a quarter f — a f feet in circum erence per ormance which , in those days , must have made an enormous impres

o f sion on the people, to say nothing the patient ! The work o f training Chinese assistants which Parker thus inaugurated was continued by various medical men who succeeded him, notably by o f Dr John G . Kerr the American Presbyterian

f o f Mission, who , in a remarkable li e nearly ﬁfty

o f years medical missionary service at Canton , not only helped to instruct some two hundred THE NEW PROFESSION IN CHINA 109 students but also made invaluable contributions to the building up o f the new Chinese medical literature , which, as we have seen , Benjamin 1 Hobson had been the ﬁrst to undertake . Kerr personally translated over twenty medical text

- books , comprising thirty two volumes .

I Thus was medical education commenced on a

fo r f humble scale in China , and the next fi ty or sixty years similar classes fo r students were organized in various parts o f the country, in connection with different mission hospitals . Most o f these students came from poor homes and were deficient in general education but in spite o f so many handicaps many o f them became valuable workers and rendered great assistance in various hospital centres , both as physicians and evangelists . Meantime the first steps were being taken towards the provision o f a new supply o f fully trained Chinese physicians , by the sending abroad o f students whose knowledge o f English was sufficient to enable them to pursue their medical

o f studies in Europe or America . The ﬁrst these n was Mr Wang Fun , who was se t to Edinburgh through the generosity o f some British merchants in Hongkong, and who graduated there with 1 8 distinction in 55 . He returned to China in

1 857 c , in onnection with the London Missionary

1 ide 4 V p. 6. 110 CHINA AND MODERN MEDICINE

o f Society, and Dr Henderson wrote him a few years later There is not a medical man now in China who has a better knowledge o f his profession ” 1 in all its branches than Dr Wang Fun . Many years elapsed before Dr Wang ’ s example f was ollowed, and indeed it is only in very recent times that any considerable number o f Chinese students have left their country to study medicine

o f abroad . Most these have gone to Japan , where , f un ortunately, they have not as a rule attached themselves to the higher -grade Japanese medical f f schools , and thus have ailed to secure the ull

o f beneﬁts modern medical science . There have, however, been some notable exceptions , especially amongst those students who have proceeded to

Europe and America, the most conspicuous being

- o f Dr Wu Lien teh, a graduate Cambridge , now Director o f the Plague Prevention Service o f

o f North Manchuria ; Dr S . P . Chen, also Cam

o f bridge, who has charge both the Central Hospital

o f and the Isolation Hospital , Peking ; and Dr

- . o f o f F C . Yen , Yale, Dean the Hunan Yale

Medical College at Changsha . In this connection mention must be made o f a brilliant little group o f Chinese women students who have studied medicine in America . The

o f . ﬁrst these was Dr Y May King, an adopted

o f McCart e e o f daughter Dr Ningpo , who graduated ’ from the Women s Medical College o f the New

1 Mm ia s o m n n MD 1 e or l J a es H d rs . . f e e o , . , p . 79

112 CHINA AND MODERN MEDICINE responded to an invitation to open up medical work in another huge city, Nanchang, where by the successful treatment o f the wife o f an ofﬁcial she opened the gates to Protestant missionaries .

II The year 1 8 8 1 is one that should long be remembered in connection with the development o fo r f medical education in China , it saw the Opening o f the ﬁrst medical school established

1 inc e in the country on a modern basis . Its p tion was due to Kenneth Mackenzie, who , on hearing that several Chinese students who had been sent to America fo r collegiate education were being recalled by the Government, at once

o f memorialized the Viceroy Chihli, Li Hung

Of Chang, petitioning that eight them might be “ placed under his care fo r the study o f medicine and surgery, with a view to their being utilized eventually as medical ofﬁ cers by the Government .

Li Hung Chang not only acceded to this request, but also placed suitable premises at Mackenzie ’s disposal at Tientsin and became responsible fo r

o f the ﬁnancial upkeep the school , giving Mackenzie full freedom fo r missionary work amongst the students . Three classes were admitted to the school during

1 Medical Scho ols were established in China in th e reign o f Sh en Tsun D o f th e Sun D nas and were s ill ur er g g(A. . g y ty, t f th d Min d nas ies S u s e uen l e elo ed in th e Yuen and . v p g y t b q t y, h o we er h e ell in o a e ance v , t y f t b y . THE NEW PROFESSION IN CHINA 113

’ f - Mackenzie s li etime , each taking a three year course . All instruction was given in English , f mostly by Dr Mackenzie himsel , who received valuable assistance from Dr Atterbury o f Peking and from some o f the British and American naval surgeons stationed at Tientsin . Nineteen men were graduated in all , and though Mackenzie wrote in 1 8 8 7 that his hopes had not been entirely f ulﬁlled , Dr Fred Roberts was able to write in the following strain four years later

Yo u will be glad to know that the fo rmer labo urs o f Dr Mac enz ie in co nnec io n wit th e Go ernment Medi ca Sc o o k , t h v l h l un er his c ar e a e een far ro m rui ess . U t o th e d h g , h v b f f tl p ime o f his eat it seeme t o him a mo st i e a our in ain t d h d l l k l b v , seeing that th e graduates were no t successful in Obtaining r mi a o in m i er differen no w . In c o se o i pp t ents . It s v y t l p x ty ’ to o ur o wn o s i a is an im o sin ui in the Vicero s h p t l p g b ld g, y ’ o s ita mana e fo r th e mo s art t ree o f Mac en ie s h p l, g d t p by h k z o rmer s u en s and wi the ro s ec if we l co n ucte o f f t d t , th p p t , l d d, i sic In Po rt Ar ur do ing much go o d in the heal ngo f the k . th there is a naval and military ho spital and dispensary which is muc a recia e the so iers and it also is wo r e h pp t d by ld , k d r e O ers a ain a e een a o in e to by fo mer stud nts . th g h v b pp t d

Wei Hai Wei a na a st a io n . Dr C an h as een acce te , v l t h g b p d many mo nths ago fo r the po st o f ho us e surgeo n to the Alice Memo ria Ho s i a Ho n o n w ile ast but no t l p t l gk g; h , l eas Dr Mai h as een fo r so me time success u treatin l t , b f lly g h 1 t e father o f the Empero r in Peking. It is interesting to know that this medical school is still in existence , being now supported

o f by the provincial government Chihli, and known as the Peiyang Medical College, Tientsin . In 1 8 87 the Hongkong College o f Medicine was

1 b rs B r s o n Mack n i M 6 . J hn K nneth e z e . 37 o e , y y , p 114 CHINA AND MODERN MEDICINE

opened, with Dr Manson (now Sir Patrick Manson)

ﬁr as its st Dean . The London Missionary Society was closely connected with the college from its ’ inception, the Society s hospitals being used fo r

practical instruction, and their physicians assisting

in the teaching work . It was in that college that

Dr Sun Yat Sen received his education, and formed that friendship with Dr James Cantlie (then Professor o f Anatomy and Surgery) that was

ra f to play so d matic a part in his uture career . Other small medical schools slowly came into

o f existence , mainly as a development those classes fo r student - assistants which had been started in connection with various mission 1 f hospitals . But it was a ter the Boxer uprising o 1 9 0 n fo r f 0 , when the eed constructive and educative work on a broad basis was brought

f o f home to all riends China, that the ﬁrst attempt was made to establish a School o f Medicine in

Peking . This was the ﬁrst medical college to be established in China by the combination o f

both British and American medical men, and through the c o -Operation o f missionary societies ff representing di erent religious denominations .

It was organized by Dr Thomas Cochrane, n o f the Lo don Missionary Society, who was fortunately successful in securing the patronage

1 A s eries o f successfu l c lasses o f this nature had already been z Dr W Bo o ne at Sh an h ai Dr Van S o mere r ni ed . . n o ga by H g , Ta lo r and Dr Os o o d at Fo oc h o w Dr Dunc an Main at Han c o w y g , g h , m n o Dr Chri s ie at Mo u den Dr illis o n at Han o w and a h ers. t k , G k , y t

116 CHINA AND MODERN MEDICINE

questionable wisdom . Not that there was not

fo r ample room them all , and many more in

if o f addition, the needs so vast a country were taken into consideration ; but the suitable men ff who were available to sta such institutions , and the funds from which to supply the extensive buildings and equipment needed, were both so limited that there was no h Op e unless the number o f these colleges was reduced that any o f them f would be adequately manned or urnished . At the Biennial Conference o f the China Medical Missionary Association in 1 91 3 a resolution was f passed, urging that no urther Medical Schools be established until the eight Union Colleges then in t 1 existence were made efﬁ cien . It soon became evident that even that number was far beyond

o f ff the power the missions to render e ective . In addition to the eight missionary medical

f o f colleges just re erred to , all which were conﬁned

fo r to men students , three medical schools women had also been established in China . In the South, — Dr Mary Fulton one o f the pioneer women physicians in the Far East — laid in 1 8 99 the foundations o f what has become the Hackett

n . Medical College , Canto In Central China another pioneer worker, Dr Margaret H . Polk, made a similar effort at Soochow ; whilst in the

1 Th ese ei were s i ua ed at Mou den Pe in Tainan ght t t k , k g, , Han o w Chen u Nan in wi h Han ch o w Fo o c ow and k , gt , k g ( t g ) , h ,

Canton . THE NEW PROFESSION IN CHINA 117

fo r was North 3. Union Medical College Women established at Peking . These three schools not ff only di ered widely in their location, but also in the language employed fo r the instruction o f the students , Cantonese being used at Canton , English at Soochow, and Mandarin at Peking . Many valuable women workers have received

unfo rt un their training in these institutions , but ’ ately the Women s Colleges , like the others , have been so starved fo r lack o f workers and equipment as severely to cripple the efﬁciency o f their medical instruction . Important steps are now on foot ’ looking to the concentration o f women s medical education in either one or two thoroughly eﬁi cient

c o - schools , and possibly to operation with one or ’

o f . other the men s medical colleges Such a plan , combined with a large expansion o f staff and improved buildings and equipment, should ensure that the important work o f training women medical students fo r the unique service that they can render to their suffering sisters in China will f f be placed on a satis actory ooting .

III

Meantime , however, important new factors began to appear on the scene . In the ﬁrst place there came into existence a body o f Chinese medical men who had received their training on modern lines , mostly in Europe and America , and who subsequently formed themselves into 118 CHINA AND MODERN MEDICINE

1 o a National Medical Association f China . The

o f - leader this group , Dr Wu Lien teh , who is still — known in England as Dr G . L . Tuck the name he adopted while at Cambridge— lost no time in memorializing the Government fo r the establish

o f o f ment modern standards medical education ,

fo r and outlined a suggested syllabus the purpose .

o f At the same time, various the Chinese provincial governments began to S how their keen interest in

this work, not only by opening provincial medical

colleges (as at Soochow, Hangchow, but also by c o -operating in the development and support

o o f f some the missionary medical colleges , notably that connected with the work o f the Yale Mission

at Changsha, and with the Moukden Medical

College .

In the second place , other organizations inter est ed in the progress o f China began to take a share in the work o f medical education The

o f University Hongkong, which was established

1 90 f o f in 7 , incorporated the ormer College f Medicine . In a similar way were ounded the Harvard Medical School at Shanghai the German Medical Colleges at Shanghai and Tsingtao (both since closed) ; and the Japanese Medical College

o f at Moukden . But none these organizations made so large a contribution to the cause o f f medical education , nor has exerted so pro ound

o f an inﬂuence in the setting modern standards , 1 V Vide Appendix I .

120 CHINA AND MODERN MEDICINE

if activities in Peking and Shanghai, a suitable scheme could be formulated fo r association with the missionary medical

colleges in those two centres and that, in

addition, some assistance should be given to the Canton Christian College and to the Yale Mission in their plans fo r medical education at Canton and Changsha re

s ecti e l p v y.

6 . That assistance should be given to the development o f a higher standard o f pro

fessio nal f e ﬁciency in various hospitals , commencing with those S ituated in the ﬁelds tributary to the medical schools

aided by the Foundation . This assistance should take the form o f grants towards the support o f increased medical and nursing

ff . sta s , business managers , etc , and the provision o f laboratory equipment fo r

improved diagnostic measures .

7 . That encouragement should be given to the

training o f nurses . The recommendations o f this Commission were adopted by the Foundation and a special organi z atio n created fo r the purpose o f putting them into effect ; this has been designated the China

ard o f f Medical B o the Rocke eller Foundation . The ﬁrst act o f this new Board was to enter into arrangements with the London Missionary Society by which the Board acquired the whole THE NEW PROFESSION IN CHINA 121

o f k property the Union Medical College , Pe ing,

v Of esting it in a new Board Trustees , upon which the various missionary societies interested in the work in Peking, and the China Medical Board, are equally represented . An extensive property, f o f ormerly owned by one the Chinese princes , e was purchased , and here there has been rected what it is no exaggeration to describe as the most

f o f beauti ul modern building in the whole China, and one o f the best - ordered and best - equipped medical schools and hospitals to be found any

in o f where the world . An adaptation Chinese architecture has made it possible to give to the

f fo r buildings , in addition to the use ulness which

o f they were planned, beauty design in harmony with the great architectural monuments in Peking, and pleasing both to the Chinese and to westerners . A sum approaching two million pounds sterling ff has been expended on this school , and every e ort has been made to ensure that each department ff should be sta ed by expert medical men, and furnished with everything necessary fo r up -to date scientiﬁc work . The missionary societies are co -Operating in

o f fo r the selection teachers the school , and a number o f the men who have already received appointments have been drawn from the ranks o f medical missionaries . The whole cost o f upkeep o f o f ‘ the institution, which is , course , very con siderable , is being borne by the Rockefeller Fo unda 122 CHINA AND MODERN MEDICINE

tion, and there is no question that their action in thus founding a ﬁ rst - class medical school in the capital o f China has done more to raise the whole prestige o f modern medicine and o f medical educa tion than any other step hitherto taken in the country .

AS soon as the decisio n o f the Rockefeller

Foundation reached China, two serious questions confronted those medical missionaries who were

o f engaging in the work medical education . In the ﬁrst place they had to face the fact that the best modern standards were now to be introduced into China , and there was a risk that it might possibly be said o f the missionary schools that they were Offering to the Chinese a type o f medical

o f education that was a lower standard . At ﬁrst there was a considerable feeling in some quarters in favour o f retaining a number o f low grade medical schools but the large majority o f medical educationalists connected with the missions took the line that the Mission Boards ought to con centrate all their strength on just that number o f medical schools that they could make absolutely efﬁcient . To retire at so promising a stage was

fo r unthinkable, that would mean the surrender o f a wonderful opportunity o f infusing medical instruction with Christian ideals and principles , and o f winning a large number o f future leaders

124 CHINA AND MODERN MEDICINE

ease , the objection which is raised to medical

instruction in Chinese, on the score that the graduates have too limited a medical literature from which to extend their knowledge and ex i er enc e f . p , alls at once to the ground The Council on Medical Education (o f the China Medical Missionary Association) which was formed in 1 9 1 5 took up the question with great seriousness , and sent a unanimous resolution to the China Medical Board , requesting that they would assist in the support o f at least one medical college teaching in Chinese, and expressing the . Opinion that the school most suitable fo r such development was the one that was situated in

o f o f Tsinan, the capital the province Shantung . They further urged that all missions interested in the advance o f medical education through the medium o f Chinese in the great Mandarin - speaking area o f east and central China S hould concentrate their forces in the development and support o f that school . Such a recommendation carried with it the giving up o f two medical colleges at Nanking and Hankow, where very promising work had f already been done . But so strongly was it elt that a policy o f concentration was absolutely essential if high standards were to be secured that

o f even this great sacriﬁce local interests was urged . This proposal received the endorsement o f the newly formed British Advisory Board o f Medical

o f Missions , as well as many missionary leaders in THE NEW PROFESSION IN CHINA 125

f North America , and the trans er to Tsinan was ff —1 e ected in 1 91 7 8 .

At the same time the China Medical Board , whilst it did not feel able to undertake the responsi bilit o f y maintaining another school , invited the Tsinan authorities to receive three classes o f f students ormerly under instruction at Peking, and in return fo r so doing made a generous grant o f over towards the cost o f additional

o f buildings and equipment , and the support — additional members o f the staff a grant which has since been augmented . This concentration o f forces in the Tsinan Medical School (now known as the School o f Medicine o f the Shantung Christian University) is probably one o f the most remarkable instances

f c o - O fo r o missionary peration in China, it has brought no less than nine societies o f Great

re re Britain , Canada , and the United States , p f senting all the chie Christian denominations ,

f 1 Of into ellowship , and in ﬁve cases out the nine it has involved the transference o f representatives o f a mission to a part o f China in which that particular society had no previous responsibility .

1 Th es e nine s o cieties are in Great Britain th e Baptis t Missionar So cie th e So cie fo r th e Pro a a io n o f th e os el y ty, ty p g t G p , th e Londo n Missionar So cie th e Wes le an Miss io nar So cie y ty, y y ty, and (to a les s degree) th e English Pres byterian Mis sio n ; m th e Uni ed S a es th e American Pres t erian Missio n No rt h th e t t t by , merican Pres t erian Mis sio n S o u h th e No rwe ian Lu h eran A by t , g t i anada th e Pres erian sion Mission and n C byt Mis . 126 CHINA AND MODERN MEDICINE

f It has , however, had the satis actory result o f enabling the Medical School to secure an expert f o f f - aculty more than twenty ull time teachers .

Besides Tsinan , the Council on Medical Edu cation is urging the development o f two other missionary medical colleges teaching in Mandarin . One o f these is the well - known Medical College at

Moukden, which will always be connected with the indefatigable work o f the veteran Dr Dugald Christie and the glorious self- sacriﬁ ce o f Arthur

ff o f Jackson . Commencing as the o spring the

o f United Free Church Scotland, it is now linked

i n with the other two missions working Manchuria , and receives strong support from the provincial government . The other Mandarin school is the Medical Department o f the young and vigorous

West China University at Chengtu , where British Friends and Churchmen link hands with Methodists

o f and Baptists Canada and the United States . Two medical colleges employing English as the chief medium o f instruction are also receiving strong encouragement from the China Medical

o f Missionary Association . One these is in Central

China (Changsha) , where the Yale Mission, in

- c o Operation with the Hunan Government , has established an important school , in which the

Wesleyan Mission is now taking a share , and in the establishment o f which Dr F . C . Yen and

Dr E . H . Hume have taken a leading part . ’ The other is at Shanghai, where St John s

128 CHINA AND MODERN MEDICINE assumption argue that in face o f such an nu relieved mass o f suffering as the population o f

China presents , and in a land where indigenous

SO medical methods are crude , it would be better

fo r to aim at quantity rather than quality, and the mission colleges to turn out hundreds o f students with a superﬁcial knowledge o f how to treat common ailments or to administer practical

ﬁ rst - o f f aid, instead a mere hand ul , year by ye ar, o f students highly trained and qualiﬁed after long

o f and expensive years study . Such an argument suggests that we are im pro vising a temporary Red Cross organization to deal with an acute situation which has suddenly If developed and which will rapidly improve .

u stiﬁ ca this were the case , there might be some j

r a h c a tion fo such an d o policy . But th t does

o f not represent the state the case at all . We are engaged in the tremendous task o f assisting a great and ancient nation to work out a

o f worthy system medical education and practice . Amongst the leaders o f that nation are already to be numbered an inﬂuential group o f medical men and women who are fully conversant with the best

o f science the West , and who are eager to see S imilar standards adopted in their own country . One o f them has already expressed himself publicly in the following words

we er necessar mo ern medicine ma be to this co untr Ho v y d y y, I wo uld rather see fewer well -qualiﬁed men and wo men with M D MA RY S T ON E . . ,

Mi ch . (U n iv . ,

FORMER LY PHYS I C I AN I N

’ ‘ C HARG E O F T H E D A N F OR I H P L MEMOR I A L HO S I TA ,

K I UK I AN G

(S ee j ﬁa ge I I I )

W E - T EH M A U LI N . . , ,

L D H o n o n L . . ( gk g)

PH YS I C I A N EX TRAORD I N A RY T O TH E PRE S I D ENT O F C H I N A D I RE C TOR O F T H E N ORTH MA N C H UR I A PL AG UE PREV ENT I O N S ER V I C E

(S ee p age I 1 0 )

130 CHINA AND MODERN MEDICINE to the adoption by the China Medical Missionary Association o f the highest scientiﬁc standards

- o f (comparable to the best hospital schools London ,

Edinburgh , or Baltimore) in those medical colleges whose diplomas they recognize . And this con t ributio n to the life and ideals o f the Chinese people represents an achievement o f which the

Association , and the Missions which called it into being, have every right to be proud . Not only has this policy been followed in the general medical curriculum, but the Council on Medical Education has also taken the progressive step o f outlining a two - year course o f pre - medical study in the laboratory sciences , to be taken by students previous to entering upon their ﬁve ’ years medical training . This requirement is now enforced at the leading medical schools , and not only ensures a sound scientiﬁc foundation in the

- pre medical subjects (chemistry, physics , and

fo r re - o f biology) , but also allows a arrangement the medical curriculum by which the ﬁnal year can be wholly devoted to clinical and pathological investigations . This emphasis upon practical work in laboratory and ward is o f special importance in China where

o f centuries memorizing, whilst they have pro f o f duced a marvellous aculty recollection, have also left an unhappy legacy o f passive mental

o f receptivity, to the discouragement aggressive thought . THE NEW PROFESSION IN CHINA 131

There is always a demand fo r the well -trained

r graduate . The Government, the ailway com

anies p , the national army and the progressive communities in the Treaty Ports vie with mission

fo r hospitals throughout the country his services . And the demand will certainly increase faster than it can possibly be met . Thus there is becoming established in the mind o f the Chinese people an appreciation o f the trained and competent doctor with which neither quackery nor superstition will be able to compete . To meet this growing demand not only is there a need fo r an increasing number o f fully - qu aliﬁed

Chinese physicians , but it is essential that all medical science S hould be available in the language

s o f the people . The China Medical Mis ionary f Association has been ully alive to this fact . Special Publication and Terminology Committees

fo r have been at work many years , translating 1 o f - several the leading medical text books , and

f o f preparing a ull vocabulary scientiﬁc terms .

Co u sland o f Dr P . B . , the English Presbyterian

fo r o f Mission, has been set aside the direction this work, whilst in recent years a strong Translation

1 mo n s h os e alread ransla ed o r sh o r l to be u lis ed A g t t y t t , t y p b h , ’ ’ ’ ra s Anato m Halli ur on s Ph sio lo Cunnin am s are G y y, b t y gy, gh ’ ’ Practical Anato m Lewis and S ohr s Histo lo Osler s Medicine y, t gy, , ’ ’ ’ s and Carless s S ur er Fuc s O hthalmo lo S en els Ro e g y, h p gy, t g ’ ’ Patho lo Ris e and ! insser s B acterio lo Hare s Thera u t gy, gy, pe ics , ’ ’ chins on and Rain s Clinical Methods Holt s Diseases Hut y , of

Childhood and man o ers . , y th 132 CHINA AND MODERN MEDICINE Department has been organized in connection with the Tsinan Medical School , under the able leader M o i . . cAll ship Drs T . Gillison and P L and their

Chinese associates . At ﬁrst this important work had to be carried on without any certain guarantee that the scientiﬁc terms so created would be recognized by the

Chinese Government . That stage has now happily passed . Within recent years the Central Educa tion Board and other ofﬁ cial bodies have appointed their own representatives to act with the Ter mino lo f gy Committee, thus giving an o ﬁcial imprimatur to their decisions . All medical terms are now be ing revised and added to by this joint

o f body, the Chinese G vernment de raying the cost o f publishing them and the China Medical Board also assisting most generously in this essential work o f translation and publication . It is impossible to conclude this chapter without referring to the encouraging attitude which the Chinese Government is beginning to adopt towards

o f the development medical education . This was clearly S hown by the great step which was taken by the Board o f the Interior in November 1 9 1 3 in giving permission fo r human dissection and post - mortem examinations to be practised in medical schools , thus removing the last obstacle to the effective teaching o f anatomy and patho

f o logy . More recently, at the Con erence f the s 1 920 China Medical Missionary A sociation in , a

CHAPTER VI

THE ADVE NT OF THE CHINE S E NURS E

S o in so uteous ili en k d, d , d g t , S o ten er o er his o ccasio ns rue d v , t , - So eat so nurse i e . f , l k SHAK ESPEARE C line , ymbe .

THE RE have been few events in China within recent years which have marked so fundamental a change o f mental attitude on the part o f the people as the fact that it has now been f ound possible , in many centres , to introduce into Chinese hospitals the practice o f nursing on a modern basis . Such a possibility was practically

o f undreamed as recently as twenty years ago , except in a few o f the more progressive treaty ’ TO - ports . day there is a ﬂourishing Nurses

o f Association China , with two hundred and thirty members (foreign and Chinese) working in all

o f f parts the country, and over ﬁ ty Training

Schools already registered in connection with it . To appreciate something o f what this means to

China, and the steps by which it has been brought

o f about , we must remind ourselves the conditions which existed in the hospitals in the old days , and the difﬁculties with which the pioneer nurses had to contend . 1 34 ADVENT OF THE CHINESE NURSE 135

- The old time hospital , to which we have attempted to do justice in a previous chapter, was ’ a sorry institution from a nurse s standpoint . It ﬂagrantly broke every law o f hygiene which it did not ignore . Nor could this well be avoided . The wards were not clean and tidy because the patient ’ s friends were coming in and out all the o f time , bringing with them whatever sort para

l fo r ph erna ia the invalid expressed a desire . The beds were not made because the hospital did not possess any bedding , and how can one make a bed which only consists o f one enormous wadded ? quilt , wrapped around the patient The sick man ’ s body and clothes remained unwashed— at — any rate in the colder parts o f China because ff there was neither a warm bath to o er him, nor n clean garments to change into . The wi dows were kept tightly shut , as soon as the doctor had ﬁnished his round, because every patient was

f o f fo r terribly a raid a draught . As anyt hing S O

fo r modern as dietetics , asepsis , or measures the

o f - prevention insect borne disease, etc . , such ideas but rarely intruded into the Old- time

o f ward . There were , course, some notable cases in

o f which doctors , by dint remarkable organization v and eternal igilance, succeeded in keeping their hospitals both neat and clean but these were the exceptions to the general rule . Nor were these the only difﬁ culties that con f ronted the pioneer nurse in China . A still greater 136 CHINA AND MODERN MEDICINE

difﬁ culty arose from the fact that sh e had to create her own traditions as she went along— and to do so in a country where the care o f the sick

was regarded as menial work, and beneath the

o f o f attention any the educated classes . She had no great Florence Nightingale tradition in China to back her up and to win her a place in

the community on the contrary, the ﬁrst patients to whom she ministered regarded h er frankly as a rather pec uliar mixture o f an unqualiﬁed doctor

’ and a ward coolie . Moreover the patients friends looked askance at a system which found no place

fo r t e their attentions , and which relegated h whole care o f the unfortunate invalid to someone wh o was neither a menial nor a relative

The introduction o f trained nurses into China is not so clearly marked an historical event as the

o f coming the ﬁrst western physicians , but it would appear as if the honour o f being the ﬁrst graduate nurse to work in that country amongst

Chinese patients belongs to Miss Elizabeth M .

McK ec h ni e McK ech nie (now Mrs Thomson) . Miss went to Shanghai in 1 8 8 4 in connection with the

’ o f Women s Union Missionary Society America, and was attached fo r many years to the Margaret Williamson Hospital— an institution that will always be associated with the remarkable operative

work o f Dr Elizabeth Reifsnyder . Other nurses

138 CHINA AND MODERN MEDICINE

f always having their riends by their side . There was an economic argument also which helped to

fo r bring about this change , previously the patient had been under the necessity o f providing food

fo r f f both himsel and his riend , whereas he soon found that under the new system he was just as well looked after without this double burden on his shoulders f ’ The great trouble, rom the nurse s point o f

V iew, was that in those early days she could only secure the services o f ward attendants drawn

- from a poorly educated or illiterate class . The dignity o f service fo r the S ick and needy members o f the community had not at that time penetrated

o f deeply into the consciousness the Chinese, and students had no incentive to take up as a pro fessio n a form o f work which they considered quite derogatory to their rank . A large propor tion o f these early hospital orderlies were recruited

o f from the poorer Christians , and many them did f f most aith ul work, according to their ability . But their lack o f education made it impossible fo r them to grasp the scientiﬁc basis o f modern nursing ; and in their anxiety to please the t f patients , and to keep every hing peace ul in the

Of f wards , it is not surprising that they ten ailed to enforce medical instructions which seemed absurd and unnecessary both to them and to the ’ th e o patients . Why shouldn t sick man get out f a d if f bed n walk about the ward , he elt well ADVENT OF THE CHINESE NURSE 139 enough to do so ? And why shouldn ’ t he be allowed to take o ff the bandage and scratch his operation wound , when it was itching to distrae tion ? And how ever was that poor typhoid patient to get well and strong if the nurse would

o f not even give her a bowl rice to eat , and she half crazy with hunger ? It was amidst c o nun drums o f this sort that the poor ward attendant had to pass his perplexed days , and little wonder

f o f if he often ollowed the line least resistance .

o f Needless to say, this state things did not f f f satis y the nurse resh rom a modern hospital . She quickly came to see— as missionary doctors — had seen in another sphere that one o f the greatest responsibilities that was to devolve upon her must be along the lines o f training up an f nl educated Chinese nursing pro ession . O y so ’ could China s immeasurable need be met ; and if o f ul , in the training such nurses , she co d so inﬂuence those young lives as to w in their full allegianc e to the service o f the Kingdom and permeate the new nursing profession with the

o f highest ideals Christian service , she might well feel that this was the greatest contribution which she could possibly make to the country o f her adoption .

A start was made in this direction , in some o f ’ f the Women s Hospitals , even be ore the arrival o f trained nurses in China , notably by Dr Coombs in

Peking , and by Dr Mary Fulton and Dr Mary 140 CHINA AND MODERN MEDICINE

Niles in Canton . But nothing was attempted on any organized scale until the nurses themselves

e wer in a position to take it up . Commencing

o with small groups , or possibly (as in the case f

Mrs Stevens , the ﬁrst L . M . S . nurse in Hongkong)

o f with only a single schoolgirl , the training the ﬁrst Chinese nurses was o f a more personal and

practical nature than anything else . But gradu ally the work began to spread and with the new ideals o f social service which began to lay hold o f

o f few the imagination young China a years ago,

and, above all , with the new inspiration to work fo r Christ and fo r humanity which was everywhere

taught in the mission schools , the opportunity o f securing educated classes o f probationers at last a became a re l possibility .

NO one who has engaged in hospital work in China under both old and new conditions can ever forget those exciting days when the introduction o f a regular nursing system into the wards was

ﬁrst attempted . Let me tell some personal exp eri enc es in the province o f Shantung in illustration

o f this point . Our ﬁrst hospital in connection with the medical school in the city o f Tsinan was run on very much the same primitive lines as those already described

o f at the beginning this chapter, and even when the ﬁrst nurse was appointed t o the hospital by

142 CHINA AND MODERN MEDICINE that they fully appreciated the warmth and

nl f o f Al clea iness and com ort the wards . though the capacity o f the hospital had been greatly f increased, it was not long be ore every bed was ﬁl f led, and since then the only serious di ﬁculty has been the utter inadequacy o f the ac co mmo dation fo r the many needy patients who seek admission . The other problem which faced us was an even

o f more serious one . What was the use ﬁtting up a hospital on modern lines unless our English nurse could be given opportunity to train a staff to carry out her ideas throughout the whole in stit utio n If the hospital was to serve its purpose

ff f ff o f e ectively, a ull sta trained nurses was at

- least as essential as a well equipped building . But how was that staff to be produced It was just as we were facing this situation that one Of our Chinese colleagues suggested that the time had come when a challenge ought to be thrown out to Christian students in the best schools in China to come forward and study

f - nursing as a li e work . He stated that there were already signs o f a new attitude in the country (particularly in Christian circles) towards service o f this kind, and urged that a notice be sent round to the mission schools , mentioning the conditions under which nursing is undertaken in the best

fo r hospitals in the West , and appealing volunteers .

This suggestion was adopted, and an appeal ADVENT OF THE CHINESE NURSE 143 was sent out fo r twelve probationer nurses to — form the ﬁrst class in the new hospital all o f them to come on approximately the same con ditio ns as to age , educational standard , remunera

o f tion , and length service as at home . To our Surprise and delight more than forty applica

o f tions were received, almost all them from Old High school students in different parts o f

o f o f the province , and all them members the

Christian Church . In the fear lest some o f these candidates did not understand what nursing really involved , and possibly regarded it as a short cut to becoming

o f doctors , twelve the number were picked out ’ and given a month s hard probation in the wards , at the same time being informed that they would be required to promise , in their contract , that they would never call themselves physicians , nor act as such . It was anything but an easy month fo r them . It involved innumerable duties which l they wou d naturally regard as unpleasant, or even repellent ; it included the admitting and bathing

o f o f new patients , some whom were distinctly reminiscent Of that famous Afghan beggar who was soaked and scraped until the bath - attendant suddenly came down upon an old suit o f clothes ; and it meant strenuous work, by night and day , unrelieved by lectures or classes, such as the

o f Chinese student takes delight in . But none o f these things deterred them . Only one the 144 CHINA AND MODERN MEDICINE

twelve dropped out at the conclusion o f the l month, and the place was immediately ﬁ led . Thus was founded the Nurses ’ Training School

o f . the University Hospital , Tsinan From that time onward there has never been a lack o f applicants fo r the class o f new probationers which f is admitted yearly, and over orty Chinese nurses are now under instruction there . What took place in Tsinan has taken place at the same time (or even before that time) in other

Of centres also . The social conscience the Chinese is being increasingly stirred, and every year sees new training schools fo r nurses established in connection with hospitals in different parts o f the country . The lot o f the new probationer was by no means an easy one . The home inﬂuence was too Often against her and she had to proceed in the face o f f severe opposition rom her people , who knew nothing o f nursing and naturally looked down upon a calling which appeared to them so menial . In the wards her position was even more subject to misunderstanding The patients could not imagine who she was , nor why she was engaged in such work ; to their minds her position was

Of l that a ward coolie , and the more devoted y she served them the more they were inclined to treat her with contumely . How was she to establish her professional dignity or to maintain any discipline in the ward

146 CHINA AND MODERN MEDICINE

dressings not thoroughly sterilized , and a number o f other things even more serious than that . The need fo r doing things quickly and punctually has also been difﬁcult fo r Chinese probationers to appreciate . The common attitude is well char act eriz ed in the following Limerick from the NursingMirror

T ere o nce was a bad i t e ro h l t l p , Who se mo vements were t erribly S lo w en as e co ul she h urr Wh k d, d y, ’ She re ie at s the ﬂurr pl d, Wh y ’ in n I ve o ur ears to train o u o w . f y , y k f l Night work has all along been a di ﬁcu ty, and this is not to be wondered at in a country where night duty is so little known . It was every

! bit as hard fo r some o f those poor young Chinese nurses to keep awake at night as it was fo r them to sleep properly by day, and most hospitals have f a sad record o dismissals on this account .

And yet , when all is said , it is astonishing what progress has been made in so short a time . The response o f the Chinese nurses to good training has been remarkable , and the true nursing spirit is being more and more evinced every year . The graduates o f the Training Schools are rapidly winning a place fo r themselves among all

o f sections the community . There is an increasing demand fo r their services both in the homes o f

- - well to do patients and in hospital work, and all who have experienced their gentleness and skill are learning to appreciate their worth . ADVENT OF THE CHINESE NURSE 147

The Chinese nurse o f the future will certainly be able to hold her own with nurses o f any other nation , and there is every reason to believe that she will be able to offer her own unique c o nt ribu tion to the traditions o f the world - wide nursing f pro ession . III

As the number o f nurses increased in China it was felt that the example o f the doctors in forming a Medical Association was one that was 1 909 ’ worth copying , and in the Nurses Associa 1 o f tion o f China came into being . The object

f . the Association was two old First , it sought to establish the status o f the nurse in China by enrolling under one organization all those

f l o f who had received a u l course training ,

f . whether oreign or Chinese Secondly, it sought to protect the standards o f the new nursing f f pro ession which was being ormed in the country, by standardizing the curricula and examinations and the minimum requirements o f all training schools that desired to register themselves under its auspices and to secure its diplomas . The success o f the Association h as been remarkable . Commencing with a small group in 1 9 09 1 920 , by it was possible to announce that one hundred and eighty - three foreign and forty eight Chinese graduate nurses had already joined,

ﬁft - that y two training schools had been registered , 1 Vide Appendix VI 148 CHINA AND MODERN MEDICINE and that one hundred and ﬁfty Chinese nurses had successfully passed the examinations and

o f received the diploma the Association . Nor is

fo r ul this all , the Association has held reg ar con ferences , at ﬁrst annually and now biennially, which have attracted increasing attention through ’ out the country, and have brought the nurse s work before the notice o f all sections o f the

f o f community . At the Con erence the Association 1 9 1 5 held in Peking in , a special address was presented to His Excellency, President Yuan

- o f f f r Shih kai, which the ollowing is a brie ext act

’ The Nurses Asso ciation o f China is at present co mposed main o f ra uate nurses ro m Euro e and America who ly g d f p , , in o s it a s in the arious ro inces o f C ina are en a e h p l v p v h , gg d in the rainin o f nurses a mi wi es Year ear the t g nd d v . by y num er o f ra uate C inese nurses wi increase and t e b g d h ll , h y will gradually take up the leadership o f the Asso ciatio n in a The o rei n mem ers o f th e Asso ciatio n are but e in Chin . f g b h lp g t o lay the fo undatio ns upo n which may be built the great nursin ro e sion o f C ina the mem ers o f w ic s al c o m gp f s h , b h h h l e to be as much admired and respected by pu blic sentiment as e r ssio n i a are the members o f th p o fe n o ther l nds .

’ In replying to this address , Admiral Ts ai , who specially attended a session o f the Conference as the representative o f the President o f the f ’ f Republic , re erred to the Nurses Con erence as

- an epoch making event in Peking, adding

Yo u medical men and wo men have bro ken do wn the bars to o sea e o mes and ins ire o ur men and wo men to o ur l d h , p d g forth and study likewise fo r yo ur pro fessions at ho me and a The o cto rs s a e the o icies fo r the curin a d bro ad . d h p p l g n re en io n o f isease but it is th e nurses wh o ermanen p v t d , p tly

150 CHINA AND MODERN MEDICINE

Of f nursing ethics throughout the pro ession, and to encourage Chinese nurses to regard their work as a true act o f service to God and to their countrymen . Another very important duty undertaken by the Association has been the preparation in Chinese o f nursing handbooks and also a quarterly

- - Nursing Journal . Several well known text books , ’ ’ Anatom and Ph sio lo such as Bundy s y y gy, Robb s ’ S stem o Nursin Midwi er y f g, Russell Andrews f y, ’ cIs aac s B acterio lo . M gy, etc , have already been

o f translated , and others are in course preparation .

ul Chinese ideas on etiquette , partic arly as regards the kind o f work which it is considered

fo r proper young women to engage in, have so far made it necessary fo r male nurses to be employed ’ almost exclusively in men s hospitals , and in the

o f male wards a general hospital . How long this

o f necessity will continue it is , course , impossible

Of to predict , but there are already signs a changing

sentiment in the more progressive cities . The fact that women nurses are used ext ensively in

Japanese hospitals , and that the China Medical Board has decided to use only women nurses (and male orderlies) throughout their new hospital in

Peking , is bound to exercise a considerable in

e O ﬂuenc upon public pinion in China, and it is quite probable that the day will soon come when ADVENT OF THE CHINESE NURSE 151 it will be possible to employ female nurses in any o f the hospitals in the larger cities . Meanwhile it is encouraging to notice that well educated male students are willing to take up the — study o f nursing in fact some hospital matrons in China are inclined to think that they take it up even more seriously than the women nurses , f — regarding it more deﬁnitely as a li e work . A number o f the hospitals in China are now training ’ such men , who register under the Nurses Associa tion on exactly the same terms as the women, follow the same curriculum (with the substitution o f Genito - Urinary Diseases fo r Obstetrics and

Gynecology) , and take the same examinations . In many general hospitals the male and female nurses take a large number o f their classes to

o f o f gether . It is significant the growth public opinion in China within recent years that such a thing is possible . Male students who have concluded their course o f training find no difficulty whatever in securing positions in which they can use the knowledge and experience that they have gained , either in other hospitals or as assistants to medical practitioners . Several such men went over to France in the recent war in connection with the

Chinese Labour Corps . Many o f the mission hospitals which previously trained student - assistants are ﬁnding it much f more satis actory to train male nurses instead . 152 CHINA AND MODERN MEDICINE

They can easily be taught to do all the routine work o f the hospital ; they follow the regular ’ course o f study prescribed by the Nurses Associa tion and when they have completed their course ’ they receive the recognized Nurses Diploma , so that the hospital which trained them is free from any charge o f deliberately turning loose on the public a number o f unqualiﬁed medical practitioners . An extremely important development which has taken place within recent years in several mission

o f w hospitals has been the training mid ives . One o f the ﬁrst hospitals to undertake this special Al work was the ice Memorial Hospital , Hongkong . It is a fact o f S pecial interest that it was a Chinese l 1 8 87 gentleman who bui t that hospital in , in

o f f memory his wi e , and other Chinese who sub sequently added to it the Maternity Hospital . Since then similar work has been started in other — centres notably at Hangchow, in connection ’ with Dr Duncan Main s extensive operations , and

o f at Kiukiang , under the leadership Dr Mary

Stone .

l - Chi d birth in China , as has already been re

nl o f marked , is commo y attended by an intensity suffering and a heavy mortality which words cannot describe , and which are unparalleled tod ay

d o in western countries . This is due to the epl r able ignorance and dangerous methods o f the f f untrained Chinese midwi e . A wonder ul ﬁeld

CHAPTER VII

RE S E ARCH AND PUB LI C HE ALTH

To wrest fro m nature th e secrets which have perplexed i o so ers in all a es t o trac t o eir so urces the causes o f ph l ph g , k th isease to co rre ate th e as s ores o f no w e e t at t e ma d , l v t t k l dg , h h y y be quickly available for the preventio n and cure o f disease t ese are o ur am itio ns — SIR ILLIAM OSLEE The Vocation o h b W , f Medicine and Nur n 1 1 si g, 9 9 .

WHE REVE R western medicine S pread in China

pioneered, as we have seen , by the missionary doctor- the possibility o f advancing medical science and beneﬁting human sufferers by patient research and careful investigation was always f be ore the minds o f its most progressive leaders . Although the medical missionary does not go abroad with the primary purpose o f scientiﬁc

o f wi i discovery, his sphere service includes th n its orbit everything that will help to throw new

o f light upon the incidence and causation disease, and will mitigate or prevent the sufferings o f the

people . Thus it is that the prosecution o f medical research and the promulgation o f public health measures are matters o f vital concern to the true

' success Of the medical missionary enterprise .

That remarkable trio , Colledge , Parker, and f f f Bridgman, were ully alive to this act rom the

f o f outset , and in the ﬁrst o ﬁcial pronouncement 1 54 RESEARCH AND PUBLIC HEALTH 155 the Objects o f the Medical Missionary Society in 1 83 8 f China , issued in , they re erred to it in the following terms

Co untries are no t mo re characterized by the fo rm and nature o f the so i and its ro uctio ns t an e are th e re a ence l p d , h th y by p v l o f cert ain maladies and a partial o r co mplete exemptio n fro m The co ntem atio n f as i flu o thers . pl o dise e as n ence d by the o sitio n and ei t o f a co untr its in an o r maritime o catio p h gh y, l d l n, and the enera a i s o f th e eo e con uc s the s u ent to a g l h b t p pl , d t t d mo st en a in ran e o f me ica ilo so w i e it isc o ses g g g g d l ph phy, h l d l many impo rtant lessons t o assist him in the way o f benefiting e o w creatures Th a anta es i a e his f ll . e dv g der v bl fro m such a co ntem la io n a e een ackno w e e at all erio s and in p t h v b l dg d p d , rs To secure ese a an a es it is re uir a all quart e . th dv t g q ed th t a bo o k sho uld be kept in all th e institutions co nnecte d with this S o ciet in o w ic an entr wi be ma e o f allim o rtant cases y, t h h y ll d p , wi a no tice no t o n o f th e isease and th e reatment ursue th , ly d t p d, but a so o f the ro ince a i s and o t er circumst ances l p v , h b t , h u h is r o f ac bearing pon t e h to y e h individual . A k no wledge o f th e language will o pen ano ther doo r o f en uir name in re a ion t o the su s ances use in e q y, ly l t b t d Chin se armac and to t eir ecu iar mo es o f re arati As h ph y h p l d p p on . t e recipro catio ns o f health and sic kness are vario us in different co un ries so Pro i ence h as is a e a co rres o n in ar t , v d d pl y d p d gv iety ri u io n o f reme ies T is co rres n in the dist b t d . h po dence between the prevailin gdiso rders o f any co untry and the remedies which th e an o f nature h as ro i e is o ten er s ri in and wil h d p v d d f v y t k g, l s th e su ect is es i a e e ma beco me mo re so a bj inv t g t d . W y there fo re lo o k fo r a great many valuable additio ns t o o ur dispensa to ries w i e an e en e ac uaintance wit disease un er new , h l xt d d q h d mo dificatio ns will help t o enlarge and complete o ur system o f

no so lo gy . Long before the China Medical Missionary 1 8 8 6 Association came into existence in , men were beginning to contribute original papers to the

S pages o f the scientiﬁc journals . A early as 1 8 42 William Lockhart published a Treatise 156 CHINA AND MODERN MEDICINE on Chinese Midwifery in the Dublin J ournal of

Medical S cience l , whi st ten years later Benjamin Hobson read before the China Branch o f the Royal Asiatic Society an important paper on ” Leprosy in China and the East .

There were many diﬁiculties attending the pursuance o f scientiﬁc research in China in those

r f ea ly days , chie amongst which was the super stitio us fear which the Chinese cherished towards f any inter erence with the cadaver, owing to their traditional attitude regarding the spirits Of the

S o f f f departed . In pite that act , Parker per ormed his ﬁrst post - mortem examination as long ago as 1 8 49 , whilst Dr James Henderson, in his report fo r 1 8 6 2 f o f , not only re erred to a number similar autopsies in the London Mission Hospital ,

Shanghai , during the preceding year, but even stated that he had been able to give to Chinese practitioners in that city a series o f demonstrations o f surgical Operations performed upon the dead body . A second disability arose from the conditions under which medical work had to be carried on at

o f ff ﬁrst , owing both to lack adequate sta and

fo r equipment , and also to the need avoiding anything that might offend the susceptibilities o f the people . It may be conﬁdently stated that the largest sacriﬁce which the medical missionary

158 CHINA AND MODERN MEDICINE superintendence o f building operations in the

o f i hospital and elsewhere, to say nothing nnumer able clerical duties and committees , put in a claim fo r e o f the r mnant his time and strength . How

f o f then , in ace such endless duties , was he ever to ﬁnd the necessary leisure and energy fo r scientiﬁc pursuits It says much fo r the professional keenness Of

f o f the medical orce in China that , in spite all fﬁ l these many di cu ties , there have always been a number o f physicians who have found means o f

o f maintaining the scientiﬁc side their work, and the pages o f the China MedicalJ ournalduring the

- o f last thirty three years its existence , as well as occasional articles in the J ournal of Trop ical

Medicine and other medical periodicals , bear eloquent testimony to the valuable contributions which have been made in the past by such men 1 and women . Recent years have witnessed a great advance

f o f along these lines . The biennial con erences the China Medical Missionary Association , which at one time were largely devoted to the discussion

o f o f questions general medical mission policy, are becoming increasingly valuable from the f 2 scientiﬁc aspect also . At the last con erence over one hundred original theses were sent in by members , with the result that simultaneous meetings o f a technical character were held

1 2 1 is in A endix 1 a e 209. Fe ru ar 920 . Vide l t pp , p g b y RESEARCH AND PUBLIC HEALTH 159

F e ve ry afternoon throughout the conference . our f separate sections were ormed , representing di Anthropology, Me cine, Surgery, and Special

Diseases . In each section important papers f were read and help ul discussions took place . At the same conference an Anatomical and

fo r Anthropological Society was inaugurated, the purpose o f pursuing special investigation in that department .

i o f Prior to that date, at a sim lar gathering the Association , a special Research Committee had been appointed , with a view to stimulating scientiﬁc investigation and collecting reliable data . This Committee has issued a number o f valuable f reports rom time to time, and has already made some important contributions to our knowledge o f medical conditions in China , particularly in

d o f f the epartment helminthology . Two ormer o f ff members that Committee , Dr W . H . Je erys

o f . . o f Shanghai and Dr J L Maxwell (Jr . ) Formosa, prepared an excellent text - book on the diseases o f

ful o f China . It is l most interesting information concerning the distribution o f disease in the Far 1 9 1 0 East , and was published in by a Philadelphia 1 publisher . II

The main investigation that has so far been carried out in China has followed three distinct — — paths historical , physiological , and clinical and 1 Diseases o China b J eﬁ er s and Ma well f , y y x . 160 CHINA AND MODERN MEDICINE it may be o f interest to give some indication as to the lines upon which it has proceeded, or is proceeding tod ay .

HistoricalInvesti ation — 1 . g From earliest days the exponents o f western medicine in China have recognized that amidst much that is un scientiﬁc and unreliable in Chinese medical lore there must assuredly be a great deal o f correct

ful O l and use bservation , particu arly as regards

o f the course various diseases , and the action o f such medicaments as are in general use f amongst Chinese practitioners . Un ortunately, as was pointed out in the opening chapter, the absence o f a professional spirit amongst

o f o f o the doctors , or any conception c i operation w th regard to medical knowledge , has

Of prevented the publication such discoveries , so that the task o f the historical investigator is a

fﬁ ul very di c t one . But there is every reason to f o f f believe that a und interesting in ormation , and possibly also the knowledge o f new remedies fo r

o f some complaints , awaits the patient search the scientiﬁc student who has time and skill fo r the

o f o f a unravelling the secrets Chinese ther peusis . Of those who have made the chief contributions to our knowledge o f Chinese medicine the most noteworthy are the American missionary, Dr J . C . 1 o f Thomson Macao , whose interesting writings

1 Dr ms n f Not t o be c o n used wi h J . 0 . T o o o Edin ur wh o f t h b gh, n n wo rked fo r many years in Ho gko g.

RESEARCH AND PUBLIC HEALTH 161

have ﬁlled many pages o f the China Medical

J ournal o f ; Dr James Henderson Shanghai , who crowded more useful activities into his brief ﬁve years o f life in China than anyone before or since

and Dr John Dudgeon , the ﬁrst Englishman to hold the position o f Professor o f Medicine in a 1 Chinese College . Dr Henderson ’ s paper on The Medicine and ” o f Medical Practice the Chinese , which was read before the North China Branch o f the Royal

1 8 6 4 fo r Asiatic Society in , and which he was awarded the Fellowship Of the Royal College o f

o f Surgeons , Edinburgh , is one the most lucid 2 contributions ever made to this subject . Com menc ingwith the beginnings o f medical knowledge

o f in all parts the world , Henderson showed convincingly at what point China had missed

o f desc ri the stream progress , and gave a graphic p tion o f anatomy and physiology as interpreted in Chinese medical lit erat ure f His article also included an extensive list o f Chinese medical m wi works , co mencing th the earliest treatises , ascribed to the teachings o f Shen -Nung and

- f Hwang Ti many centuries be ore Christ , and concluding with the famous Yu -t swan - e -tsung ” kin - kien , published in ninety volumes in the 1 7 40 year .

1 This was the Tun Wen Colle e Pe in to w ic a scien g g , k g, h h tiﬁc de ar men was added in 1865 and f hic h v o w Re W. . A. P. Mar in p t t , t , D ec am Pres i n LL. . e de in 1869. , b t 1 Pro ceedi n s North China Branch Ro al Asiatic S ociet 18 g , , y y, 64 . 162 CHINA AND MODERN MEDICINE

Most o f t h e books which Henderson mentions consist o f dissertations by ancient physicians on every imaginable complaint and symptom ;

o f i elaborate theories , mostly a ph losophical

n nature, as to their causation ; and in umerable f fo r . prescriptions their relie In addition to these, however, is the great Chinese Materia Medica ’ - - - l (Pen ts ao kang muh) , which was compi ed by Li Shi -chen in the middle o f the sixteenth century

o f by command the Emperor, and which contains some seventy volumes and eleven hundred illustra

. 3 00 tions This interesting work , although over

Old f o f years , re ers to a large number drugs well

o f known to practitioners western medicine (such, fo r example , as sulphur, magnesia, calomel ,

aconite , and specially mentions one drug (probably hyoscyamus) as being o f value as an O 1 analgesic fo r surgical perations . The book also includes a vast number o f substances which practitioners in the West have never learned to

regard as Of medical value . It classiﬁes all drugs into the fo llo wmg varieties

’ 1 a-T O th e a er o f C inese sur er wh o li ed in th e hir W , f th h g y, v t d D is said to h a e er o rmed a lar e num er o f ma A. . o c entury , v p f g b j r ra ions includin la aro o mies u o n a ien s wh o had een o pe t , g p t , p p t t b

wi h Canna is ndica. He is als o c redi previo usly drugged t b I ted with f a s ec ial o wder whi c h h e a lied t o his O era io n wo unds the use o p p , pp p t n h em su uratm ! Un o r una el his c o ura eous to preve t t pp g f t t y, t g a e t o an un imel end fo r o n advis in a mili ar adventurer c m t y , g t y er wh o had c o nsul ed him a o u se ere h eadac h es to su mi o ﬂic , t b t v , b t i O era io n the la er ro m l had him exec u ed t o a trephin ng p t , tt p pt y t fo r making a suggestio n tantamount to an attempt o n his life !

164 CHINA AND MODERN MEDICINE

n bee translated into English , although Mr Daniel Hanbury and others have published very valuable 1 notes upon it . The subject o f Chinese pharma c o lo gy thus remains practically virgin soil fo r the

o f f investigator , and a vast number drugs re erred to in Chinese medical books have never yet been identified or classified . Possibly some o f the enterprising graduates o f the newer medical schools in China will enter this fascinating field o f research , and make discoveries which will lay the whole world under a debt o f Obligation to them . i ala d Ph si l icalI n i i A atom c n o o vest at . 2 . n y g g on In addition to the efforts o f the newly formed in An atomical and Anthropological Society China , which has already published an interesting series o f papers as a supplement to the China

l J r al o f f Medica ou n , one the chie tasks to which the Research Committee o f the China Medical Missionary Association has addressed itself has

o f been th e collecting accurate data, as to the

o f physical conditions the average Chinese , in comparison with Europeans and Americans o f equal age .

This investigation , carried out especially by Dr Duncan Whyt e o f Swatow and Dr Arthur

Shoemaker o f Peking , has already established deﬁnite standards as to height, weight , chest

1 uticalJ c arnaland Trans actions ul Au us 1860 Vide Pharmace , J y, g t m er Decem er 1 861 Fe ul Oc o er No e ruar 1862. May, J y, t b , v b , b b y RESEARCH AND PUBLIC HEALTH 165

l i urinana s s . measurement, y , etc , which are essential

o f ff o f to a correct appreciation the e ects disease, or to any scientiﬁc determination o f dosology 1 fo r Chinese patients . Similar statistics are also being gathered with regard to various anatomical measurements , etc . In addition to these investigations a most import ant branch o f research work has recently been commenced in the study o f the food - value

r o f o f the chief a ticles Chinese diet . Physiological text - books dealing with the subject o f Dietetics are necessarily founded upon a study o f those substances which go to make up the ordinary

fo r o western diet , and , that reason, are f but little value in a country where the staple food ff s f Of di er widely rom western standards . what advantage is it to the physician in China to be told the number o f calories in half a pound o f ’ beef- steak when his patient s chief meal consists o f o f f two large bowls rice , a little resh vegetable, and some bean -curd ? It is plain that this whole subject o f Dietetics needs to be studied

f if s a resh in every country, cientiﬁc deductions

f fo r are to be drawn rom it use in disease . One o f the ﬁrst papers published on this topic

1 Amongst these s tandards are th e follo wing

A era e ei —Ad l mal No r a u e in Chin 5 It . i v g h ght t th , 7 n. male in o h S u China 5 . 4 in. t , ft mal i e e n Sou h C ina 4 ft . 1 1 in. f t h , } A era e wei t of adul 1 16 lbs v g gh t, . C es measuremen of adul 28 i to 1 h t t t, n. 3 in. 166 CHINA AND MODERN MEDICINE

1 9 1 5 1 was written in by Dr J . B . Neal , and con sisted o f a series o f studies carried out by himself and his students in the physiological laboratory f o f the Tsinan Medical School . A urther in v esti atio n g , dealing speciﬁcally with the analysis

f - o f - and ood value Chinese bean curd , was made in the same laboratory by Dr P . C . Kiang and f 1 9 1 9 a Pro essor Adolph during , whilst a simil r research was conducted at the Peking Union Medical College by Professor Wilson and Miss

u o f Embrey . The res lts these investigations were presented at the Medical Conference in

A start has thus been made, and the next few years will no doubt add fresh c o nt ribu

o f tions to the knowledge the subject , which will make it possible to deal scientiﬁcally with the vast range o f digestive disorders which are met with amongst the Chinese .

Cl al a d Path lo ical I es i a — 3 . inic n o g nv t g tion But the chief investigations which have so far been carried out have been in the clinical ﬁeld

o f and, more recently , in the ﬁelds pathology and bacteriology, and in this respect China naturally Offers an unrivalled opportunity fo r research . Numerous conditions are met with in that country which are seldom found in the

West , and those complaints which are common to alllands are seen in an aggravated and unusual

1 C ina M di alJ o urnal 1 16 h e c 9 9 . , , p. 1 V ide C M i alJ al 5 hin d c o urn 1 . 6 a e , 920, pp 2 8, 03 .

168 CHINA AND MODERN MEDICINE which formed the ﬁrst subject o f investigation conducted by the Research Committee o f the

China Medical Missionary Association . A large number o f varieties o f metazoal parasites are

-t s e met with in China , particularly in the Yang valley, and their distribution , symptomatology, f etc . , have been care ully worked out in recent years by medical missionaries in that area . In many cases this has meant considerable original

i rec o ni research, part cularly in regard to the g tion o f metazoa hitherto barely known in China

o f bu kii e. . s ( g schistos mum japonicum, asciolopsis , and the result o f this study has been o f the greatest service in throwing light upon conditions i not previously understood . These helm nths are now shown to be responsible fo r a wide range o f f abdominal and blood diseases and obscure evers , and in all the more up -to -date hospitals in China a routine fae cal examination is conducted upon every patient admitted to the wards .

- - Malaria , kala azar, beri beri , elephantiasis,

o f leprosy, and a host other tropical diseases are l also very common , particu arly in central and southern China, whilst the dysenteries , the

- typhoid and para typhoid groups , cholera and

o f are other diseases the intestinal tract , met

o with in almost every part f the country . In addition to the great researche s o f Sir

Patrick Manson, much valuable work has already been done by medical missionaries and others in RESEARCH AND PUBLIC HEALTH 169 investigating and describing some o f these con 0 it i s . . o f d o n . It is to the late Dr T Logan

. . o f Changteh , Hunan , and to Dr F W Goddard

Sh ao shin o f g, that we owe much our present knowledge o f the distribution o f intestinal para

in . . o f sites China It was Dr S Cochran , Hwai

Yuan , who ﬁrst discovered that the Leishman Donovan bodies o f kala - azar were present in the lymph - nodes o f patients affected with that

. . o f disease . It was Dr E C Peake Tientsin who described the new blood parasite which appeared to be responsible fo r the condition o f anaemia and dropsy from which many inhabitants o f o f l ff 9 1 the ﬂooded districts Chih i su ered in 1 8 . It was Dr Duncan Whyte o f Swatow who drew attention to the prevalence o f thrombo -angiitis obliterans amongst Chinese patients . And many others might similarly be named . Interesting statistics have also been published in many o f the hospital reports as to the incidence o f disease in

o f different parts the country . In this connection reference must specially be made to the valuable information regarding vesical calculus in China which has been collected at the Canton Hospital , where over three thousand operations fo r that f complaint have now been per ormed .

But when all has been said , it must be con fessed that up to the present time only the fringe o f clinical research in China has been touched . A large variety of fevers and other complaints FT 170 CHINA AND MODERN MEDICINE

o f u n exist , the etiology which is completely known , whilst innumerable other problems are awaiting investigation . With the better equip

articu ment which hospitals are now securing , p larl o f y in the matter laboratory apparatus , and with the larger staffs and the advent o f keen

o f Chinese graduates , this promising ﬁeld study

o f can be attacked with new hope success , and every ' year should see additional discovery to our general knowledge o f Chinese medical con ditio ns and their treatment .

III

Any attempt to deal with the problem o f disease in China which left untouched the roots from which that disease has sprung would be

f o f simply utile . What hope can there be ridding China o f those parasitic affections which have just been referred to if we fail to deal with her soil - polluted water- supply and vegetation How ’ “ i o f is China s White Per l , the scourge tuber c ulo sis f , to be combated , apart rom a resolute campaign on behalf Of good ventilation and f ? sunshine and resh air How, indeed , is China ever to be saved from the devastating epidemics which continually decimate large sections o f her population if her people are not instructed in f f f the undamental acts which govern in ection , the knowledge o f which has so effectively reduced mortality in the West

172 CHINA AND MODERN MEDICINE country carry less people to the square mile than 1— certain parts o f Europe this suggestion is at least open to question .

Again , such a proposal is economically unsound, as was well brought out by the report o f the China Medical Commission o f the Rockefeller If Foundation . a nation is healthy and f ” energetic and e ﬁcient , that Report argued , “ it will be able greatly to increase its productive ” f o f 2 power rom an economic point view . It is not a strong, healthy, educated China that the world has to dread it is an ignorant , unhealthy, impotent China that may well be a menace to

o f civilization . It is supreme importance to the world at large, as well as to China, that she should be healthy and strong, and able to make her own unique contribution towards the solution ’ Of the world s ills ; and that is impossible whilst

o f her progress is held up by the ravages disease . The action o f the League o f Nations at their ﬁrst Assembly in voting a large sum o f money with which to attack the problem o f typhus in central Europe was not dictated by mere bene

o lence . v It was sound economics , which recog niz ed that it was unsafe to the rest o f the world to allow so dangerous a plague - spot to be left

o f unmolested . And the same is true China .

1 s r Pet e en D W. o ed ro m s a m b . er and rom Chin Qu t f t t t y W , f a

- Bish W. Bas fo rd. An I n ter retati o n b o . p , y p J h 1 i C ina . 1 . Medicine n h , p RESEARCH AND PUBLIC HEALTH 178 Everyone has been so preoccupied with the horrors o f the Great War during these last years that but few have had time to con template the magnitude o f the disaster which was wrought throughout the world by the great

o f 1 9 1 8 -1 9 influenza pandemic , which actually destroyed more lives in the whole world than ” 1 did the European war in five years . And but few have appreciated the significance o f the fact that that appalling disaster, which produced widespread havoc in North America , where it l f f assumed a peculiarly viru ent and atal orm, had traversed China before spreading across the Pacific . In this connection every student o f bacteriology will remember the important scientific law which teaches us that the passage o f any infective organism through a host o f low

o f resistance increases the virulence the germ . In th ese days o f shortened communications it is l o f f hard y a matter unconcern , in ace o f the

o f - possibility such world wide epidemics , whether the health and resistance o f China is normal or

- sub normal . f But apart rom all such questions , any thought o f refusing to make China healthier and happier strikes at the root o f every conception o f Christian brotherhood . We must help her in her ﬁght fo r health if we are pretending to be Christian at

1 Re ort o the Minﬁrm; o Health up o n the Pandemic o In uenza p f f f ﬂ ,

14 . p . 174 CHINA AND MODERN MEDICINE

all and to do this successfully it is not enough to content ourselves with opening up hospitals fo r the reception o f those already diseased ; we must go deeper and try to assist her in the eradica tion o f those very conditions which help to spread 1 disease . For many years past the need o f preventive medicine in China has been a matter upon which f many medical missionaries have elt urgently, and wherever large epidemics have broken out — cholera , plague , etc . these men and women have usually been foremost in their efforts to organize

e o f preventiv measures . In the dread epidemic pneumonic plague which broke out in Manchuria

1 9 1 1 - 1 2 f o f in a orce medical missionaries, assisted

o f di by students the Peking Union Me cal College, lent their services to Dr Wu Lien- teh and those

- associated with him in the Anti Plague Bureau .

It was then , as most readers will remember, that Arthur Jackson and two o f the Peking students fell victims themselves to the terrible com f plaint , a act that will ever be immortalized in China by the wonderful speech o f the Viceroy ’ o f f Manchuria at Arthur Jackson s uneral , and which concluded with these moving words

O s irit o f Do cto r J ac son we ra o u to in terce e for th p k , p y y d e twent milio ns o f Manc uria and to ask the Lo r o f Hea en y l h , d v

1 ’ Th e po int at which China s po pulation p ro blem sh o uld ﬁrs t be a ro ac h ed is ha o f earl marri a e Th e re o rm o f marria e pp t t y g . f g customs in China wo uld bear alike u pon the health and number o f h er peo ple

176 CHINA AND MODERN MEDICINE

where it is attracting increasing attention . In — many o f the larger centres notably at Chuchow in connection with the work o f Dr E . I . Osgood

— f o f special committees , usually ormed both f Chinese and oreign members , have endeavoured to educate public opinion on the importance o f sanitation and hygiene , and have initiated various

ff r o f e o ts to improve the health the city . At another city, Tsinan , an extensive and well equipped Hygiene Section has been established in connection with the Museum and Institute which the Rev . J . S . Whitewright organized there 1 90 5 in , and which has already been visited

f f . by over our and a hal million people Charts , models , and diagrams illustrate to the visitor the chief causes fo r the spread o f disease in

W o f China , hilst comparative tables statistics demonstrate the enormous incidence o f infectious disease and the high mortality which exist in China as compared with those countries which have adopted preventive methods . Possibly the

- o f most eloquent object lesson all , however, is the Chinese melon - seller who sits at the gate o f ff the Institute , o ering hygienic melons from a ﬂy- screened stall to the people passing in and out 1 But there have been two events within the past few years which have probably done more than anyt hing else to focus the attention o f the

Chinese on this important question . The ﬁrst RESEARCH AND PUBLIC HEALTH 177 o f these was the holding o f an International Plague Conference in Moukden in connection with

- 2 the plague outbreak o f 1 9 1 1 1 . This important f gathering, to which experts in public health rom eleven different countries sent their representa t ives - , was presided over by Dr Wu Lien teh , and their recommendations were published in the leading papers .

The other event , and one which is having an increasing inﬂuence throughout the country, has been the setting aside , by the Lecture Department

o o f . fo r f the Dr W W . Peter the estab lish ment o f a special Health Division o f that

o f organization, and the subsequent action the China Medical Missionary Association in appointing a Council on Public Health to c o - operate with the National Medical Association and the in the development o f this special ﬁeld o f enter prise . The China Christian Educational Associa

ff rt tion and have since joined in this e o , and the Council has now become known as the

l . Counci on Public Health Education Dr Peter, with his able colleague , Dr S . M . Woo , are giving ff their whole time to this work, and their e orts have already met with striking success . A large

o f number attractive posters and pamphlets , illustrating simple laws o f hygiene and disease prevention , have been produced by the Council and circulated by the tens o f thousands through o u t China ; unique Public Health Exhibitions o f 178 CHINA AND MODERN MEDICINE a spectacular and impressive character have also been organized from time to time in the leading o f cities China .

o f Dr Peter, who is an apt student psychology as well as an adept in inventing popular de

fo r f vices impressing acts upon an audience , has shown remarkable ingenuity in the planning o f these exhibitions, and has succeeded in mak ing Public Health a live topic throughout the whole city in which the campaign is being

o f sa m . ndwich en made Long processions , as well as strings o f coolies transporting the thirty

- o f eight case loads models and charts , serve as

o f an excellent advertisement the exhibitions , which are invariably attended by every class o f f f the community, rom the highest o ﬁcials to the ” . f ul humblest schoolboy A local Health ac ty, recruited at each centre and consisting o f students f rom neighbouring colleges , explain the various exhibits , and all day long popular lectures are

r given to c owded audiences , illustrated by most ingenious mechanical models , as well as by stereopticon pictures and the cinema . By a skilful process o f question and answer Dr Peter gets his audience to suggest the very questions

which he wishes to impress upon them, as he discusses the relation o f national health to national strength and inﬂuence, or reveals the fact that the death - rate o f China is probably — not less than 40 per lOOO the highest in any

CHAPTER VIII

THE OUTLOOK TO -DAY

Methinks I see in my mind a no ble and puissant nation ro us in erse i e a stro n man a ter s ee and s a in her g h lf l k g f l p, h k g in inci e o c s met in s see h er as an ea e mewin her v bl l k ; h k I gl , g mi o ut and in in her un a e e es at th e u ghty y h, k dl g d zzl d y f ll

- mid day beam.

MILTO Areo itica. N , p ag

NE ARLY a hundred years have passed since Thomas Colledge opened his ﬁrst hospital in

China . The time has come when we may ask ourselves what has been the harvest o f these years . Has modern medicine inspired a nobler con c eptio n than the practice o f the old Chinese physician ? Has it replaced conjecture and superstition with assured diagnosis and scientiﬁc truth ? Is there promise o f a high professional standard and a new ideal o f service 7 Is there hope o f advance and success in ﬁghting the great ’ battle fo r China s true health

I Before we attempt to estimate the effect which h as been produced by the introduction o f western

‘ medicine into China, we must ﬁrst notice h o w 130 THE OUTLOOK TO -DAY 181

pitiably under -staffed the medical forces have

been and still are , and how insigniﬁcant is the total work which has so far been accomplished

u when calc lated in purely quantitative terms . if Let us examine the case critically, and see there is not justiﬁcation fo r this sweeping

assertion . At the present time the total number o f fully qualiﬁ ed western -trained physicians practising amongst the Chinese probably does not exceed — 1 1 500 men and women . Now let us suppose

that each physician can , on an average , give

adequate medical attendance to people .

fo r This is probably an exaggerated estimate, in

Great Britain , with one physician to every o f the population , and with all those additional safeguards to health which preventive f medicine , sanitation, and wel are movements have

u f far f built p , the pro ession is rom being over manned . But let us suppose that by energetic efforts our fully -qualiﬁ ed physicians in China can do full justice to the physical needs o f — f people each what , a ter all , does it amount to It merely means that adequate medical care is provided fo r people out o f a population

1 Th e numb er o f wes tern-train ed do cto rs in China is o ften quoted as but th at ﬁgu re wo uld include a large number of students wh o h a e recei ed rac ic al rainin in mission h os i als etc but v v p t t g p t , . , have never had th e Oppo rtuni ty o f takin g th e mo dern medical cours e and wh o s ould not ere ore be c oun ed amo n s th , h th f t gt e fully l r i io ers qua iﬁed p act t n . 182 CHINA AND MODERN MEDICINE

o f approximately In other words , there is no chance o f the quackery o f the un qualiﬁed being replaced by the competent medical treatment o f fully -trained physicians until the number o f qualiﬁed doctors in China is one

- hundred and twenty times as many as it is to day . A similar ﬁgure can be arrived at by a different

o f method estimating . Statistics which have been compiled in connection with the operation o f the National Insurance Act in Great Britain demonstrate that about sixty per cent o f insured persons require medical attendance each year, and that the average number o f medical visits (either at the doctor ’ s surgery or the patient ’ s home) works 1 If out at about six per annum . such ﬁgures were applied to China it would mean that about people would need to consult a physician each year, and that their total visits would amount to But the total number o f patients seen in all hospitals and dispensaries in China , or in the private consulting rooms o f western -trained Chin ese physicians , probably does not exceed per

o f annum , whilst the total number visits which they pay is less ‘ than This means

1 lied b th e Minis r o f Heal h th Fro m inf o rmation supp y t y t . If e l numb er o f medic alvis its annu allybe c alcu ated o n th e to talnumb er red and no t on the 60 er c en wh o re uire medical a end o f ins u , p t q tt

ear th e a era e wo r s o ut at 3 6 er annum. anc e in any y , v g k p 2 s o als the re urns o f mission h o s i als s h o w a li le Of th e e t t , t p t tt n s er annum a in sli l less an o ver patie t p , p y g ght y th s i s vi t .

184 CHINA AND MODERN MEDICINE appreciable impression upon the total amount o f ff sickness and su ering in China, there can be no question as to the far-reaching inﬂuence o f their work, particularly among the progressive classes , and in the large cities and treaty ports .

In the ﬁrst place , it is questionable whether there has been any other agency at work in China during this last century which has done so much to gain the conﬁdence and goodwill o f

and o f f the people , to dispel that miasma ear and suspicion which beclouded all intercourse f between East and West in ormer years . It is start ling to notice how great progress has been made in this direction . Only a few sho rt years ago every political or social upheaval

o f in China, every occasion discontent and

o f anxiety, was accompanied by an outburst anti

f f l 111 foreign eeling , o ten cu minating riots and bloodshed . Did the heavens appear as brass and refuse to send the needed rain upon the parched crops ? Then it was the foreigner whose presence was irritating the gods and producing the disaster . Did pestilence appear in the district and carry o ff hundreds o f children whose parents lived in daily deﬁance o f the laws o f hygiene It was the western barbarian who

w u had be itched them and who , nder the cloak o f religion and charity, was poisoning the wells

f fo r and hatching ne arious schemes their undoing .

Did bandits roam the countryside , and unpaid THE OUTLOOK TO - DAY 185 soldiers loot the helpless villagers There would never be peace so long as these strangers were permitted to live amongst them . And so on .

- But what a contrast to day, when political revolution is invariably accompanied by pro clamatio ns holding the life and property o f the foreigner inviolate ; when the ﬁrst act o f the

f o f o ﬁcials , at times disorder, is to despatch troops to reassure and protect their western guests ; when good feeling and gratitude and appreciation are the commonly expressed senti ments o f all classes towards the work o f the f ’ w oreign doctor . The hospitals own ork and inﬂuence have been the largest factor in bringing about the change . They have represented a new and tangible expression o f brotherhood and né ne ul sympathy which co d gainsay, even in

o f times misunderstanding and hostility . Thus

o f they have won their way, not by the amount ff su ering and sickness which they have relieved, but rather by the spirit which they have f mani ested . In the second place , the mission hospital has been one o f the most effective means o f present ing and spreading Christianity in China . This it has done , not merely by dispelling misappre hensio n and producing a favourable atmosphere fo r o f the unprejudiced reception the truth, but also by creating an ideal opportunity fo r

o f the systematic teaching the Christian message . 186 CHINA AND MODERN MEDICINE Many a patient who has entered a hospital ward with little or no interest beyond the immediate

o f - needs his pain racked body, has had his whole imagination ﬁred by the story o f the life o f Jesus Christ that has been told him there ; and many such have gone out o f the hospital pro f f o f essed ollowers Him, witnessing to His power in districts where formerly His name had never been heard .

Again, it may be conﬁdently claimed that

o f the practice modern medicine , in the hands o f men and women who have endeavoured to make their medical work a true expression o f f Christ and His teaching , has had a pro ound effect upon the attitude which the Chinese have themselves come to adopt towards the indigent

o f and needy . A new sense responsibility is

f - being mani ested in China to day, especially by the younger and better - educated Chin ese who have come under the inﬂuence o f Christian f teaching , and this expresses itsel in an increasing

ff i effort to assist the poor and the su er ng .

I well remember, on one occasion , being asked to address a large company o f students in North

fo r China on the need public health measures . I wanted to speak about community life and

a - f soci l service and such like , but I ound it most difﬁ cult to discover any adequate expression in the Chinese language with which to convey these

- s . ideas . That was less than ten year ago To day,

188 CHINA AND MODERN MEDICINE

Another hopeful sign o f the times is the way in which the Chinese people are extending ﬁnancial support towards the hospitals and medical schools which have been organized in their country. ua dl Ever since the day when How Q , the lan ord o f the building in which Parker had his ﬁrst f hospital , re used to accept any rent , the Chinese have repeatedly given proofs o f their apprecia

o f f o f o f tion such orms medical charity, and their willingness to share in the ﬁnancial support o f these institutions . Recent statistics have shown that over ﬁfty per cent o f the cost o f upkeep o f the mission hospitals in China to -day is borne by the Chinese themselves , and that no less than twenty- seven per cent o f the hospitals

f- f are now entirely sel supporting , apart rom the f f ff 1 salaries o the oreign sta . Such financial assistance is not confined to private subscriptions and fees : fo r in many in it f f stances is also derived rom o ficial sources .

' The most striking example o f such c o - operation is the agreement entered into by the ofﬁ cials o f the Hunan Government and the Yale Mission in China fo r the establishment o f the Hunan l Ya e Medical College and Hospital at Changsha . The Hunan Government has undertaken to provide no less than per annum towards th e s institution, in addition to large sums toward

1 An Enquiry into the S cientiﬁc Eﬂiciency of Misaion Hospitals in

China . 33 37 . , pp , THE OUTLOOK TO -DAY 189 the purchase o f land and the erection o f th e initial buildings ; and although constant revolution and military occupation have since impoverished the f province to a piti ul extent , a most determined ff f l e ort has been made to ulﬁ the compact . Similar generosity has been shown in other

f o cases . The o ﬁcials and gentry in the city f Anking have fo r some years past contributed the sum o f per annum towards the support o f the American (Protestant - Episcopal ) Hospital

few in that centre, whilst within the last months

o f the provincial government Shantung, at the

o f instance the Civil Governor, has passed a bill approving o f an annual appropriation o f from the provincial budget towards the support o f the University Hospital at Tsinan . But the most encouraging feature o f all has been the action which the Chinese have taken in many cities in establishing and supporting di o f hospitals and spensaries their own . The

Central and Isolation Hospitals at Peking, erected and maintained by the Chinese , and now under

o f the able superintendence Dr S . P . Chen

o f ’ (a graduate Cambridge , and St Thomas s

Hospital , London) , are excellent examples o f ﬁrst - class institutions which we may conﬁdently expect to see multiplied all over China . In other cities also , Government Hospitals are now

. o f beginning to spring up Many these , it is interesting to note , have both Eastern and 190 CHINA AND MODERN MEDICINE

“ s a s a We tern departments , p tient being llowed to choose whether they will be treated by Chinese medicine or in accordance with western methods , f in either case receiving medical treatment reely, or at very small cost . These new Chinese hospitals are affording an excellent opportunity fo r c o - operation on the

o f mi part medical ssionaries and nurses , and in some o f the larger cities local medical societies are now being organized fo r the purpose o f pro viding a common ground on which the staffs o f the Government and Mission Hospitals can meet fo r social intercourse and mutual consultation . At the same time applications are being received ’ by the Nurses Training Schools , which , as we have seen , are at present all connected with

fo r o f s medical missions , a supply trained nurse fo r the new Government Hospitals . It will thus be seen that while the quantitative side o f the work which has so far been aecom plish ed by the practitioners o f western medicine in China has been very insigniﬁcant , the qualita tive side o f the enterprise has been extraordinarily impressive and effectual . This at once brings us face to face with the signiﬁcant fact that it is not the amount o f work done by the medical missionary o f to - day which is the most important factor in his success ; it is the kind o f work he f is able to per orm which means everything . He cannot hope to do more than touch the barest

192 CHINA AND MODERN MEDICINE spent a large amount o f time consulting agricultural e experts in his nativ country, and attempting to secure from them a better specimen o f pea -nut fo r u introd ction into China . He had no means f to set up every small armer with nuts, but he could ensure that those which he introduced were the very ﬁn est that were grown in his own

- f land . And to day armers all over that extensive province are under a deep obligation fo r his

dl far- ff kin y thought and seeing e ort . Surely the same rule applies to the medical missionary enterprise . It is altogether beyond the powe r o f missionary societies to cure all the

o f ills China, and probably God never intended l that they shou d . In every country He is raising

o f wi s up people the land to be His tnes es , and to do the great work o f evangellz mg and up in lifting . But to us has been entrusted the estimable privilege o f setting some o f these new forces into operation or, to change the metaphor , o f sketching an outline which other and abler l ﬁ hands will ﬁl in . How in nitely important then that we sketch it aright, a worthy image o f Him whom we would represent to His children who at present do not know Him .

III

Let us now apply this principle and see where it leads us in the framing o f a wise and long

s sighted policy fo r the day ahead . THE OUTLOOK TO - DAY 193 Once we believe that the physical and spiritual

o f regeneration China will , in the last analysis ,

be brought about by the Chinese themselves , everything that we have the privilege o f doing will have to be scrutinized from the standpoint

f r o f its contribution towards that end . How a are we building fo r the future And how far is the medical missionary work o f to - day assist ing the Christian forces o f China in their immense task These are the questions that we need most o f all to ask ourselves . Christian Chinese are already showing a re markable capacity fo r leadership in every walk

o f f . li e In the political sphere, men like Mr C .

o f T . Wang, one the Chinese delegates to the

f r Peace Con erence , are making thei inﬂuence felt throughout the whole country . In the educational world, Mr P . W . Kuo , Principal ’ o f the Government Teachers Training College ,

Po - o f Nanking, and Mr Chang ling , Principal Nan

Kai School , are weaving the latest methods o f education and school organization into the fabric

f o f o f Chinese social li e . In the army that Eastern

Yu - Republic , General Feng hsiang, the great

Christian soldier, is showing an astonished world how clean a military camp can be . In industry,

o f Mr Fong Sec, head the Commercial Press ,

Nieh o f Mr C . C . , President the Chinese Chamber o f Commerce , and others like them, are applying the most modern and humanitarian methods to o 1941 CHINA AND MODERN MEDICINE

o f m the development large co mercial enterprises . In the and and in all sections o f the Chinese Church , outstanding men and women such as Mr David Yui , Rev . C . Y . Cheng ,

- Bishop Syng , Rev . Ding Li mei, and Miss Dora Yu are showing remarkable gifts o f Christian statecraft and spiritual leadership . And we who have had the privilege o f sharing in the training o f the new medical profession o f China conﬁdently believe that from the students who have passed through our hands there will emerge great surgeons , physicians , and investigators , who will

o f contribute to the medical science the world , bringing to their work those high ideals which they caught in the atmosphere o f Christian schools and colleges . It is to such men and women that we look to - day fo r the regeneration o f China ; and the medical missionary in that country can do nothing greater

o f c o than assist in the training such leaders , operating with them and helping forward their if ff . e orts Such training, it is really to count , must be the very best available ; and such c o if operation , it is not to be misunderstood or

ff o f i resented , must be o ered in the spirit hum lity

and true comradeship . The day is past when the missionary enterprise should revolve around

the foreign missionary, to the practical exclusion

o f or subordination the Chinese worker . The Chinese Church and the trained Chinese Christian

196 CHINA AND MODERN MEDICINE But it is not the leaders alone— not even the — progressive leaders o f Young China who can solve the gigantic problem o f suffering and need which China still presents . The people them selves must see a new vision and assist in the enterprise, and the whole Chinese Christian

Mo o rsh ead Church , as Dr Fletcher pointed out 1 some years ago , must awake to its responsibility in this direction . For this reason hospitals and f re uges , dispensaries and public health centres , are required throughout the length and breadth o f o f the country, and each one them should be a model to the community around, and a means

f o f o raising the whole level public opinion . The medical mission should be a model Of ff evangelistic e ort , revealing to visitors and patients alike the great purpose fo r which it exists , and the great Personality whom it seeks

ul o f to represent . It sho d be a model sympathy

ff O - and true charity, a ording an bject lesson to the whole district in the considerate and kindly treatment which it extends to every class o f patient who seeks its help . It should be a model o f hygiene and sanitation , and thus be able to make a permanent contribution in teaching the people the principles by which disease can be ff prevented and su ering avoided . It should be a model o f up -to - date investigation and treat ff ment , and prepared to o er every patient who

1 R w o Missions A ril1916 nal vie . 2 The I ntematio e f , p , p 77. THE OUTLOOK TO - DAY 197 enters its doors the best that modern science ff has discovered . It should be an e ectual train ing- ground fo r every assistant and employee who is engaged : a place where nurses and orderlies appreciate the responsibility o f Christian service ; where ward cleaners and operating - room attendants learn the importance o f scrupulous cleanliness ; where kitchen servants realize the risk to health and comfort which carelessness on their part may produce ; where one and all are taught a new conception o f their duty towards

ff a wo rd the sick and su ering around them . In , we are there to build a model o f which neither we nor the Chinese need ever be ashamed, and one which we shall be proud to see them copying . This Objective c an never be realized so long as the majority o f our mission hospitals are as hopelessly under - staffed and ill -equipped as d they are to ay . No hospital can rise to its evangelistic or scientiﬁc Opportunities whilst it

o is run by a single d ctor . An institution which possesses neither a bath nor an efﬁcient microscope can hardly be thought o f as a model hospital fo r the Chinese , still less a hospital which is unable to sterilize its ward dressings . Yet in such a condition o f poverty are some o f our medical

- 1 missions in China to day .

1 Sixt een h OS pitals in China repo rted in 1919 that they did not possess a bath ; fourteen were with o ut a b acteriolo gic almicro sco pe ; and hir -six s a ed h a h e did not s eriliz e h eir ward dressin s t ty t t t t t y t t g . ‘ AnEn uir into theS cienti c E icienc o Missio n H a ital in na ( q y ﬁ ﬁ y f c p s Chi . ) 198 CHINA AND MODERN MEDICINE

The idea] which we have sketched by no means requires sumptuous buildings and luxurious

t . fittings , nor any hing approaching extravagance The point to be aimed at is that each medical mission should be so furnished and administered as to be a true object -lesson to the particular community which it serves , in economy as well f as in e ficiency, in educative influence as well as in evangelistic zeal . This policy demands a great variety Of in stit utio ns Of ff f di erent grades , rom the highly equipped Union Hospital , with its Medical College ’ - and Nurses Training School , its many sided ff im sta , its elaborate apparatus and modern

lement s o f p investigation , down to the rough building in a western province , where, in his

- i i lime washed theatre, the pioneer m ss onary needs

f o f fo r surgical equipment , per ect its sort , his

Often difﬁcult and always lonely work .

In a huge country like China, where conditions — differ so widely in different provinces o r indeed — in different parts o f the same province the equipping Of mission hospitals needs to be suited to local circumstances . It would be unnecessary and wasteful to furnish a rural hospital on the same lines as would be required fo r a hospital in one o f the large provincial capitals or treaty ports . On the other hand , it is inappropriate ,

o f and hardly worthy missionary statesmanship , to build a hospital in one Of those inﬂuential

200 CHINA AND MODERN MEDICINE

o f ful the care the sick . It must keep care watch

upon the newer movements in China , readjust ing itself continually to the requirements o f a

changing scene, and deliberately throwing on the scrap -heap such methods as no longer serve ff their end in the most e ectual manner . This will often entail the sacrifice o f individual or denominational interests fo r the sake o f the if larger good, but , in the process , such sacrifice brings about the uniting o f Christian forces the increased efficiency and economy so secured will more than compensate fo r the loss . There is a failure somewhere in our Christian faith and — practice o r at least in our missionary states manship— when two or more under - staffed mission hospitals exist separately in the same city, each ff unable to do thoroughly e ective work . And such an example cannot but Weaken our witness

o f o f f to the love God and the unity our aith , as well as proving a serious detriment to medical

s f progres and e ﬁciency . There are still some cities in China where such a state o f things exists . But there are others in which the medical missionary efforts o f different

Societies have been united with striking success,

fo r as, example , in the University Hospital at f Nanking, the Union Hospital at Huchow u, etc . Where formerly there were three hospitals in ff Nanking , each belonging to a di erent mission ,

- - and each under manned and ill equipped , one THE OUTLOOK TOD AY 20] excellent union institution is now in existence

c o - O in which all these missions perate , and in the conduct o f which each doctor is able to develop

o wn his special department . These great union medical schemes have a value that is far greater than the sum o f the

o f efﬁciency the several units . They stand not only fo r a wealth o f medical experience and

fo r o knowledge , but a united presentation f that which is the heart and the common ground o f

Christian truth . 2 . A sustained attempt must be made to secure the services o f trained Chinese physicians in all our hospitals and other branches o f medical

missionary work, and to accord them positions

o f full responsibility and trust . There is no student o f the missionary enterprise who will not

far agree with this in theory, but so as we have at l ul gone present , it wou d be ridic ous to pretend that the policy o f missions towards promoting the full development o f Chinese leadership and initiative is carried out at the expense o f the foreign missionary and his ideas . There are but few Mission Boards which are yet prepared to subsidize Chinese work without demanding control . Many missions have not even appointed ff a qualiﬁed Chinese doctor on their hospital sta , much less entrusted the lives o f their repre — sent ativ es to his care whilst in many other centres the Chinese doctor is regarded merely G* 202 CHINA AND MODERN MEDICINE

o f as the employee the mission , or designated an

assistant at best . Chinese physicians or surgeons who have taken the full medical course in a modern medical school , and are elected to positions in our mission hospitals , must be given exactly the same status f e as their European or American con r res , and regarded as true colleagues and fellow- members o f the great medical fraternity . The most efﬁ cient o f them must be promoted to admini~ strativ e posts , where their responsibility will be as great and as independent as the foreign members o f ff the sta , and where they will be given equal opportunity to try out their ideas and make their o wn mistakes .

Where this is done, and where the hospital is so equipped as to offer them proper facilities fo r their medical work, there is every reason to hope that their services may be secured . Of 1 1 5 men who completed their medical training between the years 1 906 and 1 9 1 9 at the Union

Medical College, Hankow, the Medical Depart

o f o f ment the University Nanking , or at the 1 00 Tsinan Medical College, more than have served as internes or assistants in mission

hospitals , and the great majority are still — doing so and that in spite o f the fact that only a comparatively small percentage o f them were under any obligation to return to such

work .

204 CHINA AND MODERN MEDICINE young and elastic to adapt himself to an entirely new environment .

Go d give us men ! A time like this demands f Strong minds , great hearts , true aith and

ready hands .

Surely it is high time that the professors o f our home medical colleges should bear in mind

o f ul the vast needs Asia , and sho d constantly present the facts o f the situation to their classes . Cannot we appeal to them to lay before their most promising students , year by year, the great adventure o f science and o f service to which the pathetic cry o f the suffering millions o f China is summoning men and women ? And f urthermore , is it unreasonable to ask that more direct lines o f communication be established between the profession at home and its members in distant outposts ? Why should not some o f the leading physicians and surgeons o f London and New York come and visit our hospitals in

— - China not as globe trotters , but staying long enough to acquaint themselves with the con ditio ns o f medical life and practice out here and give us the Opportunity o f sharing in their experience and skill Better facilities should at the same time be provided in the laboratories

o f o f and wards the large hospitals the West, f f so that medical men rom China on urlough, or Chinese medical graduates proceeding to Europe THE OUTLOOK TO -DAY 205

fo r - ld or America post graduate study, shou have full opportunity o f being brought into touch with the latest methods o f investigation and

o f treatment , and securing expert advice and assistance in attacking the unsolved medical

o f 1 problems the Far East .

benefi ce t fo r 4 . This great and n service China can never be satisfactorily accomplished until Christian people in the homelands recapture the spirit o f the men who founded and endowed — our own great institutions o f healing such as B ahere and Thomas Guy and others like them and are prepared to employ a similar munifi c enc e f . o f on behalf o the East . Numbers our mission hospitals and medical schools here in China are suffering tod ay from impaired efficiency and retarded progress on account o f inadequate f f financial support . The urlough o the missionary doctor , which should be largely devoted to the replenishing o f his professional and spiritual f ff resources , is too o ten taken up with the e ort to secure funds fo r the maintenance o f beds and cots in his wards or the completion o f his hospital buildings . This should no longer be , now that we have reached a day when the unity o f the world and the brotherhood o f its people are

1 Th e Chma Medical Bo ard h as already generously awarded a large number o f fello ws hips t o medical missio namos o n furlo ugh and Ch in es e medi cal radua es t o ena le h em t o ursue o s g t , b t p p t a e s ud No rth Ameri r a B ri ai gradu t t y ih ca o r G e t t n . 206 CHINA AND MODERN MEDICINE subjects which constantly occupy our thoughts and our conversation . l China is no onger an alien land . She has

f - become our neighbour, our ellow counsellor

o f around the Table Versailles , a member with us in the Council o f the League o f Nations . And if ff ff . she su ers , we too must su er with her If this battle fo r the redemption o f China is worth our fighting , it is worth our sacrifice also . Such sacrifice has already been given by many

f o f humble ollowers the Christ , who gladly lived upon small incomes voluntarily reduced, in order that China might share the richest blessings t hey possessed .

The healing o f the world

Is in its nameless saints . Each separate star is nothing A myriad scattered stars

Break up the night,

And make it beautiful. And after all is not this the fundamental

l o f f phi osophy the Christian li e , that the seed should die in order that it might bring forth fruit ? That was what the Cross o f the Son o f

God meant . And after the Cross came the

Resurrection .

208 CHINA AND MODERN MEDICINE

r H n B s r h e Marshall Dr A i t o eav w Kin on De G uc . p co f e elo . gt

B ro s . 1 91 1 . Price 48 . * Medicine in Chi na Re o r o f Chin a Medical Commission o f 1 . p t

th e Roc e eller Founda ion 61 Bro adwa New o r . 1 914 . k f t , y, Y k

III BIOGRAPHICAL

* T i t a d Ho n. e r Park r h L t rs and J ur o v. n te i e fe, Le e o nals f the Re P e , eo r e B e h e D B s n o n re a M. v ns D . o o C Re . . S . G g t p , t g g i al l c ie t o o . n Sunday Sc h o o and Pu b . S ty D o 1 M mo rials m H n M . Nis be C . 8 5. e o J a es enderso . 7 T f , t * M m ri al R a c T h o ﬁ eld MD H rold A S ho ld. c . . o s o . T e f . ﬁe A. . S , dder h o o 1885 . H Sto u g t n . * ‘ J hn nn th Ma r s F1 in ev ell o 1 1 m H. R C . 9 . o K e e ck nz i Mrs B on . e 8 1 e e. y g F d r s lle r C R b rts Ti ntsin B n R . A ns o n. 189 o e o e . rs o . H. 5. T e . f M y * ‘ T lo Peill e Ph sic an Tsan C u Rev . . eadl h e v h J . H 1 e ed y i of g o . y gr s o . 1 908. lle S dne Ru rt H d Rev Hill. Ro er Cu . 1 908 . y y p e o ge. . J . K . b t y Price 1s 6 . d.

* ‘ Arthur a k s ain . o der n A. . o H d 1 J c so of Manchuria. J C t

o u h o n . 1 1 1 St g t 9 . n — Ar r Heali g and S aving The Life S to ry of Phi lip Rees . W. thu ll ric e 5 Tatc h e ell 1 14 . P 2 . L. R . C P. . 9 , K y H rb rt tanl nki ic h ar lo er MD. Rev R d e e S e J e ns . . y , , G v , s a 1 4 Pric 8 . 6d. re re s 91 . e 3 C y P . * Cecil Rob rts n ian u Re F B e er D D. are o o S . v . . M . e f f . y , C y r P es s , 1914 . Pric e 33 . 6d. ’ Dr I l lar b Mit Man F Nei l. e sa u W. S . O C el chell of ch ria. . k

Co . 1917 . Price 38 . 6d.

IV S CIENTIFIC AND STATISTICAL BOOKS

S ur ical Practi a n ce mo t t hin . e r ar s he C es e P e P er M. D T g g t k , . Su h erland o 1 4 6. t K n x. 8 Di as China r s es o W ffe s . an e . H. J e MD. d . . a ll r . L M we . f y , , J x , J , ’

M. D Bla s o e . i n So n 85 Co . Ph iladel hi a. 1 910 . k t , p Chines e Materia M drea and Natural Hi t r r er mi e s o . F. Po S j y t th, ME meric an e ria s h an i . . A Pres n Pres S h a . 1871. byt , g No tes o n Chin Mat ia M ica a i l a T ese er ed . D n e H nbur E. L. S . i y, 862. ” Chines e Mat ria M i ca n m e ed Ve etable Ki do . Rev . . A. S uar ( , g g G t t , “ M. Americ an Pres erian Pres h an h ai 1 S . 19 1 . byt , g An Enquiry into the S cien tiﬁc Eﬁiciency of Mi ssio n Ho sp i tals in h l C i na. Ba H. m F R r i S . Re in ed ro m h na ed . . C M . J l. a O. ( p t f Ho s i alSu lemen No aina le r v . O o m p t pp t, bt b f Pric e d . o s ree 71 p t f . China Mi ss i on Y B k P lish an all ha ai r o . h ea o ub ed nu y in S n . O aina le ro m Lo ndo n Mi ssionar S oc ie o r rom o m bt b f y ty, f s mitt ee o f Re erence and o el is New C uns 25 Mad o n A enue . f , v Y r i o . Pr 1 s c e 0 6d. k . APPENDICES 209

V SOME SCIENTIFIC ARTICLES

(a) Chines e Medical Practi ce

Mid i r oc h ar Dublm W. T tise on Chinese w e . L rea f y k t,

J o urnal o f Medic al S cienc e . 1 842.

n t mi l P at s W. o c h ar scri ti o n o Chi nes e A a o ca l e . L De p f k t,

Chinese Re o si o r v o l. ix . . 1 94 . p t y, p i arla h s lo . . A. n Chines e S ys tem of Anato my and P y o gy W H d.

Trans China B ranch R o al As ia i c S o ci e . 1 847 . , y t ty m e r D az e e He do . d n i er M. . La Médeci ne e Ch na. . . J G K , G tt b

decin e 1 . Mé . 859 i n Henders o n and Mdical Practic o the Ch ese. . The Medi cine e e f J , D Pro ce din s No r h Chi n a Branc h Ro al M. . e , g t , y

As ia ic o c ie 1864 . t S ty.

hina R e iew. 18 2 n err M. D. C 7 . Chines e Medz cr e. . . J G K , v m ti n D. J . Chi nes e Use of S had and I o di ne Plan ts in Co nsu p o . o an D Pro ceedin s o r h Chin a Bran ch Ro al Mac w M. . N g g t , y ie o 1 2. As iatic S c ty. 87 s h Mac o wan MD. Pro ceedin s No r Chine e Toxico lo . D. J . . gy g , g t ia o As ic oc ie 1 4 . China Branc h R al S . 87 , y t ty i s Ma r a M i h m o n . D B r in t d o M . i i a h Ch se ca . T bl o g p y of e e e . J . C , l o rn al 1 Chin a Medic a J u . 890.

i . r h Hi stor hi li s n hi na Thin M. D E u Earl o S C . . din y y f yp G , b g l Medic a J o urnal. 1868 .

s n tr a d . Ro ers . China C in D tis rr . D. n h e e . J . . e M . 0 e y G K , G g

R e iew 1 877 . v . o i D es R o r er H n . eo n D hin e ec d Chines e Arts eal . ud M. . C f g J g , , l a vo s . ii. iii . nd iv . , m l in hina h s hina ed . 1 0 . T o m o n MD. . J l 88 . S al x C . M po J. , . C 7 i an r t a t a Th o ms on . D. a Nativ Pr c ce d P c i ti n rs . M C in e o e . . C J , h edi al o u rnal 1 M c J . 890 . C in An t m t a e l rn D eon . D hin Mdic a A ode h es e a o i s . M M . u C J dg , .

J o u rnal. 1893 . C a r i h in i a e i l t n r D eon . D. n d a A h C es u er . M c e e S J . ud C M p g y g , h

al. 1 J o u rn 895 .

N li n in ul S ts an lie ro e Pa o . . . T . Md 1 916 eed C J1 . . g f p J t , p ’ A C n m s e e s Far Ea ern R i w. 1 1 hi Ch is t s S . . 9 9. e e e ho p . G n t v a I N hin M di i . Wo h in ed 1 1 M. D . . . o s C e c . O. n M k on es e ne . C J 9 8 K g, i M di i t ra u M l n e ca D hina ed. . 1 1 Ch lL t r . . . Wo n es e e e C M. . C J 9 8 . K g, Chin i l and S ta a i n o D es Med calS cho o s te Ex m nat s . . . W n M. . e i o K O g, l China Medic al Jou rna . 1 919.

(b) General and Phys io lo gical

Chin Patients and their Pr udi h ese S . . uan D e ces . H C M. . C ina j , h Medic al o rnal 1 1 J u . 9 7 .

Chines e S u ers titions relati n to Chi ldbirth . ueenie Ts a a p g Q y. Chin dic al o l 1 Me J urna . 1 9 8 . D m Po ss si n E R a r n on W e M. D. i a ed e es o . . n C M l . J 189 . g , h 8 E ils o in t- ll v h es F bi ndin . P a we MD C o o J . . M . f e g x , hina Medic al ou rh a 1 1 C J L 9 6 . 210 CHINA AND MODERN MEDICINE

iol i l tand r s i n C na Ph s o ca S a d hi . . D . h D W e M. . China y g G yt , di al rnal 1 an 1 Me c J o u . 1 9 2 d 1 9 8 . Anthro o metr o Chin se S tud nts e e E. M. Merri s D . n M . hi p y f , . C na l l Medic a J o u rna . 1 910 . Anato mical S u lement to China Medical J o urnal J ul 1 2 pp , y 9 0 . P lvimetr and Ce halo metr o Chin E a e es e. M. . rner MD y p y f G , . . hma edical o u al 1 1 C M J rn . 9 8 . Ch mi cal I nves ti ati o n o Alimentar Canal in C e hin s . D g f y e e G . . D hi i l Wh e M . C na Med c a o u rnal 1 1 J . 9 6 . yt , A tud in F l S o Ch s o s . D n d . S . i s o Ph D e e o W . . C ina Medical y f , h

J o urnaL 1920. Nu triti alu S o an Pr u ve V e o B e od cts . W Ado l h H. Ph B n . a f y p , . . , d ian M hin a e ic l P. . D. C M d a o u rn al C. . 1 2 K g, J 9 0. D d eo Di as es o Chi na. J . u n D las se M. . o w Medical o urnal f g , G g J . ls Max w ll D 1 o . . ] o M . f r 8 . A J L e J . T o Med. 1 77 . . 16 , p 9 . I nci n in C i Dis as d ce h na. A. l e e e Hedb om M. D. hina Medic al , C l 1 J o urna . 19 7 l tatis ti in C m i ta S cs hina. S e V W. . Lenno M. D. hina o G x, C l al Medic a J o urn . 1919 .

M m randum o n Medical Educati n in - e o o C ina. W Lie t h h u n e , hina edic al o urnal D. C M J . 1 14 M. 9 . Th S anitar Or aniz ation o China A anle e . . D. in a S M. C y g f t y, h l l 1 Medic a J o u rna . 913 .

M dical Pro r s in China sin R i W ien -t h es ce the e bl c. L e u D. u e M. g p ,

Ma 29th 1 920 . Lance . t y ,

(0 ) Clinical and Patho logical B s in ina and Ea t . Ho s on ME L ro Ch s . P c e . . ro eedi p y b , ngs Chin a al sia i o c ie Branc h R o A c . 1 5 S 8 2. , y t ty las si catio n o F v rs in Cen tral C ina E C e e h . . H. e M. D ﬁ f Hum , .

China Medic al J o urnal. 1 910 . A N n -malarial Remittent Fever and its H cemata o z oo n. E . W o n , . v lm h in i e D. a Med c al o al Tun ann M. C urn 1 g , J . 897. me a Ascites as so ciat d wi th S leno l . Ho h e H. S . u o n D M. p g y g t , .

China Medic al J o urnal. 1 910 . m — n 1 n al R ort 04 s . D h e l o e e o Cas . W D S e e . h a M. . in p g y p G yt , C l Medical J o urna . 1 915 . S ome Diseases the Paras itic Causes o which are Obscur f e. J. L. ll a e i l o D. hin Md c a u rnal Maxwe M C . 1 1 , J 9 3 . B r E t mias is A. s B nk lo s o . C. on M. . h S . ina A . C edi al y y , , M c

Jou rnal. 1 913 . m S read o Asiati c S chis to so iasis . R . T. Lei er B c and L p f p , . S . E. . kins o n hina Medic al ournal 1 C J . 19 5. At . mum I n cti histo s e on . 0 T o an D c M. o r Cas es o S o . . L l f T o f f g , J . p.

1 06 E . Pea e D l o r ed 9 . C M. . J . f T o M . ed 1 M . 909 , ; k , , p , ; hin a h es on M. D. Med 14 u C . Jl 1 9 A. C. H c . t , , hum in S o uth China u a Ain . P. Ma well Goundo nd . M. D J x , al o f Tro i al edi cine F R . C. o urn c M 1 0. . S . J p . 90 i I n cti n in an Heanle B in ns s e o C to n . C. . i tho rchis S e es e M . Op s f y, M. , al o f ro ic al M i B . J o ur n T ed cine. 1908 . . S p

212 CHINA AND MODERN MEDICINE

II INFORMATION REGARDING MEDICAL MISSIONARY SERVICE IN CHINA

1 VO T s r s e s f a io n and a im elli des ire . O . A on n e o o c n n CA I N t v t , p g t o undertake suc wo rk as a definite s ervic e fo r Go d and fo r humani are th e rs essen ials o f th e medical mis sionar ty, fi t t y en er ris e This en er ris e h as no nanc ial indu c emen s t p . t p fi t t o o er o n th e c o n rar it ma es c o ns an demands fo r ff ; t y, k t t th e ex erc is e o f ai h and s el - enial Fo r ha reas on it f t f d . t t is not t o b li h l r d Bu t th e man o r w o man e g t y ente e u p on . wh o engages in it as a resu lt o f clear c o nviction and Chris tian ex erience will it sesses c o m ens a io ns which p find th at po s p t mo re han s fii e t u c .

2. PROFES S O TR uden s wh o are lo o in o rward I NAL AINING . St t k g f t o this s ervic e are required in th e ﬁrs t plac e t o o btain a rec o niz ed edic al al a io n In iew o f the demands g m qu iﬁc t . v h a Wi ll be made u on h eir ro es sio nal a ili and o f th e t t p t p f b ty, pro bability th at th ey may o ften b e deprived o f th e o ppo r tuni t o f medic al c o ns ul a io n it is rec o mmended h a his y t t , t t t initial train in g s h ould b e as th o rough and c o mplete as o ssi le s uden s a in a Uni ers i de ree wh ere er p b , t t t k g v ty g , v rac i le r o lle e i l ma c a in e erence t o a C d o . p t b , p f g p

F L S S ST E TR I NI In addi io n to t he 3 . INANCIA A I ANC D UR ING A NG . t Open sc h o lars hips and burs aries o ffered at th e various medic al sch o ols in th e h o me lands o h er o o r uni ies o f s ec u rin , t pp t t g ﬁnancial assistanc e to wards th e h eavy c o st o f medical trainin g are oc c asio nally affo rded t o s tudents wh o pu rpo s e to ec o me i al issio aries Th e Lon o n and Edin b med c m n . d bu rgh Medic al As s o ciations eac h maintain h o stels fo r such s tu dents and make annual grants to wards part o f th ei r expenses ; whils t th e S oc iety fo r th e Pro mo ti o n o f Chris tian Kno wledge als o o ffers burs aries fo r medi c al students wh o intend t o wo rk in c onnec tion with th e Chu rch o f n lan 1 E g d.

4 P T- R E W is o f th e mo s im o r anc e a OS U T OR . u . G AD A K It t t p t th t s tudents s h ould o btain suitable po st -gradu ate exp erienc e e o re r e m a ro a Medic al mi ssio nar w o r is to b f p o ce d b d . y k b e re arded as a Iife -s er ice and fo r h a reas o n th e u r enc g v , t t g y o f t h e need ab ro ad S h o uld never be allo wed t o o bscure th e r ar io less e c e ional impo rtanc e o f th o rough p ep at n . Un x pt

Fu ar iculars an be taine fro m Dr H . e i e urc i Lon on ll p t c Ob d M lv ll Ch h ll , d A b L n n 5 Dr H F L n i ur o o N . . ec edica issionar ss ocia io 51 H ar . M l M y t , gh y P k, d h mere Taylo r Edin urg Medic al Missi onary Assoc mt ion 56 George S quare , b h , , ’ a n on W. O 2 E in ur or th e Secre ar G St ar in s Pl ce Lo . . d b gh t y, M t , d APPENDICES 213

’ th e s den s a e a e it im ss l . u m o i e a c ircums ances e. t ( g t t g ) k p b , minimum o f two years s h o uld b e devo ted t o po st -gradu ate wo r o ne at leas ein s en in residen a o mtments k, t b g p t t pp , and th e remainder in su ch s tudy as Wi ll b e mo s t suitable r n f o r h a i i c o e la i fo r th e particu la ki d o w k t t s n nt mp t on.

D E 5. VARI ETI ES o r MEDICAL WORK , AN SP CIAL PREPAR ATION . Bro adl s ea in medical missions in Chin a ma be di ided y p k g, y v into th ree c lass es - a The i o neer s tatio n o r u co untr ho s i tal. This re res en s ( ) p , p y p p t th e type o f wo rk in which mo s t medic al missionaries are

en a ed and is lar el sur ic al in c h arac er. A residen g g , g y g t t appo mtment as Ho us e Su rgeo n is th erefo re an invalu able re ara i o n whils s ecial e x erience in O h h almo lo p t , t p p p t gy, in ro i c al di s eas es es ec iall h elmin h o lo in h o s i al t p ( p y t gy) , p t adminis tratio n (such as is iven in c o nnec tio n with th e rs a d igwifer ar i larl as es f D . c o e n in m cu c o P. H u . ) , y (p t y l l h e r o s ruc ed la o ur is exceedin us e u . T doc o in b t t b ) , gy f t c h arge o f suc h a h o spital is res po ns ible fo r all path o lo gic al wo r and als o fo r th e admini s ra i o n o f th e ins i u io n k, t t t t t ; a kn o wledge o f lab o rato ry tec hnique and o f acc o unt -keepmg i ere o re f rea s ervi c e s th f o g t .

b The bas e ho s ital in the lar e treat o rts etc. This wo r ( ) p g y p , k is o fferin an increasin O o r uni fo r s ecializ a io n g g pp t ty p t , articularly wh en such h o spital is Operated o n a unio n as is S u den s des ined fo r hi s e o f medic al missio n . t t t t typ wo r sh ou ld direc h eir o s - radu a e rain in ac c o rdin l k t t p t g t t g gy, and in addi io n t o ex eri enc e in eneralmedic ine o r su r er , t p g g y, s h o uld p repare th emselves in o ne o r o th er o f th e s peciah ties t r in a i o l (no fo gett g R d o gy) . T m di ca ll Th e wo r o f medic al e u ca io i hina (0 ) h e e l co ege. k d t n n C t o -day demands th e s ame spec ializ atio n and th e s ame ex pert rainin as is needed fo r s imﬂar o s s in th e h o me c o un r t g p t t y, to geth er Wi th s o me ex perienc e if po ss ible as a demons trator h er a d a i fo r o ri inal o r eac n n a ude wo r . t , pt t g k

Medical missionaries are 6 THEO O TR . no t advised . L GICAL AINING t o attempt t o add th e study o f th eo lo gy t o th e lo ngmedic al cu rriculum but an ade u a e c o u rs e o f s ud in Bi li c al , q t t y b Ex e es is Ch ris ian A o lo e ics and Co m ara i e Reli io n g , t p g t p t v g , if ro curable Will rea l enh anc e h eir us e ulnes s as members p , g t y t f s ar r Ex rie i o f th e mis io n y fo c e. pe nce n Chri s tian s ervice is als o an in alu a le and nec ess ar re ara ion v b y p p t .

’ L U E S TU Y A medic al miss io nar s e f . h O o e in 7. ANG AG D y p g tt ginto c lo s e to uc h with his pati ents and h elpers depends u po n his ree use o f h ei r lan ua e and it is s ro n l ad i s h f t g g , t gy v ed t at th e ﬁrs t two years o f resi dence in China s h ou ld be kept free ro m medic al res o ns i ili and de o ed to lan ua e s d f p b ty v t g g tu y. Such a c ou rs e do es no t prevent a man fro m keepingu p s o me

ro feSS io nalwo r ro i ded it do es n o t in o l e an enc r . k, p v v v y o ach in u on the ime allo ed t o th e s ud of Chines e g p t tt t y . 214 CHINA AND MODERN MEDICINE

E S ERV E RT FR OM M S S O S . China do es no t t 8 . M DICAL IC APA I I N ye pres en t many Opp o rtuniti es fo r medic al wo rk o n b eh alf o f t h e Chines e eo le a ar ro m missio nar s erv we h o u h p p p t f y , t g a few rac i io ners at th e lar e o r s wh o are amiliar wi h p t t g p t , f t i th e Ch in es e lan u a e include a nu m er o f Ch nes e a ien s g g , b p t t h eir c lien ele s amili ari wi h wes ern medic in in t t . A f ty t t e S reads and Chinese medi c al sc h o o ls and h o s i als in crease p , p t , it is po ss ible th at new o penings will o c cu r fo r th e s ervice o f Eu ro pean o r Americ an phys ic ians wh o h ave n o c onnectio n wi h m si ar s o c ie i s t is on y t e . M medi c almis s io naries are rec o mmended 9 FOR T O . In endin . IN A I N t g t o get in to early c o mmunic atio n with t h e Sec retaries o f th e particu lar Missio n o r o th er o rganiz atio n under whic h th ey la o r n o rma i o n re ardin medic al wo r c o ntemp te w king. I f t g g k in an ar o f Chin a o r c o nc ernin th e ario us acancies y p t . g v v re uirin rein o rc emen s c an alwa s be o ained o n a li q g f t , y bt pp c atio n t o th e S ec retary o f th e Advis o ry Bo ard o f Medical

Missio ns Edin u r h Ho us e 2 Ea o n ate Lo ndo n S . w. l , b g , t G , , wh o will als o su l de ails re ardin c ondi io ns o f ser ic e pp y t g g t v ,

urlo u hs etc . f g , Info rmation c oncerningmedi caleduc atio n c an be o btained from th e follo wingaddresses Peking Unio n Medi cal Co llege

China Medi c al B o ard 61 Bro adwa New o r U. S . A , y, Y k , o r Lo ndo n Missionar So cie 48 Bro adwa y ty, y,

Lo ndo n , S . w. l.

un ri t an niv rsit Ts inan S hant gCh s i U e y,

19 Furniv al S ree Lo ndo n E C. 4 and 1 56 Fi h t t , , ; ft

A enu e New o r U. S . A. v , Y k, Moakden Medical Co llege

1 21 eo r e S ree Edin ur h . G g t t , b g China nio n nivers it Chen tu Wes t U U y, g Me odis Fo rei n Mis sio n Bo ard 1 50 Fi h A enue th t g , ft v , New o r o r Canadian Me h o dis Mis sion 299 Y k ; t t , ’ ueen S ree Wes To ro n o o r c O Friends Fo rei n Q t t t , t ; / g Missio n As s o c ia ion 15 De o ns ire S ree Bis h o s a e t , v h t t , p g t ,

Londo n , E. C. 2. i C l Chan sha Hnnan Yale Med cal o l ege, g l io w a e o e U . 5 hi e Hall a e S a n N H n C nn . S A W t , Y t t , v , o r Wesle an Mission Ho us e 24 Bish o s a e y , p g t ,

Lo ndo n , E . C. 2 . ’ i r it S han hai S t J o hn s Un ve s y, g

1 Fo u r h A enu e New o r U. S . A. 28 t v , Y k , Canto n Chris tian Co llege Fi h A enu e New o r o r c o Lo ndon 1 56 ft v , Y k, / B ro adwa o ndo n o ie 48 L . l. w. sio nar S c . S Mis y ty, y, ’ i W men s Medi cal Co lle e Pekin N. China Un o n o g , g

o m 10 1 50 Fi h A enu e New Yo r U S . A. R o 7 , ft v , k, r Wo m n Canto n Hackett Medi cal Co llege fo e , ’ erian Wo man s B o ard 156 Fi A enue New Pres byt , fth v , A o r U. S . . Y k ,

216 CHINA AND MODERN MEDICINE

IV NATIONAL MEDICAL ASSOCIATION OF CHINA

Th e Na io nal Medic al Ass oc ia io n o f China was o rmed in 1 915 t t f , Y o f ar ard s rs Pr i D F . en H es de h C n . Its m wi t r . v a ﬁ t t embers hip — me in 1920 was 450 men and wo n.

Th e Obj ects of the Asso ci atio n are as fo llOws 1 To ro mo e o o dwill and union amon Chinese ra i . p t g g p ct tioners c o f w es tern medi in e . To main ain th e o nour and th e in eres s o f th e m al 2. t h t t edic pro

fessio n . i S rea o f mo dern medi c al i 3 . To e ed e th e d s c ence in C in a xp t p h , and t o aro us e in teres t in puhko h ealth and preventive i th eo l med cine amo ng e p p e. 4 To c c -o rdin a e and c o -O era e wi h the e is in medical o rc . t , p t t , x t g f es in China Chinese and o rei n in th e wo r in o ut o f th e a o , f g , k g b ve s Objec t . Membership of the Associatio n is divided into the follo wing three clas s es — Re ular mem ers wh o mus be radua es in medicine o f o rei n 1 . g b t g t f g uni ersi i es o r c o lle es o r o f rec o niz ed medical c o lle es v t g , g g in China and wh o mus be ac u ain ed wi h at leas o ne wes ern , t q t t t t n a e la gu g . As s o cia ed mem ers— radu a es o f medi c al c o lle es in China 2 . t b g t g , wh o do no t p o sses s an ac qu aintance with any western l n a e a gu g . Hono rar mem ers—medic almen and wo men o f an na ionali 3 . y b y t ty, wh o h a e rendered s o me s i nal s er ice t o China and are v g v , s l o o f th e s cia i elec ted by a pecia v te As o t on.

Th e Na ional Medic al Ass o cia io n mee s ienniall at th e s ame t t t b y, ime as th e Chin a Medi c al Mi s s i o nar As s o mat i o n s o me ses sio ns t y , ein h eld o in l als o bhs o f th e t wo As s o ciatio ns b g j t y. It pu h es a ar erl medic al o urn al whi c h is rin ed o h in Chines e and qu t y j , p t b t n lis h Th e Cen ral Of ce o f th e Ass o cia io n is s i u a ed at E g . t ﬁ t t t Sh an h ai the En lis Secre ar ein Dr 4 Nan in R oad . S . 3 k g , g , g h t y b g W New . APPENDICES 217

V MEDICAL CURRICULUM IN CHINA

Th e o llo win c o u rs e o f s u d ex rac ed ro m th e re u iremen s f g t y, t t f q t Of th e Premedi c al and Medical Departments o f th e Sh antung Chris ian ni e r i c al o f Wh a is o llo w ed rs i ma be re a ded as t U v ty, y g typ t f at th e mo re mo dern medical sc h o ols rec ently establis h ed in China b Bri ish and American o r aniz a i o ns Th e curriculum of th e y t g t . Ch in ese Medi cal Sc h o o ls is s o mewh a mo re res ri c ed at resen t t t p t , and h as no s e ara re e i l e p te p m d ca c ours .

PREMEDICAL COUR S E First Year

no r anic Ch emis r lec ures and la o ra o r 6 ou rs er I g t y ( t b t y) , h p w eek eneral Ph sics lec ures and la o ra o r 5 ours er wee G y ( t b t y) , h p k Elemen ar B o an and ! o o lo la o ra o r 7 h o urs er t y t y gy ( b t y) , p week Chines e Li era ure and Ess a s 4 h ours er wee t t y , p k En lis h 4 h o urs er w ee g , p k Ps ch o lo 2 h o u rs er wee y gy, p k Math ematic i 1 h our er wee fo r s ix mo n hs , p k t

S eco nd Year — Ch emis try Qualitative Analysis and Organic Chemis try la o ra o r c o u rs es 9 h o u rs er w ee ( b t y ) , p k Ph sics Mec h anics Elec rici Hea and Li h 4 ours y ( , t ty, t g t) , h per w eek Ad anc ed ! o o lo la o ra o r 8 h o u rs er wee v gy ( b t y) , p k Chin es e Li era u re and Ess a s 4 o u rs er wee t t y , h p k En lis h 4 h ours er wee g , p k

MEDICAL COURS E

Firs t Year

Ana om includin diss ec ion o f wh o le o d 16 ours er t ( g t b y) , h p w eeyr His o lo 9 ours er wee t gy, h p k Em r o lo 9 h o u rs er wee for 8 wee s b y gy, p k k Ph s io lo i c al Ch emis r 12 h ours er wee fo r sec o nd h al y g t y, p k f year (lab o rato ry c o urs e ) En lish 5 ou rs er wee g , h p k

S eco nd Year

A lied Ana om 3 ours er wee fo r rs a - ear pp t y, h p k ﬁ t h lf y Ph sio lo ex erimen al 1 1 h o urs er wee y gy ( p t ) , p k Ma eria Medic a Ph armac and Ph armaco lo 8 h ours er t , y, gy, p week 218 CHINA AND MODERN MEDICINE

Bac erio lo and Sero lo 9 ours ei wee fo r rst al t gy gy, h p k fi h f year Pa h o lo la o ra o r c o urse 1 1 h o urs er wee six mon s t gy ( b t y ) , p k ( th ) En lish 5 o urs er wee g , h p k Third Year Pa h o lo c o n inued 1 1 ours er wee fo r 3 wee s t gy ( t ) , h p k k Medic ine lec ures and demo ns ra io ns 5 h o u rs er wee ( t t t ) , p k Su r er lec u res and demo ns ra io ns 5 h o urs er wee g y ( t t t ) , p k Th era eu ics 4 h o u rs er wee fo r rs h al - ear p t , p k fi t f y Ph sic al Dia n o sis 4 h o urs er wee fo r rs h al - ear g , p k fi t f y La o ra o r Di a no sis and Parasi o lo 6 h o urs er wee t y g t gy, p k Clinical Medic in e and Su r er o u t - a ien rac ice 13 h o urs g y ( p t t p t ) , per week fo r sec o nd h alf -year O s e rics 3 h ours er wee fo r s eco nd al - ear b t t , p k h f y En lish 4 h o urs er wee g , p k

Fo urth Year Medicine 4 h o urs er wee , p k Sur er 5 h o urs er wee g y, p k O s e rics 3 h ou rs er wee fo r rs al - ear b t t , p k ﬁ t h f y O h halmo lo 4 h o urs er wee p t gy, p k Derma o lo and S hilo lo 2 h ours er wee t gy yp gy, p k Pedia rics 3 h o u rs er wee fo r s ec o nd h al - ear t , p k f y Clinic al Medic ine Sur er and S ec iali ies wards and o u t , g y p t ( a ien de ar men s 12 h ours er wee p t t p t t ) , p k En lis h 4 h ours er wee g , p k

Fifth Year Clinic al Medicine Sur er and S eciali ies class di ided in o , g y p t ( v t h ree rou s ro a in h rou h ear and ein res o ns i le t g p , t t gt g y , b g p b fo r allclinical and a h o lo ic alin es i a ions o n a ien s p t g v t g t p t t ) , 18 h o urs per week Ad anc ed Pa h o lo 4 h o urs er wee fo r rs h al - ear v t gy, p k ﬁ t f y Sur ical Pa h o lo 4 h o u rs er wee fo r s ec o nd h al - ear g t gy, p k f y Pre en i e Medicine 2 h o urs er wee v t v , p k Ner o us and Men al Dis eas es 1 h o ur er wee v t , p k G nec o lo 1 h o u r er wee y gy, p k O erati e Su r er 2 h o urs er wee fo r rs h al - ear p v g y, p k ﬁ t f y Anaes h e ics 1 h o u r er wee fo r sec ond h al - ear in a di ion t t , p k f y , d t t o prac tic al ex perienc e Diseas es o f Ear No se and Th ro a 1 o ur er wee , t, h p k Radio lo 1 h our er wee gy, p k MedicalJ uris r udence 1 h our er wee fo r 2 mon hs p , p k t

220 CHINA AND MODERN MEDICINE

Th e Examinatio ns of the Asso ciatio n are c onﬁned t o such c andida es as o ssess c er i c a es ro m h eir rainin s c o o ls t p t ﬁ t f t t g h , guaranteeing th at th ey h ave b een under trainin gfo r at leas t th ree ears h a e re ularl a ended c las s es fo r ins ruc io n and h a e y , v g y tt t t , v already given c o mplete s atis fac tio n in th eir ward wo rk and general c onduc Pa ers are s et in th e ollo win su ec s t. p f g bj t ~ Anato my and Phys io lo gy ’ w Medic al Nu rs ing and Ch ildren s Dis eas es w Su rgic al Nurs ingand Bacteriology s Materia Medic a mDietetics p Ophth almic Nu rsing q Genit O-Urinar Nursin and Firs Aid men onl o r y g t ( y) , Obs tetrics and Gynec o lo gy (wo men only)

Full info rmation regardingth e As soc iation o r c o nc erningnurs ing i m t B wo r in Ch na c an be O ained ro h e Ho n. Sec re ar Mis s a k bt f t y, tty,

C ina nland Mission Sh an h ai. h I , g INDEX

— A Chinese medi cme contmued ac f ci n 2 L k o s e ce , 0 , 61 a f r 2 Abercro mbie Dr 4 5 Us ge o d ugs , 1 , 1 62 , , i nes e h armac o ma 23 A r f W H . 1 66 c 6 o o . . 1 3 d lph , P , Ch p p , , Amo 48 inese i o so 23 26 y , Ch ph l phy, , Anaes es ia 43 44 6 6 i nese si cians 21 23 28 th , , , Ch phy , , , Ana o mi ca in es t i a ion 1 64 o era 21 t l v g t , Ch l , Ana o m 22 6 6 1 59 o u nas 22 t y , , , Ch Dy ty , o u an 6 An in 1 89 C , 3 k g , h h n i- fo rei n fee in 53 5 8 6 3 ris i ani s rea o f 6 8 7 2 91 1 85 A t g l g, , , Ch t ty , p d , , , , Assis ants rainin of 89 rist ie Dr u a 52 1 1 4 1 26 t , t g , Ch , D g ld , , , ’ te rbur Dr 1 1 3 h uan S ur eo n-Ge nera 1 49 At y , , C , g l , Chuc o w 1 7 6 h , Clinical invest i ga io ns 1 66 B t , Coc h ran Dr S 1 69 , oc ran Dr o m C h e Th as , 1 1 4 ac erio o ica in es i ati o n 1 05 1 6 6 , B t l g l v t g , , o e e T o s . Ric ar s on 36 C ll dg , h h d 37 38 a i n fac ul ies 8 7 1 05 1 9 7 , , , , B th g t , , , 1 07 , 1 54 eadle Re v . Dr uo e 44 B , (q t d) , 5 Communal servi ce , 35, 1 4 1 86 in 5 , Bedding and clo h g, 1 0 , 1 35 t nﬁ en cul i a i n f Co <1 ce , v o o , 44 63 88 ene o en asso ci a io ns 82 t t , , B v l t t , 1 84 2 Bhndness in China 9 , 37 7 5 96 , , , o nfuci an e i c 31 C th , o o diseases 7 5 1 68 Bl d , , m D Lucm a Co o bs , r d , 57 1 39 c ati o n 32 , B o ard o f Edu , 1 o o er S ir s e 36 M 5 C p , A tl y , B o one B is ho , . D . 0 , p , Co - o era i e effo r s 1 1 4 1 25 1 90 200 p t v t , , , , B oo ne Dr H . W. , 50 1 1 4 , , Go un ou o n Medical Educa ion 1 24 1 30 in 5 t , , B o xer u ris g , 8 p Co uncil o n Pubh c Heal h Educa ion ranc di s ens aries 7 9 t t , B h p , 1 7 7

man E . 36 41 1 54 ri Rev . . C B dg , , , , lan Co us d Dr P . B 1 31 , ri is Adm o r oar 1 24 B t h y B d , Dr Cummmg, W . H 48 ro er o o 1 85 B th h d , Medi cal 21 7 , O Naming 1 49 21 9 , ,

Calculus 43 1 69 , , D an i e Dr ames 11 4 C tl , J , an o n 96 1 1 6 1 20 1 2 7 1 40 C t , , , , , a en o r Dr . . uo e 103 8 D v p t, C J (q t d) , Fi rs dis ens ari es , 3 t p ea and um 96 4 3 1 69 D f d b , H os i al , 0 , 4 , p t i 1 65 D e , 87 , an PO- i n 1 87 1 93 t Ch g l g, , f a iseas es o Chi n , 66 1 67 D , Chan gsha 1 1 8 1 20 1 26 , 1 88 , , , c a i 30 D islo o ns , , 6 6 rms 4 t Cha , 8 is ens aries 7 9 il 96 D p , Chaulmo o gra O , issect io n 22 1 32 1 D , , Chen Dr S . P. , 1 0, 189 , s 62 D rugs , Chi ne e, 1 en u 1 1 6 1 2 6 Ch gt , , D udgeon , Dr J 51 , 1 61 i - bir 5 7 94 1 52 Ch ld th , , , hi na en enar onference 33 C C t y C , ar 1 2 3 2 E Chi na Medi cal B o d , 0, 1 2, 05 ca urna 1 58 Chi na Medi l Jo l , ina e i ca iss io nar Ass ocia ion Ear marria e 1 74 Ch M d l M y t , ly g , 104 1 30 1 31 1 58 1 7 7 Eas Indi a o m an 3 7 38 , , , , t C p y , , ines e urc 1 94 1 96 Eco no mi c ro em 1 72 Ch Ch h , p bl , nese e i ca o e es 11 2 11 8 1 32 Edi nbur e ica Miss mna Chi M d l C ll g , , , gh M d l ry S omety, m 6 Chinese medi c e, 1 0 4 5 Em irica now ed e 21 Educa ion edica 20 107 1 95 p l k l g , t m l , , 221 222 CHINA AND MODERN MEDICINE

Educat ve inﬂuence of os itas 101 Ho s itas—continued h p l , , p l lgé a Ide l , 99 66 Em re , Miss , 1 Lac o f 28 b y k , E i emics 29 1 70 1 74 1 84 Old- ime 8 5 1 35 p d , , , , t , , E ui men of o s i as 64 75 87 105 Ro man a o lic 7 8 q p t h p t l , , , , , C th , 1 97 S ec i a 94 p l , E an e is ic services 72 92 Ho st e s 1 99 v g l t , , l , Examina i o ns absence o f 22 H o war Dr Leonora 57 t , , d , , Nursing 1 4 9 220 H uc o wfu 200 , , h , ' uc L b H , M Ab é , 20 Ha in - n g e g, Mis s 1 1 1 K , F Hum Dr E e , . H . , 1 26 Hunan 6 3 , , 1 26 , 1 88 Fami doc rs 28 H un er Dr o . M. 51 ly t , t , J , 1 6 9 H wan - Fevers , g Ti , 1 61 Financml su o r 188 205 H iene 53 101 1 75 pp t, , yg , , , w 5 Fooc ho , 0, 57 , 1 1 4

Fo rmos a, 50 w Fo ler Dr H . , 95 I , Frac ures 66 92 t , , Fu on Dr Mar 1 1 6 1 39 Im eria e i ca o e e 107 lt , y, , p l M d l C ll g , n Fur oughs, 205 Incide ce o f di s ease 1 83 l , Inﬂuenz a an emic 1 7 3 p d , an 6 Ins e, 9 G Ins ec - o rne is ease 105 t b d , In w tens w e o rk, 85

Gau d Dr W. 51 Interna io na a ue o n erence 1 77 l , , t l Pl g C f , Gener l rac i io ners cc -o era ion o f In es inal aras ites 1 67 p t t , p t , t t p , 5g Irwm Dr 58 , , German e i ca o e es 1 18 Iso a io n b oc s 105 M d l C ll g , l t l k , m Gi Dr . G . 1 1 5 It eratin o urs 68 bb , J gt , on Dr Gillis , , auco ma 40 7 6 Gl , , a Dr F W 1 69 Go r . dd d , J Go en irro r o f e ic a Prac ice 21 ld M M d l t , Gra ua es ackson Dr Art ur 1 26 1 74 d t J , h , , e i ca 1 31 202 a an 4 8 49 M d l , , J p , , Nuis m 1 46 1 53 a an ese Me ical o e es 1 1 8 g, , J p d C ll g , ’ Gu s Hos i a 43 45 ardine W. 4 1 y p t l , , J , ,

J ﬁ e Dr . 1 5 e rys , W . H , 9 ohnson iss Frances 1 37 J , M , H

Hac e edi ca o e e 1 1 6 K k tt M l C ll g , Hall Dr FranCis J 1 1 5 , n Hanbur ani e 1 64 K ah , Dr Ida 1 11 y, D l , , Hanc on 65 ang-Hsi 51 h g, K ,

Han c o w 95 97 1 1 4 1 16 1 1 8 1 52 K err Dr . G 96 1 04 108 g h , , , , , , , J , , n Han o w ia g Dr P . C. , 1 6 6 k , K , 2 Har ar e ica S c o o 1 1 8 ilbo rn , Dr 0 . L 6 v d M d l h l , K Dr Y Ma 1 10 Hea Ex i bi ions 1 7 7 in . lth h t , K g, y, Helmin o o 1 59 Ki n Mrs 57 th l gy , g , , n- ian Hen erson Dr ames 1 56 1 61 Ki g , 1 11 1 52 d J , k , , ,

He urn Dr . G . 48 u in 9 7 pb , J , K l g , H o are is o 99 K um-li- fo w Ho s i a 46 , B h p , p t l , Ho bso n Dr en amin 45 46 96 1 56 K uo P . W. , 1 93 B , , , j , , , 3 3 K wan-tao Dr 1 08 Ho dge Dr S . R . , 3 , 1 0 , , , 6 1 52 Hong ong 4 5, 4 , 1 40, k , 1 1 3 Co llege o f Medicme, Uni ersi o f 1 1 8 1 27 L v ty , , Honoriﬁc ab e s 43 6 7 t l t , , La ra or wor 7 5 105 Ho r er Dr T . G. 95 o d , , b t y k, , i als La aro o mi es 1 62 Ho sp t p t , Acc o mmo a io n o f 7 7 La G . T . 41 d t , y, , inese Leaders hi Chinese 80, 1 93 , 201 Ch , p , , E uca i e inﬂuence 101 1 96 Lea ue o f Na ions 1 8 1 72 206 d tv , , g t , , , E ui men of 64 75 87 105 197 Le ers 94 1 56 q p t , , , , , p , ,

224 CHINA AND MODERN MEDICINE

R Tras Dr S i ourn L k, g ey . 57 a Trees , s cred , 83 Recrui s need fo r 80 203 Trus ees i 1 7 27 t , , , t h p , , R ed ross S ocie 1 87 Tru C ty , th Re is ra io n o f rac i i oners 6 2 1 32 Re i io us 31 g t t p tt , , l g , Rei s n er Dr Eh z ab th 1 36 f yd , e S oienti ﬁ c 1 5 , , ’ Res earc 1 32 1 54 Ts ai A a h , , , dmrr l, 1 48

Ro ber s Dr F. 1 1 3 Tsan o u 80 t , , g Ch , Roc e e er Fo un a ion 1 1 9 1 72 Tsman k f ll d t , , Medi cal S cho o l 1 1 6 , , 1 66 2 2 , 02, 1 7 S useum and Ins i u e 1 76 M t t t , Uni ers i Ho s i a v ty p t l , ’ St o n s Uni ers i 1 27 Tuberculosrs 97 J h v ty, , , Sch o ﬁ eld Dr R Haro A 54 , . ld Science

Absence in China, 21 Re a i on to me icine 1 6 l t d , Scien iﬁc in es i a io ns 1 59 Vacc in a ion 38 t v t g t , t , Sc rent iﬁ c wo r of o s i a s 1 02 V enerea di sease 1 67 k h p t l , l , S an ai 45 50 1 1 4 1 27 1 56 1 75 Vernac ular e uca ion in 1 23 h gh , , , , , , , d t , 5 7 5 S hansi , 4 , 1 33 , 1 S an un 51 1 24 1 40 1 89 1 91 h t g, , , , , S an un ris ian Umversrt 1 25 h t g Ch t y, W

1 44 , 1 89 n - un Wan T S e N 1 61 . 1 9 h g g , C 3 , 811 6 1151 6 5 Wang Fun 1 09 , , S o ema er Dr Ar ur 164 War o r erlies 1 38 h k , th , d d , S iao kan 95 Ward servi ces 92 , , Sma o x 21 29 Wa er su 1 05 llp , , t pply , i r F r er 53 We o n Dr 5 W. 0 Sm D . o th , P t , lt , , n 4 1 Wen am Dr S ocral co ns cie ce , 31 , 1 4 , 87 h , H . V . , 1 1 5 S o oc o w 1 1 6 1 1 8 1 9 9 Wes ina Universm 1 26 h , , , t Ch y,

S iri ua inﬂuence 31 90 W i ewri R ev . . S . 1 76 p t l , , h t ght, J , S anle Dr Ar ur 1 7 5 W t e Dr uncan t y , th , hy , D ,

1 8 Wi s o n ro f. S S a ist ics 7 7 7 8 1 81 8 D. 1 6 6 t t , , , , l , P , Wi s on Dr Wi lia M. 1 1 5 m S en o use Dr . t h , J , l , l , St erili z m 1 05 1 97 Wo men sicians 56 58 g, , phy , , ’ S e ens Mrs 1 40 Wo men s os itals 56 94 t v , , h p , , n’ S o ne Dr Mar 1 1 1 1 52 Worre s e i ca ol e es . 1 1 6 1 27 t , y , , M d l C l g , , i95 S uar Dr G . A. 1 6 3 t t, ,

S u en assis an s 1 09 Wo o Dr S . 1 77 t d t t t , , M S uﬁ erin re en ab e 29 57 Wu nen-teh Dr 110 11 8 129 1 74 g, p v t l , , , , , , , , n r 1 1 4 ! S un Yat Se , D , 77 S u ers t i io n 22 1 p t , , S ur i ca rac ice 43 g l p t , , Swa ow 50 t , - X Rays, 105 T

0 Y Taylo r Dr C. , 5 , 4 Taylo r Dr V an S o meren, 1 1 , a ission 1 1 8 20 Ta o r . Hu so n 52 e 1 yl , J d , Y l M , , , Tem es o f medi cme 83 Yen Dr F. C. 1 1 0 126 pl , , , , - Te anus 30 Yen HSi c h an o erno r 1 33 1 75 t , , G v , ,

T o mso n Dr ose C. 38 1 60 Yin and an 26 h , J ph , , Y g,

A . 1 Tientsm 57 1 1 3 1 87 Y . M . C . , 7 7 , , ,

Trans a i on wo r 46 53 109 1 23 1 31 o un Dr . W . 1 7 5 l t k, , , , , , Y g , C 1 50 1 75 Yuan Shi h-kai PreSi dent 148 , , ,

Prin fed in Great B rita in

J Tu rné u ll y Spears , E dméu rgh