IN , OLD AND NEW* By EDWARD H. HUME, M.D.

NEW YORK

I. Int ro du ct io n themselves as at the center of the HE great French Orientalist, universe. Their country they called Cordier, said in his “General “The Middle Kingdom.” All outside ,” published were barbarians. The great Chinese nine years ago: scholar of the eighth and ninth cen- turies of the Christian era, Han Yu, TThe Occidentals have singularly con- probably the most respected of all tracted the field of history of the world when they have grouped around the Chinese literary and historical critics, people of Israel, Greece, and Rome the protested in a memorial to the Em- little that they knew of the expansion peror against the honors being paid of the human race, being completely to a Buddhist relic. He said “Buddha ignorant of those voyagers who plowed was a barbarian. Elis language was the China Sea and the Indian Ocean, of not the language of China. His clothes those cavalcades across the immensities were of an alien cut. He did not utter of Central Asia up to the Persian Gulf. the maxims of our ancient rulers, nor The greatest part of the universe, and at conform to the customs which they the same time a civilization different, but have handed down.” Such pride in certainly as developed as that of the one’s own national heritage, coupled ancient Greeks and Romans, remained with contempt for other and less unknown to those who wrote the history of their little world while they believed understood cultures, while a universal that they were setting forth the history trait, is perhaps excusable in the of the world as a whole. Chinese people, who have had so rich and so continuous a historical The unconsciousness that there was development. a vast area of the universe east of the Euphrates River is a conspicuous II. The Evo lu ti on of Med ic in e in Chi na fact in the attitude of our ancestors. It is commonly believed that Chi- Concerning the great deluge in the nese medicine began to take formal time of Noah, we now know that it shape at least twenty-seven hun- laid waste a large area in Mesopotamia, dred years before Christ. As in every as described so vividly in the Old other early civilization, religion and Testament; but we also know that astrology, superstition and witch- it was by no means a universal flood. craft, were curiously merged with the From the narrow outlook of our profession of healing. Priests and forbears we are just beginning to sorcerers dominated it. This is well break loose. We are just at the thres- illustrated in the Chinese ideograph hold of a new era in which it is to be for medicine which consists of a quiver our quest to find our real debt to the and a spear surmounting a symbol older civilizations in the center and representing a witch and a wizard. east of Asia. With the passage of time, the witch The Chinese always thought of symbol was replaced by the symbol *Read at the Section of Historical & Cultural Medicine, N. Y. Academy of Medicine, May 8, 1020. for a jar of wine, indicating the intro- cine has been sketched for us with duction of alcoholic decoctions into great illumination by Dr. C. M. Wang the pharmacopoeia. It is entirely of Hangchow. He divides its history probable that a study of other Chi- into four periods, and for convenience nese characters will throw further I shall follow his outline. light on the evolution of the indi- 1. The Anci ent Perio d (down to genous system of medicine. iooo b .c .): Much that is said of this Conscious of this admixture of era is legendary, as we have no witchcraft and sorcery with the art dependable records. Three names, of healing, the thoughtful in China however, are held in the highest have never been willing to commit regard. The ancient period may be their relatives to the care of those said to have begun with the Emperor who were likely to be untrained and Shen Nung who reigned about 2737 superstitious. Thus it arose that the b .c . He is universally known as the family became, and still remains, the originator of the Chinese materia final arbiter as to the appropriateness medica. Every one knows that “Shen of the diagnosis and treatment indi- Nung daily tasted a hundred herbs.” cated by the physician. For many Naturally, he is called “the father centuries, the intellectuals of China of medicine.” Following him reigned have read the really classical medical Hwang Ti who, in association with works as they have read classical one of his ministers, is said to have literature, history, philosophy and written the famous “Classic of Inter- poetry. They have been better in- nal Medicine.” Upon this classic is formed as to the classical medical built up most of the medical literature authorities than the average physician of China and it still stands as the whom they might summon. I have universally accepted medical author- often been subjected to such question- ity throughout the land. A French ing by the family court as would translation has been made by Dabry. astonish and repel the average Ameri- The third member of that early can physician. After examining a distinguished trio was I Yin, an able patient and giving my verdict, with prime minister who lived about 1800 an outline of the procedure proposed, b .c ., and who is credited with being I have seen the family court sit in the originator of medicinal decoctions. conference to decide whether or not 2. The Clas sic al Perio d (1000 to accept the suggestions offered. b .c . to about 1000 a .d .): During this More than this, following the custom era, literature and art, philosophy of centuries, I have seen the family and government, religion and medi- send for one consultant after another, cine, reached a very high degree of finally deciding for itself between the development. Confucius and Mencius, diagnoses suggested and the treat- Laotze and Moti, lived at this time. ment outlined. No family in old Unfortunately, philosophic reflection China ever put the patient under and subtle debate characterized the the care of a single physician, but period rather than experimental prog- always reserved to itself the final ress. In this period there arose, also, decision as to action in the patient’s the two doctrines which form the behalf. basis of Chinese medicine. The first The development of Chinese medi- is the doctrine of the two primary principles, Yang and Yin. From these 600 a .d . that it gained recognition two principles everything in nature as a definite department of medical is supposed to arise. They represent, science. A special chair, under a in antithesis, the male and the female special professor, was then established element, heaven and earth, day and in the imperial medical school. The night, heat and cold, life and death, publications of the Jesuit Fathers the sun and the moon, strength and brought it to the attention of Europe weakness, positive and negative, and towards the close of the sixteenth other contrasting forces. We still century. No one who has lived in a know far too little of that dim distance Chinese will fail to recognize when, in widely separated areas of the familiar sound of the gong struck Asia, philosophic reflection gave rise by the blind masseur who roams to so many related ideas. the streets at night, hoping to be called The second doctrine is that of the in to administer the treatment in five elements in nature, namely, metal, which he is so adept. Acupuncture is wood, water, fire and earth. The also an ancient Chinese practice. human body is described as made up It extended early to , was of these elements in harmonious pro- brought from there to Europe by a portions, health remaining while the Dutch surgeon at the end of the proportions are normally adjusted, seventeenth century and was par- and disease following if the balance ticularly valued in France during is disturbed. Corresponding with these the early part of the nineteenth five elements are the five major century. There is a copper model organs: spleen, liver, heart, lungs and of the human body in the Imperial kidneys. These elements and organs Academy of Medicine in Peking, are related, furthermore, in a complex pierced with 367 holes at the points scheme, to the five planets, the five where acupuncture may be performed. colors, the five tastes, the five cli- Paper is pasted over the figure and mates, etc. the student of acupuncture is required During the earlier part of this to practice needling so as to acquire classical era, probably about 250 accuracy in striking the spots where b .c ., there lived a famous practitioner, treatment may be safely given. In Pien Chiao. He is said to have been nearly every provincial capital as the first to use narcotic drugs, ad- well as in some smaller towns, less ministering them in wine. This made formal models of the body are to be it possible for him to undertake found, some pierced with arrows at certain surgical operations. No higher the points where acupuncture is safe. honor can be paid a physician in Those who have tried to secure China today than to call him a living cadavers for anatomical teaching in Pien Chiao. China realize how reverence for the During this period, lasting about dead has made human dissection two thousand years, certain medical practically impossible. Only recently procedures came into common use, has opposition to anatomical study the two most important being mas- weakened. It is reported, however, sage and acupuncture. While massage that early in the Christian era certain was practiced in China from the criminals were killed and dissected, earliest days, it was not till about measurements of the internal organs made, and bamboo sticks inserted be used singly, instead of the shotgun into the blood vessels to trace their prescriptions favored by the ordinary course. Certainly the circulation of physicians of the day. Chang rec- the blood was distinctly foreshadowed ommended, also, that typhoid fever at least two thousand years before be treated by cool baths as an anti- the time of William Harvey. Consider pyretic measure, thus antedating the following passage from the Classic James Currie by some seventeen hun- of Internal Medicine: dred years. He recommended the All the blood is under the jurisdiction use of enemas rather than cathartics. of the heart. The twelve blood vessels are Chang was the first of a series of deeply hidden between the muscles and clinicians who gave attention to phys- cannot be seen. Only those on the outer ical signs and symptoms and who ankles are visible because there is nothing carefully recorded the actual results to cover them in these places. All other following the administration of drugs. blood vessels that are on the surface of He was not only a keen observer of the body are veins. The harmful effects disease, but an upholder of the dignity of wind and rain enter the system first and responsibility of the medical through the skin, being then conveyed profession. No one else in medical to the capillaries. When these are full, history could fairly be said to deserve the blood goes to the veins and these in the title of the Hippocrates of China. turn empty into the big vessels. The (c) Hua To, however, was the blood current flows continuously in a circle and never stops. most famous surgeon in China’s his- tory. It is reported that with the use Whatever the achievements of Chi- of narcotic potions he was able to nese medicine prior to the second perform many operations, ranging century b .c ., its real progress began from venesection to laparotomy. He with the Han dynasty. Dr. Wang is said to have excised the spleen and well says that its scientific advance- to have done resections of the intes- ment centers in the three figures: tines and liver. (a) Tsang Kung who lived about Aside from the contributions of 170 b .c . and left a reputation for his these three distinguished men, physi- detailed clinical case records, 25 of cal diagnosis became established at which have been preserved, 10 of this time, and included four methods; them the records of fatal cases. observation, attentive listening, in- (b) Chang Chung-king who lived terrogation and palpation. The Chi- about 195 a .d . His eminence as a nese physician certainly observes with physician was widely recognized and severe scrutiny and can detect many he even held office for a time as mayor of the signs of disease with singular of the city of Changsha. Chang’s accuracy. He seldom undresses the work on typhoid fever is one of China’s patient, so that his observations center great medical classics. The descrip- about congestion, pallor, tumescence tions of the malady are clear, although and pulsation in the head and hands. other diseases than typhoid are His auscultation is neither aided by evidently included in some of the instruments nor performed with the clinical observations. In this treatise ear against the body. It consists in it is noteworthy that only a few attentive listening to the patient’s potent drugs are recommended, to groans, grunts, sighs and ejaculations to which custom has given individual- methods used were to take the wet ity, so that each has a definite mean- serum directly from pustules, to use ing. Interrogation is formal and tends a moistened scab or powdered dry to elicit answers in line with China’s scabs and to wear the garment of traditional medical philosophy, rather an infected person. A long article than to provide objective information. appears in a medical classic of this Of the four methods, the palpation period discussing minutely the choice of the pulse is the most studied and of scabs and the determination of most highly regarded diagnostic proce- persons suitable to receive inoculation. dure in China. Quantities of treatises Methods of inoculation were four, by have been written on the pulse, de- the needle, by blowing the powdered scribing the information to be gained scab into the nostril, by inserting a from the several points to be palpated wet scab into the nostril and by on the left wrist and on the right wearing an infected garment. wrist. It is remarkable to watch a 3. The Contr over sial Perio d Chinese physician feeling the pulse (nth and 17th centuries a .d .): and to observe the keenness with During this epoch there appeared a which he interprets his findings. The great number and variety of mono- procedure is a literary ritual, under- graphs on particular diseases. This taken deliberately and reflectively. was particularly true during the Sung I remember seeing a Chinese physi- dynasty which lasted three centuries cian feel the pulse of a Western and came to an end about 1280 a .d . professor. After careful palpation, he Among the original works we find said without hesitation that the pa- monographs on the following: on tient was thoroughly healthy except Beri-Beri; on the Care of the Aged, for his lungs which appeared to an early treatise on the care and be seriously below par. Singularly feeding of old people; on Women’s enough, the patient had had pleurisy Diseases, a textbook in 24 volumes; with effusion only a year or two on Obstetrics, the earliest monograph earlier! I have repeatedly seen a on this subject in China; on Pathol- Chinese physician feel the pulse of ogy, a textbook in 18 volumes entitled a patient and report unhesitatingly “Three Courses of Diseases”; on that he was suffering from nephritis. The Fontanelle, an anonymous work Laboratory examinations confirmed in 2 volumes; on Carbuncle, together the diagnosis 1 with a nine-volume publication en- Still further features introduced titled “Royal Infirmary Model Es- during this classical period were the says,” which is in fact a collection of catheter, formed of the hollow leaves examination papers. In addition to of allium fistulosum; vaccination; and these monographs, an Imperial Cyclo- organotherapy. Vaccination is de- pedia of Medicine was published dur- scribed as having been introduced by ing the Sung dynasty, compiled under Prime Minister Wang about 1000 a .d . orders of the Emperor by a staff of He inoculated his son with the scab medical men. The work was published from a patient who had smallpox. in 200 volumes, most of which have He learned the method from a priest unfortunately been lost. who came from O-mei Shan, the sacred In addition to the inoculation mountain of . Other against smallpox, mentioned above, which was discovered in 1022 a .d ., recently extracted alkaloid ephedrine two other features of the Sung dy- occurs in this Chinese plant, which nasty are worthy of note, namely, had a place in the pharmacopoeia the establishment of medical schools of that land centuries ago. and the holding of state medical ex- Another feature of the Ming dy- aminations, both of which began in nasty was the appearance of syphilis 1068 a .d ., under the Emperor Shen in China, the source of which has Tsung. It is interesting to reflect caused much controversy, reminding that at a period only two years after one of the argument in southern William the Norman landed in Eng- Europe as to whether syphilis came land, when that country was still there through French or Italian a long way from the organizing of armies. Most Chinese writers main- its formal education, China had made tain that it was unheard of in China such progress in medical education until the middle of the sixteenth and examination. century and that it was introduced During the Ming dynasty (1368- into Canton by Portuguese from 1644 a .d .), the “Synopsis of Ancient India. “The descriptions of this disease Herbals” was published. This impor- were very accurate and illumi- tant work was compiled by a district nating and in one interesting mono- magistrate in , and graph, written in 1631, the various consists of 52 books. manifestations and hereditary trans- All known works on materia medica, mission of syphilis are mentioned in to the number of 41 were consulted, while full detail.” ~ references to 360 treatises and 591 other 4. The Moder n Perio d : The last scientific and historical works were freely of the Chinese imperial dynasties, made. There are 71,096 formulae given the Manchu, came into power in in this work and the substances enumer- 1644. By this time, Westerners were ated include 1892 kinds. These are already in the land, the Portuguese arranged in sixty-great classes under having reached Canton in 1516, the sixteen orders. This treatise is one of the Spaniards and Dutch a little later most popular and important books in and the English in 1622. Undoubtedly Chinese medical literature and merits many of the foreign commercial the praise accorded to it by doctors as groups brought ship’s physicians with well as laymen. them; while the Jesuits, who first Published in 1590, no medical refer- appeared in Peking in 1581, had not ence book in the western world begins a few scientists in their number, men to wield such influence in its field familiar with aspects of botany and as this work on materia medica does chemistry, as well as with mathe- in China. It is more than probable matics and astronomy. Some of them that pharmacological studies, based received high honor at the court of on suggestions from this and similar K’ang Hsi, who came to the throne Chinese works, will enrich the world’s in 1662 and reigned for sixty years. knowledge of potent pharmacals. We Falling seriously ill with malaria in find reference in this work, for ex- 1698, he sent for his Jesuit friends, ample, to a plant called Ma-huang, who were reputed to have secured a or ephedra vulgaris, that grows wild potent bark from Peru, one that was on the hills of . The said to be of great value in cases of ague. Much against the wishes of the hospitals in until his court officials, the Emperor insisted death in 1878. on taking the bark under the guidance The first Western physician to settle of a Jesuit father. He was completely in Canton and to launch a permanent cured and presented to the religious hospital work was Dr. Peter Parker, a order a splendid site in the capital, graduate of Yale, who reached China where one of their largest cathedrals about 1835 and is known as the man now stands. More than this, the that “opened China at the point of Emperor was a patron of the arts the lancet.” He was the first of a long throughout his reign, many medical line of medical missionaries, men publications being issued with his with the pioneer spirit that would approval. These were, however, com- not be discouraged by the difficulties pilations for the most part, rather and obstacles they constantly en- than original works. countered. The establishment of mod- The eighteenth century was one of ern medicine in China is due, in large comparative isolation against the part, to their ceaseless activity in West, but by 1805 an English phy- starting hospitals and dispensaries sician, Dr. Hobson, is reported to and in breaking down the almost have visited Canton, although Dr. universal suspicion that met them Thomas R. Colledge, a physician wherever they went. The old Chinese of the East India Company, was systems of medicine have been so undoubtedly the first to establish a deeply intrenched in the popular there. confidence, that the countless in- In May 1806 the modern method of novations proposed by the foreigner vaccination was introduced into China aroused fear and hostility that cost via the Philippines and Macao. It not a few medical lives. Surgery is noteworthy “that a century before was undoubtedly the most dramatic Jenner’s epoch-making discovery, the aid the Western doctor used in getting Chinese seem to have had an idea of established; and even today the aver- vaccination, for in the Synopsis of age Chinese citizen, intellectual or Ancient Herbals the use of cow fleas illiterate, will tell you that he has is described as a method of preventing great admiration for the surgical smallpox.” It was believed that the procedures of the foreign doctor, but fleas of a cow suffering with vaccinia that when it comes to internal medi- might be used to immunize a human cine, he believes the Chinese doctor individual. This treatment is said to the better able to understand and have become very popular. treat his malady. By 1844 the first Chinese student, With the opening of the twentieth C. H. Wong, was ready to go abroad century, great strides began to be for the study of Western medicine, made by modern medicine. For one travelling to the United States with thing, Japan, which had already made his schoolmaster, the Rev. Samuel R. German medicine its state model, Brown. After studying here for four began to graduate in its Grade b years, he went to Edinburgh and medical schools, numbers of alert received his medical degree there in young Chinese. Returning to their 1855. Two years later he returned to own country, this Japan-trained group China and worked assiduously in acquired political influence and ex- erted it, frequently in opposition tant botanical specimen into the an- to the Western-trained physicians, cient empire. Alfalfa proved to be not whether Chinese or Westerners. It only food for horses but was used in will take half a century to reconcile a number of ways in the Chinese the conflicting interests represented pharmacopoeia. From the capital it in such a situation, for the early spread all over the north of China and group that received its medical train- in recent years has been carried to ing in Japan, was unprepared in Russia. Singularly enough, the Chi- basic science, studied superficially nese word for alfalfa is mu-su, taken while there, and returned with little directly from the Iranic word, proba- or no clinical experience after grad- bly muk-suk. General Chang also uation. Even today there are two brought the grape to China in 128 b .c . national medical associations, one Through the centuries other ex- founded by those trained in Japan, changes have occurred. We know and the other by those trained either that the peach and apricot originated in Europe and America, or under in China and were carried thence W estern doctors who taught them in to the West and South. Camphor China. and cinnamon, cassia and rhubarb, were drugs highly prized in China iii. The Chi ne se Phar maco poei a and regarded in other countries as Berthold Laufer of Chicago has of better quality if they came from placed us under a great debt by China. In 1562 Garcia da Orta said his studies of Chinese medicine that the best rhubarb in Persia came and particularly by his monograph from China. entitled “ Sino-Iranica,” in which he In the Chinese pharmacopoeia we describes the exchanges between an- find many others of our familiar cient Iran and China, of material medicaments, such as saltpetre and products such as silk, bamboo, etc., sarsaparilla, calomel and red oxide as well as pharmacopoeial articles. of mercury. The latter was sent as a The Emperor Wu (140 to 87 b .c .), tribute to the imperial house each for instance, greatly desired to possess year from a district in the west of the fine thoroughbred horses of Iran Hunan province, where an abundant and sent General Chang Kien on a supply has always been available. memorable expedition to Fergana in Other drugs that have been promi- 126 b .c . to get them. Returning nent in the Chinese pharmacopoeia with the splendid animals, which are asafoetida, which is used for were believed to have been the off- chorea, for syphilis and as a vermi- spring of a heavenly breed, General fuge; galls, which are used both in Chang, who was a practical man, ointment form and internally; mus- concluded “that if these much coveted tard; castor oil; balsam; nux vomica horses were to continue to thrive on and many aromatics. Chinese soil, their staple food, alfalfa, Tea has had many uses in the phar- had to go along with them.” He there- macopoeia. The pomegranate is an fore took from Iran to China the illustration of the way in which seeds of alfalfa, planted these on wide ancient China mixed objective facts tracts of land near the imperial and symbolism. It is said to have palaces and thus introduced an impor- been brought to China from ancient Iran and found its way into the federation of medical missionary Chinese pharmacopoeia. More than teaching units; the St. Johns Medi- this, however, because of its exuberant cal School in Shanghai; the Medical seeds, it is regarded as an emblem School of Shantung Christian Univer- alluding to numerous progeny. It has sity in Tsinan; the Medical School become a symbol opposed to race- of Nanking University; and the West suicide. Two pomegranates were pre- China Medical School in Chengtu. sented to King Ngan-tch when he was Two cooperative schools were also being married. It was explained that under way, including the Hunan-Yale the pomegranate enclosed many seeds Medical College in Changsha, and the and implied the wish for many sons Kung-Yee Medical School in Canton. and grandsons. The fruit is still a Soon after 1915 the institution favorite marriage gift. in Peking was taken over by the Rockefeller Foundation which built a iv. Mode rn Med ic in e in Chi na Tod ay magnificent medical school and hospi- The noteworthy facts regarding tal plant in the national capital, modern medicine in China today are preserving the old name of Peking that medical education is well Union Medical College. Formally launched, that there is already at opened on September 15, 1921, this work a goodly number of trained institution represents the highest physicians, quite an army of nurses ideals of medical education and prac- and a few public health workers, tice and serves as a center where already leavening the social order. Chinese students may go to receive Through the past decades, every the .best possible training for the Western physician who conducted profession and where physicians of hospital work in China gave informal any nationality, practicing in China, training to such men as he could may go from time to time to renew gather about him. It was these medi- their strength. cal missionaries who laid the founda- The day of western leadership in tion of modern medical education in medicine in China has well-nigh passed China. Gradually, formal teaching by. Westerners are needed, however, was introduced. to cooperate with the Chinese in By 1915 several modern schools clinical work, in medical teaching, were under way. The Chinese group in research, in education and included a National Medical School in public health work. The field of in Peking, a provincial school in opportunity is boundless. China offers Soochow, one in Hangchow, one in a tremendously attractive opportu- Canton and certain others. The medi- nity for men and women of science who cal missionary schools included the desire to search, to practice, and to Peking Union College formed by a prevent, in the field of medicine.