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Full text of "China and modern medicine: a study in medical missionary development"

CHINA AND 
MODERN MEDICINE 

A STUDY IN MEDICAL 
MISSIONARY DEVELOPMENT 






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Thomas Richardson Colledge, M.D., F.R.S.E. 



FOUNDER OF THE FIRST VOLUNTARY HOSPITAL ESTABLISHED IN CHINA 
— THE OPHTHALMIC HOSPITAL, MACAO 

F7om the paititing by G. Chinnery 



CHINA AND 
MODERN MEDICINE 

A STUDY IN MEDICAL 
MISSIONARY DEVELOPMENT 

BY 

HAROLD BALME 

F.R.C.S.(Eng.), d.p.h. 

President {formerly Dean of the School of Medici i/e) 
Shantung Christian University, Tsinan, China 



WITH PREFACE BY 
SIR DONALD MagALISTER, K.G.B., M.D. 

President of the General Council of Medical Education 

and Registration of the United Kingdom 

Principal and Vice-Chancellor of the University of Glasgow 



LONDON 

UNITED COUNCIL FOR MISSIONARY EDUCATION 

EDINBURGH HOUSE, 2 EATON GATE, S.WM 

1921 



First Edition, June 1921 
Second Edition, November 1921 

.63 



TO 

MY WIFE 

AND 

MY TSINAN COLLEAGUES 



PREFACE 

By Sir Donald MacAlister, K.C.B., M.D. 

In these unrestful times, when faith is apt to 
faint and love to wax cold, the story unfolded in 
this book will come to many a perplexed Christian 
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." 
Even the brave are daunted and the wise are 
baffled by the outlook. The believer in the 
Fatherhood of God and the Brotherhood of Man 
is hard put to it to vindicate his creed. He knows 
that for lack of that vision the peoples are perish- 
ing about him, but for the time he feels powerless 
to reveal or revive it. He shrinks from 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 for a while from his misgivings 
for Europe to the history of Christian medical 
missions in China, as it is set forth in the following 
pages, and he will take heart again. A hundred 
years ago no human enterprise could have seemed 
more hopeless than the physical and spiritual 
transformation of China. Millions were in soul 



6 CHINA AND MODERN MEDICINE 

and body sick unto death ; but the science of 
healing was unknown, while its native practice 
was discredited, and indeed discreditable. Dis- 
interested service and sacrifice for the sake of 
Christian ideals was a motive scouted by the 
rulers and unthinkable by the masses. The vast- 
ness of China's territory and population, the 
antiquity of her traditions, her inveterate social 
habits, and her stolid contempt for western in- 
novation, made the project of the first adventurers 
for the uplifting of China seem to the worldly- 
wise merely fantastic. The hope of the little 
band of Christian pioneers, that their efforts 
would one day raise the mighty mass of China to 
a higher level, that their teaching and practice 
would in the end leaven the inert lump of its 
pride and prejudice, was regarded even by many 
western Churches as a fond illusion. 

The task set before these pioneers, inspired as 
they were by trust in God and compassion for 
men, was indeed harder and less promising than 
that of reconstructing European Christendom to- 
day. But in faith they faced it, and their faith 
has not been belied. This book shows, for our 
example and encouragement under stress of evil 
days, the huge difficulty of their undertaking, 
the spirit and method of their effort, and the 
measure and promise of their triumph. 

Two points in the " method " I would lay 
stress upon. They are set out in the statement 



PREFACE 7 

of the original " Medical Missionary Society in 
China " by its first President, Thomas Richardson 
Colledge, M.D., Aberdeen. Among its aims were 
these : — 

1. To encourage Western Medicine among the 

Chinese, and afford an opportunity for 
Christian philanthropy and service. . . . 

2. To educate Chinese youths in Western 

Medicine. 

First, 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 of God and 
to cure the sick." His mission was tw^ofold : a 
mission of healing, affording him " an opportunity 
of Christian philanthropy and service " ; and a 
mission of teaching, whereby he proclaimed the 
true motive of such service to be that befitting a 
son of God and a follower of Christ. His faith 
and his works had to be of a piece ; they had a 
common groundwork, and each reinforced the 
other. 

It is of high importance that the blessings of 
medical and hygienic science shall continue to be 
associated in the mind of China with the Christian 
ideals of brotherhood and service. Corporate 
responsibility for the welfare of individuals, the 
duty of each to safeguard the public health of the 
community, are still novel conceptions in Chinese 



8 CHINA AND MODERN MEDICINE 

life. It is necessary to real progress that they 
shall be assimilated and become operative. 

Secondly, no medical mission is complete which 
does not provide for training Chinese practitioners 
as well as for treating Chinese patients. Scientific 
medicine in China must not continue indefinitely 
to be a " foreign doctrine." The medical pro- 
fession of China must become national if it is 
to be universally accepted. To build up, on the 
best and surest foundations, a Chinese medical 
profession which shall be instructed in the 
soundest knowledge of the West and capable of 
advancing it, and which at the same time shall be 
imbued with the spirit and ethics of Christianity, 
has become the conscious aim of the foremost 
Christian Medical Schools of China. From small 
beginnings they have grown in some happy in- 
stances into great institutions. These vie with 
the best of other countries in the scope and 
standard of their instruction, and they are able, 
if at this juncture they receive fuller support and 
sympathy from Western Christendom, to render 
a unique service not only to China but to civili- 
zation. Barely half a century ago Japanese 
medicine was simply receptive of what the West 
could teach ; it is now making valuable con- 
tributions of its own to the common stock. 
There is no doubt whatever that Chinese medicine, 
guided into the true path by the devotion of men 
like Professor Balme and his colleagues, will in 



PREFACE 9 

due course enrich the science of the world with 
new discoveries in China's own immense and un- 
explored fields. The time is therefore opportune 
for helping the Medical Colleges of China to fulfil 
their high mission of sowing the good seed ; and, 
for earnest that the harvest will be plenteous on 
such a soil, the growth and development of the 
scantily-furnished medical missions here recorded 
should be more than enough. The labourers are 
still too few. But the promise of the future 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 PREFACE 

The privilege of introducing the benefits of 
modern medicine to the Chinese people during 
the past century has been shared, for the most 
part, by the representatives of medical missions, 
and this book is a humble attempt to sketch 
some of the main lines of development which 
have been followed in connection with that 
enterprise. It does not claim to be a history of 
modern medicine in China, nor does it offer a 
comprehensive review of the various activities 
which have been connected with medical mis- 
sionary work in different parts of the country. 
Limitations of space have made it impossible 
to do more than refer to some of the leading 
features which have characterized this effort ; 
and as a result a large number of interesting 
facts have had to be omitted. Moreover, the 
difficulties under which the book has been written, 
owing to a temporary absence from China and 
to the constraints of an inexorable time-limit, 
have still further increased the possibility of 
serious omissions : a sincere apology is offered 
if such have occurred. 

The book could not have been produced at 
all had it not been for the generous assistance 
afforded by the Secretaries of 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 
are due to Mr C. H. Fahs, B.A., Librarian of the 
New York Missionary Research Library, for his 
indefatigable efforts in procuring sources of 
information ; to Mr Lionel Colledge, F.R.C.S., 
for his kindness in supplying details of the life 
of his distinguished grandfather and in granting 
permission for the reproduction of Chinnery's 
famous painting ; to Miss E. J. Haward, formerly 
Matron of the Peking Union Medical College 
Hospital, and Miss Batty, Secretary of the 
Nurses' Association of China, for their generous 
assistance in the preparation of material for the 
chapter on nursing ; to Drs A. C. Hutcheson 
and J. L. Maxwell, Jr., for valuable information 
regarding the progress of medical research in 
China ; to Rev. William Paton, Rev. Nelson 
Bitton, Dr R. Fletcher Moorshead and Dr H. 
Melville Churchill, for their helpful comments 
and suggestions ; to the Women's Foreign 
Missionary Society of the Methodist Episcopal 
Church, U.S.A., and the Master of Emmanuel 
College, Cambridge, for permission to reproduce 
photographs ; and, most of all, to Mr T. R. W. 
Lunt, late editor of the United Council for Mis- 
sionary Education, for his invaluable literary 
criticism and inspiring counsel. 

H. BALME 

LONDON; April 1921 



CONTENTS 



PAGE 

Preface by Sir Donald MacAlister, K.C.B., M.D, . o 

Author's Preface ....... 10 

CHAPTER I 

THE RATIONALE OF MEDICAL MISSIONS 

The characteristic features of modem medicine — Its demand for exact 
scientific truth — Its emphasis on principle of trusteeship — Chinese medicine 
in olden time — Its limitations to-day owing to ignorance of basic sciences — 
Its failure to develop sense of trusteeship — Consequent widespread sufiering 
in China — The special contribution of medical missions — Their objective 
and the methods of attainment 15 

CHAPTER II 

THE COMING OF THE WESTERN PHYSICIAN 

The first pioneers, CoUedge and Parker — Striking success of their work — 
Their conception of content of medical missionary programme — Foundation 
of Medical Missionary Society in China — Lockhart and Hobson — First trans- 
lation of medical books into Chinese — Extension of medical effort along sea- 
coast provinces — Extension inland — Co-operation of general medical practi- 
tionere— The first women physicians 36 

CHAPTER III 

METHODS OF APPROACH 

Problems confronting the medical pioneers — The redemption of the medical 
reputation — The overcoming of hostility and prejudice — Disabilities from 
inadequate staff and equipment — The methods of the pioneer doctor — The 
function of the out-patient department — How it should be conducted — The 
vastness of the untouched territory — Methods of reaching new sections of 
community 60 

CHAPTER IV 

THE EVOLUTION OF THE HOSPITAL 

Treatment of sick in China — The old-time hospital and its handicap — Its 
value — The cultivation of goodwill — Surgical successes — Spiritual influence 
— Development of special hospitals — The true function of a mission hospital 
— Its educative side — The China Medical Missionary Association — Evolution 
of the modem hospital— Inadequate facilities in many mission hospitals 82 

12 



CONTENTS 18 



CHAPTER V 

THE NEW PROFESSION IN CHINA 

Early attempts at medical education — Apprentice method — Classes for 
student assistants — First Medical College — Development of union effort in 
medical education — Medical colleges for women — The founding of the China 
Medical Board — Medical instruction in Mandarin — The Council on Medical 
Education — The question of a double standard — Premedical instruction — 
Preparation of a scientific literature — Attitude of the Chinese Government . 107 

CHAPTER VI 

THE ADVENT OF THE CHINESE NURSE 

The old-time hospital from the nurse's standpoint — Problems facing the 
pioneer nm-se — Ward orderlies and their limitations — Early attempts at 
training — Recent developments — Characteristics of Chinese nurse — The 
Nurses' Association of China — Male nurses' work — Maternity training . 134 

CHAPTER VII 

RESEARCH AND PUBLIC HEALTH 

Difficulties of research in China — The attitude of the people — Lack of 
facilities or leisure — Early efforts — Historical investigations — Chinese 
Materia Medica — Anatomical and physiological investigations — Clinical and 
pathological research — Diseases prevalent in China — The importance of 
public health measures — Methods employed— The field for preventive 
medicine 154 

CHAPTER VIII 

THE OUTLOOK TO-DAY 

Effect of western medicine in China — Quantitative results meagre — In- 
fluence of western physician far-reaching-^New attitude towards foreigners — 
Extension of Christian influence— Awakening of social conscience — Oppor- 
tunities for co-operation with Chinese — The policy of the future — Chinese 
leadership — The medical mission as a model — What the new policy requires 180 

Appendices — 

i. bibliogeaphy . . ..... 207 



II. INFORMATION REGAEDING MEDICAL MISSION SERVICE 
IN CHINA ...... 

in. CHINA MEDICAL MISSIONARY ASSOCIATION 

IV. NATIONAL MEDICAL ASSOCIATION OF CHINA . 

V. MEDICAL CURRICULUM IN CHINA . 
VI. nurses' ASSOCIATION OF CHINA , 



Index 



212 
215 
216 
217 
219 

221 



Map End Paper 



When we glance backward at the history of medicine, 
those mighty in medical art and science, though long dead, 
are conjured up before us, and pass on as a panorama. A 
grave-looking Chinaman seems to take the lead ; the shadowy 
form of some Egyptian priests, and some Grecian priests 
headed by Aesculapius, scarcely less shadowy, follow ; then 
come the silent and deeply contemplative Pythagoras and his 
disciples ; next come the Cnidians and the Asclepiades, mth 
Hippocrates at their head. Socrates, Plato, and Aristotle 
bring up the rear of this group. Afterwards come the disciples 
of the Alexandrian schools, with those of Pergamus — Galen, 
Celsus, etc. Then follow the Arabians, with Rhazeres at 
their head, in the ninth century. 

It is a strange and motley array ; cowled priests, short- 
frooked bath-men and barbers, hooded women, gowned and 
bearded necromancers, with the symbols of Astrology and 
Christianity on their banners. The panorama moves on ; 
light begins to dawn. Galileo, Bacon, Vesalius, Harvey, 
Sydenham, Hunter, and Jenner, with other names as famiUar, 
appear on the scene ; while, intermingled with these great 
and good men, come Rosicruoians and pretenders. Alchemists 
and HumoraUsts, Solidists and Chronothermalists, mesmerists, 
and fantastic dreamers of all sorts. 

—James Henderson, M.D., F.R.C.S.E., 1864. 



14 



CHAPTER I 

THE RATIONALE OF MEDICAL MISSIONS 

That He might be the lirstbom of a great brotherhood. 
Romans viii. 29 (Moffatt's Version) 



It may not be possible to speak with exact pre- 
cision as to what we would all imply by Modern 
Medicine, or as to the particular number of 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 for exact truth in the investiga- 
tion and treatment of disease, and its employment 
of every known form of science in the attainment 
of that ideal. 

It is easy for us to smile at the queer fantastic 
notions of the Chinese physician, with his strange 
ideas as to the causation of bodily disorders and 
his ingenious classification of 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 
physiology of that time, or any work on the 

16 



16 CHINA AND MODERN MEDICINE 

etiology of disease, and you will find a medley of 
empirical observation and superstitious theory, 
with many an amusing reference to the various 
" humours " which affect the functions of the 
body. 

But no sooner did physicians learn to yoke to 
the chariot-wheels of medicine the vital forces of 
natural science, with its insistent demand for the 
truth, than the old order began to pass away, 
and the era of modern medicine was ushered in. 
It was no longer of any avail to indulge in plausible 
theories as to the functions of the different organs 
of the body. The test-tube of the chemist and 
the experimental observation of the physiologist 
were henceforth to be sole arbiter and judge. 
It was idle to draw fancy pictures as to the 
supposed location of artery and nerve, of viscus 
and gland, for the keen scalpel of the dissector 
was laying each structure bare. It was futile to 
speculate as to the processes of disease, based 
upon an alleged interpretation of a patient's 
feelings and fancies, when the expert pathologist 
could unfold the whole story by autopsy and 
microscope, and ruthlessly expose every incorrect 
deduction. 

What a tremendous change has been brought 
about ! How wonderful is the new conception 
of the growth and development of the human 
body since first we summoned bio-chemistry and 
physical chemistry to our aid, and were taught 



RATIONALE OF MEDICAL MISSIONS 17 

to understand something of the function of the 
endocrine glands. How complex and fascinating 
is the study of the processes of digestion and in- 
digestion now that we have learned to appreciate 
the action of enzymes and vitamines. As for 
medicine and surgery, and the vast field of pre- 
ventive medicine, all have been utterly revolu- 
tionized since bacteriology, serology, and radiology 
began to shed their wondrous light upon them, 
and to open up new vistas where formerly all 
was dim and uncertain. 

It is a magnificent fight that has been going on 
— ^this fight for exact scientific truth — and though 
there still are innumerable regions to be explored 
and conquered it may confidently be asserted 
that the struggle for this great ideal has now 
been won, and that no one to-day can claim to 
be an exponent of modern medicine who has 
not inscribed this emblem of Truth upon his 
banner. 

There is a second great ideal which, while not 
perhaps entirely confined to modern times, may 
also be claimed as one of the greatest contributions 
which western medicine has had to offer to the 
world. This is the conception of trusteeship, in 
relation both to medical knowledge and to the 
care of the sick. 

The doctrine of mandates, as at present under- 
stood, is a direct product of those newer ideas 
of international responsibility which have found 



18 CHINA AND MODERN MEDICINE 

their expression in the League of Nations. But 
the application of 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 
to the causation and treatment of disease, were 
the common heritage of every practitioner of 
medicine, and not the private monopoly of the 
discoverer himself. And when one begins to 
consider the implications of that teaching — 
particularly against the background of those 
countries where no such doctrine has ever been 
taught — the immense potentiality of such a 
truly Christian conception at once seizes the 
imagination. 

Think for a moment where medicine would be 
to-day if Jenner had set up a private consulting 
room for the practice of vaccination, and had 
never made it possible for others to share in 
his discovery. Think of the appalling and un- 
necessary suffering that hundreds of thousands 
would have endured if Morton and Simpson had 
appropriated to themselves the sole right to the 
administration of anaesthetics, the secret of 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 
triumphs of modern medicine, had it not been 
for the fact that this conception of trusteeship 



RATIONALE OF MEDICAL MISSIONS 19 

has been the dominating ideal of every medical 
investigator of modern times ? 

Nor was it only in the realm of medical dis- 
covery that this new ideal became operative. In 
spite of certain regrettable exceptions, the sense 
of trusteeship has gradually become the funda- 
mental conception governing the attitude of 
physician and nurse towards their patient, with 
the result that everything connected with the 
sick man — his health, his life, his very confidence 
— is regarded as a sacred trust, for which his 
doctor is answerable to God and to his fellows. 
It is around this central thought that the whole 
of our modern system of medical and nursing 
ethics has been built up. Hospitals and dis- 
pensaries, Red Cross Societies and asylums, have 
all alike been organized as an embodiment of 
this creed. And the faithful work of every 
conscientious physician and nurse has been an 
exposition of this underlying sense of personal 
responsibility for the patient's welfare. 

II 

It is as one comes to study the civilization and 
progress of other lands, and to appreciate the 
appalling loss, both to health and to general 
knowledge, w^hich the absence of these two domin- 
ating ideals means, that one first learns to estimate 
them at their true worth. No close observer of 
Chinese life and thought can fail to be astonished 



20 CHINA AND MODERN MEDICINE 

that a country of such magnificent history and 
such ancient civilization, and a people with such 
reverence for scholarship, should be left so far 
behind by the nations of the West in all matters 
of 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 of 
scientific medical education ; that a land where 
benevolence has been held up as a primary virtue 
should be devoid of hospitals ; and that a people 
who have set so great a store upon knowledge 
should 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 
medical profession, as we understand the term ; 
there were no restrictive regulations to safeguard 
the practice of medicine, and no authority which 
could prevent any illiterate adventurer who 
wished to do so from hanging out a doctor's sign, 
and preying upon the credulity of the public. ^ 

How may this be accounted for ? May it not 

1 " The profession of medicine is considered an excellent conduit, 
or waste pipe, to carry off all the literary bachelors who cannot 
attain to the superior grades, or pretend to the mandarinate ; 
and China is consequently swarming with doctors, even without 
counting the almost innumerable amateurs, for . . . almost every 
Chinese has a smattering of medical knowledge, and the smallest 
village boasts several professional practitioners." — M. L'Abbe Hue, 
Christianity in China, Tartary and Thibet, vol. iii. p. 209. 



RATIONALE OF MEDICAL MISSIONS 21 

all be explained by the lack of those two great 
ideals, which, as we have seen, have done so much 
to build up the tradition of medicine in western 
countries ? Centuries ago, when a shrewd ob- 
servation of human nature and an empirical 
knowledge of the use of drugs formed practically 
the only stock-in-trade of the physician in any 
part of the world, China was not far behind any 
other country in medical knowledge — in fact, in 
some respects she was actually leading the way. 
Two thousand years before the birth of Christ 
the Chinese medical teachers were accurately 
describing the symptoms of cholera. Seven 
hundred years before the value of inoculation 
against smallpox was recognized in this country 
it was freely practised in China. The uses of 
mercury, of arsenic, of rhubarb, and of numberless 
other medicaments, have been known for centuries 
among the Chinese. And even such essentially 
"modern" ideas as the importance of clean, airy, 
and well -lighted rooms, and the value of quietness, 
are referred to by Lew-Ian in the regulations which 
he drew up for the treatment of smallpox nearly 
two hundred years ago, and which were published 
in the Golden Mirror of Medical Practice. 

But in spite of this promising beginning, the 
application of natural science to medicine never 
reached China, and even so fundamental a physio- 
logical fact as the circulation of the blood was 
not even guessed at by a Chinese practitioner. 



22 CHINA AND MODERN MEDICINE 

The superstitious ideas regarding the dead body 
made the practice of dissection an impossibility. 
These things, together with complete ignorance as 
to the use of the microscope or the principles of 
chemistry and physics, necessarily resulted in the 
most erroneous ideas becoming current as to what 
took place within the human organism ; whilst 
the absence of any system of examinations, or 
other qualifications for medical practice, made 
the widespread exploitation of the profession not 
only possible but inevitable. Perhaps it was due 
to this fact that in the Chou dynasty, 1249-1122 
B.C., the public were warned against swallowing 
the medicine of any physician whose family had 
not been in practice for at least three generations ; 
whilst at the same time it was decreed that all 
medicine administered to a ruler of the state 
must first be tasted by the Prime Minister .^ A 
new use for that influential statesman, and pos- 
sibly a novel means of removing him from office ! 

Such conditions made the formation of a real 
medical profession an utter impossibility, with the 
result that any knowledge accumulated in course 
of years by a practitioner of 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 of those 
old Chinese physicians, by dint of careful observa- 

* Historic China, by H. A. Giles, p. 10. 



RATIONALE OF MEDICAL MISSIONS 23 

tion, gathered together in course of time a mass of 
valuable information as to the symptoms of various 
diseases, and the action of the chief drugs in the 
pharmacopoeia. Their knowledge may have been 
empirical, and difficult of explanation in terms of 
modern science, but much of it would undoubtedly 
be accurate, and of great benefit to the patient. 
Unfortunately most of this information has been 
lost to the world, for the reasons above stated, 
and such secrets as still remain are exceedingly 
difficult of discovery. 

Often, too, the Chinese physician compensated 
for his ignorance of exact science by a ruminating 
philosophy and a profound study of human nature. 
An amusing instance of this left me with a very 
deep admiration for 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 of the bodyguard 
of one of the provincial governors. He was a 
magnificent specimen of physical strength, a man 
who, when carrying important despatches to and 
from Peking, would think nothing of riding sixty 
or eighty miles a day on the relay of ponies pro- 
vided for him. He was a member of the Christian 
Church, and a man who was looked up to by all 
who knew him. But, alas, he became a victim to 
cancer of the stomach, and by the time he con- 
sulted me about his symptoms^ eH isppe^f effecting 






24 CHINA AND MODERN MEDICINE 

a cure had gone. A hard tumour had formed 
which was firmly fixed, and already giving signs 
of secondary growths, whilst the poor man could 
barely retain any kind of 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 
occasion, on visiting him, I found 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 
then, with an expressive jerk of his finger towards 
the next apartment, gave me to understand that 
there were domestic troubles afoot. His wife was 
a little bit of a thing, but the sharpness of her 
tongue was proverbial I She had never had any 
sympathy with her husband's attitude towards 
Christianity, and had thoroughly disapproved of 
his consulting a foreign doctor about his com- 
plaint ; and the trouble on this occasion had 
arisen from her insistence that he should call in 
a Chinese physician. 

On ascertaining the state of the case, I urged 
him to do as his wife suggested, and stated that 
I would be only too glad to meet such a physician 
in consultation. The matter was accordingly 
arranged, and a few days later the doctor was 
summoned. 



RATIONALE OF MEDICAL MISSIONS 25 

He was an elderly gentleman, with large horn- 
rimmed spectacles and a most impressive manner, 
and on alighting from the cart which had been 
sent for his conveyance he walked slowly and 
sedately up the path to the house. On being 
admitted, he proceeded leisurely to a chair, and 
spent the next half hour in full and earnest con- 
versation with the lady of the house, whom he 
doubtless recognized as a person of some import- 
ance. He then entered the patient's room, asked 
him a few questions as to his symptoms, and pro- 
ceeded, with utmost gravity, to feel the patient's 
pulse. First the right wrist was taken up and 
thoroughly studied and then the left, after which, 
without further examination of physical signs, he 
retired from the bedroom and commenced to 
expound the case to the wife and myself. How far 
this was done to impress the lady, and how far 
in deference to my ignorance of Chinese medicine, 
I am not in a position to say, but I rather imagine 
it was the latter. So far as I can recollect the 
incident after the lapse of some years, he pro- 
ceeded somewhat as follows : — 

" This case is a perfectly simple one, and 
presents no real difficulties at all." (This to the 
wife, who looked immensely relieved. Then, 
turning to me, he continued :) "In our under- 
standing of the human body, the state which we 
call health is dependent upon an exact balance 
being maintained between the two elements of 



26 CHINA AND MODERN MEDICINE 

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 nurtures it ; whilst the noxious 
elements, the Yin, are excreted. 

" Now this patient looks to me as though he 
had done a great deal of horse-riding " (this with 
an enquiring glance at the wife, who beamed her 
approval of such insight and intelligence), " and I 
fear that in the course of his travels he has been 
subjected to a severe strain, which has caused an 
internal twist. The result is that the Yang and 
Yin elements have been reversed, so that now the 
good food that he takes, instead of passing into 
the body, is immediately rejected as soon as 
swallowed " ! 

Who could wish for a clearer explanation than 
that ? How far more convincing than all that 
stupid talk about a carcinoma of the pylorus, 
and reversed peristalsis ! The lady's face was a 
study in vindicated prophecy ! 

I would have done well to leave the matter 
there, but unfortunately, in my ignorance, I 

1 The powers of the Yin and the Yang are popularly supposed 
in China to underlie the creative principles of the universe, and 
by their interaction to have produced and to control the forces 
operating in nature. Chinese metaphysics of the last thousand 
years have been based upon the supposedly universal operation 
of the Yin and the Yang. Geomancy and spiritism, as well as 
medicine and chemistry, have had this belief at their foundation. 



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 
Avhat I shall prescribe. But as this patient has 
already taken a great deal of foreign medicine, I 
greatly fear that the efficacy of the remedy may 
be impaired and interfered with in this particular 
case " ! 

That evidently was so, for the poor patient died 
within ten days of taking the first dose of 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 
of human nature, and that modern medicine had 
little or nothing to teach him as to the best means 
for impressing one's patients and inspiring con- 
fidence ! 

Ill 

But if the scientific ideal has been lacking 
amongst Chinese practitioners, the conception of 
trusteeship has been even more conspicuous by 
its absence. Owing in part to the failure 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 
within its ranks, the Chinese doctor, except in 
rare instances,^ never becomes a family 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 
unless perchance the family 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 
called in after him, almost as soon as his medicine 
has been sampled. 

In exactly the same way this lack of any 
conception of trusteeship — and, may we not add, 
the lack of the impelling constraint of Christian 
service — led to a complete failure to develop any 
system of hospitals, or of other institutions for the 
reception and care of the sick. It was nobody's 
responsibility to do such a thing, nor was it any- 
body's responsibility to institute measures for the 
prevention of disease or for the health of the 
community. 

^ These exceptions are chiefly the cases of notable families, 
usually belonging to the official class, who retain the services of a 
medical practitioner. Such an appointment may become hereditary, 
being handed on from father to son. 



RATIONALE OF MEDICAL MISSIONS 29 

In times of serious epidemics the Chinese have 
often improvised special expedients, in the face of 
an immediate and pressing danger, but this has 
been merely of a temporary nature, and inspired 
by motives of self-protection. There has been no 
systematic attempt to organize works of public 
beneficence, because China has lacked a religious 
dynamic of sufficient vitality and positiveness to 
give to her public and social life a sense of cor- 
porate responsibility. 

This state of things resulted in the widespread 
suffering and disease of which writers on China 
have constantly spoken — suffering and disease 
which are all the more pathetic because of the 
numerous instances in which they are due to 
entirely preventable causes. There is no sadder 
sight in China to-day than the collection of 
suffering humanity which gathers at every hospital 
clinic, and which always includes a number of 
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. 

Here, for example, is a group of children, 
totally blind, who have lost their sight during 
an attack of measles or smallpox, simply because 
there was no one at hand with the requisite know- 
ledge and skill or the requisite sense of responsi- 
bility 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 of the Chinese " bone-setter " have 
failed to reduce. Here are inoperable tumours 
that might easily have been removed — and with 
every hope of success — if the patient had only 
been in a position to receive skilled help last year 
or the year before. 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- 
flicted 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 of tetanus. 

So it passes on — this ceaseless procession of 
sufferers — until at last the physician feels perfectly 
desperate to do something which will stop this 
awful wastage of life and usefulness, and bring 
health and comfort in place of needless pain and 

disease. 

IV 

It was from sentiments such as these that the 
work of medical missions had its birth in China ; 
but, as we shall see in the following chapter, the 
men who laid the foundation of the enterprise were 
men who longed not only to stem this tide of 
human sorrow, and to offer to the Chinese those 
great ideals of truth and trusteeship which 
Chinese medicine had failed to contribute, but 
also to use the art of healing as a handmaid of 



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 
sway, where fear of evil spirits lay at the root of 
much of the hostility to western science and 
progress, where the social conscience rarely passed 
beyond the limit of family and clan and was 
insensible of civic and national obligations ; and 
where the moral beauty of the Confucian ethic 
was not commuted into the "pure religion" of 
self-sacrificing service. These great pioneers of 
modern medicine in China desired above all else 
that they might be able to make a worthy con- 
tribution to the physical needs of 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 
those founders themselves, in their first published 
paper, when they wrote : — 

Although medical truth cannot restore the sick and 
afflicted to the favour of God ; yet, perchance, the spirit of 
enquiry about it, once awakened, will not sleep till it enquires 
after the Source of truth ; and he" who comes with the blessings 
of health may prove an angel of mercy to point to the Lamb 
of God. 

At any rate, this seems the only open door ; let us enter 
it ; loathsome disease in every hopeless form has uttered her 
cry for reUef from every corner of the land ; we have heard 
it, and would and must essay its healing. A faith that 
worketh not may wait for other doors. None can deny that 



32 CHINA AND MODERN MEDICINE 

this is a way of charity that worketh no ill, and our duty to 
walk in it seems plain and imperative.^ 

Such men as these could never be content 
merely to relieve the external conditions which 
they saw around them. Nothing would suffice 
but to bring the whole message of God's love and 
compassion, as Jesus taught it, to bear upon this 
barren situation. With this before them they 
deliberately set about the twofold task, to 
alleviate suffering and wretchedness wherever it 
was found, and thereby to prepare a way for 
the whole gospel of God's goodness. In doing so 
they quickly proved, not only that they were 
blazing a trail for the preacher, but that their 
ministry of healing was itself an exposition of 
the Christian message which even the dullest or 
most hostile could understand. 

Every missionary doctor and nurse goes to this 
work with the primary purpose of bringing the 
blessings of the Gospel to those who have never 
before heard of the coming of Jesus Christ. They 
would not call themselves missionaries if it were 
not for this. Similarly, everything that is done 
in the mission hospital or Christian medical 
college is done with the single object of repre- 
senting and interpreting the Christian message to 
those who have never understood it. But so far 
from the work of healing being regarded as a 

^ Original suggestions for the formation of a Medical Missionary 
Society in China. 1836. 



RATIONALE OF MEDICAL MISSIONS 33 

mere means to an end — to be laid aside, presum- 
ably, as soon as that end is attained — every 
missionary doctor and nurse regards his pro- 
fession as an integral and essential part of the 
presentation of Christianity itself. They believe 
that in this they are following the example of the 
Great Physician, who can never be accused of 
using His gifts of healing as an advertisement for 
His message. 

" The Master's philanthropy," as the late Dr 
S. R. Hodge wrote thirty years ago, " went hand 
in hand with His preaching of the Kingdom, and 
for Him there was but one philanthropy — a love 
to the complete man, body, soul and spirit. There 
never was by Him, and there never can be by 
us, a splitting up of the Church's mission into 
evangelistic and philanthropic. The gospel is 
good news to the whole man, and when John sent 
to enquire whether Jesus was ' He that should 
come,' he was pointed to the twofold witness of 
healing and preaching.'" ^ 

The same idea was succinctly expressed by the 
China Centenary Conference at Shanghai in 1907 
in the following words : — 

Medical missions are not merely an adjunct, but an integral 
and co-ordinate part of the missionary work of the Christian 
Church. 2 

The aim of medical missions may therefore be 

1 China Medical Journal^ September 1891. 

2 Eesolutions of Centenary Conference, Shanghai, 1907. 

B 



34 CHINA AND MODERN MEDICINE 

stated as being nothing less than an attempt to 
offer, in the Name and for the sake of Jesus Christ, 
all those blessings to body and soul which have 
come to us through His Example, His Life and His 
Death. As He gave perfect healing and restora- 
tion to health and activity, so the medical mis- 
sionary of to-day seeks to carry with him the very 
best that modern medical science has to offer, in 
the careful investigation and treatment of all 
manner of disease. As He manifested a new 
spirit, of gentleness, of concern, of willingness to 
touch the most loathsome, so the medical man 
who calls himself by His Name seek? to act as 
He did, and so to represent Him. As He trained 
His followers in service, so the missionary doctor 
and nurse regard as one of their chief tasks the 
training of their Christian helpers in a like con- 
ception of disinterested service and self-sacrifice. 
And, just as He taught that the greatest need of 
man was not physical but spiritual — the restora- 
tion of 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 
made possible for all. 

It is in the quest of this objective that medical 
missions have been the pioneers of modem 
medicine in every part of China. It is this aim 
which has led to the establishment of medical 
colleges and nurses' training schools, to the under- 



RATIONALE OF MEDICAL MISSIONS 35 

taking of scientific investigation and the trans- 
lation of medical text-books, to the initiating of 
public health reforms and the education of 
public opinion in the prevention of disease ; as 
well as to those other activities of which subsequent 
chapters will treat. 

The new conception of communal service and 
responsibility, so notable a feature of student life 
in China to-day, and bursting with hope for the 
future of the East, has its roots in little mission 
schools and hospitals all over China, where the 
young people of that ancient nation are learning 
at last the true meaning and obligation of brother- 
hood and the significance and the joy of unselfish 
service. 



CHAPTER II 

THE COMING OF THE WESTERN PHYSICIAN 

The world is a whole : and as the human race approxi- 
mates to the perfection which it is destined to reach, the 
principle of union and fellow-feeling will become more and 
more influential. A Bacon, a Newton or a Franklin is not to 
be monopolized. Such men belong not merely to the nation 
that gave them birth, but to the whole world. . . . Upon 
those who first enjoyed the boon rests the obligation to extend 
universally their principles, which have revolutionized the 
philosophy and science of Europe, and which, whenever per- 
mitted free ingress, will produce similar results in China. . . . 
If the principle is admitted that our race is one, then the 
remoteness of the empire for which we plead cannot neutralize 
the obligation. — Colledge, Parker and Bridgman, April lith, 
1838. 

In the days, nearly a century ago, when the 
trading adventurers of all Europe were eontendmg 
for the markets of the Far East, and competing to 
develop the limitless resources of *' East India " 
and China, an old Rugby schoolboy was pushing 
his way along the streets of a busy Chinese sea- 
port. He had studied medicine after 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 for duty on the ship to which he 
was attached, and in the emergency Sir Astley 
Cooper, the famous surgeon, had confidently 

36 



COMING OF WESTERN PHYSICIAN 37 

recommended this favourite student, Thomas 
Richardson Colledge, for the post. A few 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 of Macao and in contact with 
the seething masses of Asiatic humanity which 
crowded the busy streets. 

It was an extraordinary sight that met Coll edge's 
eyes. But it was not the strangeness of the 
Chinese dress, nor their unfamiliar language, 
which most of all impressed him ; it was the 
appalling spectacle of suffering which confronted 
him on every side. Every kind of painful disease 
seemed to be represented, and what affected him 
most of all was the pathetic helplessness of the 
blind — the old man tapping his way along with 
his stick, the procession of beggars guiding one 
another's footsteps, the children clinging to the 
shadows to avoid the painful glare of the strong 
eastern sun. Such sights stirred his very soiil, 
and though there was but little he could do, he 
resolved there and then to devote as much of his 
time and money as he could to the relief of these 
sufferers. With characteristic energy he pro- 
ceeded at once to make enquiries as to the possi- 
bility of opening a hospital in the port, and before 
long — in the year 1827 — he had succeeded in 
founding the first institution ever opened in 
China for the purpose of bringing the benefits of 



38 CHINA AND MODERN MEDICINE 

western medicine to the suffering Chinese — ^the 
Macao Ophthalmic Hospital.^ 

The hospital thus established was the fore- 
runner of the great adventure of medical missions, 
which represents the most beneficent gift which 
the white man has ever had to offer to the most 
ancient civilized nation of the world. 

No wonder that fifty-two years later, looking 
back over a long life of useful service, Thomas 
Coll edge said of the hospital — or, more parti- 
cularly, of the Medical Missionary Society which 
followed it ten years later : " That was the one 
good thing of my life." And Dr Joseph Thomson, 
the careful American historian of medical work 
in China, regarded Colledge as the originator of 
medical missions in that country.^ 

In 1828, the " British Factory " being stationed 
in Canton, Dr Colledge opened a dispensary in that 
city also. A visitor thus describes the scene : — 

At an early hour in the morning one may daily witness the 
sick, the blind, and the lame, of all ages and both sexes, crowd- 
ing around the doors of the dispensary. We have seen helpless 
children brought there in the arms of their nurses, or more 
commonly, according to the custom of the country, lashed upon 
the back of a young servant. We have seen old, blind, decrepit 

^ This was not, however, quite the first introduction of western 
medicine to China. In the year 1805, Dr Alexander Pearson, 
surgeon to the East India Company, had introduced the practice 
of vaccmation, whilst in 1820, Robert Morrison and Dr Livuigston, 
also of the East India Company, had started a dispensary in 
Canton for the Chinese poor, conducted for the most part, however, 
by Chinese practitioners and with Chinese drugs. 

* China Medical Journal^ 1888, p. 41. 



COMING OF WESTERN PHYSICIAN 39 

men, with staff in hand, led thither by their little grandchildren, 
while others, who were in better circumstances, were brought in 
their sedans. The number of those who have come for aid has 
been very great, and the cures not a few.^ 

I 

Coll edge was not a medical missionary in the 
ordinary sense of the term, but he was a man of 
great devotion and piety, eager to employ his 
talents in the service of humanity and in the 
extension of the Kingdom of God. Thus it was 
that when, in the October of 1834, there landed 
in Canton the first medical missionary ever 
appointed as such by a Mission Board — Peter 
Parker, of the American Board of Commissioners 
for Foreign Missions — Colledge extended to him 
the warmest welcome, and the two men became 
fast friends. They formed a remarkable com- 
bination, and their friendship was a happy augury 
of the co-operation of Briton and American, of 
civil servant and missionary, which the future 
development of the medical missionary enter- 
prise in China was to manifest. 

Peter Parker was a Yale graduate and a 
man of striking ability and inexhaustible energy.^ 
Within a year of his arrival in China he opened, 

^ Chinese Repository, vol. ii., p. 276. 

* The biography of Peter Parker — who in later years played a 
very notable part in the relations of U.S.A. and China — will well 
repay study. It is written by the Rev. Geo. B. Stevens, D.D., 
and published by the Congregational Sunday School and Publishing 
Society, Boston, U.S.A. 



40 CHINA AND MODERN MEDICINE 

on November 4th 1835, the first Medical Mis- 
sionary Hospital of the Far East — the Ophthalmic 
Hospital, Canton, afterwards known as the 
Canton Hospital. His success was immediate 
and sweeping. He himself thus describes these 
days : — 

It was after a long effort that a place was found for a 
hospital, and when at length a suitable building was rented 
and previous notice had been given, on the first day no patients 
ventured to come, on the second day a solitary female affiicted 
with glaucoma, on the third day half a dozen, and soon they 
came in crowds. It is difficult to convey to a person who 
has not visited the hospital a just idea of them. He needs to 
be present on a day for receiving new patients, and behold 
respectable women and children assembling at the doors the 
previous evening, and sitting all night in the street that they 
might be in time to obtain an early ticket for admission. He 
need behold in the morning the long line of sedans, extending 
far in every direction ; see the officers, with their attendants ; 
observe the dense mass in the room below ; stand by during 
the examination, and giving out of tickets of admission, 
urgent cases being admitted at once, while others are directed 
to come again at a specified time. Numbers from other pro- 
vinces, from Nanking and Peking, who were resident at Canton, 
have called.^ 

But Coll edge and Parker both saw from the 
very first that if this enterprise of medical missions, 
so happily inaugurated, was to be placed upon 
a permanent and satisfactory foundation, and 
possess a definite and clear policy, it must be 
related to a proper organization. They accord- 
ingly proceeded to draw up plans for the founda- 
tion of a Medical Missionary Society, and to issue 

The Medical Missionary in China, by W. Lockhart, p. 122. 



COMING OF WESTERN PHYSICIAN 41 

" suggestions " with regard to the same. This 
great document is now unfortunately out of print, 
but the following extracts may be quoted in addi- 
tion to those already given in Chapter I ^ : 

Viewing with peculiar interest the good effects that seem 
likely to be produced by medical practice among the Chinese, 
especially as tending to bring about a more social and friendly 
intercourse between them and foreigners as well as to diffuse 
the arts and sciences of Europe and America, and in the end 
to introduce the Gospel of our Saviour in place of the pitiable 
superstitions by which their minds are now governed, we have 
resolved to attempt the formation of a society to be called the 
Medical ]\Iissionary Society in China. . . . 

All truth is of God : the introduction of medical truth 
into China would be the demoUtion of much error. As a 
means, then, to waken the dormant mind of China, may we 
not place a high value upon medical truth, and seek its intro- 
duction with a good hope of its becoming the handmaid of 
rehgious truth. . . . 

That enquiry after medical truth may be provoked, there 
is good reason to expect ; for exclusive as China is in all her 
systems, she cannot exclude disease, nor shut her people up 
from the desire of rehef . 

These suggestions were published in 1836, but 
it was not until February 21st 1838 that a public 
meeting was held in Canton at which the Society 
was definitely brought into being.^ 

The first statement published by the newly 
formed " Medical Missionary Society in China " 
in April 1838, embodying the original suggestions, 
bears eloquent testimony to the statesmanlike 

1 Vide p. 31. 

2 The first officers were: CoUedge, President; Parker, Rev. E. C. 
Bridgman, W. Jardine (of Jardine, Mathieson & Co.), and G. T, 
Lay, Vice-Presidents. 

B * 



42 CHINA AND MODERN MEDICINE 

character of the founders and their broad outlook 
upon the task of medical missions. We do well 
to study the splendid conception which these men 
held as to the aim and content of 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 

Chinese, and afford an opportunity for 
Christian philanthropy and service. 

2. To extend to the Chinese people some of 

those benefits which " science, patient in- 
vestigation, and the ever-kindling light of 
discovery, have conferred upon the West." 

3. To cultivate confidence and friendship, and 

thus introduce the Gospel of Christ in 
place of heathenism. 

4. To provoke enquiry into truth by the 

opposing of exact science to superstitious 
ignorance. 

5. To make a contribution towards the relief of 

human suffering, and the cure of loathsome 
diseases. 

6. To educate Chinese youths in western 

medicine. 

7. 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 

reputation, and patients of all classes entrusted 
themselves in his hands. Within two months of 
the opening of the Canton Hospital — in pre- 
ansesthetic days, let us remember — he is removing 
a huge and dangerous tumour weighing a pound 
and a quarter from the temple and face of a Chinese 
girl of thirteen, the child bearing the operation 
with wonderful patience and fortitude, and the 
wound healing by first intention. A year later 
he is performing the first amputation ever 
attempted on a Chinese patient (a disarticula- 
tion through the shoulder- joint for osteosarcoma of 
the humerus, which he performed in exactly one 
minute, and from which the patient recovered and 
was walking about in six days !). In 1838 he is 
successfully operating upon a large scirrhous 
cancer, whilst from another patient he removes 
an extraordinary growth which grew from beneath 
the chin and had to be supported in her lap — an 
operation which won for him the undying gratitude 
of the relatives, who presented him with a most 
eulogistic tablet.^ 

In 1844 Parker is doing his first lithotomy 
operation, and for the first time on record is able 
to give complete and permanent relief to one of 
those many sufferers from calculus who are found 

1 On visiting England in 1841 Parker brought with him a most 
interesting set of paintings of some of the surgical cases which 
he had successfully treated in Canton, given to him by a Chmese 
artist. These he presented to Guy's Hospital, where they may 
still be seen in the Gordon Museum. 



44 CHINA AND MODERN MEDICINE 

in such great numbers in the Canton area. In 
1847 he is rejoicing in being able to introduce the 
blessings of anaesthesia to the Chinese, and within 
a few months has gained such a reputation for 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 ! 

The gratitude and confidence of 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 
of one old Chinese gentleman whose sight Parker 
had been successful 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 of him : " Dr Parker opened the 
gates of China with a lancet when European 
cannon could not heave a single bar." 

During 1840 and 1841 Parker had a most 
successful tour through the United States and 
Great Britain, preaching before Congress at 
Washington, addressing large and enthusiastic 
meetings in London, Edinburgh, Glasgow, and 
Liverpool, and receiving strong support for the 
newly formed Medical Missionary Society from 
such prominent leaders as the Duke of Wellington, 
Sir Robert Peel, the Lord Provost of Edinburgh, 



COMING OF WESTERN PHYSICIAN 45 

and the Archbishop of Canterbury. It was as a 
result of this visit that the Edinburgh Medical 
Missionary Society was first founded (though 
under a different name at that time) on November 
30th, 1841, with the celebrated Dr Abercrombie 
as its first president. 



II 

Meanwhile other medical men had been arriving 
in China to take up missionary work, the most 
conspicuous being William Lockhart, F.R.C.S. in 
1838, and Benjamin Hobson, M.B. in 1839, the 
former a graduate of Guy's Hospital and the 
latter of University College, London, and both of 
them members of the London Missionary Society. 
Like Colledge and Parker before them, they were 
exceptional men. William Lockhart was a born 
pioneer. After working for a short time in Macao 
and Hongkong he proceeded farther north, and 
in 1844 he opened the first hospital in Shanghai 
and laid the foundations of one of the most 
successful medical missions in China. The Tai 
Ping Rebellion found him still at his post, and 
there he remained throughout the siege and 
capture of the city in 1853-4,^ rendering con- 
spicuous service to the hundreds of wounded for 
whom no sort of medical provision had been made. 

* It was the Triads, a section of the Revolutionaries, who actually 
captured Shanghai. 



46 CHINA AND MODERN MEDICINE 

He left Shanghai in 1857 and returned to England. 
But four years later, on the ratification of the 
Treaty of Tientsin which opened up Peking for 
foreign residence, the old pioneering instinct again 
asserted itself, and he immediately returned to 
China and opened the first mission hospital in the 
national capital. 

The great contribution of Benjamin Hobson lay 
in rather a different sphere from that of Lockhart. 
He, too, did most successful medical work, first 
in Hongkong and subsequently in the new hospital 
which he opened in the western suburbs of Canton 
(Kum-li-fow), and in Shanghai. But he soon 
recognized that the great problem of 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 of a modern medical literature. His own 
words best describe this effort. Writing on this 
subject in 1858, he says : — 

It seemed very desirable to attempt to introduce the well- 
established principles and facts of western medical science, to 
prepare the way for changes in the present system of China. 
Under this conviction a work was prepared in Canton eight 
years ago on the subject of anatomy and physiology, avoiding 
all theoretical opinions. This has been extensively read and 
very favourably received, and has proved a good foundation 
for what was to follow. 

The next treatise was on the properties of air, light, heat, 
and electricity, and the elements of astronomy and natural 
history, designed as an introduction to these varied branches 



COMING OF WESTERN PHYSICIAN 47 

of natural phenomena. This has been succeeded by a work 
on the principles and practice of surgery ; by another on 
midwifery and the diseases of children ; and by a fifth on 
the practice of medicine and materia medica, together with a 
medical vocabulary in English and Chinese, to explain and 
fix the terms used. The illustrations show at once the sub- 
jects treated of, and I have spared no pains, by the aid of an 
intelUgent assistant, to make these works accurate, perspicuous, 
and useful. 

Although attended with difficulties, it is still quite prac- 
ticable to make every subject with which we are ourselves 
acquainted as clear and expressive in Chinese as in Enghsh. 
Both religious and scientific works should, however, only be 
made by persons who have been some time in the country, 
and conversant wdth Chinese authors. The great desideratum 
for a translator is a good and fixed nomenclature on every 
branch of science. The language admits of a satisfactory 
and distinct explanation of most new terms ; where it does 
not, these must be transferred.^ 

The magnitude of Hobson's task becomes the 
more apparent when it is remembered that in 1850 
when he produced his first book there was no 
scientific background amongst the Chinese medical 
practitioners of that day, nor was there any 
scientific nomenclature in Chinese, such as he 
speaks of as the great desideratum of every trans- 
lator. In 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 
Viceroy of Canton, who had the illustrations recut, 
printed separately, and made up into rolls, in 
Chinese fashion. Each volume, as it came out, 

* The Medical Missionary in China, by W. Lockhart, p. 155. 



48 CHINA AND MODERN MEDICINE 

was republished in this way, Government officers, 
physicians, and people of every rank reading 
them, whilst the foreign merchants of Shanghai 
contributed the sum of $2,000 towards the pre- 
paration of a larger edition. 

The years that followed saw a steady extension 
of medical work to other centres, led by a suc- 
cession of men as remarkable, in many instances, 
as the first four pioneers already referred to. 

Commencing, as we have seen, with Macao, 
Canton and Hongkong, the movement soon 
spread northward and by 1842 had reached 
the important seaport of Amoy. Here Dr 
W. H. Cumming, a self-supporting American 
physician, led the van, to be followed a few 
months later by Dr J. G. Hepburn of the American 
Presbyterian Mission — the most versatile figure, 
perhaps, who has yet been seen in the Far East. 
Compelled to leave China on grounds of health 
after two years' work in Amoy, Dr Hepburn 
practised successfully as a physician in New 
York for thirteen years ; then, again hearing 
the call to the Orient, he turned his back on the 
promising career that had opened to him and 
sailed for 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- 
tinctions and honours from the Japanese Emperor, 



COMING OF WESTERN PHYSICIAN 49 

from his Alma Mater (Princeton), and from 
many other sources. ^ 

At NiNGPO, where medical work was opened 
in 1843, another great American physician who 
afterwards rendered signal service in Japan, 
Dr D. B. McCartee, was the pioneer, together 
with Dr D. J. Macgowan of the American 
(Northern) Baptist Mission. Dr McCartee's 
services to the Far East were almost as varied 
as those of Dr Hepburn. An expert linguist in 
both Chinese and Japanese (he spent no less than 
twenty-eight years in each country), a scientist 
of no mean attainment, a profound student of 
international law and a successful diplomatist, he 
served in turn as medical missionary, as consul, 
as Professor of Natural Science and Law in the 
Kasei-Gakko, Tokyo (forerunner of the Tokyo 
Imperial University), and as Foreign Adviser 
to the first Chinese Legation in Japan, and 
was largely instrumental in the establishment 
and maintenance of good relations between the 
Chinese and Japanese people. 

The first hospital at Ningpo consisted of three 
rooms in an old Taoist temple, but afterwards 
a new building was erected by Dr Macgowan, 
towards the furnishing of which the foreign 
community of Bengal contributed a large sum 
of money. An interesting feature of the work 

1 Vide Hepburn of Japan, by William Elliot Griffis, D.D., West- 
minster Press, Philadelphia, 1913. 



50 CHINA AND MODERN MEDICINE 

at Ningpo was the special course of lectures 
to Chinese practitioners of the city which Dr 
Macgowan used to give from 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 of the hospital 
to the life of the city. 

From Ningpo the new enterprise soon reached 
Shanghai. There, as we have already seen, 
it fell to William Lockhart, in 1844, to make 
the first advance, followed a few years later by 
Dr Charles Taylor of the American (Southern) 
Methodist Mission, and by Bishop Boone, M.D., 
and his son Dr H. W. Boone, founders of the 
important medical work connected with the 
American Protestant Episcopal Church. 

So the work spread, British and American 
physicians vying with one another in friendly 
rivalry, leading the pioneer movement in new 
centres. Down in Foochow it was a repre- 
sentative of the Church Missionary Society, 
Dr W. Welton, who was first in the field, in 1850, 
and the old temple which he secured as his 
first dispensary, in the teeth of fierce opposition, 
quickly became the resort of crowds of patients, 
and in the end opened the way for the remarkable 
developments of all branches of missionary 
work in that neighbourhood in later years. 
Similar foundations of a great future were surely 
laid in Swatow and Formosa, in 1863 and 



COMING OF WESTERN PHYSICIAN 51 

1865, by two well-known pioneers of the English 
Presbyterian Mission, Dr William Gauld and 
Dr James Maxwell — men who subsequently made 
noteworthy contributions to the cause of medical 
missions in Great Britain. 

During this period medical work was also 
spreading to the most northerly provinces of 
the Empire, commencing in Peking under 
William Lockhart in 1861. ^ From a humble 
beginning in some buildings belonging to the 
British Legation, with only two or three patients 
a day, he was able in two years' time to report 
a total attendance of over 10,000 separate cases 
before he handed on the work to Dr John Dudgeon. 

It was that same American physician, Dr 
McCartee, whose varied career has been briefly 
sketched above, who first brought the benefits 
of modern medicine to the people of the sacred 
province of Shantung, whilst a young Irish- 
man, Dr Joseph M. Hunter, blazed the trail in 
Manchuria. Hunter had been deeply moved 
by the last appeal of that great Scotsman, William 
Chalmers Burns, uttered as he lay dying in his 
lonely inn at Newchwang. It was this appeal 

^ It is interesting to remember that this was not the first time 
that western medicine was practised in Peking. In 1692 the 
emperor Kang-Hsi, during a severe attack of fever, was induced 
by the Jesuit missionaries to take quinine, which they were 
employing with success for similar cases in the city. This proved 
efficacious, and in gratitude for the cure the emperor gave them 
a house within the precincts of the palace. 



52 CHINA AND MODERN MEDICINE 

which led to the commencement of the work 
of the Irish Presbyterian mission in Manchuria, 
and thus paved the way for the great medical 
service rendered there during the last thirty 
or forty years by members of that mission and of 
the United Free Church of Scotland, with which 
all readers of Dr Dugald Christie's interesting 
book will be familiar.^ 

Ill 

Up to this period the opening of medical work 
had been almost entirely confined to the chief 
commercial centres on the coast and the treaty 
ports, and indeed it was not until after the treaty 
of Tientsin in 1858 that foreigners were permitted 
to travel inland. But from the 'sixties onwards, 
the great advance into the interior provinces began, 
led in most instances by members of the China 
Inland Mission. 

For years before the doors had opened James 
Hudson Taylor — most romantic of dreamers and 
most practical of saints — had been poring over 
the map of China and praying for its untouched 
provinces. He had also been increasing his 
medical knowledge and practising his skill in 
successful dispensaries at Ningpo and Hangchow, 
and had been training a band of men whose 
highest ambition it was to preach the Gospel in 
the most inaccessible regions. Thus when the 

* Thirty Years in Moukden, by Dugald Christie, C.M.G. 



COMING OF WESTERN PHYSICIAN 53 

gates swung back, the China Inland Mission was 
ready to take instant advantage of the opportunity 
and was the first to occupy many of the inland 
provinces. 

In Hankow it fell to Dr F. Porter Smith, of 
the Wesleyan Missionary Society, to introduce 
modern medicine to the people, and his zeal as a 
missionary, coupled with his gifts as a doctor, 
eminently fitted him for pioneer work. In an 
interesting review of Porter Smith's life Dr Max- 
well thus describes the early stages in Hankow : — 

Very soon two small houses were rented as a hospital, 
the work at which touched before long all grades of life at 
Hankow. Officials, both civil and miUtary, priests and people 
aUke, sought Dr Smith's assistance. One of the chief officials 
in the province of Hupeh sent his little daughter from Wuchang 
to reside near the hospital in order that she might obtain the 
services of the doctor. A mihtary mandarin of high position, 
after his recovery, appeared one day in his official visiting 
robes, and attended by his full retinue of servants and attendants, 
in order that personally and publicly he might thank the 
doctor. There was no longing in those days for western science, 
but rather an utter scorn for everything and every person 
from the West, and it is a tribute to medical missions that even 
under such conditions the proudest was willing in the day 
of his distress to come and receive at the doctor's hands. 

In 1866 the first hospital ever erected in Central China 
for the reHef of the suffering was opened by Dr Smith. Sanita- 
tion also, and hygiene for the milUon, were dealt with by means 
of tracts written by the doctor, and distributed broadcast 
by the generosity of the Commissioner of Customs. A work 
on the Materia Medica and Natural History of China laid 
the foundation of a good deal that has been written in later 
years by other pens. Dr Smith became the trusted friend 
of many of the native doctors. Often might he be found 
seated behind the counter of a native doctor's shop, pre- 



54 CHINA AND MODERN MEDICINE 

scribing native drugs in conjunction with an enlightened 
native doctor.^ 

By the year 1880 the north-westerly province 
of Shansi is being invaded, another C.I.M. pioneer, 
Dr Harold Schofield, leading the assault. He was, 
in some respects, the most remarkable man who 
had volunteered for medical work in China up 
to that time. Educated at Owen's College, 
Manchester, and at London and Oxford Uni- 
versities, he had carried everything before him, 
securing scholarships to a total value of £1,400, 
and on one occasion needing to requisition a 
cab in order to carry home his load of prizes. 
At Owen's College he obtained the Victoria 
Scholarship in classics, and was elected an associate 
of the College. At London University, where he 
took his B.A. and B.Sc. degrees, he was first in 
the Honours List in Zoology and third in honours 
in geology, paleontology, and classics. At Oxford 
he obtained an exhibition to Lincoln College, 
secured the Greek Testament prize of the Uni- 
versity, graduated with first-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 
Fellowship of the Royal College of Surgeons, in 
addition to obtaining degrees in arts and medicine 

* Medical Missions at Home and Abroad. June 1910, p. 134. 



COMING OF WESTERN PHYSICIAN 55 

at Oxford. At the conclusion of 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 
post was open to him, and a senior member of the 
staff of his own hospital was just approaching him 
with a request that he would collaborate with him 
in the preparation of 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. 

There for three brief years he laboured, until 
typhus fever — that deadly enemy of medical men 
in North China — claimed him for a victim ; but 
during that short period of service he made an 
impression on the people of Shansi that time can 
never efface. With all his brilliant successes he 
was one of the most modest of men and most 
earnest of evangelists, and his influence over 
individuals was deep and lasting.^ 

So the work extended, until, one by one, each 
of the remaining provinces was opened up to the 
work of the physician. 

By the year 1887 more than one hundred and 
fifty medical missionaries had worked in China 
since Parker led the way sixty years before. 
Although these men had been the pioneers in 
every new centre that was opened up, it must be 
remembered that they were not the only means by 
^ Vide Memorials of R. Harold A. Schofield, by Dr A. T. Schofield. 



56 CHINA AND MODERN MEDICINE 

which the benefits of modern medicine were being 
introduced to China. With the development of 
foreign trade which followed upon the various 
treaties entered into between China and foreign 
powers, a number of western physicians settled 
down at the chief ports — notably at Hongkong, 
Shanghai, Hankow, and Tientsin — and though for 
the most part their practice was confined to the 
European and American population, several of 
them took a keen interest in the relief of the 
Chinese, and co-operated 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- 
sionary superintendent, non-missionary doctors of 
the Shanghai European community took complete 
charge of the medical side of its work. 

IV 

A new and a most important chapter in the 
history of medical missions in China was opened 
with the arrival (in 1873) of the first woman 
physician, and the founding of special hospitals 
for women and children. Although China has no 
purdah system, and her female 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 of approach for a male 
physician, and it is certain that a large percentage 



COMING OF WESTERN PHYSICIAN 57 

of suffering Chinese women failed to secure the 
medical attention that they were in need of, especi- 
ally at the time of child-birth, because of their 
unwillingness to be attended by a foreign man. 

It was in Peking that the first women's hospital 
was opened under Dr Lucinda Coombs, a graduate 
of Philadelphia, the first woman medical mis- 
sionary in China. She was sent out by the 
Women's Missionary Society of the Methodist 
Episcopal Church in U.S.A., who in the following 
year sent Dr Sigourney L. Trask to Foochow. 
Dr Trask's work was remarkable not only for its 
own success but for the entree which it won into 
the homes of the leading Chinese officials in this 
important provincial capital. 

Meanwhile Dr Coombs was welcoming a 
colleague to Peking in the person of Dr Leonora 
Howard (now Mrs King), who was afterwards 
associated with Dr Kenneth Mackenzie in saving 
the life of Lady Li, the wife of the influential 
Viceroy, Li Hung Chang. 

This story has been told before in many places, 
but it well bears re-telling. Mackenzie had found 
a dismal prospect awaiting him on reaching 
Tientsin at the beginning of 1879, for the medical 
mission had closed the year with a deficit, there 
were no foreign drugs in stock, nor were there 
any funds available to purchase them, still less to 
erect a proper hospital A petition to the Viceroy 
produced nothing but a perfunctory acknowledg- 



58 CHINA AND MODERN MEDICINE 

ment. Week by week, as the members of the 
mission met in prayer, this urgent need was made 
a matter of special intercession. At the close of 
one of 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 
successful. Thus, by a happy combination of all 
forces, a great wall of prejudice was broken down, 
and the confidence of the highest official in the 
country secured. 

The immediate result was the founding of a 
new mission hospital in Tientsin, the cost of which 
was borne by the Viceroy, and this subsequently 
led to the establishment of the first medical 
school ever attempted on western lines in China, 
and the full recognition of women's medical work. 
Women physicians were soon welcomed every- 
where, and the entrance which they secured into 
the best homes of the Chinese did much to estab- 
lish fresh contacts and to win new confidence and 
friendship. 

Thus the work spread until the year 1900, when 
occurred the great Boxer uprising, that last and 
most desperate attempt to exclude from China — 
or at least from its northern provinces — all that 



COMING OF WESTERN PHYSICIAN 59 

savoured of the West. Medical missions shared 
in the common turmoil : no less than twenty-two 
hospitals were burnt to the ground and four 
others stripped of their contents, whilst four 
medical men were counted among the martyrs, 
Drs G. Yardley Taylor and Cecil V. R. Hodge of 
the American Presbyterian mission at Paotingfu, 
and Drs W. Miller Wilson (C.I.M.) and Arnold 
Lovitt of Shansi. 

This great tragedy proved but the prelude to 
an extraordinary awakening and advance in the 
years that followed. The medical missionary staff, 
which in 1902 totalled slightly over a hundred 
men and women, more than quintupled its 
numbers by 1917 ; and of the three hundred 
mission hospitals at work to-day in China full 
eighty per cent have been erected during the last 
two decades. 



CHAPTER III 

METHODS OF APPROACH 

We cannot expect the Chinese to grasp with eagerness at 
our improvements ; yet the cure of diseases, set down at once 
as fatal in their experience, must be Ukely to faciUtate the in- 
troduction of our knowledge, and add most humanely to their 
comfort and civiUzation. — Sir Henry Halford, Presiderd of 
the College of Physicians, London, 1834. 

The introduction of western medicine to the 
various classes who compose the three hundred 
and sixty milHon inhabitants of China has followed 
two definite lines of 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 blessings of the art of healing 
to the service of the people throughout the length 
and breadth of the land. 

Secondly, there are those new impacts which 
are being brought to bear upon different sections 
of the community through the medium of the 
out-patient dispensary and other agencies of 
every hospital. In any attempt to study this 
subject, therefore, both of these sides must be 
considered. 

60 



METHODS OF APPROACH 61 



It is quite impossible to understand the work 
of the medical missionary pioneer in China, to 
appreciate his methods, to sympathize with his 
difficulties, or to estimate his success or failure, 
unless one first has a clear idea of the problems 
which have faced him, and their underlying 
causes. 

1. The Redemption of the Medical Reputation. — 
The first, and in some respects the most serious, 
of 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 
sickness with the influence of evil spirits, and on 
the other hand to the low standard of medical 
science in China until quite recent times. A 
medical profession could not, by any stretch of 
imagination, be said to exist. Still less was there 
any recognized standard of practice. The better 
educated of the old-fashioned practitioners had a 
certain general acquaintance with the action of 
drugs, and a rough and ready knowledge of the 
treatment of some conditions, yet on the other 
hand the most enlightened of them had never 
had the advantage of the most rudimentary study 
of the fundamental sciences — chemistry, biology, 
anatomy, physiology, etc. Thus it is clear how 
much justification there has been for the people's 



62 CHINA AND MODERN MEDICINE 

attitude, seeing that medicine was looked upon 
as very little more than a mixture of quackery, 
commercial exploitation, and superstition. Dr 
O. L. Kilborn has well described the position :— 

Anyone may be a doctor in China. There are no medical 
colleges, no examinations, and no diplomas. No licence is 
required for practice. A man makes up his mind to practise 
medicine, and hangs out his sign. He buys a book or two, 
and begins to read. As soon as he can get a patient, he will 
diagnose his complaint, write a prescription, and accept the 
very small fee which is given to the beginner. After varying 
fortunes for a year or two, he makes a " marvellous cure,*' 
surprising no one, probably, so much as himself. Likely as 
not his cure was effected by the method by which pins saved 
a great many hves in the small boy's composition — " By people 
not swallowin' of 'em." The medicines which brought about 
the cure were entirely harmless ; nature's methods were not 
interfered with ; and a cure was effected quickly and well. 
Now the new doctor's fame goes up, his patients increase, 
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 
educated classes. Yet such were the difficulties 
which the pioneers of medical missions were called 
upon to overcome in every province of China. 
They had to prove, by the solid merit of their 
work, that modern medicine does rest upon a 
basis of exact science, at the same time as they 

1 Heal the Sick, by 0. L. Kilborn, p. 86. 



METHODS OF APPROACH 63 

were exhibiting, by life and precept, that great 
message of redemption — physical, moral, and 
spiritual — which they had come to proclaim. 

2. The Winning of Goodwill. — The second pro- 
blem which faced the pioneer is one which happily 
we can now begin to speak of in the past tense. 
The traditional Chinese policy of isolation and 
exclusion, w^hich expressed itself in suspicion, fear, 
and prejudice towards everything and everyone 
from the West, engendered a deep antipathy 
towards the mission hospital, just because it was 
foreign. No sooner was a hospital opened, parti- 
cularly in the inland provinces, than the doctor's 
motives became at once the object of 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 
indulging in secretly. There was a time, for 
example, in the province of Hunan, when an in- 
fluential official, Chouhan by name, published a 
series of inflammatory pamphlets declaring that 
the missionary doctors took the eyes from infant 
children for medicinal purposes and were guilty 
of the most flagrant crimes in their operations 
upon women. And this was typical of the reports 
that were often spread abroad concerning the 
work of the hospitals. 

It must not be thought for a moment that the 
success which crowned Parker's efforts in Canton 
followed so inevitably or so rapidly in the more 



64 CHINA AND MODERN MEDICINE 

remote portions of the country, where the dreaded 
foreigner was less well known. In such places 
the pioneer had to proceed with great caution, 
carefully picking his cases, and avoiding, as far 
as was possible, all risk of failure. At the same 
time he sought, by every means in his power, to 
cultivate the friendship and win the confidence of 
the people around him, and especially of 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 of his colleagues and the reputation of 
his profession, and that any false step might 
jeopardize the prospects not only of his own 
work but also of the whole mission for which 
he stood. 

3. The Overcoming of Limitations. — The third 
great difficulty arose from the lack of proper 
facilities for up-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 for such a work : not the least semblance 
of sanitation, nor of intelligent measures to prevent 
the spread of disease. The pioneer doctor had 
nothing but a Hmitless mass of human suffering 
and ignorance around him, a few instruments 
and drugs in his hand, an unshakable sense of 
vocation, and a dauntless faith in the sufficiency 
of God. 



METHODS OF APPROACH 65 

II 

Such, then, were some of the grave problems 
which confronted the men who attempted to blaze 
the trail of medical missions in China. And it is 
to their patient and triumphant work that the 
remarkable change of attitude towards western 
medicine which has been seen in China during 
recent years must be ascribed. 

To combat such difficulties was a problem of 
strategy. The following is a description, in a 
hitherto unpublished paper, of how Dr William 
Wilson, of the China Inland Mission, set to work 
to win his way in the far inland province of 
Shensi. After referring to his unsuccessful efforts 
to secure a foothold in the provincial capital, 
where the literati instigated a riot and forced him 
to leave, Dr Wilson writes : — 

Commencing work in Hanchong, so far in the interior, 
where foreigners were little known, and foreign hospitals not 
at all, it seemed the wisest plan to concentrate at first all 
our energies on a vigorous, efficient, and attractive out-patient 
department, and, later on, as the confidence of the people was 
secured, to develop a surgical in-patient work — even then at 
first Umiting ourselves to operative cases where a speedy and 
complete recovery could be anticipated, before undertaking 
more serious surgical cases. 

We were fortunate in obtaining very suitable premises, 
one part constituting our dwelling-house, and the other, 
with a long street frontage, furnishing us, when fitted up, 
with a large well-stocked dispensary and consulting-room, 
together with commodious waiting-room for men and women 
respectively. Here we were soon rewarded with the joy of 
receiving steiidily increasing numbers of patients, goffering 
C 



66 CHINA AND MODERN MEDICINE 

from all kinds of diseases, most of them similar to those met 
with at home, but in a far more aggravated condition, due 
to the deplorable consequences of native treatment. In a 
vast number of cases, such as skin diseases, ophthalmia, bums, 
ulcers, wounds, and all kinds of open sores, the utterly irrational 
methods of native treatment only perpetuate and aggravate 
the condition. . . . Thousands of such cases present them- 
selves to the medical missionary, and while not perhaps 
particularly interesting from a professional point of view, 
he may continually rejoice that he is afforded abundant 
opportunity of ciuriag diseases, alleviating a vast amount of 
suffering, and winning thereby the real affection and goodwill 
of his patients, to say nothing of the higher privilege still of 
daily carrying out Christ's twofold command to heal the sick 
and preach the gospel. 

The Chinese doctor's ignorance of anatomy tells, of course, 
very seriously in cases of fracture of bones and dislocation 
of joints, and our treatment of a few such cases in our early 
days mspired a most encouraging confidence, resulting in many 
such cases coming to us, even from long distances. Cases 
of injury or disease necessitating amputation or the removal 
of tumours are, by his own confession, beyond the power of 
the native doctor ; but coming to the hospital as a last hope, 
and there being operated upon under all the advantages due 
to chloroform and antiseptic treatment, the reputation 
gradually spread to great distances, so that it was not long 
before we were able to fit up accommodation and undertake 
in-patient surgical work. 

Another important branch of the work was the curing of 
opium patients, who used, as a rule, to stay with us for a month. 
In the case of young men of sound constitution, we found the 
best results were gained by an immediate and entire withholding 
of opium m any form, and the treatment of symptoms as 
they arose. The deliverance from the opium crave was thus 
the more quickly effected, though, for the first few days, the 
physical distress was sometimes considerable. In older men, 
or men of weak constitution, or very heavy smokers, ex- 
perience taught us that a less drastic method was preferable, 
and such would for two or three weeks be treated with medicine 
•ontftining «> steadily diminishing quantity of opium, till at 



METHODS OF APPROACH 67 

the end of that period no opium was being taken. Many 
hundreds of these passed through our hands, and in nearly 
all instances were able to return home freed entirely from this 
terrible crave and the demoralizing effects of the opium habit ; 
best of all, many proved by their after Uves that they were not 
only deUvered from the bondage of opium, but had entered into 
the Uberty of the children of God. 

To make our medical work more widely known, and to 
inspire the people with confidence, we were glad to avail our- 
selves of the Chinese custom of accepting from grateful patients 
of the wealthier class the large handsome honorific tablets, 
on which the donor inscribes in letters of gold his name and 
official position, the history of his disease and finally, in 
very flowery language, his unbounded gratitude to the doctor 
who has so successfully undertaken his case. In a few years, 
more than ten of these, some as large as an average dining- 
room table, had been presented, and adorned the street 
frontage of our hospital and the walls of the dispensary and 
waiting-room. 

The presentation of these tablets, as is customary in China, 
was always the occasion for a somewhat imposing ceremony. 
The grateful patient, accompanied by a dozen or more of 
his friends, marched through the streets in full official dress, 
accompanied by a band of musicians, and in the procession an 
honoured place was assigned to the tablet, carried by bearers 
and festooned with scarlet silk. 

The formal presentation and speeches over, the tablet was 
hung in the place allotted to it, and the guests were invited 
to a feast, after which a general inspection of the hospital 
and any objects of interest usually occupied their attention 
for an hour or two; thus was afforded a fresh opportunity 
for friendly intercourse betv/een the missionary community 
and these representatives of the literary and official class, 
which, especially in those days, was the most difficult class 
to reach. Such occasions naturally gave scope for conversation 
as to our real purpose in coming to their land, and on leaving, 
each guest was presented with portions of the Scriptures and 
other Christian books. 

Concurrently with the opening of 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 of the medical mission over a 
wider area by means of itinerating tours. Im- 
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- 
point, certainly helped to familiarize the people 
of the district with the objects and work of the 
medical mission hospital, and probably encouraged 
some patients, who would not otherwise have 
done so, to take the journey to the medical mission 
station for purposes of in-patient treatment. 
From such humble beginnings many a branch of 
the Christian Church in China has sprung. 

Ill 

It is not only in the more remote parts of 
China that contacts are made with new sections 
of the community in the manner described 
above. Hardly a day passes in the out-patient 
clinic of any mission hospital but there are 
included, amongst those who come for help, 
numbers of men and women who have never 
before been brought into touch with western 
medicine, and who have not the slightest acquaint- 
ance with the teachings of Christ. They have 
come because of their physical need, which 



METHODS OF APPROACH 69 

hitherto they have found no one able to relieve. 
But away back in their village or country town 
they have met another patient, possibly suffering 
from some affliction very similar to their own, 
who has told them of 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 of missionary publications are some- 
times so impressed with the progress that has been 
made at particular stations that they are apt to 
lose sight of the enormous mass of untouched 
population which forms the hinterland of each 
and all such centres. It is from this teeming 
hinterland that these patients come, and it is 
just this fact which invests the out-patient dis- 
pensary of every mission hospital with all the 
importance of 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 of being corrected 
or amplified by subsequent residence in the 
hospital wards, or by closer contact with those 
who profess to represent and serve the Greatest of 
all Physicians. It is here also that the patient 
will make up his mind, not merely about the 
western doctor and his methods of investigation 
and treatment, but also about the new truths 
which, as he learns, the hospital is intended to 
promulgate. 



70 CHINA AND MODERN MEDICINE 

It is no small matter for the doctor to stand up 
before men and women of this kind and to reflect 
that he and his assistants represent — if one dare 
to use the term — the only manifestation of the 
Great Father that some, at least, of these patients 
will ever meet. A discourteous reception ; dry, 
perfunctory preaching ; slipshod methods of 
diagnosis ; impatient or hurried treatment — 
these things, which might under ordinary circum- 
stances be easily excused on grounds of pressure, 
take on a new significance when it is remembered 
that these are the impressions which it will take 
longest of all to efface, and that they will effectu- 
ally distort the image of the Christ w^hich the 
doctor would fain have presented to the patient's 
view. 

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 
doctor, overburdened as he often is with the 
pressure of the wards and of the countless other 
duties that fall to his lot, is apt to relegate his 
out-patient department to the care of a poorly- 
trained Chinese assistant and evangelist. 

Here in the West emphasis is being increasingly 
laid upon the importance of senior members of 
the leading hospitals taking an actual share in 
the treatment of 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 Cl^na by deliberately limiting 
himself to such numbers (in-patients and out- 
patients) as he could do real justice to. This does 
not mean that he should concentrate all his time 
and attention on a favoured few, 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 of anyone who has been received in 
the out-patient department going away with the 
feeling that he has not been properly looked after, 
or his case not thoroughly investigated. 

Nothing is more difficult than to curtail the 
number of patients, especially in a country where 
terrible suffering and disease abound on every 
side, but it must never be forgotten that, in any 
case, western doctors are not able to do more than 
touch the barest fringe of the work. It is often 
stated, for instance, that in some particular pro- 
vince or district there is only one fully qualified 
physician to half a million or a million of people, 
as if forsooth he were able in some way to be of 
some service to such a number. The probability 
is that not one in every hundred ever come near 
him when they are sick, nor could he possibly 
attend them if they did. 

There are four points in connection \\4th the 



72 CHINA AND MODERN MEDICINE 

out-patient side of the work which are specially 
worthy of notice. 

1. It is of the utmost importance that patients 
should always be regarded as guests, and be 
received with courtesy and kindness by the gate- 
keeper or registrar whom they first meet. He is 
the first representative of 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 
for the patients should be of a character worthy 
of the great cause which is to be proclaimed, and 
calculated to emphasize the winsomeness and 
graciousness of the Message. It must never be 
forgotten that the patient has not come to the 
hospital for the sake of 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 for the hour at which 
the clinic is due to open ; but if that address is 
to grip him it must be presented thoughtfully, 
earnestly, and with every possible consideration 
for the condition of the hearers. 

A very 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 the evangelist 
and his helpers, instead of keeping up a continuous 



METHODS OF APPROACH 73 

preaching performance as is so often the case, 
mingle with the patients, and get into general 
conversation with them one by one. They find 
out where they have each come from, and what it 
is that has brought them to the hospital, at the 
same time explaining to them, in a simple way, 
the procedure that is to follow — how long it will 
be before the doctor comes ; in what order they 
will be seen ; where they will get their medicines ; 
what they will have to do if they need to be 
admitted to the wards, etc. In these and similar 
ways they gain the confidence of the patients, 
and make them feel that they have their interests 
at heart. 

About twenty minutes before the clinic is to 
open a bell is rung, and an announcement is then 
made that a short service will be held, at which all 
are asked to sit quietly, special stewards being 
appointed to show into their seats any fresh 
patients who may arrive during this time. The 
service opens with a brief introduction, in which 
the evangelist, or better still the doctor himself, 
explains simply why such a gathering is held. 
He tells them of the great Gift which the hospital 
tries to represent, and points them in simple 
language to the Father who cares for them all. 

Having made this introduction, and shown 

them how that Father may be approached by all 

who care to do so through the use of prayer, he 

asks them all to stand reverently in their places 

c* 



74 CHINA AND MODERN MEDICINE 

while he offers up an intercession on their behalf. 
Prayer concluded, an earnest address is given, 
usually on some incident in the life and teaching 
of Jesus Christ, and a strong appeal is made to all 
to study for themselves the truths of the gospel. 

As the hour for the opening of 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, w^hose registration number will entitle 
them to be seen first, are directed to the proper 
door, while the evangelist sits with those who 
have some time to wait, explaining in more detail 
what has been said during the service, offering 
portions of the Scriptures or other books for sale, 
and attempting to draw them into conversation. 
In this way he soon learns to recognize those who 
are coming regularly for treatment, and in some 
cases is able to obtain an invitation to visit them 
in their own homes, there to follow up the im- 
pression that has been formed. 

8. The investigation of the patients, prior to 
the adoption of any particular line of treatment, 
should be as careful and complete as possible. 
Superficial medical practice ill accords with a 
fervent religious service. If the work of a mission 
hospital out-patient department is to be properly 
done, both the religious and the professional sides 
should be treated as of the utmost importance, 
and neither should be sacrificed for the sake of 



METHODS OF APPROACH 75 

the other. It would be better to give 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 of very 
secondary importance. 

To do real justice to the medical care of the 
out-patients, the enthusiastic work of the doctor 
himself is essential, and he needs to have a 
well-trained staff and adequate equipment. In 
a country like China, where parasitic and blood 
infections abound, the more modern hospitals are 
finding that they need not only well-fitted exa- 
mination- and dressing-rooms in their out-patient 
departments, but that a small clinical laboratory 
in constant use is also an indispensable adjunct 
for thorough investigations. Fortunately the 
Chinese make excellent technicians, and it is not 
difficult to train them in laboratory methods. 

4. The human side of the work is the supreme 
thing and must always be paramount. It may 
not be very easy for the doctor himself, in the rush 
of his work, to spend a large amount of time 
talking with individual patients, but his attitude 
towards them and the attitude of his helpers will 
count for everything. Here, for example, is a 
poor old man who has tramped fifty or a hundred 
miles in the hope of recovering his sight, because 
he has heard of someone else who was operated 
on for cataract with most successful result. But 
a glance is sufficient to show that his trouble, 



76 CHINA AND MODERN MEDICINE 

unfortunately, is due to a very different cause. 
His is a case of absolute glaucoma, for which 
nothing can possibly be done. It is a bitter dis- 
appointment for the old man, and very hard for 
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 
why his case is incurable. And after all, it is 
these human impressions which are the most 
potential. 

Some years ago a Chinese patient suffering from 
cataract consulted a friend of mine, and was 
successfully treated. Subsequently there came 
from his district a procession of seven blind men, 
walking one behind the other, each touching the 
shoulder of the one in front. They had tramped 
for many days across the mountains, in hope of a 
similar cure. When they reached the hospital it 
was immediately evident that no cure was possible 
in any of their cases. But they were received 
and treated as guests, and their confidence and 
friendship were won. For very many years one 
of those blind men was an untiring and successful 
evangeUst, not only to the blind but to those who 
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 
of all. 



METHODS OF APPROACH 77 

IV 

China is sometimes spoken of as a country 
which is now well covered with missionary agencies 
of every description, and in which mission hospitals 
and dispensaries abound. It is not difficult to 
demonstrate how completely fallacious such a 
statement is. Throughout the whole country 
there are not yet more than three hundred mission 
hospitals (possibly three hundred and fifty, if 
branch dispensaries are included), and the majority 
of 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 
careful estimate has recently been made, based 
on the records of two hundred of these hospitals, 
in order to ascertain how much accommodation 
they are able to provide for the needs of the com- 
munity. This has revealed the fact that there is 
but one mission hospital bed at present to every 
26,640 of the population.^ To this should be 
added the relatively small aggregate number of 
beds provided by the Chinese government and 
private hospitals which are just coming into ex- 
istence, and also the accommodation for Chinese 

^ An Enquiry into the Scientific Efficiency of Mission Hospitals 
in China. Beprinted from China Medical Journal, November, 1920, 
Hospital Supplement. 



78 CHINA AND MODERN MEDICINE 



afforded by the Community hospitals of the 
Roman CathoHc Church.^ 

In this connection the statistics of the individual 
provinces are most enlightening, revealing, as 
they do, the tremendous stretch of unoccupied 
line which the more remote portions of China 
still present. They are as follows : — 

Province of Fukien . . 1 bed per 
Kiangsu . 
Chekiang . 
Kwangtung 
Manchuria 
ChihU 
Hunan 
Shansi 
Hupeh 
Shantung . 
Honan 
Kwangsi . 
Szechwan 
Anhwei . 
Kweichow 
Shensi 
Kansu 
Kiangsi . 
Yunnan . 

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

^ According to the statistics given in the appendices to The 
Catholic Church in China, by Rev. Bertram Wolferstan, S.J., 
pubUshed in 1909, the Roman CathoHc Church was supporting 
82 hospitals and 328 dispensaries in China in the year 1907, in 
connection with its various branches. Most of these institutions, 
however, appear to have been in charge of Catholic priests, lay 
brothers, or sisters of mercy, only a small proportion of the patients 
being attended by qualified western physicians. 



9,210 of 


population 


9,240 




9,850 




11,940 




20,100 




20,130 




23,700 




31,130 




36,590 




38,240 




42,550 




44,000 




68,180 




70,800 




76,500 




81,250 




86,540 




151,600 




246,490 


,, 



METHODS OF APPROACH 79 

bed in a voluntary hospital for one in every six 
hundred of the population, and this does not 
include the large number of additional beds 
provided by the Poor Law infirmaries.^ 

How is the territory to be covered ? There 
are three principal methods that are worthy of 
careful consideration : — 

1. Branch Dispensaries. — 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 
depend upon the facilities of communication, as 
well as the strength of available staff, as it is 
essential that they should be administered from 
the central institution and be visited regularly. 
Well-trained Chinese workers should reside at 
these outposts, capable of dealing with the spiritual 
needs as well as the minor physical ills of the 
people. Such dispensaries will not only make 
provision for the large number of patients who 
do not require prolonged hospital treatment, but 
will also act as collecting stations for the more 
serious cases who need to be transferred to the 
central hospital. 

The success of this method depends upon the 
main hospital and its branch dispensaries being 

_i In England and Wales there is a hospital or infinnaiy bed 
for one in every 320 people. 



80 CHINA AND MODERN MEDICINE 

organized as a single unit, under the control of a 
fully qualified and experienced medical staff. 
The late Dr Arthur D. Peill of Tsang Chou was a 
life -long advocate of this policy, which has since 
been developed by his brothers and many besides.^ 

2. New Medical Mission Centres. — It is im- 
possible to study a map of the unoccupied territory 
in China without realizing the urgent call for the 
opening up of new medical mission centres. Men 
and women are needed to-day who will take the 
torch from the hands of the pioneers, and will 
carry the new light into the remote and backward 
portions of the country. This will not be easy 
work. It will entail loneliness and isolation in a 
land where other missionaries are enjoying the 
stimulus of professional comradeship and the 
facilities of adequate equipment. But the thing 
is worth doing, and it has compensations which 
those only who have tried it can fully appreciate. 
And in face of the limitless mass of human suffering 
which these neglected parts of China represent, 
and of the unique gift which the science of medicine 
and the evangel of redemption have to offer, no 
one worthy of the profession can resist such a call 
if it comes to him. 

3. The Development of Chinese Leadership, — 
Upon the nations of the West has been placed the 
great responsibility and privilege of carrying to 

^ Vide The Beloved Physician oj Tsang Chou, edited by Rev. 
J. PeiU. 



METHODS OF APPROACH 81 

the Orient those priceless blessings with which 
modern medicine has endowed them, and thus of 
leading the w^ay in the medical missionary enter- 
prise of to-day. But in the physical salvation of 
China, no less than in her educational uplift and 
spiritual regeneration, it is the Chinese leaders 
themselves who are the great and important 
factor, and it is to them that the future will in- 
creasingly look. That does not mean to imply 
that the West can now regard her work as accom- 
plished, and shift her responsibility on to the 
shoulders of her Chinese brethren. Far from it. 
There never was a day when the opportunity and 
the need presented such a clamant appeal for 
western help. But it does involve a resolute and 
persevering policy deliberately to promote the 
Chinese at the expense of the foreigner. And this 
will never be achieved until we learn to discover 
and develop the immense capacity for leadership 
latent in our young Chinese students, both men 
and women. 



CHAPTER IV 

THE EVOLUTION OF THE HOSPITAL 

All the larger rooms, 
Lofty and bare, they made their hospital. 
In which by night and day they ministered 
Unto their sick ; and these were alwaj-s full. 
And all of them had diUgently learnt 
The art of healing, and among them were 
Some sm*geons and physicians much expert. 
But mostly those, whom they received within, 
Were stricken by diseases, tedious more 
Than mortal, needing tenderness and care : 

And all as brethren, they compassionately 
Waited upon, and tended. . . . 
A house of holy service and of peace 
Was this they dwelt in ; living in one bond 
Of purity, and brotherhood of love ; 
Speaking but httle, praying, praising God 
With joyful service of the hearts and hands. 

Harriet Eleanor Hamilton King 
The Disciples, 1872. 

Prior to the introduction of modern medicine 
into China there was nothing in the whole country 
that was at all analogous to the western hospital. 
There were, it is true, a certain few Chinese 
Benevolent Associations, but they were chiefly 
concerned with the distribution of food to the 
indigent, or the care of foundlings, 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 of serious illness ? 

In the first place, the local physician was called 
in, and if his prescription failed to give immediate 
relief a selection of others would be summoned, 
limited only by the finances of the family. 

The next step was usually the invocation of 
religious aid. All over China are to be found 
temples of medicine, mostly created in honour of 
celebrated physicians of prehistoric fame. Many 
an ancient tree outside a Chinese town or village 
has a similar shrine of healing — the abode of some 
mythical animal of fabulous powers, or other 
supernatural being. These trees are favourite 
resorts in times of sickness, and their gnarled 
branches present a strange appearance of dilapi- 
dated splendour from the worn-out banners 
suspended from them — the votive offerings of 
grateful worshippers. 

I well remember a visit I once paid to the 
Temple of Medicine in an inland city. A care- 
worn woman was entering the outer court as I 
approached, and a few minutes later, having 
made her offering of money to the priests, she 
was admitted to the innermost precincts of the 
building. There the chief idol was enthroned, 
and having placed her sticks of lighted incense 
before 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 
swayed backwards and forwards, calling upon the 
idol in a low crooning voice, so she shook the open 
box, until one of the slips fell to the ground. The 
priest, who had been watching her, at once 
stepped forward and picked it up ; then, glancing 
at the figure which it bore, he walked across to 
the other side of the temple, and tore down from 
the wall a paper with a corresponding number. 
This he handed to the poor suppliant, with a 
brief word of instruction as to the way in which it 
was to be used. A moment later she was speeding 
homeward, there to try the effect of this new 
" cure " upon her loved one. 

In some cases such a paper would contain a 
prescription for medicine, or a few words out of 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, 
who was pleading for the life of her husband, 
evidently " drew " an unlucky number, for 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 of a Christian 
Chinese friend, who came to the rescue !) And 



EVOLUTION OF THE HOSPITAL 85 

this was all that the temple had to offer. Where 
there was extreme poverty, even this meagre 
consolation could not be sought, and the poor 
invalid was left untended, and oftentimes alone. 



It was to conditions such as these that the 
pioneers of western medicine in China addressed 
themselves, and they set to work immediately to 
establish hospitals wherever they could secure a 
footing. By the year 1850 there were at least 
ten such institutions, by 1889 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 of 
medical itineration work or of centralization in 
hospitals, but experience early convinced the 
large majority of medical men of the superior 
value of an intensive policy, with the result 
that the work of 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 of institution which 
we associate with that name in Europe or 
America, nor do many of them to-day. Far from 
it. The buildings of the old-time hospital, which 



86 CHINA AND MODERN MEDICINE 

for the most part consisted of adapted Chinese 
premises, were most primitive in character, and 
the organization was still more so. 

Under the arch of an ornamental Chinese 
gateway, at the side of which a small room 
accommodated the gate-keeper or registrar, the 
visitor passed into an open courtyard where the 
patients and their friends assembled. Ranged 
round the court were several one -story buildings 
— rooms for the hospital employees, a shed for 
sedan-chairs, a stable for the temporary shelter 
of the animals which brought patients from long 
distances — ^whilst on the further side there was 
usually the out-patient dispensary, with its 
waiting-rooms for men and women, its preaching 
chapel and consulting-rooms. 

Similar courtyards opened out beyond, some 
reserved for male patients, and others for women. 
Each consisted of a series of 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." 

The walls were either of porous brick or adobe, 
and the floors of beaten mud, Chinese " concrete " 
or brick tiles ; whilst the windows, at any rate in 
the quite early days, were invariably of paper. 
These windows were seldom made to open 
effectually, and it must be confessed that neither 



EVOLUTION OF THE HOSPITAL 87 

ventilation nor cleanliness was a marked feature 
of these old hospitals. 

The furniture of the ward was of the scantiest 
description, and probably consisted of nothing 
more than a few Chinese beds (wooden or bamboo), 
a table or two, and some chairs. Everything else 
was provided by the patient, who brought his 
own clothes to sleep in, his own bedding to lie on, 
and his own friends to nurse and feed 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, 
served as a kitchen. Here the patient's friends, 
or the hospital cook, prepared whatever the sick 
man fancied. It was almost impossible for 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- 
titiously procure a solid meal of dumplings, or 
slake his thirst with a hard pear. 

Even if the hospital possessed a bathroom, it 
was hardly of such a sort as would tempt an 
unwilling patient to make experiment with soap 
and water. 

An ill-furnished, but well-kept operating room, 
where some remarkably successful operations were 
performed, usually completed the hospital plant. 

Such was the old-time hospital, and such its 
handicap — the lack of trained nurses, the absence 



88 CHINA AND MODERN MEDICINE 

of any real control over the patients, the impossi- 
bility of ensuring ordinary cleanliness, to say 
nothing of asepsis. But as we read the records 
of the work that was successfully accomplished 
we cannot withhold a tribute of admiration for 
the courage and skill of the medical men, and in- 
cidentally for the efficiency of the "anti-bodies" 
of the average Chinese patient ! 

It is obvious that such a building was not a 
hospital at all, in the modern sense of the term. 
It was really a hostel or inn, in which the patient 
resided with his friends whilst attending the 
doctor, and where he was always accessible to 
medical treatment and spiritual influence. But 
whilst not possessing any of those accessories 
which go to make up the hospital of to-day, and 
which have proved to be indispensable to the 
modern investigation and treatment of disease, 
the old-time hospital had a value which should 
never be underrated. 

One great advantage of such a building in the 
early days was that its unpretentious appearance 
soothed the suspicions of would-be patients and 
their friends. This was a very important matter 
in times when the mental attitude of the patient 
was the most difficult of 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 



EVOLUTION OF THE HOSPITAL 89 

or foreign place. Thus their apprehensions were 
allayed ; and the kindness and sympathy with 
which they were received rapidly won their con- 
fidence and friendship. In this way the old-time 
hospital laid the foundation for every advance 
which followed, and for developments which would 
have been impossible but for the work and in- 
fluence of those very primitive institutions. 

Then again, even in such rudimentary accom- 
modation, doctors were able to carry out certain 
forms of treatment, especially of a surgical 
character, which it would have been impossible 
otherwise to attempt. Some of these simpler 
operations, performed with uniform success a great 
number of times, did more than anything else to 
inspire confidence in western medicine, and to 
familiarize the Chinese with its beneficent results. 
Moreover the western doctor, often quite single- 
handed at the outset, quickly gathered around 
him a little group of Chinese assistants to whom 
he gave a simple course of training in the elements 
of hospital routine. Such instruction was neces- 
sarily of a very elementary character, as the 
assistants of those days were drawn from the less 
educated classes. But the Chinese have a natural 
facility for practical work, and thus were easily 
trained to become valuable helpers in the operating 
room, as anaesthetists and dressers and also as 
dispensers. 

With such a staff to assist him, the doctor's 



90 CHINA AND MODERN MEDICINE 

sphere of usefulness rapidly grew, and though it 
was not possible to do very much for cases that 
required skilled nursing or elaborate medical 
treatment, he generally succeeded in building up 
an extensive surgical practice, and in obtaining 
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 of the 
modern hospital, and the employment of up-to- 
date methods of investigation and therapeusis, the 
foreign physician of to-day has every prospect of 
securing the same measure of confidence as is 
accorded to the foreign surgeon. 

But the value of the old hospital did not merely 
rest upon the opportunity which it afforded for 
a wider use of medical and surgical skill. No 
sooner did the missionary begin to grapple with 
the immense problem of China's suffering than 
he realized that he was engaging in a much 
sterner conflict than appeared on the surface. 
Deeper, far deeper, than the physical ills of the 
Chinese patient was a problem of mind and spirit 
which medical science alone could never relieve. 
To make provision for disease and suffering and 
turn out a series of " cures " with the regularity 
of so many Ford cars, whilst it might go a long 
way towards the alleviation of distress, was never 
going to solve the whole of China's problem, nor 



EVOLUTION OF THE HOSPITAL 91 

provide that full restoration to health of which 
the Chinese people stood in such dire need. 

Psychologists of those days knew considerably 
less than they do now of the intimate connection 
which exists between mental and spiritual out- 
look and physical disease. And to-day, looking 
backward over the years, we can see that the 
founders of those old-time hospitals built more 
wisely than they knew. Perhaps the very limita- 
tion of buildings and professional equipment under 
which they had to w^ork helped to preserve their 
sense of 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 w4th no thought beyond their bodily ailment 
became glad and eager listeners to the Story which 
was there unfolded to them. 

Various were the methods employed in carrying 
out this 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 of 
Scripture and verses of 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 for convalescent patients who were 
anxious to enquire more deeply into the truths of 
the Christian revelation. 

But the most commonly used method was the 
simple service conducted daily in the hospital 
chapel, if such existed, or more commonly in one 
or other of the " wards." The following descrip- 
tion of such a gathering may be taken as typical 
of what occurred in other parts of China (the 
original account has been slightly amended) : — 

The clang of the gong, which has just resounded, sends the 
workmen home for the night, and the bell we hear so shortly 
after is calling patients and helpers aUke to Evening Service. 
Presently we see a little stream of people wending their way 
towards one of the wards. We might as well join the pro- 
cession behind this old man limping along on a crutch and a 
back-splint, and see where it brings us to. 

We enter a somewhat rough-looking ward, the beds crowded 
up together, with a lamentable disregard for the London 
County Council (or any other authorities') demands for air 
space, whilst in the centre are a number of forms arranged 
in rows, converting the ward for the time being into a sort 
of ^Mission Hall. The occupants of the beds sit or lie, in varying 
stages of sickness or convalescence. Here are two poor fellows 
who were only operated on this morning, and so far have but 
little interest in what goes on around them. There, up in the 
corner, is an old man who has just arrived, blind for over 
ten years, upon whom we are hoping to operate for double 
cataract. Opposite to him is a young man who Jaas been 
suffering at the hands of unqualified doctors, and whose mal- 
united fracture has had to be re -broken and wired together. 
These, and many like them, are the proper patients of the 
ward, but patients from other parts of the hospital are also 
here, together with our own helpers, and not only are all the 
forms occupied, but several find seats upon the end of a neigh- 
bour's bed. One or two former patients also are with us to-night 
for the service, and we always give a special welcome to such. 



EVOLUTION OF THE HOSPITAL 93 

At the further end of the ward, underneath a large drawing 
of the Good Samaritan, is arranged a tiny table and chair for 
the leader, who to-night is our head assistant. A hjrmn is 
given out and sung (with possibly more vigour than melody) 
to a well-known tune ; a short prayer is offered for blessing 
upon the service ; and then the old story of the Lost Sheep 
is slowly read and explained. The talk goes on for nearly 
half an hour, with a brief pause every now and again to 
emphasize a point or to ask a question of someone who appears 
to be specially dense. Sometimes the address is enUvened 
by various unexpected incidents, as, for example, when a 
particularly interested hearer gives vent to audible comments 
on the sermon, or when the service is being conducted by a 
very original person. 

One such man gave an address a Uttle time ago on the story 
of the Impotent Man at the Pool of Bethesda. After exhaust- 
ing the more ordinary appUcations of the miracle, he said : 
" Now you know, this story has another very important lesson 
for you to learn. Some of you have come here to hospital 
expecting to have your sickness treated or your operation 
performed the very day you come, and you make ever such 
a fuss if you have to wait a day or two. You ought to try 
and copy this man's patience, for he waited thirty-eight years 
before he had his disease attended to " ! 

It was that same speaker who, on another occasion, after 
watching us set a fracture for a poor beggar with a broken 
thigh, who had crawled to the hospital in a shocking condition 
of emaciation and sores, prayed in pubhc on the following 
evening that " God would use the means which the doctor 
was employing to take the man to heaven." 

But meanwhile we are forgetting all about the head assistant, 
whom we left giving the address. With simple forcible language, 
illustrated from the daily work of the hospital, he tells the 
patients of the fuller life to which the Saviour of men is calling 
them ; then an earnest prayer is offered that they may one 
and all be found of the Good Shepherd and brought back to 
the true fold ; and the service is over for the night. ^ 

1 A Quiet Evening in a Mission Hospital. Vide Medical Missions 
at Home and Abroad, 1908, p. 166. 



94 CHINA AND MODERN MEDICINE 

II 

In the earliest hospitals accommodation was 
provided for any type of case that sought 
admission, and the only distinction that was 
made was in the matter of sex, male and female 
patients being housed, as a rule, in entirely 
different buildings and compounds. But as the 
work developed, special hospitals were opened in 
various cities for the reception of particular 
classes. 

With the coming of women physicians, hospitals 
for women and children were established, many 
of which developed important maternity depart- 
ments. It is difficult to do adequate justice to 
the remarkable service rendered by these insti- 
tutions in a country where so little is known of 
the scientific treatment of women's diseases, and 
where indescribable suffering too often accom- 
panies child-birth. If reliable statistics could be 
secured as to the prevalence of puerperal septi- 
caemia and tetanus neonatorum in China they 
would undoubtedly startle the whole medical 
world. The Women's Hospitals have a splendid 
record to show of work accomplished in combating 
these and similar diseases. 

The leper is another unfortunate class of sufferer 
for 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 
dread, and the sufferer's lot has been a most 
unhappy one. Prevented from living at home, 
or in their native village, lepers usually join the 
overcrowded ranks of mendicants, and hundreds 
of them have doubtless ended their lives of misery 
with an overdose of opium. 

The first Leper Hospital in China was estab- 
lished at Pakhoi in 1890 in connection with the 
work of the Church Missionary Society, Dr E. G. 
Horder being the doctor in charge. This institu- 
tion rapidly grew, and one hundred and fifty 
patients — men and women — are now accom- 
modated there. At the same time other centres 
also developed, notably at Siaokan (Hupeh pro- 
vince), where Dr Henry Fowler of the London 
Missionary Society has been making a lifelong 
study of this subject, and at Hangchow, where 
the Chinese gentry have subscribed generously to- 
wards the erection of the splendid Leper Asylum 
which Dr Duncan Main built there in 1915. 
Other refuges are being opened up for these un- 
fortunate people, whose number is estimated at 
not less than four hundred and fifty thousand. 
The Mission to Lepers has now appointed Dr 
Fowler as its special representative for the Far 
East, with a view to the further development of 
this branch of service. At the same time it is 
hoped, in connection with the newer medical 
schools in China, to establish departments for 



96 CHINA AND MODERN MEDICINE 

scientific research in the treatment of this disease. 
In this connection it is interesting to note that 
the drug upon which greatest rehance is placed 
by modern leprologists in their efforts to cure this 
terrible complaint, namely Chaulmoogra Oil, has 
been known to the Chinese for years past, and was 
successfully employed by Dr Hobson as long ago 
as 1854. f 

Refuges for the blind, such as those associated 
with the honoured names of David Hill of Hankow 
and Hill Murray of Peking, have as a rule been 
connected with the general work of the missions 
rather than with the medical branch of the enter- 
prise. The same is true of special institutions for 
the deaf and dumb, of which the Home at Chefoo 
under the able superintendence of Mrs S. R. Mills 
is the most conspicuous example. 

In the care of the mentally afflicted, however, it 
has been the medical missionary who has led the 
way, and the well-known name of the great 
American physician, Dr J. G. Kerr, will always be 
remembered in China in connection with this 
development. The Hospital for the Insane which 
he first advocated in 1872, and which was actually 
opened in Canton in 1898, was the first ever 
established in China, and as such has won the 
admiration of all classes of the people. It now 
has accommodation for six hundred patients, and 
is largely subsidized by Chinese officials who 
make themselves responsible for the support of 




A Ward in an Old-time Mission Hospital 



{Set' />a^e 87) 




A Ward in a Modern Mission Hospital 



{See page 106) 



EVOLUTION OF THE HOSPITAL 97 

patients whom they constantly send to the 
refuge. 

Refuges for victims of the opium habit were 
established from earliest days in connection with 
mission hospitals, and hundreds of these unfor- 
tunate creatures have, in them, found deliverance 
and happiness. 

Another development of more recent years has 
been the provision of sanatoria for tuberculosis 
in several centres, notably at Ruling and Hang- 
chow, the latter being one of the many institutions 
connected with the work of the Church Missionary 
Society which owes its origin to the enterprise 
and administrative ability of Dr Duncan Main. 
These institutions are breaking ground which it 
is hoped the Chinese themselves will be able to 
develop and cultivate in the future. 

Ill 

The style of the old-fashioned hospital, originally 
dictated by the conditions under which it arose, 
continued long after these conditions had passed, 
and even to this day a large number of mission 
hospitals in China, especially in the interior, are 
operated on the same primitive lines as those 
already described. The causes of this are of two 
kinds. First, the financial stringency of mis- 
sionary budgets, incessantly crippling plans for 
necessary development, tends in the long run to 
cramp the initiative of the missionary organiza- 

D 



98 CHINA AND MODERN MEDICINE 

tions in the field. Secondly, the way to progress 
is constantly barred by the lack of imagination on 
the part of committees and supporters at home, 
or by that inadequate conception of the medical 
missionary enterprise which regards it merely as 
a means to an end, and not as an end in itself. 
The difficulties created by this point of view have 
been well expressed by the veteran missionary, 
Dr James L. Maxwell. Writing on this subject 
sixteen years ago, he said : — 

All are agreed that the great end of medical missions, as of 
all missions, is the exalting and commending of Christ as the 
Saviour of men. But all are not agreed on the lines on which 
a mission hospital is to be wrought so as to accomplish this. 
In the main there are two prevailing ideas. 

One idea is that it does not matter very much in what kind 
of building your medical and surgical work is performed, 
provided it gives you an opportunity of preaching the gospel 
to your patients ; and, further, that seeing that the spiritual 
results are the chief thing, there is no special call to lay yourself 
out for and to be ready to deal with difficult cases. Such cases 
will take up a lot of time, and will give the medical missionary 
a good deal of anxiety and trouble ; therefore, it would be 
well to cultivate only those cases that can be easily and quickly 
managed. Those who hold this view — and there are not a few 
on mission boards and among the Christian public who do 
hold it — are perfectly satisfied that in this way the greater 
gain is to be reached. 

The other idea, that which prevails, though not universally, 
among medical missionaries themselves and their colleagues, 
is that a mission hospital ought to be laid out on the very best 
lines for securing the heahng of the sick ; that the medical 
missionary should be ready, to the very utmost possible, to 
meet and deal with the most difficult cases, and that along 
these lines we may expect the largest ultimate spiritual results. 

It will be manifest at once that the mission hospital idea 



EVOLUTION OF THE HOSPITAL 99 

must widely differ, according as the one or other of these two 
views is accepted.^ 

Dr Maxwell then went on to state the reasons 
for his strong conviction in favour of the latter 
view, which he summed up in the words : "An 
ideal mission hospital is one in which the ordering 
of all things has a primary reference to the healing 
of the sick, and into which the whole round of 
sufferers may come." 

It is this larger conception of the scope of the 
mission hospital which is increasingly engaging 
the attention of medical men and women in China 
to-day — as well as of many at the home base — 
and which is responsible for the new developments 
which are taking place in medical mission policy. 
Once it is admitted that the mission hospital 
exists as an integral part of the full presentation 
of the Message of Christ, then it follows that the 
hospital itself must be made as perfect an expres- 
sion of the ministry of Jesus as it is possible for us 
to make it. Every effort must be adopted to 
safeguard our hospitals from inefficiency on the 
one hand or mere commercialism on the other. 
No longer may the quantitative aspect of the 
medical mission monopolize our thought. Nor 
are the numbers of converts whose admission to 
the Church can be directly traced to the influence 
of the hospital the ultimate criterion of its success. 
Bishop Hoare's words, written twenty years ago, 
1 Medical Missions at Home and Abroad, 1905, p. 340. 



100 CHINA AND MODERN MEDICINE 

find a response in the heart of every medical 
missionary still : — 

If we saw no spiritual results, if we saw no converts brought 
out by medical missions, if we saw no doors opened by their 
means, it would still be the bounden duty of Christian i)eople 
to do what they can with this western science which God has 
given to alleviate misery and wretchedness, pain and disease, 
wherever it may be found. ^ 

This emphasis upon the qualitative aspect of 
the work of the hospital is entirely in line with 
those two important axioms upon which students 
of missions to-day are more and more basing their 
policy. The first of these is that no country can 
be truly evangelized — nor set free from ignorance 
and disease — except through the efforts of its 
own sons and daughters. The second — and it is 
the obvious corollary of the other — that the work 
of every missionary in China, no matter what 
branch he or she may be engaged in, is primarily 
and essentially educative. 

The permanent value of the evangelist's work 

cannot be expressed in terms of the number of 

people to whom he has personally preached, or 

given tracts ; it can only be truly expressed in 

terms of 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 of disciples of Christ whose passion is the 

saving and uplifting of their country. 

^ Mercy and Truth (Church Missionary Society), Feb. 1900, 
p. 41. 



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 for the immediate ills of a certain 
number of patients, nor even solely as an object- 
lesson of kindness and sympathy, great as that 
may be. The permanent work of medical relief 
is ultimately a matter of education even more 
than of curative treatment. We in the West 
escape the untold sufferings of so many thousands 
of Chinese patients, not because of the number of 
physicians at our doors to cure us, but mainly 
because of the great hygienic measures that have 
been adopted for the prevention of disease. We 
escape the horrors of typhus because we have 
learned to appreciate the vital importance of 
ridding our persons and our clothing of typhus- 
bearing vermin. Our children are saved from 
the blindness which so often accompanies small- 
pox in the Orient, because they are protected 
against smallpox itself. Our infantile death-rate 
is beginning to decrease because, at long last, the 
blessings of fresh air, of suitable diet, and of 
skilled nursing are beginning to be appreciated. 
Such considerations should be in our minds as we 
face the problem of China's suffering, of which 
so large and terrible a proportion is entirely 
preventable. 

Even our smallest hospitals, if they are to be 
worthy of 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 of 
cleanliness and hygiene and the kindly care of the 
sick, which have had such an enormous educative 
value in our own countries, and which are so 
desperately needed in China to-day. In that way 
forces will be generated w^hich should have a 
permanent and increasing influence in promoting 
the health of 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 hospitals known to the educated classes 
in China. Hundreds of students and merchants 
who have travelled in Europe, in America, or in 
Japan, have had personal experience of modern 
hospital treatment in those countries, and are 
increasingly conscious of how far many mission 
hospitals fall short in scientific equipment and 
modern nursing methods. The last few years 
have also seen the starting by the Chinese them- 
selves of several hospitals, one of w^hich — ^the 
Central Hospital, Peking — was erected at a cost 
of nearly $300,000, and has been fitted out and 
equipped in the most modern manner. The 
graduates of the new medical schools in China 
likewise learn to appreciate the value of those 
special diagnostic methods which we associate 
with modern medicine, and to depend upon skilled 
nursing for the treatment of their patients. 

If, therefore, the mission hospital is not to 



EVOLUTION OF THE HOSPITAL 103 

become discredited in the eyes of the educated 
Chinese from a professional standpoint, but is to 
become a centre in which the highest scientific 
and spiritual ideals are pursued together, it is 
obvious that it must attempt to keep pace with 
modern developments — in other words it must 
become, in fact as well as in name, a Christian 
hospital. This is not a question of placing the 
scientific side of the work in antithesis to the 
evangelistic ; it is simply a question of ensuring 
that both are truly efficient, and worthy of that 
great Name which the hospital bears. 

One of the first medical men in China to recognize 
this fact and to preach it, in season and out of 
season, was Sydney Rupert Hodge of the Wesleyan 
Mission, Hankow. As far back as 1891 we find 
him pleading in the China Medical Mission 
Journal for the coming of trained nurses to China, 
in order to make the work of the hospitals truly 
efficient ; and from that time until his death in 
1907 his voice was constantly raised on behalf of 
every new development which was to improve the 
professional work of the mission hospitals through- 
out the country. " Dear old Hodge ! " as one 
great friend wrote of him, " nothing second-rate 
for his offering to Christ. Always the very best, 
in medicine, in science, in life." And to this, 
Dr Cecil J. Davenport adds : — 

The standard he set up for himself, his work, his patients, 
his surroundings, was the Best. He was satisfied with nothing 



104 CHINA AND MODERN MEDICINE 

less. . . . Xo half -up-to-date methods of work for the Chmese 
were allowed by him. His aim was quality rather than 
quantity, and he saw to it that his directions and lines of treat- 
ment were strictly carried out. He has raised a standard of 
medical work in Central China the influence of which will be 
felt for years to come.^ 

The influence of Hodge, and of medical men 
and women of his type, gathers force as the years 
go by. No question is exercising the minds of 
medical missionaries in China more deeply to-day 
than that of making their hospitals a real object- 
lesson to the Chinese, in professional standards and 
scientific efficiency as well as in spiritual power. 

The China Medical Missionary Association, 
which was founded in 1886 with Dr J. G. Kerr of 
Canton as its first president, and which now has 
a membership of nearly six hundred medical men 
and women, 2 has continually lent the pages of its 
journal to a discussion of this topic. It was 
made the main subject for discussion at the last 
Conference of the Association, held in Peking in 
February 1920. In preparation for that confer- 
ence a somewhat exhaustive questionnaire, dealing 
with every aspect of the scientific efficiency of 
mission hospitals in China, had been prepared 
during the preceding twelve months, and this was 
sent out to every medical mission station in the 

^ Sydney Rupert Hodge, by the Rev. J. K. Hill, pp. 59 and 100. 

2 Membership of the Association is not confined to medical 
missionaries, but is open to all physicians who are in sympathy 
with missionary work. See Api-endix JII for a fuller account of 
this important Association. 



EVOLUTION OF THE HOSPITAL 105 

country. It is significant of the interest which 
this subject is arousing that, in spite of the lengthy 
and detailed character of the enquiry form, 
returns were received from no less than eighty 
per cent of the hospitals. 

The enquiry brought to light the very difficult 
conditions under which many hospitals even in 
important towns and cities still have to carry on 
their work, owing to the utter lack of facilities for 
modern medical treatment. This is clearly shown 
in the following summary of some of the evidence 
which appears in its pages : — 

34 per cent of the hospitals whose reports were received 

have no nurse whatever, foreign or Chinese, and 60 

per cent not more than one trained nurse. 
37 per cent depend entirely on the patients' friends for all 

nursing, whilst 62 per cent have no night -nursing. 
37 i>er cent possess no bedding, or only sufficient for a very 

few patients. 
58 per cent are unable to clothe their patients in clean 

hospital garments. 
8 per cent only have a pure water supply, and 6 per cent 

only have running water laid on throughout the 

hospital. 
50 per cent seldom or never bathe their patients, and 

43 per cent have no laundries, or only inadequate 

accommodation for dealing with the hospital linen. 
34 per cent do not possess a pressure sterilizer for their 

dressings, and 73 per cent have no means of sterilizing 

bedding or mattresses. 
37 per cent have no protection whatever against flies or 

mosquitoes, and 65 per cent have no isolation block 

or courtyard. 
31 per cent do not possess a laboratory of any kind, whilst 

82 per cent have no bacteriological incubator 
87 per cent do not possess an X-Ray plant. 



106 CHINA AND MODERN MEDICINE 

It will be seen from the above table how much 
leeway there is yet to be made up before these 
hospitals are worthily equipped for their work. 
At the same time there is solid ground for en- 
couragement in the progress that has already 
been made, and in the new plans for advance 
which many mission boards are now^ contem- 
plating. There are already, in different parts 
of China, nearly a hundred mission hospitals 
which are being operated on approximately 
modern standards, with up-to-date equipment, 
skilful nursing, careful and thorough investigation 
of disease, and above all, a determined effort on 
the part of every worker to manifest and proclaim 
the spirit of Christ in the whole work of the insti- 
tution. This represents a force in the life of China 
whose far-reaching influence no one can estimate. 



CHAPTER V 

THE NEW PROFESSION IN CHINA 

The greatest need of China is not, after all, for highlj'- trained 
scientists, although they are essential ; it is not, after all, 
for the greatest technical skill, although that is absolutely 
necessary if the great end is to be attained. But the great 
need of China is scientific knowledge and technical skill 
dominated by idealistic loyalty to the highest and best things 
in human life ; and that idealism that is most enduring, that 
can be most counted upon, that is least Ukely to fail, is an 
idealism based upon a deep and abiding religious conviction. — 
George E. Vincent, President of the Rockefeller Foundation^ 
March Uh, 1920. 

It was characteristic of men of such far-sighted 
vision as Colledge and Parker that they saw, from 
the very commencement of their medical work in 
China, that the vast needs of the country could 
never be met except by the trained efforts of her 
own sons and daughters. And since China at 
that time had no Medical College of her own 
whatever,^ they at once realized that one of the 
chief contributions which medical missions must 
offer should be in the direction of the training of 
Chinese youths in western medical science. Not 
only was this object included in the fxrst statement 

^ The so-called Imperial Medical College at Peking, established 
from the time of the Yuen Dynasty (a.d. 1280-1368), merely 
existed for the conferring of degrees on court physicians. No 
instruction was given, nor were examinations conducted. 

107 



108 CHINA AND MODERN MEDICINE 

of the Medical Missionary Society, which as we 
have seen the}^ founded in 1838, 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 of oral instruction of a practical char- 
acter, on very much the same lines as in the old 
apprenticeship days in this country, for there 
were no Chinese medical text-books that could be 
employed, nor any facilities for laboratory work. 
But the clinical teaching which Parker gave these 
men was so successful that one of them, Dr Kwan- 
tao, subsequently obtained a reputation as surgeon 
and oculist that was almost as widespread as that 
of his teacher. On one occasion he was sent for 
by the Viceroy of Szechuan, nearly 2,000 miles 
away, upon whom he operated for cataract. He 
also performed various major surgical operations, 
one of which was the removing of a tumour which 
is said to have measured some three and a quarter 
feet in circumference — a performance which, in 
those days, must have made an enormous impres- 
sion on the people, to say nothing of the patient ! 
The work of training Chinese assistants which 
Parker thus inaugurated was continued by various 
medical men who succeeded him, notably by 
Dr John G. Kerr of the American Presbyterian 
Mission, who, in a remarkable life of nearly fifty 
years of medical missionary service at Canton, 
not only helped to instruct some two hundred 



THE NEW PROFESSION IN CHINA 10S> 

students but also made invaluable contributions 
to the building up of the new Chinese medical 
literature, which, as we have seen, Benjamin 
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 
humble scale in China, and for the next fifty or 
sixty years similar classes for students were 
organized in various parts of the country, in 
connection with different mission hospitals. Most 
of these students came from poor homes and were 
deficient in general education ; but in spite of so 
many handicaps many of 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 of a new supply of fully- 
trained Chinese physicians, by the sending abroad 
of students whose knowledge of English was 
sufficient to enable them to pursue their medical 
studies in Europe or America. The first of these 
was Mr Wang Fun, who was sent to Edinburgh 
through the generosity of some British merchants 
in Hongkong, and who graduated there with 
distinction in 1855. He returned to China in 
1857, in connection with the London Missionary 

1 Vide p. 46. 



110 CHINA AND MODERN MEDICINE 

Society, and Dr Henderson wrote of him a few 
years later : " There is not a medical man now in 
China who has a better knowledge of his profession 
in all its branches than Dr Wang Fun." ^ 

Many years elapsed before Dr Wang's example 
was followed, and indeed it is only in very recent 
times that any considerable number of Chinese 
students have left their country to study medicine 
abroad. Most of these have gone to Japan, where, 
unfortunately, they have not as a rule attached 
themselves to the higher-grade Japanese medical 
schools, and thus have failed to secure the full 
benefits of 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 
Dr Wu Lien-teh, a graduate of Cambridge, now 
Director of the Plague Prevention Service of 
North Manchuria ; Dr S. P. Chen, also of Cam- 
bridge, who has charge both of the Central Hospital 
and of the Isolation Hospital, Peking ; and Dr 
F. C. Yen, of Yale, Dean of the Hunan-Yale 
Medical College at Changsha. 

In this connection mention must be made of a 
brilliant little group of Chinese women students 
who have studied medicine in America. The 
first of these was Dr Y. May King, an adopted 
daughter of Dr McCartee of Ningpo, who graduated 
from the Women's Medical College of the New 

^ Memorials of James Henderson, M.D., p. 179. 



THE NEW PROFESSION IN CHINA 111 

York Infirmary in 1885, took various post-graduate 
appointments, and finally returned to China to 
work in connection with the Reformed Church at 
Amoy. She was followed a few years later by 
Miss Hu King-eng, the daughter of a Foochow 
pastor, who subsequently returned to do splendid 
work in her native town. 

In 1892 no little excitement was caused at the 
Medical School of the University of Michigan by 
the arrival of two Chinese girls to study medicine. 
They were the protegees of Miss Howe of Kiu- 
kiang, the one Miss Mary Stone (Shih Mei-yn) 
and the other Miss Ida Kahn. They completed 
their course in 1896, and no more popular figures 
took part in the graduation exercises of their 
year than those two dignified Chinese women in 
their native dress, of whom President Angell said : 
" Their future career will be watched with every 
expectation of eminent success." Their return to 
Kiu-kiang was made the occasion of an extra- 
ordinary popular ovation, the Chinese welcoming 
them with a huge demonstration in which some 
forty thousand fire -crackers were let off ! Dr 
Mary Stone remained in Kiu-kiang, where in 1916 
she treated no less than twenty-four thousand 
cases at the Danforth Memorial Hospital, and 
w^here she developed an excellent school for the 
training of Chinese mid\^^ves.^ Dr Ida Kahn 

* Dr Mary Stone has recently removed to Shangliai, where she 
has established a large nursmg home and private hospital. 



lU CHINA AND MODERN MEDICINE 

responded to an invitation to open up medical 
work in another huge city, Nanchang, where by 
the successful treatment of the wife of an official 
she opened the gates to Protestant missionaries. 

II 

The year 1881 is one that should long be 
remembered in connection with the development 
of medical education in China, for it saw the 
opening of the first medical school established 
in the country on a modern basis. ^ Its incep- 
tion was due to Kenneth Mackenzie, who, on 
hearing that several Chinese students who had 
been sent to America for collegiate education 
were being recalled by the Government, at once 
memorialized the Viceroy of Chihli, Li Hung 
Chang, petitioning that eight of them might be 
placed under his care '' for the study of medicine 
and surgery, with a view to their being utilized 
eventually as medical officers 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 for 
the financial upkeep of the school, giving 
Mackenzie full freedom for missionary w^ork 
amongst the students. 

Three classes were admitted to the school during 

^ Medical Schools were established in China in the reign of 
Sheng Tsung (a.d. 1068), of the Sung Dynasty, and were still further 
developed in the Yuen and Ming dynasties. Subsequently, 
however, tliey fell into abeyance. 



THE NEW PROFESSION IN CHINA US 

Mackenzie's lifetime, each taking a three-year 
course. All instruction was given in English, 
mostly by Dr Mackenzie himself, who received 
valuable assistance from Dr Atterbury of Peking 
and from some of the British and American naval 
surgeons stationed at Tientsin. Nineteen men 
were graduated in all, and though Mackenzie 
wrote in 1887 that his hopes had not been entirely 
fulfilled, Dr Fred Roberts was able to write in the 
following strain four years later : — 

You wiW be glad to know that the former labours of Dr 
Mackenzie, in connection with the Government Medical School 
under his charge, have been far from fruitless. Up to the 
time of his death it seemed to him almost like labour m vain, 
seeing that the graduates were not successful in obtaining 
appointments. It is very different now. In close proximity 
to our own hospital is an imposing building, the Viceroy's 
hospital, managed for the most part by three of Mackenzie's 
former students, and mth the prospect, if well conducted, of 
doing much good in the healing of the sick. In Port Arthur 
there is a naval and military hospital and dispensary which 
is much appreciated by the soldiers, and it also is worked 
by former students. Others again have been appointed to 
Wei Hai Wei, a naval station. Dr Chang has been accepted 
many months ago for the post of house surgeon to the AUce 
Memorial Hospital (L.M.S.), Hongkong; while, last but not 
least, Dr Mai has been for some time successfully treating 
the father of the Emperor in Peking.^ 

It is interesting to know that this medical 
school is still in existence, being now supported 
by the provincial government of Chihli, and known 
as the Peiyang Medical College, Tientsin. 

In 1887 the Hongkong College of Medicine was 

1 John Kenneth Mockeyizie, by Mrs Bryson, p. 376. 



114 CHINA AND MODERN MEDICINE 

opened, with Dr Hanson (now Sir Patrick Hanson) 
as its first Dean. The London Hissionary Society 
was closely connected with the college from its 
inception, the Society's hospitals being used for 
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 of Anatomy and Surgery) that was 
to play so dramatic a part in his future career. 

Other small medical schools slowly came into 
existence, mainly as a development of those 
classes for student-assistants which had been 
started in connection with various mission 
hospitals.^ But it was after the Boxer uprising 
of 1900, when the need for constructive and 
educative work on a broad basis was brought 
home to all friends of China, that the first attempt 
was made to establish a School of Hedicine in 
Peking. This was the first medical college to 
be established in China by the combination of 
both British and American medical men, and 
through the co-operation of missionary societies 
representing different religious denominations. 
It was organized by Dr Thomas Cochrane, 
of the London Hissionary Society, who was 
fortunately successful in securing the patronage 

^ A series of successful classes of this nature had already been 
organized by Dr H. W. Boone at Shanghai, Dr Van Someren 
Taylor and Dr Osgood at Foochow, Dr Duncan Main at Hangchow, 
Dr Christie at Moukden, Dr Gillison at Hankow, and many others. 



THE NEW PROFESSION IN CHINA 115 

and financial support of the Dowager Empress 
and many of the leading Chinese officials, and 
who received invaluable assistance from such 
men as the late Sir Robert Hart, Sir Ernest 
Satow and Dr Douglas Gray. The college was 
recognized by the Chinese Government from the 
outset, the Board of Education giving a special 
diploma to all graduates and making an annual 
grant towards the support of the institution. A 
very able group of men was obtained as members 
of the teaching staff, many of whom, alas, passed 
away in early life. Such men were the late Dr 
H. V. Wenham — a man of exceptional charm and 
brilliant gifts, who had gone to China with a view 
to organizing such an institution himself, and 
with characteristic unselfishness threw himself 
into the Peking scheme — and Dr J. G. Gibb, of 
St Bartholomew's, Dr J. M. Stenhouse, of London 
Hospital, who died of wounds received during the 
recent war, and Dr Francis J. Hall, an American 
physician — men to whom the whole cause of 
medical education in China owes a large debt of 
gratitude. This college in Peking had the distinc- 
tion of conducting its medical teaching in Chinese, 
aided by text-books which a special committee 
had translated into that language. 

It was not long before other centres followed 
Peking's lead, and Missionary Medical Colleges, 
both denominational and union, were opened all 
over the country, with commendable zeal but 



116 CHINA AND MODERN MEDICINE 

questionable wisdom. Not that there was not 
ample room for them all, and many more in 
addition, if the needs of so vast a country were 
taken into consideration ; but the suitable men 
who were available to staff such institutions, and 
the funds from which to supply the extensive 
buildings and equipment needed, were both so 
limited that there was no hope unless the number 
of these colleges was reduced that any of them 
would be adequately manned or furnished. At 
the Biennial Conference of the China Medical 
Missionary Association in 1913 a resolution was 
passed, urging that no further Medical Schools be 
established until the eight Union Colleges then in 
existence were made efficient. ^ It soon became 
evident that even that number was far beyond 
the power of the missions to render effective. 

In addition to the eight missionary medical 
colleges just referred to, all of which were confined 
to men students, three medical schools for women 
had also been established in China. In the South, 
Dr Mary Fulton — one of the pioneer women 
physicians in the Far East — laid in 1899 the 
foundations of what has become the Hackett 
Medical College, Canton, In Central China 
another pioneer worker, Dr Margaret H. Polk, 
made a similar effort at Soochow; whilst in the 

* These eight were situated at Moiikden, Pekmg, Tsinan, 
Hankow, Chengtu, Nanking (with Hangchow), Foochow, and 
Canton. 



THE NEW PROFESSION IN CHINA 117 

North a Union Medical College for Women was 
established at Peking. These three schools not 
only differed widely in their location, but also in 
the language employed for the instruction of the 
students, Cantonese being used at Canton, English 
at Soochow, and Mandarin at Peking. 

Many valuable women workers have received 
their training in these institutions, but unfortun- 
ately the Women's Colleges, like the others, have 
been so starved for lack of workers and equipment 
as severely to cripple the efficiency of their medical 
instruction. Important steps are now on foot 
looking to the concentration of women's medical 
education in either one or two thoroughly efficient 
schools, and possibly to co-operation with one or 
other of the men's medical colleges. Such a plan, 
combined with a large expansion of staff and 
improved buildings and equipment, should ensure 
that the important work of training women 
medical students for the unique service that they 
can render to their suffering sisters in China will 
be placed on a satisfactory footing. 

Ill 

Meantime, however, important new factors 
began to appear on the scene. In the first place 
there came into existence a body of 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 

a National Medical Association of China.^ The 
leader of 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 for the establish- 
ment of modern standards of medical education, 
and outlined a suggested syllabus for the purpose. 
At the same time, various of the Chinese provincial 
governments began to show their keen interest in 
this work, not only by opening provincial medical 
colleges (as at Soochow, Hangchow, etc.), but also 
by co-operating in the development and support 
of some of the missionary medical colleges, notably 
that connected with the work of the Yale Mission 
at Changsha, and with the Moukden Medical 
College. 

In the second place, other organizations inter- 
ested in the progress of China began to take a 
share in the work of medical education. The 
University of Hongkong, which was established 
in 1907, incorporated the former College of 
Medicine. In a similar way were founded the 
Harvard Medical School at Shanghai ; the German 
Medical Colleges at Shanghai and Tsingtao (both 
since closed) ; and the Japanese Medical College 
at Moukden. But none of these organizations 
made so large a contribution to the cause of 
medical education, nor has exerted so profound 
an influence in the setting of modern standards, 

^ Vide Appendix IV. 



THE NEW PROFESSION IN CHINA 119 

as has been effected by the Rockefeller Foundation 
of New York. During 1914 and 1915 the Founda- 
tion despatched two influential commissions to 
China, including some of the leading university 
and medical men of the United States, " to enquire 
into the condition of medical education, hospitals 
and public health." After making an extended 
tour through a large part of China, in which they 
visited practically all the medical colleges, and 
personally inspected some eighty-eight hospitals, 
they issued a careful report, entitled Medicine in 
China, '^ in which they made a series of recom- 
mendations to the Foundation, of which the 
following is a brief summary : — 

1. That the Rockefeller Foundation should 

undertake medical work in China. 

2. That the Foundation should, so far as 

possible, co-operate with existing mis- 
sionary institutions " which have already 
done such good work in China." 

3. That medical instruction in which the 

Foundation is concerned should be on the 
highest practicable standard. 

4. That the English language should be the 

medium of instruction in those medical 
schools with which the Foundation should 
become connected. 

5. That the Foundation should commence its 

1 Published by the Rockefeller Foundation, 61 Broadway, 
New York. 



120 CHINA AND MODERN MEDICINE 

activities in Peking and Shanghai, if a 
suitable scheme could be formulated for 
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 for medical 
education at Canton and Changsha re- 
spectively. 

6. That assistance should be given to the 

development of a higher standard of pro- 
fessional efficiency in various hospitals, 
commencing with those situated in the 
fields tributary to the medical schools 
aided by the Foundation. This assistance 
should take the form of grants towards the 
support of increased medical and nursing 
staffs, business managers, etc., and the 
provision of laboratory equipment for 
improved diagnostic measures. 

7. That encouragement should be given to the 

training of nurses. 

The recommendations of this Commission were 
adopted by the Foundation and a special organi- 
zation created for the purpose of putting them 
into effect ; this has been designated the China 
Medical Board of the Rockefeller Foundation. 

The first act of 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 

property of the Union Medical College, Peking, 
vesting it in a new Board of Trustees, upon which 
the various missionary societies interested in the 
work in Peking, and the China Medical Board, 
are equally represented. An extensive property, 
formerly owned by one of the Chinese princes, 
was purchased, and here there has been erected 
what it is no exaggeration to describe as the most 
beautiful modern building in the whole of China, 
and one of the best-ordered and best-equipped 
medical schools and hospitals to be found any- 
where in the world. An adaptation of Chinese 
architecture has made it possible to give to the 
buildings, in addition to the usefulness for which 
they were planned, beauty of 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 
has been expended on this school, and every effort 
has been made to ensure that each department 
should be staffed by expert medical men, and 
furnished with everything necessary for up-to- 
date scientific work. 

The missionary societies are co-operating in 
the selection of teachers for the school, and a 
number of the men who have already received 
appointments have been drawn from the ranks of 
medical missionaries. The whole cost of upkeep 
of the institution, which is, of course, very con- 
siderable, is being borne by the Rockefeller Founda- 



122 CHINA AND MODERN MEDICINE 

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

IV 

As soon as the decision of the Rockefeller 
Foundation reached China, two serious questions 
confronted those medical missionaries who were 
engaging in the work of 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 of the missionary schools that 
they were offering to the Chinese a type of medical 
education that was of a lower standard. At first 
there was a considerable feeling in some quarters 
in favour of retaining a number of low grade 
medical schools ; but the large majority of medical 
educationalists connected with the missions took 
the line that the Mission Boards ought to con- 
centrate all their strength on just that number of 
medical schools that they could make absolutely 
efficient. To retire at so promising a stage was 
unthinkable, for that would mean the surrender 
of a wonderful opportunity of infusing medical 
instruction with Christian ideals and principles, 
and of winning a large number of future leaders 



THE NEW PROFESSION IN CHINA 123 

of the medical profession for the service of Jesus 
Christ. 

Secondly, the Rockefeller authorities having 
decided to use the English language as the medium 
of instruction at Peking, there was a fear lest the 
splendid work that had been done in the creation 
of a medical terminology in Chinese, and the 
translation of medical text - books, would fall 
into abeyance. Whilst medical educationalists 
have been divided in their opinion as to whether 
English or Chinese is the best medium of instruc- 
tion at the present time, it is almost unanimously 
agreed that both types of education should, if 
possible, be maintained, and at an equal standard 
of efficiency, as it is recognized by all that sooner 
or later the Chinese language must and will be 
universally employed for teaching all scientific 
subjects. This last fact necessitates that some- 
body must bridge over the gap which exists 
between the assimilation of medical knowledge in 
a foreign tongue, and the imparting of that know- 
ledge in the language of the people. Surely 
therefore it is a sound policy that there should be 
preserved in China at least one or two first-class 
medical schools in which the materials for the 
building of such a bridge are carefully conserved, 
and added to year by year. Furthermore, if the 
students in such a college have a sufficient working 
knowledge of English to enable them to read 
medical books in that language with comparative 



IM CHINA AND MODERN MEDICINE 

ease, the objection which is raised to medical 
instruction in Chinese, on the score that the 
graduates have too hmited a medical literature 
from which to extend their knowledge and ex- 
perience, falls at once to the ground. 

The Council on Medical Education (of the 
China Medical Missionary Association) which was 
formed in 1915 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 of at least one medical 
college teaching in Chinese, and expressing the 
opinion that the school most suitable for such 
development was the one that was situated in 
Tsinan, the capital of the province of Shantung. 

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

This proposal received the endorsement of the 
newly formed British Advisory Board of Medical 
Missions, as well as of many missionary leaders in 



THE NEW PROFESSION IN CHINA 125 

North America, and the transfer to Tsinan was 
effected in 1917-18. 

At the same time the China Medical Board, 
whilst it did not feel able to undertake the responsi- 
bility of maintaining another school, invited the 
Tsinan authorities to receive three classes of 
students formerly under instruction at Peking, 
and in return for so doing made a generous grant 
of over £30,000 towards the cost of additional 
buildings and equipment, and the support of 
additional members of the staff — a grant which 
has since been augmented. 

This concentration of forces in the Tsinan 
Medical School (now known as the School of 
Medicine of the Shantung Christian University) 
is probably one of the most remarkable instances 
of missionary co-operation in China, for it has 
brought no less than nine societies of Great 
Britain, Canada, and the United States, repre- 
senting all the chief Christian denominations, 
into fellowship,^ and in five cases out of the nine 
it has involved the transference of representatives 
of a mission to a part of China in which that 
particular society had no previous responsibility. 

1 These nine societies are : in Great Britain the Baptist 
Missionary Society, the Society for the Propagation of the Gospel, 
the London Mssionary Society, the Wesleyan INIissionary Society, 
and (to a less degree) the English Presbyterian Mission ; in the 
United States the American Presbyterian ^lission North, the 
American Presbyterian Mission South, the Norwegian Lutheran 
Mission ; and in Canada the Presbyterian Mission. 



126 CHINA AND MODERN MEDICINE 

It has, however, had the satisfactory result of 
enabling the Medical School to secure an expert 
faculty of more than twenty full-time teachers. 

Besides Tsinan, the Council on Medical Edu- 
cation is urging the development of two other 
missionary medical colleges teaching in Mandarin. 
One of these is the well-known Medical College at 
Moukden, which will always be connected with 
the indefatigable work of the veteran Dr Dugald 
Christie and the glorious self-sacrifice of Arthur 
Jackson. Commencing as the offspring of the 
United Free Church of Scotland, it is now linked 
mth the other two missions working in Manchuria, 
and receives strong support from the provincial 
government. The other Mandarin school is the 
Medical Department of the young and vigorous 
West China University at Chengtu, where British 
Friends and Churchmen link hands with Methodists 
and Baptists of Canada and the United States. 

Two medical colleges employing English as the 
chief medium of instruction are also receiving 
strong encouragement from the China Medical 
Missionary Association. One of these is in Central 
China (Changsha), where the Yale Mission, in 
co-operation with the Hunan Government, has 
established an important school, in which the 
Wesleyan Mission is now taking a share, and in 
the establishment of which Dr F. C. Yen and 
Dr E. H. Hume have taken a leading part. 

The other is at Shanghai, where St John's 



THE NEW PROFESSION IN CHINA Ul 

University, together with the University of 
Pennsylvania Mission, has been carrying on 
medical instruction for many years past. Now 
that the China Medical Board has definitely 
decided to abandon its projected medical school 
at Shanghai, it is probable that this medical 
department of St John's University will be largely 
extended and placed upon a wider union basis. 

At Canton, after many years of unsuccessful 
effort to organize a union school in which high 
standards should be set, encouraging negotiations 
are now taking place with a view to co-operation 
between the Canton Christian College, the Medical 
School of the University of Hongkong, and the 
historic Canton Hospital. 

It has already been mentioned that the existing 
Women's Colleges are hoping to combine their 
forces so as to form at least one thoroughly 
efficient school for women. In addition to this, 
women students are now admitted to the new 
China Medical Board School at Peking, and the 
same arrangement will probably be made in 
other centres also in course of time. 

V 

The theory "of medical training and practice 
described in this chapter is based upon an assump- 
tion which has frequently been called in question 
— ^that only the fully qualified doctor is good 
enough for China. Those who challenge this 



128 CHINA AND MODERN MEDICINE 

assumption argue that in face of such an un- 
relieved mass of suffering as the population of 
China presents, and in a land where indigenous 
medical methods are so crude, it would be better 
to aim at quantity rather than quality, and for 
the mission colleges to turn out hundreds of 
students with a superficial knowledge of how to 
treat common ailments or to administer practical 
first-aid, instead of a mere handful, year by year, 
of students highly trained and qualified after long 
and expensive years of study. 

Such an argument suggests that we are im- 
provising a temporary Red Cross organization to 
deal with an acute situation which has suddenly 
developed and which will rapidly improve. If 
this were the case, there might be some justifica- 
tion for such an ad hoc policy. But that does 
not represent the state of the case at all. We 
are engaged in the tremendous task of assisting 
a great and ancient nation to work out a 
worthy system of medical education and practice. 
Amongst the leaders of that nation are already to 
be numbered an influential group of medical men 
and women who are fully conversant with the best 
science of the West, and who are eager to see similar 
standards adopted in their own country. One of 
them has already expressed himself publicly in the 
following words : — 

However necessary modem medicine may be to this country, 
I would rather see fewer well-quaHfied men and women with 




Wu LiEN-TEH, M.A., M.D. (Cantab.) 
LL.D. (Hongkong) 

PHYSICIAN EXTRAORDINARY TO THE PRESIDENT OF 

CHINA ; DIRECTOR OF THE NORTH MANCHURIA 

PLAGUE PREVENTION SERVICE 

{See page no) 



Mary Stone, M.D. 
(Univ. Mich., U.S.A.) 

FORMERLY PHYSICIAN IN 

CHARGE OF THE DANFORTH 

MEMORIAL HOSPITAL, 

KIUKIANG 

{See pa ^e in) 



THE NEW PROFESSION IN CHINA 129 

high ideala than a great many poorly-quaUfied practitioners 
\yith indifferent ambitions. For the one class makes for 
jDrogress, whilst the other leads to stagnation, if not retro- 
gression.^ 

In face of such an utterance as that, how could 
the representatives of missions possibly justify a 
policy which, in the West, would be stigmatized 
as nothing short of " flooding the country with 
quacks " ? 

It will no doubt be urged that partially trained 
men can do a great deal to relieve suffering, and 
that they can always keep in touch with an up-to- 
date and well-staffed hospital, to which they can 
send all their difficult cases. But the real fact is, 
as everybody knows, that the poorly-trained man 
is the last person in the world to admit that he 
has met a difficult case. He would lose face if 
he did so — or at least he thinks he would. 

Furthermore one must remember that the 
analogy of India and Japan, where a double 
standard of qualified doctor and licensed medical 
assistant is frankly recognized, does not hold good 
in China, where there is no authority to control 
the activities of the partially trained Chinese 
doctor. If he is in practice by himself, there 
is therefore every likeHhood of his professional 
standards gradually degenerating, thus bringing 
the mission which trained him into disrepute. 

It is considerations such as these which have led 

1 Dr Wu Lien-teh, President of the National Medical Association 
of China, speaking in Canton, January 25th, 1917. 

E 



130 CHINA AND MODERN MEDICINE 

to the adoption by the China Medical Missionary 
Association of the highest scientific standards 
(comparable to the best hospital-schools of London, 
Edinburgh, or Baltimore) in those medical colleges 
whose diplomas they recognize. And this con- 
tribution to the life and ideals of the Chinese 
people represents an achievement of 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 of outlining a two-year course of 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 
biology), but also allows for a re -arrangement of 
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 of special importance in China where 
centuries of memorizing, whilst they have pro- 
duced a marvellous faculty of recollection, have 
also left an unhappy legacy of passive mental 
receptivity, to the discouragempnt of aggressive 
thought. 



THE NEW PROFESSION IN CHINA 131 

There is always a demand for the well-tramed 
graduate. The Government, the railway com- 
panies, the national army and the progressive 
communities in the Treaty Ports vie with mission 
hospitals throughout the country for his services. 
And the demand will certainly increase faster than 
it can possibly be met. Thus there is becoming 
established in the mind of the Chinese people an 
appreciation of 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 for an increasing number of fully- qualified 
Chinese physicians, but it is essential that all 
medical science should be available in the language 
of the people. The China Medical Missionary 
Association has been fully alive to this fact. 
Special Publication and Terminology Committees 
have been at work for many years, translating 
several of the leading medical text-books,^ and 
preparing a full vocabulary of scientific terms. 
Dr P. B. Cousland, of the English Presbyterian 
Mission, has been set aside for the direction of this 
work, whilst in recent years a strong Translation 

^ Amongst those already translated, or shortly to be published, 
are Gray's Anatomy, Halliburton's Physiology, Cunningham's 
Practical Anatomy, Lewis and Stohr's Histology, Osier's Medicine, 
Rose and Carless's Surgery, Fuchs' Oyhihalmology, Stengel's 
Pathology, Hiss and Zinsser's Bacteriology, Hare's Therapeutics, 
Hutchinson and Rainy's Clinical Methods, Holt's Diseases of 
Childhood, and many others. 



132 CHINA AND MODERN MEDICINE 

Department has been organized in connection with 
the Tsinan Medical School, under the able leader- 
ship of Drs T. GilHson and P. L. McAll 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 official bodies have appointed 
their own representatives to act with the Ter- 
minology Committee, thus giving an official 
imprimatur to their decisions. All medical terms 
are now being revised and added to by this joint 
body, the Chinese Government defraying the cost 
of publishing them and the China Medical Board 
also assisting most generously in this essential 
work of 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 
the development of medical education. This was 
clearly shown by the great step which was taken 
by the Board of the Interior in November 1913 
in giving permission for human dissection and 
post-mortem examinations to be practised in 
medical schools, thus removing the last obstacle 
to the effective teaching of anatomy and patho- 
logy. More recently, at the Conference of the 
China Medical Missionary Association in 1920, a 



THE NEW PROFESSION IN CHINA 133 ' 

representative of the Board of Education gave an 
important address, in which he outhned the poHcy 
of the Board as including the provision of a 
modern medical college in each province, the 
opening of an institute for research, and the 
registration of medical practitioners. One pro- 
vincial governor — the progressive Governor of 
Shansi — has already commenced to erect buildings 
for a future school of medicine, and is now sending 
government students to Peking and Tsinan in the 
hope that they may ultimately form members of 
the teaching staff of the Shansi Medical College. 

Other schools are gradually being opened by 
the central and provincial governments as funds 
permit, and there is every reason to expect that 
in course of time China will be covered by well- 
staffed and well-equipped institutions. It will 
probably take many years to reach that stage, 
and meanwhile medical men and women from 
Great Britain and from North America are 
counting it the highest privilege to be allowed to 
assist China in this tremendous task. 



CHAPTER VI 

THE ADVENT OF THE CHINESE NURSE 

So kind, so duteous, diligent, 

So tender over his occasions, true, 

So feat, so nurse -like. 

Shakespeare, Cymheline. 

There have been few events in China within 
recent years which have marked so fundamental 
a change of mental attitude on the part of 
the people as the fact that it has now been 
found possible, in many centres, to introduce into 
Chinese hospitals the practice of nursing on a 
modern basis. Such a possibility was practically 
undreamed of as recently as twenty years ago, 
except in a few of the more progressive treaty 
ports. To-day there is a flourishing Nurses' 
Association of China, with two hundred and thirty 
members (foreign and Chinese) working in all 
parts of the country, and over fifty Training 
Schools already registered in connection with it. 
To appreciate something of what this means to 
China, and the steps by which it has been brought 
about, we must remind ourselves of the conditions 
which existed in the hospitals in the old days, and 
the difficulties with which the pioneer nurses had 
to contend. 

134 



ADVENT OF THE CHINESE NURSE 1S5 

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 of 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 
time, bringing with them whatever sort of para- 
phernalia the invalid expressed a desire for. The 
beds were not made because the hospital did not 
possess any bedding, and how can one " make " a 
bed which only consists of one enormous wadded 
quilt, wrapped around the patient ? The sick 
man's body and clothes remained unwashed — at 
any rate in the colder parts of China — because 
there was neither a warm bath to offer him, nor 
clean garments to change into. The windows 
were kept tightly shut, as soon as the doctor 
had finished his round, because every patient was 
terribly afraid of a draught. As for anything so 
modern as dietetics, asepsis, or measures for the 
prevention of insect-borne disease, etc., such 
ideas but rarely intruded into the old-time 
ward. There were, of course, some notable cases in 
which doctors, by dint of remarkable organization 
and eternal vigilance, succeeded in keeping their 
hospitals both neat and clean ; but these were the 
exceptions to the general rule. 

Nor were these the only difficulties that con- 
fronted the pioneer nurse in China. A still greater 



136 CHINA AND MODERN MEDICINE 

difficulty arose from the fact that she had to 
create her own traditions as she went along — and 
to do so in a country where the care of the sick 
was regarded as menial work, and beneath the 
attention of any of 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 her frankly as a 
rather peculiar mixture of an unqualified doctor 
and a ward coolie. Moreover the patients' friends 
looked askance at a system which found no place 
for their attentions, and which relegated the whole 
care of the unfortunate invalid to someone who 
was neither a menial nor a relative ! 

I 

The introduction of trained nurses into China 
is not so clearly marked an historical event as the 
coming of the first western physicians, but it 
would appear as if the honour of being the first 
graduate nurse to work in that country amongst 
Chinese patients belongs to Miss Elizabeth M. 
McKechnie (now Mrs Thomson). Miss McKechnie 
went to Shanghai in 1884 in connection with the 
Women's Union Missionary Society of America, 
and was attached for many years to the Margaret 
Williamson Hospital — an institution that will 
always be associated with the remarkable operative 
work of Dr Elizabeth Reifsnyder. Other nurses 



ADVENT OF THE CHINESE NURSE 137 

gradually began to follow, the first to go out from 
Great Britain being Miss Frances Johnson, who 
was appointed in 1889 to Kienning, Fukien, 
under the Church of England Zenana Missionary 
Society. But it was not until after 1900 that 
their numbers began to increase with any rapidity. 
Since then each year has seen a marked advance, 
and there are now one hundred and ninety 
" foreign " missionary nurses in the country, in 
addition to a few others not connected with 
missionary institutions. 

The pioneer nurse must have found it no easy 
task to decide just where to begin ! With a 
hospital already established on primitive lines ; 
with patients naturally suspicious of strange 
innovations ; and with little or no facilities for 
up-to-date nursing work — the new enthusiast 
certainly had a difficult road to travel. But in 
almost every case she approached it with that 
cheerfulness and tact and patience which have 
been characteristic of the trained nurse all the 
world over. 

The first step usually consisted in quietly re- 
placing the patients' friends by a staff of ward 
attendants, who would act under the nurse's 
direction. In most places this could only be 
accomplished gradually, in order to avoid arousing 
the patients' fears ; but as confidence became 
more and more established, even cases of a serious 
nature were willing to be left in the wards without 
E* 



138 CHINA AND MODERN MEDICINE 

always having their friends by their side. There 
was an economic argument also which helped to 
bring about this change, for previously the patient 
had been under the necessity of providing food 
both for himself and his friend, whereas he 
soon found that under the new system he was 
just as well looked after without this double 
burden on his shoulders ! 

The great trouble, from the nurse's point of 
view, was that in those early days she could only 
secure the services of ward attendants drawn 
from a poorly-educated or illiterate class. The 
dignity of service for the sick and needy members 
of the community had not at that time penetrated 
deeply into the consciousness of the Chinese, and 
students had no incentive to take up as a pro- 
fession a form of work which they considered 
quite derogatory to their rank. A large propor- 
tion of these early hospital orderlies were recruited 
from the poorer Christians, and many of them did 
most faithful work, according to their ability. 
But their lack of education made it impossible 
for them to grasp the scientific basis of modern 
nursing ; and in their anxiety to please the 
patients, and to keep ever}i:hing peaceful in the 
wards, it is not surprising that they often failed 
to enforce medical instructions which seemed 
absurd and unnecessary both to them and to the 
patients. Why shouldn't the sick man get out of 
bed and walk about the ward, if he felt well 



ADVENT OF THE CHINESE NURSE 139 

enough to do so ? And why shouldn't he be 
allowed to take off the bandage and scratch his 
operation wound, when it was itching to distrac- 
tion ? And how ever was that poor typhoid 
patient to get well and strong if the nurse would 
not even give her a bowl of rice to eat, and she 
half crazy with hunger ? It was amidst conun- 
drums of this sort that the poor ward attendant 
had to pass his perplexed days, and little wonder 
if he often followed the line of least resistance. 

Needless to say, this state of things did not 
satisfy the nurse fresh from a modern hospital. 
She quickly came to see — as missionary doctors 
had seen in another sphere — that one of the 
greatest responsibilities that was to devolve upon 
her must be along the lines of training up an 
educated Chinese nursing profession. Only so 
could China's immeasurable need be met ; and 
if, in the training of such nurses, she could so 
influence those young lives as to win their full 
allegiance to the service of the Kingdom and 
permeate the new nursing profession with the 
highest ideals of Christian service, she might well 
feel that this was the greatest contribution which 
she could possibly make to the country of her 
adoption. 

A start was made in this direction, in some of 
the Women's Hospitals, even before the arrival of 
trained nurses in China, notably bj^ 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 
were in a position to take it up. Commencing 
with small groups, or possibly (as in the case of 
Mrs Stevens, the first L.M.S. nurse in Hongkong) 
with only a single schoolgirl, the training of the 
first Chinese nurses was of a more personal and 
practical nature than anything else. But gradu- 
ally the work began to spread ; and with the new 
ideals of social service which began to lay hold of 
the imagination of young China a few years ago, 
and, above all, with the new inspiration to work 
for Christ and for humanity which was everywhere 
taught in the mission schools, the opportunity of 
securing educated classes of probationers at last 
became a real possibility. 

II 

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 
of a regular nursing system into the wards was 
first attempted. Let me tell some personal experi- 
ences in the province of Shantung in illustration 
of this point. 

Our first hospital in connection with the medical 
school in the city of Tsinan was run on very much 
the same primitive lines as those already described 
at the beginning of this chapter, and even when 
the first nurse was appointed to the hospital by 



ADVENT OF THE CHINESE NURSE Ul 

the Baptist Missionary Society, the absence of 
ward equipment and the lack of a trained staff 
made organized nursing work almost impossible. 
A start was made, however, first with hired 
orderlies, and then with two or three Christian 
girls from a neighbouring mission school, and 
meantime funds were being collected for the 
erection of a new hospital. It was decided from 
the outset that this should be built and furnished 
throughout on modern lines, so that it might not 
only offer the patients the best possible conditions 
but also afford the students an opportunity of 
learning how modern hospital treatment should be 
carried out. 

There were, however, two great problems 
looming ahead, which were a continual cause for 
apprehension. In the first place, would the 
patients be willing to come into a hospital of this 
unfamiliar type, where their friends would no 
longer stay with them, where their diet would 
be strictly controlled by the medical and nursing 
staff, and where — most startling of all — they 
would receive a hot bath on admission, and be 
supplied with hospital clothing and bedding ? 

Any doubts that ever existed on that score 
were dissipated almost as soon as the new wards 
were opened, for not only did the patients show the 
greatest willingness to accept the new conditions 
without a word of protest, but it soon became 
evident, from the increasing number of applicants. 



142 CHINA AND MODERN MEDICINE 

that they fully appreciated the warmth and 
cleanliness and comfort of the wards. Although 
the capacity of the hospital had been greatly 
increased, it was not long before every bed was 
filled, and since then the only serious difficulty 
has been the utter inadequacy of the accommo- 
dation for the many needy patients who seek 
admission. 

The other problem which faced us was an even 
more serious one. What was the use of 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- 
stitution ? If the hospital was to serve its purpose 
effectively, a full staff of 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 
nursing as a life-work. He stated that there were 
already signs of a new attitude in the country 
(particularly in Christian circles) towards service 
of 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 
hospitals in the West, and appealing for volunteers. 

This suggestion was adopted, and an appeal 



ADVENT OF THE CHINESE NURSE 143 

was sent out for twelve probationer nurses to 
form the first class in the new hospital — all of 
them to come on approximately the same con- 
ditions as to age, educational standard, remunera- 
tion, and length of service as at home. To our 
surprise and delight more than forty applica- 
tions were received, almost all of them from 
old High school students in different parts of 
the province, and all of them members of the 
Christian Church. 

In the fear lest some of these candidates did 
not understand what nursing really involved, and 
possibly regarded it as a short cut to becoming 
doctors, twelve of 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 
for them. It involved innumerable duties which 
they would naturally regard as unpleasant, or even 
repellent ; it included the admitting and bathing 
of new patients, some of 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 of clothes ; 
and it meant strenuous work, by night and day, 
unrelieved by lectures or classes, such as the 
Chinese student takes delight in. But none of 
these things deterred them. Only one of the 



lU CHINA AND MODERN MEDICINE 

twelve dropped out at the conclusion of the 
month, and the place was immediately filled. 

Thus was founded the Nurses' Training School 
of the University Hospital, Tsinan. From that 
time onward there has never been a lack of 
applicants for the class of new probationers which 
is admitted yearly, and over forty 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 
centres also. The social conscience of the Chinese 
is being increasingly stirred, and every year sees 
new training schools for nurses established in 
connection with hospitals in different parts of 
the country. 

The lot of 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 
of severe opposition from her people, who knew 
nothing of 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 
that of a ward coolie, and the more devotedly 
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 ? 



ADVENT OF THE CHINESE NURSE 145 

One of the first problems of training arose 
from the difficulty of securing good team work. 
It has often been remarked by writers upon 
China that, although the Chinese people have 
long ago advanced from sheer individualism, their 
community spirit has stopped short at the family 
or clan, with the result that anything approaching 
a civic consciousness, or a corporate national life, 
has been long in developing. But the young 
generation of China is undoubtedly learning its 
lesson, as the great political movement of the 
students at the time of the publication of the 
Peace Treaty amply proved. Nevertheless this 
lack of a corporate sense has been and remains an 
immense difficulty in the organization of such 
work as nursing, where a keen team spirit is 
essential. Day nurses ^vill fail to report to night 
nurses and vice versa ; whilst each probationer is 
inclined to regard her own scheduled duties, and 
nothing else, as her responsibility. 

Another problem arises from a lack of appre- 
ciation of the need for exact work. There is a 
Chinese expression which is the bane of all scientific 
workers, and which expresses a rather common 
attitude towards many things. This is " ch'a-pu- 
to," which may be pronounced "charboodor," 
and translated "not far out." But the "not-far- 
out " attitude is, of course, fatal to good nurs- 
ing, for it means that temperatures may not be 
exactly charted, medicines not carefully measured, 



146 CHINA AND MODERN MEDICINE 

dressings not thoroughly sterilized, and a number 
of other things even more serious than that. The 
need for doing things quickly and punctually has 
also been difficult for Chinese probationers to 
appreciate. The common attitude is well char- 
acterized in the following " Limerick " from the 
Nursing Mirror : — 

There once was a bad little pro, 
Whose movements were terribly slow 
Wlien asked, could she Tiurry, 
She rephed, " ^^^lat's the flm-ry ? 
I've four years to train in, you know." 

Night work has all along been a difficulty, 
and this is not to be wondered at in a country 
where night duty is so little known. It was every 
bit as hard for some of those poor young Chinese 
nurses to keep awake at night as it was for them 
to sleep properly by day, and most hospitals have 
a sad record of 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 of the Chinese nurses to good training 
has been remarkable, and the true nursing spirit 
is being more and more evinced every year. 

The graduates of the Training Schools are 
rapidly winning a place for themselves among all 
sections of the community. There is an increasing 
demand for their services both in the homes of 
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 of the future will certainly 
be able to hold her own with nurses of any other 
nation, and there is every reason to believe that 
she will be able to offer her own unique contribu- 
tion to the traditions of the world-wide nursing 
profession. 

in 

As the number of nurses increased in China 
it was felt that the example of the doctors in 
forming a Medical Association was one that was 
worth copying, and in 1909 the Nurses' Associa- 
tion of China came into being. ^ The object of 
the Association was twofold. First, it sought 
to establish the status of the nurse in China 
by enrolling under one organization all those 
who had received a full course of training, 
whether foreign or Chinese. Secondly, it sought 
to protect the standards of the new nursing 
profession which was being formed in the country, 
by standardizing the curricula and examinations 
and the minimum requirements of all training 
schools that desired to register themselves under 
its auspices and to secure its diplomas. 

The success of the Association has been 
remarkable. Commencing with a small group in 
1909, by 1920 it was possible to announce that 
one hundred and eighty-three foreign and forty- 
eight Chinese graduate nurses had already joined, 
that fifty-two training schools had been registered, 
^ Vide Appendix VI« 



U8 CHINA AND MODERN MEDICINE 

and that one hundred and fifty Chinese nurses 
had successfully passed the examinations and 
received the diploma of the Association. Nor is 
this all, for the Association has held regular 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 of all sections of the 
community. At the Conference of the Association 
held in Peking in 1915, a special address was 
presented to His Excellency, President Yuan 
Shih-kai, of which the following is a brief extract : — 

The Nui'ses' Association of China is at present composed 
mainly of graduate nurses from Europe and America, who, 
in hospitals in the various provinces of China, are engaged 
in the training of nurses and midwives. Year by year the 
number of graduate Chinese nurses will increase, and they 
will gradually take up the leadership of the Association in 
China. The foreign members of the Association are but helping 
to lay the foundations upon which may be built the great 
nursing profession of China, the members of which shall come 
to be as much admired and respected by public sentiment as 
are the members of the profession in other lands. 

In replying to this address, Admiral Ts'ai, who 
specially attended a session of the Conference 
as the representative of the President of the 
Republic, referred to the Nurses' Conference as 
" an epoch-making event in Peking," adding : — 

You medical men and women have broken down the bars 
to our sealed homes, and inspired our men and women to go 
forth and study likewise for your professions at home and 
abroad. The doctors shape the poUcies for the curing and 
prevention of disease, but it is the nurses who permanently 



ADVENT OF THE CHINESE NURSE 149 

carry out such policies. I feel that I owe the life of my child 
to the faithful intelhgent care given by a good nurse — to say 
nothing of the care I have received myself at the hands of 
nurses in time of need. 

At another session of the Conference a most 
inspirmg address was given by Surgeon-General 
Ch'uan, Head of the Army Medical College, 
Tientsin, who, in the com'se of his remarks, gave 
this interesting testimony : — 

There were those who said that the nursing profession 
could not grow in China ; but that day has passed. The 
nurse has proved her worth in this land, and has come to stay 
and to multiply. Keep your ideals high. A nurse worthy 
of the name must have education and refinement, and a 
character above reproach. Go forth with love, faith, and 
purity of heart ; your hope for the future is bright.^ 

Anyone who looks into the work of the Nurses' 
Association will agree that they certainly have 
" kept their ideals high," as Surgeon- General 
Ch'uan urged. They have set a high standard 
curriculum, demanding a full three-year course 
of training (or, in many instances, four years), 
followed by examinations in Anatomy and 
Physiology ; Materia Medica ; Medical and 
Children's Nursing ; Surgical Nursing ; Oph- 
thalmic Nursing ; Obstetrics and Gynecology ; 
Dietetics ; Bacteriology and First -Aid ; in addition 
to practical examinations in Bandaging and 
Nursing Methods. At the same time the Associa- 
tion is doing its utmost to instil the highest ideals 

* Report of Conference of Nurses' Association of China, 1915, 
pp. 13-15. 



150 CHINA AND MODERN MEDICINE 

of nursing ethics throughout the profession, and 
to encourage Chinese nurses to regard their work 
as a true act of service to God and to their 
countrymen. 

Another very important duty undertaken by 
the Association has been the preparation in 
Chinese of nursing handbooks and also a quarterly 
Nursing Journal. Several well-known text-books, 
such as Bundy's Anatomy and Physiology, Robb's 
System of Nursing, Russell Andrews' Midwifery, 
Mclsaac's Bacteriology, etc., have already been 
translated, and others are in course of preparation. 

IV 

Chinese ideas on etiquette, particularly as 
regards the kind of work which it is considered 
proper for young women to engage in, have so far 
made it necessary for male nurses to be employed 
almost exclusively in men's hospitals, and in the 
male wards of a general hospital. How long this 
necessity will continue it is, of course, impossible 
to predict, but there are already signs of a changing 
sentiment in the more progressive cities. The 
fact that women nurses are used extensively 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- 
fluence upon public opinion 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 
of the hospitals in the larger cities. 

Meanwhile it is encouraging to notice that well- 
educated male students are willing to take up the 
study of nursing — in fact some hospital matrons 
in China are inclined to think that they take it 
up even more seriously than the women nurses, 
regarding it more definitely as a life-work. A 
number of 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 
of Genito-Urinary Diseases for Obstetrics and 
Gynecology), and take the same examinations. 
In many general hospitals the male and female 
nurses take a large number of their classes to- 
gether. It is significant of the growth of public 
opinion in China within recent years that such a 
thing is possible. 

Male students who have concluded their course 
of 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 of the mission hospitals which previously 
trained student-assistants are finding it much 
more satisfactory to train male nurses instead. 



152 CHINA AND MODERN MEDICINE 

They can easily be taught to do all the routine 
work of the hospital ; they follow the regular 
course of 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 of deliberately turning loose 
on the public a number of unqualified medical 
practitioners. 

An extremely important development which has 
taken place within recent years in several mission 
hospitals has been the training of midwives. 
One of the first hospitals to undertake this special 
work was the Alice Memorial Hospital, Hongkong. 
It is a fact of special interest that it was a Chinese 
gentleman who built that hospital in 1887, in 
memory of his wife, 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 
at Kiukiang, under the leadership of Dr Mary 
Stone. 

Child-birth in China, as has already been re- 
marked, is commonly attended by an intensity of 
suffering and a heavy mortality which words 
cannot describe, and which are unparalleled to-day 
in western countries. This is due to the deplor- 
able ignorance and dangerous methods of the 
untrained Chinese midwife. A wonderful field 



ADVENT OF THE CHINESE NUKSE 153 

of service is therefore open in this direction. 
The graduates of the Maternity Training Schools 
are eagerly sought, and their opportunities are 
boundless. 

It is a remarkable fact that at the present time 
the moulding of the new nursing profession in 
China is almost entirely in the hands of missionary 
nurses from Great Britain and North America, 
and of Christian Chinese who have received their 
nursing training abroad. This is a heavy responsi- 
bility, and at the same time an extraordinary 
opportunity. To shape the traditions of the 
Chinese nurse of the future, and thus to inspire 
the whole profession with the loftiest ideals, is a 
task worthy of the best nurses whom the home- 
lands can produce. Those traditions will to a 
large extent be formed within the next ten or 
twenty years, by which time the Chinese nurses 
themselves will be the leaders of their profession. 
Until that time comes it is questionable whether 
there is any sphere in the nursing world which 
offers so unique an opportunity for the practice 
of the highest ideals and the exercise of the finest 
talents. 



CHAPTER VII 

RESEARCH AND PUBLIC HEALTH 

To wrest from nature the secrets which have perplexed 
philosophers in all ages, to track to their sources the causes of 
disease, to correlate the vast stores of knowledge, that they may 
be quickly available for the prevention and cure of disease — 
these are our ambitions. — Sir William Oslee, The Vocation of 
Medicine and Nursing, 1919. 

Wherever western medicine spread in China — 
pioneered, as we have seen, by the missionary 
doctor — ^the possibility of advancing medical 
science and benefiting human sufferers by patient 
research and careful investigation was always 
before the minds of its most progressive leaders. 
Although the medical missionary does not go 
abroad with the primary purpose of scientific 
discovery, his sphere of service includes within 
its orbit everything that will help to throw new 
light upon the incidence and causation of disease, 
and will mitigate or prevent the sufferings of the 
people. Thus it is that the prosecution of medical 
research and the promulgation of public health 
measures are matters of vital concern to the true 
success of the medical missionary enterprise. 

That remarkable trio, Coll edge, Parker, and 
Bridgman, were fully alive to this fact from the 
outset, and in the first official pronouncement of 

151 



RESEARCH AND PUBLIC HEALTH 155 

the objects of the Medical Missionary Society in 
China, issued in 1838, they referred to it in the 
following terms : — 

Countries are not more characterized by the form and uatui'e 
of the soil and its productions, than they are by the prevalence 
of certain maladies and a partial or complete exemption from 
others. The contemplation of disease as influenced by the 
position and height of a country, its inland or maritime location, 
and the general habits of the people, conducts the student to a 
most engaging range of medical philosophy, while it discloses 
many important lessons to assist him in the way of benefiting 
his fellow creatm'es. The advantages derivable from such a 
contemplation have been acknowledged at all periods, and in 
all quarters. To secure these advantages it is required that a 
book should be kept in all the institutions connected with this 
Society, into which an entry will be made of all important cases, 
with a notice, not only of the disease and the treatment pursued, 
but also of the province, habits, and other circumstances 
bearing upon the history of each individual. . . . 

A knowledge of the language will open another door of 
enquiry, namely in relation to the substances used in Chinese 
pharmacy and to their pecuHar modes of preparation. As the 
reciprocations of health and sickness are various in different 
countries, so Providence has displayed a corresponding variety 
in the distribution of remedies. This correspondence between 
the prevailing disorders of any country and the remedies which 
the hand of nature has provided is often very striking, and will 
become more so as the subject is investigated. We may there- 
fore look for a great many valuable additions to our dispensa- 
tories, while an extended acquaintance with disease under new 
modifications will help to enlarge and complete our system of 
nosology. 

Long before the China Medical Missionary 
Association came into existence in 1886, men were 
beginning to contribute original papers to the 
pages of the scientific journals. As early as 
1842 William Lockhart published a " Treatise 



156 CHINA AND MODERN MEDICINE 

on Chinese Midwifery " in the Dublin Journal of 
Medical Science, whilst ten years later Benjamin 
Hobson read before the China Branch of the 
Royal Asiatic Society an important paper on 
" Leprosy in China and the East." 

I 

There were many difficulties attending the 
pm'suance of scientific research in China in those 
early days, chief amongst which was the super- 
stitious fear which the Chinese cherished towards 
any interference with the cadaver, owing to their 
traditional attitude regarding the spirits of the 
departed. In spite of that fact, Parker performed 
his first post-mortem examination as long ago as 
1849, whilst Dr James Henderson, in his report 
for 1862, not only referred to a number of 
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 of demonstrations 
of surgical operations performed upon the dead 
body. 

A second disability arose from the conditions 
under which medical work had to be carried on at 
first, owing both to lack of adequate staff and 
equipment, and also to the need for avoiding 
anything that might offend the susceptibilities of 
the people. It may be confidently stated that 
the largest sacrifice which the medical missionarj^ 



RESEARCH AND PUBLIC HEALTH 157 

of former days had to face in undertaking work 
in the interior of China was the sacrifice of his 
scientific ambitions, and the lack of opportunity 
for professional consultation and co-operation. 
He found himself surrounded by a mass of 
fascinating problems to which he longed to devote 
time and thought, and by a wealth of clinical 
cases which he longed to investigate ; but how to 
carry out this desire, and at the same time do 
justice to the great objective which had brought 
him to China, was indeed a matter of serious 
difficulty. In most instances the doctor was the 
solitary administrator of a large and busy hospital, 
and in all probability the only medical adviser 
for a scattered community of missionaries and 
other European and American residents, in a vast 
district where communications were far from easy, 
and transport very slow. He had to carry the 
responsibility for the daily treatment of in- 
patients and out-patients, for the engaging and 
supervising of every member of the hospital staff, 
for the keeping of accounts, for the superintend- 
ence of the records of the institution, for the 
maintenance of the necessary stock of supplies, 
and for the conduct of all correspondence with 
home supporters. The organization and carrying 
out of the spiritual work of the hospital — possibly, 
also, of the local church or school — was upon 
his shoulders, and represented to him the most 
important work of his life. Often enough the 



158 CHINA AND MODERN MEDICINE 

superintendence of building operations in the 
hospital and elsewhere, to say nothing of innumer- 
able clerical duties and committees, put in a claim 
for the remnant of his time and strength. How 
then, in face of such endless duties, was he ever 
to find the necessary leisure and energy for 
scientific pursuits ? 

It says much for the professional keenness of 
the medical force in China that, in spite of all 
these many difficulties, there have always been a 
number of physicians who have found means of 
maintaining the scientific side of their work, and 
the pages of the China Medical Journal during the 
last thirty-three years of its existence, as well as 
occasional articles in the Journal of Tropical 
Medicine and other medical periodicals, bear 
eloquent te.stimony to the valuable contributions 
which have been made in the past by such men 
and women. ^ 

Recent years have witnessed a great advance 
along these lines. The biennial conferences of 
the China Medical Missionary Association, which 
at one time were largely devoted to the discussion 
of questions of general medical mission policy, 
are becoming increasingly valuable from the 
scientific aspect also. At the last conference ^ over 
one hundred original theses were sent in by 
members, with the result that simultaneous 
meetings of a technical character were held 

1 Vide list in Appendix I, page 209. - February 1920. 



RESEARCH AND PUBLIC HEALTH 159 

every afternoon throughout the conference. Four 
separate sections were formed, representing 
Anthropology, Medicine, Surgery, and Special 
Diseases. In each section important papers 
were read and helpful discussions took place. 
At the same conference an " Anatomical and 
Anthropological Society " was inaugurated, for 
the purpose of pursuing special investigation in 
that department. 

Prior to that date, at a similar gathering of 
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 of valuable 
reports from time to time, and has already made 
some important contributions to our knowledge 
of medical conditions in China, particularly in 
the department of hel mint hoi ogy. Two former 
members of that Committee, Dr W. H. Jefferys 
of Shanghai and Dr J. L. Maxwell (Jr.) of Formosa, 
prepared an excellent text-book on the diseases of 
China. It is full of most interesting information 
concerning the distribution of disease in the Far 
East, and was published in 1910 by a Philadelphia 
publisher.^ 

II 

The main investigation that has so far been 
carried out in China has followed three distinct 
paths — historical, physiological, and clinical — and 

^ Diseases of China, by Jefferys and Maxwell. 



160 CHINA AND MODERN MEDICINE 

it may be of interest to give some indication as 
to the lines upon which it has proceeded, or is 
proceeding to-day. 

1. Historical Investigation. — From earliest days 
the exponents of 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 of correct 
and useful observation, particularly as regards 
the course of various diseases, and the action 
of such medicaments as are in general use 
amongst Chinese practitioners. Unfortunately, 
as was pointed out in the opening chapter, 
the absence of a professional spirit amongst 
the doctors, or of any conception of co- 
operation with regard to medical knowledge, has 
prevented the publication of such discoveries, so 
that the task of the historical investigator is a 
very difficult one. But there is every reason to 
believe that a fund of interesting information, and 
possibly also the knowledge of new remedies for 
some complaints, awaits the patient search of the 
scientific student who has time and skill for the 
unravelling of the secrets of Chinese therapeusis. 

Of those who have made the chief contributions 
to our knowledge of Chinese medicine the most 
noteworthy are the American missionary, Dr J. C. 
Thomson of Macao,^ whose interesting writings 

1 Not to be confused with Dr J. C. Thomson of Edinburgh, who 
worked for many years in Hongkong. 




< 



Ol 



Co 



-^ o 



RESEARCH AND PUBLIC HEALTH 161 

have filled many pages of the China Medical 
Journal ; Dr James Henderson of Shanghai, who 
crowded more useful activities into his brief five 
years of life in China than anyone before or since ; 
and Dr John Dudgeon, the first Englishman to 
hold the position of Professor of Medicine in a 
Chinese College.^ 

Dr Henderson's paper on " The Medicine and 
Medical Practice of the Chinese," which was read 
before the North China Branch of the Royal 
Asiatic Society in 1864, and for which he was 
awarded the Fellowship of the Royal College of 
Surgeons, Edinburgh, is one of the most lucid 
contributions ever made to this subject.^ Com- 
mencing with the beginnings of medical knowledge 
in all parts of the world, Henderson showed 
convincingly at what point China had missed 
the stream of progress, and gave a graphic descrip- 
tion of anatomy and physiology as interpreted 
in Chinese medical literature. His article also 
included an extensive list of Chinese medical 
works, commencing with the earliest treatises, 
ascribed to the teachings of Shen-Nung and 
Hwang-Ti many centuries before Christ, and 
concluding with the famous " Yu-tswan-e-tsung- 
kin-kien," published in ninety volumes in the 
year 1740. 

1 This was the Tung Wen College, Peking, to which a scientific 
department waa added in 1865, and of which Rev. W. A. P. Martin, 
LL.D., became President in 1869. 
^ Proceedings, North China Branch, Royal Asiatic Society, 1864. 

F 



162 CHINA AND MODERN MEDICINE 

Most of the books which Henderson mentions 
consist of dissertations by ancient physicians on 
every imaginable complaint and symptom ; 
elaborate theories, mostly of a philosophical 
nature, as to their causation ; and innumerable 
prescriptions for their relief. In addition to these, 
however, is the great Chinese Materia Medica 
(Pen-ts'ao-kang-muh), which was compiled by Li 
Shi-chen in the middle of the sixteenth century 
by command of the Emperor, and which contains 
some seventy volumes and eleven hundred illustra- 
tions. This interesting work, although over 300 
years old, refers to a large number of drugs well 
known to practitioners of western medicine (such, 
for example, as siilphur, magnesia, calomel, 
aconite, etc.), and specially mentions one drug 
(probably hyoscyamus) as being of value as an 
analgesic for surgical operations.^ The book 
also includes a vast number of substances which 
practitioners in the West have never learned to 
regard as of medical value. It classifies all drugs 
into the following varieties : — 

1 Wa-T'o, the father of Chinese surgery, who lived in the third 
century a.d., is said to have performed a large number of major 
operations, including laparotomies, upon patients who had been 
previously drugged with Cannabis Indiea. He is also credited with 
the use of a special powder, which he applied to his operation wounds 
to prevent them suppurating ! Unfortunately, this courageous 
adventurer came to an untimely end, for on advising a military 
ofi&cer, who had consulted him about severe headaches, to submit 
to a trephining operation, the latter promptly had him executed 
for making a suggestion tantamount to an attempt on hk 



RESEARCH AND PUBLIC HEALTH 16S 

Water, fire and earth. 

Minerals. 

Vegetables (herbs, grains, culinary herbs, fruits 
and trees). 

Animal (insects, scaly animals, shelly animals, 
birds, hairy animals, human secretions, etc.). 

Dr J. B. Neal of Shantung, formerly President 
of the Shantung Christian University, carried out a 
series of analyses in 1888 and the following years, 
with the aid of his assistants, and their results 
served to show which of the ordinary drugs pro- 
curable at the Chinese drug-shop were free from 
impurity, and what adulteration was present in 
those that were impure. A similar investigation, 
of great practical value, was made by Dr W. Wilson 
and Dr Douthwaite, who published methods for 
purifying and utilizing many of these drugs, thus 
effecting a large and most welcome saving in their 
hospital drug bills. 

A very interesting and comprehensive list of 
Chinese medicines (including 1,575 varieties), pre- 
pared by Mr F. A. Morgan, was published by the 
Imperial Maritime Customs in 1889, whilst in 
1911 Dr G. A. Stuart of Nanking brought out a 
valuable work entitled Chinese Materia Medica: 
Vegetable Kingdom, embodying the results of 
much careful research. The death of Dr Stuart 
unfortunately prevented the completion of his in- 
vestigations into the other volumes of the Chinese 
Pharmacopoeia. That great work has never yet 



164 CHINA AND MODERN MEDICINE 

been translated into English, although Mr Daniel 
Hanbury and others have published very valuable 
notes upon it.^ The subject of Chinese pharma- 
cology thus remains practically virgin soil for the 
investigator, and a vast number of drugs referred 
to in Chinese medical books have never yet 
been identified or classified. Possibly some of 
the enterprising graduates of the newer medical 
schools in China will enter this fascinating field 
of research, and make discoveries which will lay 
the whole world under a debt of obligation to 
them. 

2. Anatomical and Physiological Investigation. — 
In addition to the efforts of the newly formed 
Anatomical and Anthropological Society in China, 
which has already published an interesting 
series of papers as a supplement to the China 
Medical Journal, one of the chief tasks to which 
the Research Committee of the China Medical 
Missionary Association has addressed itself has 
been the collecting of accurate data, as to the 
physical conditions of the average Chinese, in 
comparison with Europeans and Americans of 
equal age. 

This investigation, carried out especially by 
Dr Duncan Whyte of Swatow and Dr Arthur 
Shoemaker of Peking, has already established 
definite standards as to height, weight, chest 

^ Vide Pharmaceutical Journal and Transactions, July, August 1860 ; 
May, July, October, November, December 1861 ; February 1862. 



RESEARCH AND PUBLIC HEALTH 165 

measurement, urinanalysis, etc., which are essential 
to a correct appreciation of the effects of disease, 
or to any scientific determination of dosology 
for Chinese patients.^ Similar statistics are also 
being gathered with regard to various anatomical 
measurements, etc. 

In addition to these investigations a most 
important branch of research work has recently 
been commenced in the study of the food-value 
of the chief articles of Chinese diet. Physiological 
text-books dealing with the subject of Dietetics 
are necessarily founded upon a study of those 
substances which go to make up the ordinary 
western diet, and, for that reason, are of but 
little value in a country where the staple food 
differs widely from western standards. Of what 
advantage is it to the physician in China to be 
told the number of calories in half a pound of 
beef- steak when his patient's chief meal consists 
of two large bowls of rice, a little fresh vegetable, 
and some bean-curd ? It is plain that this 
whole subject of Dietetics needs to be studied 
afresh in every country, if scientific deductions 
are to be drawn from it for use in disease. 

One of the first papers published on this topic 

* Amongst these standards are the following : — 

Average height : — Adult male in North China, 5 ft. 7 in. 

„ male in South China, 5 ft. 4 in. 

„ female in South China, 4 ft. 11| in. 
Average weight of adult, 116 lbs. 
Chest measurement of adult, 28 in. to 31 in. 



166 CHINA AND MODERN MEDICINE 

was written in 1915 by Dr J. B. Neal,^ and con- 
sisted of a series of studies carried out by himself 
and his students in the physiological laboratory 
of the Tsinan Medical School. A further in- 
vestigation, dealing specifically with the analysis 
and food-value of Chinese bean-curd, was made 
in the same laboratory by Dr P. C. Kiang and 
Professor Adolph during 1919, whilst a similar 
research was conducted at the Peking Union 
Medical College by Professor Wilson and Miss 
Embrey. The results of these investigations 
were presented at the Medical Conference in 
1920.2 A start has thus been made, and the 
next few years will no doubt add fresh contribu- 
tions to the knowledge of the subject, which will 
make it possible to deal scientifically with the 
vast range of digestive disorders which are met 
with amongst the Chinese. 

3. Clinical and Pathological Investigation. — But 
the chief investigations which have so far 
been carried out have been in the clinical field 
and, more recently, in the fields of pathology 
and bacteriology, and in this respect China 
naturally offers an unrivalled opportunity for 
research. Numerous conditions are met with 
in that country which are seldom found in the 
West, and those complaints which are common 
to all lands are seen in an aggravated and unusual 

^ China Medical Journal, 1916, p. 9. 

2 Vide China Medical Journal, 1920, pp. 268, 603. 



RESEARCH AND PUBLIC HEALTH 167 

form in China, owing to long years of neglect, or to 
irritation from sepsis and other causes. 

Space does not avail, nor would it be appro- 
priate, to give any detailed list of the conditions 
which are commonly seen in China, but it 
may be stated that practically every ailment re- 
cognized by western physicians is to be found in 
the Far East, and a good many others besides — 
although a few diseases, such as appendicitis, 
acute rheumatism and lobar pneumonia, appear 
to be distinctly more rare in certain parts of 
China than in Europe. Tuberculosis, in all its 
forms, is every bit as rampant in China as 
in Europe, and it is a strange fact that while 
the Chinese patient has developed an excellent 
immunity from certain microbic infections — for 
example, from typhus or infection from ordinary 
cocci— he appears to have an extremely poor 
resistance to the tubercle bacillus. Venereal 
disease is also universally met with, too often 
accompanied by sepsis, and characterized by 
deep ulceration and necrosis. Tumours of every 
size, shape, and age are to be seen any- 
where daily, while dyspeptic troubles of every 
description, malignant disease, rectal complaints, 
and ophthalmic conditions are all extremely 
common. 

Of the conditions which are less frequently 
seen in western countries than in China mention 
must specially be made of intestinal parasites. 



168 CHINA AND MODERN MEDICINE 

which formed the first subject of investigation 
conducted by the Research Committee of the 
China Medical Missionary Association. A large 
number of varieties of metazoal parasites are 
met with in China, particularly in the Yang-tse 
valley, and their distribution, symptomatology, 
etc., have been carefully worked out in recent 
years by medical missionaries in that area. In 
many cases this has meant considerable original 
research, particularly in regard to the recogni- 
tion of metazoa hitherto barely know^n in China 
(e»g. schistosomum japonicum, fasciolopsis buskii, 
etc.), and the result of this study has been of the 
greatest service in throwing light upon conditions 
not previously understood. These helminths are 
now shown to be responsible for a wide range of 
abdominal and blood diseases and obscure fevers, 
and in all the more up-to-date hospitals in China 
a routine faecal examination is conducted upon 
every patient admitted to the wards. 

Malaria, kala-azar, beri-beri, elephantiasis, 
leprosy, and a host of other tropical diseases are 
also very common, particularly in central and 
southern China, whilst the dysenteries, the 
typhoid and para-typhoid groups, cholera and 
other diseases of the intestinal tract, are met 
with in almost every part of the country. 

In addition to the great researches of 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 of these con- 
ditions. It is to the late Dr O. T. Logan of 
Changteh, Hunan, and to Dr F. W. Goddard of 
Shaoshing, that we owe much of our present 
knowledge of the distribution of intestinal para- 
sites in China. It was Dr S. Cochran, of Hwai 
Yuan, who first discovered that the Leishman- 
Donovan bodies of kala-azar were present in 
the lymph-nodes of patients affected with that 
disease. It was Dr E. C. Peake of Tientsin who 
described the new blood parasite which appeared 
to be responsible for the condition of anaemia 
and dropsy from which many inhabitants of 
the flooded districts of Chihli suffered in 1918. 
It was Dr Duncan Whyte of Swatow who drew 
attention to the prevalence of thrombo-angiitis 
obliterans amongst Chinese patients. And many 
others might similarly be named. Interesting 
statistics have also been published in many of the 
hospital reports as to the incidence of disease in 
different parts of 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 for that 
complaint have now been performed. 

But when all has been said, it must be con- 
fessed that up to the present time only the fringe 
of clinical research in China has been touched. 
A large variety of fevers and other complaints 
F* 



170 CHINA AND MODERN MEDICINE 

exist, the etiology of which is completely un- 
known, whilst innumerable other problems are 
awaiting investigation. With the better equip- 
ment which hospitals are now securing, particu- 
larly in the matter of laboratory apparatus, and 
with the larger staffs and the advent of keen 
Chinese graduates, this promising field of study 
can be attacked with new hope of success, and 
every year should see additional discovery to 
our general knowledge of Chinese medical con- 
ditions and their treatment. 

Ill 

Any attempt to deal with the problem of 
disease in China which left untouched the roots 
from which that disease has sprung would be 
simply futile. What hope can there be of ridding 
China of those parasitic affections which have 
just been referred to if we fail to deal with her 
soil -polluted water-supply and vegetation ? How 
is China's ''White Peril," the scourge of tuber- 
culosis, to be combated, apart from a resolute 
campaign on behalf of good ventilation and 
sunshine and fresh air ? How, indeed, is China 
ever to be saved from the devastating epidemics 
which continually decimate large sections of her 
population if her people are not instructed in 
the fundamental facts which govern infection, 
the knowledge of which has so effectively reduced 
mortality in the West ? 



RESEARCH AND PUBLIC HEALTH 171 

But here we are met by the critic who seriously 
questions whether any steps which look to the 
lowering of China's death-rate will not really 
produce far more harm than good. " China is 
over-populated already," he argues, " and it is 
only these periodic famines and pestilences which 
enable her to persist at all. Remove these causes, 
and thus reduce her mortality, and she will either 
perish of insufficient food, or overrun the world." 

Such a criticism counsels a sheer reversion to 
jungle law, and is as unsound as it is unchristian. 
The essential unity of the life of all nations, and 
the fact that East and West are bound together 
by common ties of interdependence, are axioms 
which every student of international affairs now 
accepts. Furthermore, if such a suggestion is 
to be seriously considered, it must frankly be 
recognized that it is double-edged ; if applicable 
to China, it is still more applicable to our crowded 
little island in the West. 

But to begin with, it is a question whether 
such a criticism is not based upon false premises 
altogether. It presupposes that the population 
of China is so appallingly dense that the land 
will not support more than it is supporting at 
present. Seeing that the density of China's 
population only averages one hundred per square 
mile ; that she only ranks tenth among the 
chief nations of the world in this matter of density ; 
and that even the most populous parts of the 



172 CHINA AND MODERN MEDICINE 

country carry less people to the square mile than 
certain parts of Europe^ — this suggestion is at 
least open to question. 

Again, such a proposal is economically unsound, 
as was well brought out by the report of the 
China Medical Commission of the Rockefeller 
Foundation. "If a nation is healthy and 
energetic and efficient," that Report argued, 
'* it will be able greatly to increase its productive 
power from an economic point of 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 
civilization. It is of 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 
her progress is held up by the ravages of disease. 

The action of the League of Nations at their 
first Assembly in voting a large sum of money 
with which to attack the problem of typhus in 
central Europe was not dictated by mere bene- 
volence. It was sound economics, which recog- 
nized that it was unsafe to the rest of the world 
to allow so dangerous a plague-spot to be left 
unmolested. And the same is true of China. 

1 Quoted from statements by Dr W. W. Peter, and from China 
— An Interpretation, by Bishop J. W. Ba«hJord. 
* Medicine in China, p. 1. 



RESEARCH AiND PUBLIC HEALTH 178 

Everyone has been so preoccupied with the 
horrors of the Great War during these last 
years that but few have had time to con- 
template the magnitude of the disaster which 
was wrought throughout the world by the great 
influenza pandemic of 1918-19, which actually 
" destroyed more lives in the whole world than 
did the European war in five years." ^ And but 
few have appreciated the significance of the 
fact that that appalling disaster, which produced 
widespread havoc in North America, where it 
assumed a peculiarly virulent and fatal form, 
had traversed China before spreading across 
the Pacific. In this connection every student 
of bacteriology will remember the important 
scientific law which teaches us that the passage 
of any infective organism through a host of low 
resistance increases the virulence of the germ. 
In these days of shortened communications it is 
hardly a matter of unconcern, in face of the 
possibility of such world-wide epidemics, whether 
the health and resistance of China is normal or 
sub-normal. 

But apart from all such questions, any thought 
of refusing to make China healthier and happier 
strikes at the root of every conception of Christian 
brotherhood. We must help her in her fight for 
health if we are pretending to be Christian at 

1 Report of the Minutry of Health upon the Pandemic of Influenza, 
p. 14. 



174 CHINA AND MODERN MEDICINE 

all ; and to do this successfully it is not enough 
to content ourselves vdih opening up hospitals 
for the reception of those already diseased ; we 
must go deeper and try to assist her in the eradica- 
tion of those very conditions which help to spread 
disease.^ 

For many years past the need of preventive 
medicine in China has been a matter upon which 
many medical missionaries have felt urgently, 
and wherever large epidemics have broken out — 
cholera, plague, etc. — these men and women have 
usually been foremost in their efforts to organize 
preventive measures. In the dread epidemic of 
pneumonic plague which broke out in Manchuria 
inl911-12a force of medical missionaries, assisted 
by students of the Peking Union Medical 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 of the Peking students 
fell victims themselves to the terrible com- 
plaint, a fact that will ever be immortalized in 
China by the wonderful speech of the Viceroy 
of Manchuria at Arthur Jackson's funeral, and 
which concluded with these moving words : — 

spirit of Doctor Jackson, we pray you to intercede for the 
twenty millions of Manchuria, and to ask the Lord of Heaven 

* The point at which China's population problem should first be 
approached is that of early marriage. The reform of marriage 
customs in China would bear alike upon the health and number of 
her people. 



RESEARCH AND PUBLIC HEALTH 175 

to take away this plague, so that we may lay our heads once 
more in peace upon our pillows. In hfe you were brave ; now 
you are a spirit. Noble spirit, who gave up your life for us, 
help us still ; look down with sympathy upon us all.^ 

The lessons that were learned from the ex- 
perience of the first epidemic enabled medical 
missionaries to render still more effective aid 
dm-ing a second outbreak in 1917-18, and in 
Shansi, where most of these cases occurred, a 
most successful campaign was organized by 
Dr C. W. Young, under the patronage of the 
energetic " model " governor of the province, 
Governor Yen Hsi-shan. 

Other steps have also been taken with the 
hope of impressing upon the Chinese the vital 
importance of public health work. At Shanghai 
a striking object-lesson has been provided by 
the organization of an excellent Municipal Health 
Department, under the able leadership of Dr 
Arthur Stanley. 

Important contributions have also been made 
through the provision of popular literature and 
the formation of local health committees. The 
Christian Literature Society, the Commercial 
Press (a Chinese firm) and several other publishing 
houses have issued a number of popular books 
and pamphlets dealing with different phases of 
the question. The subject of hygiene is now 
taught throughout all the chief schools in China, 

* Arthur Jackson of Manchuria, by A. J. Contain, p. 146. 



176 CHINA AND MODERN MEDICINE 

where it is attracting increasing attention. In 
many of the larger centres — notably at Chuchow 
in connection with the work of Dr E. I. Osgood 
— special committees, usually formed of both 
Chinese and foreign members, have endeavoured 
to educate public opinion on the importance of 
sanitation and hygiene, and have initiated various 
efforts to improve the health of 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. White wright organized there 
in 1905, and which has already been visited 
by over four and a half million people. Charts, 
models, and diagrams illustrate to the visitor 
the chief causes for the spread of disease in 
China, whilst comparative tables of statistics 
demonstrate the enormous incidence of infectious 
disease and the high mortality which exist in 
China as compared with those countries which 
have adopted preventive methods. Possibly the 
most eloquent object-lesson of all, however, is 
the Chinese melon-seller who sits at the gate of 
the Institute, offering " hygienic melons " from a 
fly-screened stall to the people passing in and 
out ! 

But there have been two events within the 
past few years which have probably done more 
than anything else to focus the attention of the 
Chinese on this important question. The first 



RESEARCH AND PUBLIC HEALTH 177 

of these was the holding of an International 
Plague Conference in Moukden in connection with 
the plague outbreak of 1911-12. This important 
gathering, to which experts in public health from 
eleven different countries sent their representa- 
tives, 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 
of the Y.M.C.A., of Dr W. W. Peter for the estab- 
lishment of a special Health Division of that 
organization, and the subsequent action of the 
China Medical Missionary Association in appointing 
a Council on Public Health to co-operate with the 
National Medical Association and the Y.M.C.A. 
in the development of this special field of enter- 
prise. The China Christian Educational Associa- 
tion and Y.W.C.A. have since joined in this effort, 
and the Council has now become known as the 
Council on Public Health Education. Dr Peter, 
with his able colleague, Dr S. M. Woo, are giving 
their whole time to this work, and their efforts 
have already met with striking success. A large 
number of attractive posters and pamphlets, 
illustrating simple laws of hygiene and disease- 
prevention, have been produced by the Council 
and circulated by the tens of thousands through- 
out China ; unique Public Health Exhibitions of 



178 CHINA AND MODERN MEDICINE 

a spectacular and impressive character have also 
been organized from time to time in the leading 
cities of China. 

Dr Peter, who is an apt student of psychology 
as well as an adept in inventing popular de- 
vices for impressing facts upon an audience, 
has shown remarkable ingenuity in the planning 
of these exhibitions, and has succeeded in mak- 
ing Public Health a live topic throughout 
the whole city in which the campaign is being 
made. Long processions of sandwichmen, as 
well as strings of coolies transporting the thirty- 
eight case-loads of models and charts, serve as 
an excellent advertisement of the exhibitions, 
which are invariably attended by every class of 
the community, from the highest officials to the 
humblest schoolboy. A local " Health faculty," 
recruited at each centre and consisting of students 
from neighbouring colleges, explain the various 
exhibits, and all day long popular lectures are 
given to crowded audiences, illustrated by most 
ingenious mechanical models, as well as by 
stereopticon pictures and the cinema. By a 
skilful process of 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 of national health to 
national strength and influence, or reveals the 
fact that the death-rate of China is probably 
not less than 40 per 1000 — the highest in any 



RESEARCH AND PUBLIC HEALTH 179 

civilized country in the world. He then shows, 
by comparative tables, the chief causes of this 
mortality, demonstrating at the same time that 
China is not so over-populated as the people 
usually suppose, and pointing out how immensely 
the prosperity and stability of the country would 
be increased if due attention were paid to the 
demands of national health. 

Thus, by various means, an attack is being 
made on the outworks of this formidable citadel 
of Preventable Disease ; and though these are 
but early days, the increasing interest which the 
Chinese themselves are taking in this subject 
holds promise of great progress in the future. 
The need and opportunity are alike urgent, and 
if only the officials of the country can be aroused 
to public-spirited action for the benefit of the 
community, much will be accomplished. Mean- 
while, however, public opinion is growing, and 
there is every cause for hope. 



CHAPTER VIII 

THE OUTLOOK TO-DAY 

Methinks I see in my mind a noble and puissant nation 
rousing herself like a strong man after sleep, and shaking her 
invincible locks ; methinks I see her as an eagle, mewing her 
mighty youth, and kindUng her undazzled eyes at the full 
mid-day beam. 

Milton, Areopagitica. 

Nearly 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 of these 
years. 

Has modern medicine inspired a nobler con- 
ception than the practice of the old Chinese 
physician ? Has it replaced conjecture and 
superstition with assured diagnosis and scientific 
truth ? Is there promise of a high professional 
standard and a new ideal of service ? Is there 
hope of advance and success in fighting the great 
battle for China's true health ? 



Before we attempt to estimate the effect which 
has been produced by the introduction of western 
medicine into China, we must first notice how 

180 



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 
when calculated in purely quantitative terms. 
Let us examine the case critically, and see if 
there is not justification for this sweeping 
assertion. 

At the present time the total number of fully- 
qualified western-trained physicians practising 
amongst the Chinese probably does not exceed 
1500 — men and women.^ Now let us suppose 
that each physician can, on an average, give 
adequate medical attendance to 2,000 people. 
This is probably an exaggerated estimate, for in 
Great Britain, with one physician to every 
1,100 of the population, and mth all those 
additional safeguards to health which preventive 
medicine, sanitation, and welfare movements have 
built up, the profession is far from being over- 
manned. But let us suppose that by energetic 
efforts our 1,500 fully-qualified physicians in China 
can do full justice to the physical needs of 2,000 
people each — what, after all, does it amount to ? 
It merely means that adequate medical care is 
provided for 3,000,000 people out of a population 

1 The number of western-trained doctors in China is often quoted 
as 2,000, but that figure would include a large number of students 
who have received practical training in mission hospitals, etc., but 
have never had the opportunity of taking the modem medical 
course, and who should not therefore be counted amongst the fully, 
qualified practitioners. 



182 CHINA AND MODERN MEDICINE 

of approximately 860,000,000. In other words, 
there is no chance of the quackery of the un- 
qualified being replaced by the competent medical 
treatment of fully-trained physicians until the 
number of 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 
method of estimating. Statistics which have 
been compiled in connection with the operation 
of the National Insurance Act in Great Britain 
demonstrate that about sixty per cent of insured 
persons require medical attendance each year, and 
that the average number of medical visits (either at 
the doctor's surgery or the patient's home) works 
out at about six per annum. ^ If such figures 
were applied to China it would mean that 
about 216,000,000 people would need to consult 
a physician each year, and that their total 
visits would amount to 1,296,000,000. But the 
total number of patients seen in all hospitals 
and dispensaries in China, or in the private 
consulting - rooms of western-trained Chinese 
physicians, probably does not exceed 1,800,000 per 
annum, whilst the total number of visits which 
they pay is less than 5,000,000.^ This means 

1 From information supplied by the Ministry of Health, li the 
number of medical visits annually be calculated on the total number 
of insured, and not on the GO per cent who require medical attend- 
ance in any year, the average works out at 3*6 per annum. 

2 Of these totals, the returns of mission hospitals show a little 
over 1,000,000 patients per annum, paying slightly less than 
3,000,000 visits. 



THE OUTLOOK TO-DAY 183 

again that out of 120 sick persons who need 
competent medical help only one obtains it. 

It may, of course, be argued that such a com- 
parison loses sight of the fact that a large number 
of people in this country (especially those whose 
medical attendance is provided for by insurance) 
seek a doctor's advice for conditions which are 
quite trivial. On the other hand, in China 
there are a number of serious medical disorders 
which are not now seen in the West, thanks to 
the success of preventive medicine and sanita- 
tion. The incidence of disease is much greater 
there than it is in our own land, and, speaking 
generally, disease is apt to assume a much more 
serious form, and as a consequence the number 
of patients requiring medical help is very much 
larger. We are more than safe therefore in 
using these figures in comparison, and may 
assert that with all our medical missionaries and 
nurses from Europe and North America, and 
with our other western-trained physicians, it is 
doubtful whether we are yet touching more 
than 0*8 per cent of China's patients. In other 
words, 992 out of every 1,000 sick people in China 
still have no fully qualified medical help. 

II 

Whilst, however, it must be admitted, in face 
of such figures, that the practitioners of western 
medicine are still too few in number to make any 



184 CHINA AND MODERN MEDICINE 

appreciable impression upon the total amount of 
sickness and suffering in China, there can be no 
question as to the far-reaching influence of 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 of 
the people, and to dispel that iTiiasma of fear 
and suspicion which beclouded all intercourse 
between East and West in former years. 

It is startling to notice how great progress 
has been made in this direction. Only a few 
short years ago every political or social upheaval 
in China, every occasion of discontent and 
anxiety, was accompanied by an outburst of anti- 
foreign feeling, often culminating in 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 off hundreds of children whose 
parents lived in daily defiance of the laws of 
hygiene ? It was the western barbarian who 
had be^\dtched them and who, under the cloak 
of religion and charity, was poisoning the wells 
and hatching nefarious schemes for 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- 
clamations holding the life and property of the 
foreigner inviolate ; when the first act of the 
officials, at times of 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 of all classes towards the work of the 
foreign doctor. The hospitals' own work and 
influence have been the largest factor in bringing 
about the change. They have represented a 
new and tangible expression of brotherhood and 
sympathy which none could gainsay, even in 
times of misunderstanding and hostility. Thus 
they have won their way, not by the amount of 
suffering and sickness which they have relieved, 
but rather by the spirit which they have 
manifested. 

In the second place, the mission hospital has 
been one of the most effective means of present- 
ing and spreading Christianity in China. This 
it has done, not merely by dispelling misappre- 
hension and producing a favourable atmosphere 
for the unprejudiced reception of the truth, 
but also by creating an ideal opportunity for 
the systematic teaching of 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 
needs of his pain-racked body, has had his whole 
imagination fired by the story of the life of 
Jesus Christ that has been told him there ; and 
many such have gone out of the hospital pro- 
fessed followers of Him, witnessing to His power 
in districts where formerly His name had never 
been heard. 

Again, it may be confidently claimed that 
the practice of modem medicine, in the hands 
of men and women who have endeavoured to 
make their medical work a true expression of 
Christ and His teaching, has had a profound 
effect upon the attitude which the Chinese have 
themselves come to adopt towards the indigent 
and needy. A new sense of responsibility is 
being manifested in China to-day, especially by 
the younger and better-educated Chinese who 
have come under the influence of Christian 
teaching, and this expresses itself in an increasing 
effort to assist the poor and the suffering. 

I well remember, on one occasion, being asked 
to address a large company of students in North 
China on the need for public health measures. 
I wanted to speak about community life and 
social service and such-like, but I found it most 
difficult to discover any adequate expression in 
the Chinese language with which to convey these 
ideas. That was less than ten years ago. To-day, 



THE OUTLOOK TO-DAY 187 

one can hardly pick up any Chinese newspaper 
—one certainly cannot pick up a student pub- 
lication — without being confronted with these 
new terms on almost every page. A new social 
conscience has awakened. We see it in the 
birth of the nursing profession. We see it in the 
" model city " of Nantungchow, with its modern 
banks and mills, its refuges for the aged and 
afflicted, its blind and deaf asylums, its orphanage 
and its schools. We see it in the model prisons, 
now a feature of several of the chief cities of 
China. We see it in the free dispensary which 
is maintained by the boys of Nan Kai School, 
that great educational establishment at Tientsin 
under the able leadership of Mr Chang Po-ling. 
We see it in the Boys' Clubs ; in the night schools ; 
in the Y.M.C.A. work amongst the returned 
coolies from France ; and in the special investiga- 
tion into the economic conditions of various 
classes of workers. As we watch these innova- 
tions in ancient China, we realize that a new 
force of enormous potentiality is at work to-day, 
and that it is the Christian leaders who are 
pioneering the reforms. 

Before the Revolution of 1911 the work of the 
Red Cross, and the humane treatment of the 
wounded in battle, were almost unknown in 
China. To-day the Chinese Red Cross Society 
has its branches in every province, and its 
hospitals in numerous cities. 



188 CHINA AND MODERN MEDICINE 

Another hopeful sign of 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. 
Ever since the day when How Qua, the landlord 
of the building in which Parker had his first 
hospital, refused to accept any rent, the Chinese 
have repeatedly given proofs of their apprecia- 
tion of such forms of medical charity, and of 
their willingness to share in the financial support 
of these institutions. Recent statistics have 
shown that over fifty per cent of the cost of 
upkeep of the mission hospitals in China to-day 
is borne by the Chinese themselves, and that no 
less than twenty-seven per cent of the hospitals 
are now entirely self-supporting, apai-t from the 
salaries of the foreign staff .^ 

Such financial assistance is not confined to 
private subscriptions and fees : for in many in- 
stances it is also derived from official sources. 
The most striking example of such co-operation 
is the agreement entered into by the officials 
of the Hunan Government and the Yale Mission 
in China for the establishment of the Hunan- 
Yale Medical College and Hospital at Changsha. 
The Hunan Government has undertaken to 
provide no less than $50,000 per annum towards 
the institution, in addition to large sums towards 

* An Enquiry into the Scientific Efficiency of Mission Hospitals in 
China, pp. 33, 37. 



THE OUTLOOK TO-DAY 189 

the purchase of land and the erection of the initial 
buildings ; and although constant revolution and 
military occupation have since impoverished the 
province to a pitiful extent, a most determined 
effort has been made to fulfil the compact. 

Similar generosity has been shown in other 
cases. The officials and gentry in the city of 
Anking have for some years past contributed 
the sum of $3,000 per annum towards the support 
of the American (Protestant-Episcopal) Hospital 
in that centre, whilst within the last few months 
the provincial government of Shantung, at the 
instance of the Civil Governor, has passed a bill 
approving of an annual appropriation of $5,000 
from the provincial budget towards the support 
of the University Hospital at Tsinan. 

But the most encouraging feature of all has 
been the action which the Chinese have taken 
in many cities in establishing and supporting 
hospitals and dispensaries of their own. The 
Central and Isolation Hospitals at Peking, erected 
and maintained by the Chinese, and now under 
the able superintendence of Dr S. P. Chen 
(a graduate of Cambridge, and St Thomas's 
Hospital, London), are excellent examples of 
first-class institutions which we may confidently 
expect to see multiplied all over China. In 
other cities also. Government Hospitals are now 
beginning to spring up. Many of these, it is 
interesting to note, have both " Eastern " and 



190 CHINA AND MODERN MEDICINE 

" Western " departments, patients being allowed 
to choose whether they will be treated by Chinese 
medicine or in accordance with western methods, 
in either case receiving medical treatment freely, 
or at very small cost. 

These new Chinese hospitals are affording an 
excellent opportunity for co-operation on the 
part of medical missionaries and nurses, and in 
some of the larger cities local medical societies 
are now being organized for the purpose of pro- 
viding a common ground on which the staffs of 
the Government and Mission Hospitals can meet 
for 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 
medical missions, for a supply of trained nurses 
for the new Government Hospitals. 

It will thus be seen that while the quantitative 
side of the work w^hich has so far been accom- 
plished by the practitioners of western medicine 
in China has been very insignificant, the qualita- 
tive side of 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 of work done by the medical 
missionary of to-day which is the most important 
factor in his success ; it is the kind of work he 
is able to perform which means everything. 
He cannot hope to do more than touch the barest 



THE OUTLOOK TO-DAY 191 

fringe of China's suffering and sickness. But 
where he does touch, he can see to it that his 
impress is true and vital, and that the tiny 
contribution which he is able to make is of such a 
quality as to reach to the very depths of China's 
physical and spiritual need, and to give her the 
very best that can be offered in the Name of Christ. 

There was a time, not so many years ago, when 
the whole problem of world evangelization was 
worked out as a kind of mathematical problem, 
and many a fervid appeal has been made on the 
basis of the number of foreign missionaries who 
would be required to evangelize the whole of 
China in a given time. 

But we are learning more and more in these 
days that the saving of the world is not a question 
of mathematical formulae ; it is a problem of 
spiritual agriculture : not the physical presenta- 
tion of a certain dogma to the people of a country 
by a host of foreign agents, but the sowing 
of spiritual seeds which have the capacity of 
indigenous growth and of limitless reproduction. 
It is the quality of the seeds we plant that 
matters most. 

Some years ago a kindly-disposed American 
missionary in the province of Shantung was 
greatly distressed at the poor character of the 
pea-nuts, from the cultivation of which thousands 
of the Chinese in that province eked out a 
precarious existence. On his next furlough he 



192 CHINA AND MODERN MEDICINE 

gpent alarge amount of time consulting agricultural 
experts in his native country, and attempting to 
secure from them a better specimen of pea-nut 
for introduction into China. He had no means 
to set up every small farmer with nuts, but 
he could ensure that those which he introduced 
were the very finest that were grown in his own 
land. And to-day farmers all over that extensive 
province are under a deep obligation for his 
kindly thought and far-seeing effort. 

Surely the same rule applies to the medical 
missionary enterprise. It is altogether beyond 
the power of missionary societies to cure all the 
ills of China, and probably God never intended 
that they should. In every country He is raising 
up people of the land to be His witnesses, and 
to do the great work of evangelizing and up- 
lifting. But to us has been entrusted the in- 
estimable privilege of setting some of these new 
forces into operation ; or, to change the metaphor, 
of sketching an outline which other and abler 
hands will fill in. How infinitely important 
then that we sketch it aright, a worthy image 
of Him whom we would represent to His children 
who at present do not know Him. 

Ill 

Let us now apply this principle and see where 
it leads us in the framing of a wise and long- 
sighted policy for the days ahead. 



THE OUTLOOK TO-DAY 193 

Once we believe that the physical and spiritual 
regeneration of China will, in the last analysis, 
be brought about by the Chinese themselves, 
everything that we have the privilege of doing 
will have to be scrutinized from the standpoint 
of its contribution towards that end. How far 
are we building for the future ? And how far 
is the medical missionary work of to-day assist- 
ing the Christian forces of China in their immense 
task ? These are the questions that we need most 
of all to ask ourselves. 

Christian Chinese are already showing a re- 
markable capacity for leadership in every walk 
of life. In the political sphere, men like Mr C. 
T. Wang, one of the Chinese delegates to the 
Peace Conference, are making their influence 
felt throughout the whole country. In the 
educational world, Mr P. W. Kuo, Principal 
of the Government Teachers' Training College, 
Nanking, and Mr Chang Po-ling, Principal of Nan 
Kai School, are weaving the latest methods of 
education and school organization into the fabric 
of Chinese social life. In the army of that Eastern 
Republic, General Feng Yu-hsiang, the great 
Christian soldier, is showing an astonished world 
how clean a military camp can be. In industry, 
Mr Fong Sec, head of the Commercial Press, 
Mr C. C. Nieh, President of the Chinese Chamber 
of Commerce, and others like them, are applying 
the most modern and humanitarian methods to 
G 



194 CHINA AND MODERN MEDICINE 

the development of large commercial enterprises. 
In the Y.M.C.A. and Y.W.C.A., and in all sections 
of 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 of Christian 
statecraft and spiritual leadership. And we who 
have had the privilege of sharing in the training 
of the new medical profession of China confidently 
believe that from the students who have passed 
through our hands there will emerge great 
surgeons, physicians, and investigators, who will 
contribute to the medical science of the world, 
bringing to their work those high ideals which 
they caught in the atmosphere of Christian 
schools and colleges. 

It is to such men and women that we look to-day 
for the regeneration of China ; and the medical 
missionary in that country can do nothing greater 
than assist in the training of such leaders, co- 
operating with them and helping forward their 
efforts. Such training, if it is really to count, 
must be the very best available ; and such co- 
operation, if it is not to be misunderstood or 
resented, must be offered in the spirit of humility 
and true comradeship. The day is past when 
the missionary enterprise should revolve around 
the foreign missionary, to the practical exclusion 
or subordination of the Chinese worker. The 
Chinese Church and the trained Chinese Christian 



THE OUTLOOK TO-DAY 195 

must increasingly take the lead, and the mission- 
ary must lose no opportunity of establishing 
that leadership and making it effective. 

This means that every missionary doctor, 
wherever situated, must endeavour to co-operate 
with the trained Chinese doctors of the district, 
and with all who are interested in promoting 
the health of the community. Every mission 
hospital should organize a Chinese Committee, 
the members of which should be encouraged to 
assume a growing share of responsibility in the 
administration and finance of the institution. 
This Committee might be advisory in capacity 
at the outset, but should as early as possible be 
entrusted with executive powers. 

An increasing number of medical missionaries, 
both men and women, of the highest talents and 
richest experience, should devote themselves to 
the important task of medical education. Medical 
schools connected with missions, if they are 
to be continued, must be placed in a position 
to offer a thoroughly first-class course of training. 
In this connection we must remember China's 
urgent need of women doctors, and must make 
provision for the increasing number of Chinese 
women students who are now responding to that 
need. Hitherto British missions have taken little or 
no share in women's medical education in China, 
which has been almost entirely left to the American 
Women's Boards. This failure needs to be rectified. 



196 CHINA AND MODERN MEDICINE 

But it is not the leaders alone — not even the 
progressive leaders of Young China — who can 
solve the gigantic problem of 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 
Church, as Dr Fletcher Moorshead pointed out 
some years ago,i must awake to its responsibility 
in this direction. For this reason hospitals and 
refuges, dispensaries and public health centres, 
are required throughout the length and breadth 
of the country, and each one of them should be 
a model to the community around, and a means 
of raising the whole level of public opinion. 

The medical mission should be a model of 
evangelistic effort, revealing to visitors and 
patients alike the great purpose for which it 
exists, and the great Personality whom it seeks 
to represent. It should be a model of sympathy 
and true charity, affording an object-lesson to 
the whole district in the considerate and kindly 
treatment which it extends to every class of 
patient who seeks its help. It should be a model 
of hygiene and sanitation, and thus be able to 
make a permanent contribution in teaching the 
people the principles by which disease can be 
prevented and suffering avoided. It should be 
a model of up-to-date investigation and treat- 
ment, and prepared to offer every patient who 
* The International Fcview of Missions, April 1916, p. 277. 



THE OUTLOOK TO-DAY 197 

enters its doors the best that modern science 
has discovered. It should be an effectual train- 
ing-ground for every assistant and employee 
who is engaged : a place where nurses and 
orderlies appreciate the responsibility of Christian 
service ; where ward cleaners and operating-room 
attendants learn the importance of 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 of their duty towards 
the sick and suffering around them. In a word, 
we are there to build a model of which neither we 
nor the Chinese need ever be ashamed, and one 
which we shall be proud to see them copying. 

This objective can never be realized so long 
as the majority of our mission hospitals are 
as hopelessly under-staffed and ill-equipped as 
they are to-day. No hospital can rise to its 
evangelistic or scientific opportunities whilst it 
is run by a single doctor. An institution which 
possesses neither a bath nor an efficient microscope 
can hardly be thought of as a model hospital 
for the Chinese, still less a hospital which is unable 
to sterilize its ward dressings. Yet in such a 
condition of poverty are some of our medical 
missions in China to-day.^ 

* Sixteen hospitals in China reported in 1919 that they did not 
possess a bath ; fourteen were without a bacteriological microscope ; 
and thirty-six stated that they did not sterilize their ward dressings. 
{AnEnquiry into iheScientific Efftcienci/ of 3Iission Hospitals in China. ) 



198 CHINA AND MODERN MEDICINE 

The ideal which we have sketched by no 
means requires sumptuous buildings and luxurious 
fittings, nor anything 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 
as in efficiency, in educative influence as well as 
in evangelistic zeal. 

This policy demands a great variety of in- 
stitutions of different grades, from the highly 
equipped Union Hospital, with its Medical College 
and Nurses' Training School, its many-sided 
staff, its elaborate apparatus and modern im- 
plements of investigation, down to the rough 
building in a western province, where, in his 
lime-washed theatre, the pioneer missionary needs 
surgical equipment, perfect of its sort, for his 
often difficult and always lonely work. 

In a huge country like China, where conditions 
differ so widely in different provinces — or indeed 
in different parts of 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 for a hospital 
in one of the large provincial capitals or treaty 
ports. On the other hand, it is inappropriate, 
and hardly worthy of missionary statesmanship, 
to build a hospital in one of those influential 



THE OUTLOOK TO-DAY 199 

and populous centres, and leave it with equip- 
ment that would barely suffice for a cottage 
hospital up-country.^ 

IV 

It is not enough that -these things should 
be understood in China. Their importance must 
be fully appreciated in Britain and in America 
also before ever they can become actualities 
out there. And that is why this book has been 
WTitten. Four outstanding needs confront us : — 

1. A deliberate far-sighted policy, which 
constantly takes stock of the whole medical 
missionary enterprise, must be maintained by 
the Boards at home as well as clamoured for by 
the men in the field. Such a policy must ever 
look to the devolution of medical responsibility 
on to Chinese shoulders, the education of all 
classes in the means for fighting disease and 
ignorance, and the impressing of the whole 
Chinese Church with its duty and privilege in 

^ A most interesting experiment, combining economy of admini- 
stration with the conservation of the best hospital ideals, is now 
being attempted at Soochow by Drs Park and Snell in connection 
with the new hospital of the American (Southern) Methodist 
Mission. An excellent building is being erected for the accom- 
modation of cases requiring skilled nursing and thorough investiga- 
tion ; and, in addition, a large " hostel " is being added, where 
patients not requiring such attention may be comfortably lodged 
and brought under the kindly influence of the institution during 
the time that they are convalescing from surgical operations, or 
attending the practice of the physician. 



200 CHINA AND MODERN MEDICINE 

the care of the sick. It must keep careful watch 
upon the newer movements in China, readjust- 
ing itself continually to the requirements of a 
changing scene, and deliberately throwing on 
the scrap-heap such methods as no longer serve 
their end in the most effectual manner. 

This will often entail the sacrifice of individual 
or denominational interests for the sake of the 
larger good, but if, in the process, such sacrifice 
brings about the uniting of Christian forces the 
increased efficiency and economy so secured will 
more than compensate for the loss. There is 
a failure somewhere in our Christian faith and 
practice — or at least in our missionary states- 
manship — when two or more under-staffed mission 
hospitals exist separately in the same city, each 
unable to do thoroughly effective work. And 
such an example cannot but weaken our witness 
to the love of God and the unity of our faith, as 
well as proving a serious detriment to medical 
progress and efficiency. 

There are still some cities in China where such 
a state of things exists. But there are others 
in which the medical missionary efforts of different 
Societies have been united with striking success, 
as, for example, in the University Hospital at 
Nanking, the Union Hospital at Huchowfu, etc. 
Where formerly there were three hospitals in 
Nanking, each belonging to a different mission, 
and each under-manned and ill -equipped, one 



THE OUTLOOK TO-DAY 201 

excellent union institution is now in existence 
in which all these missions co-operate, and in 
the conduct of which each doctor is able to develop 
his own special department. 

These great union medical schemes have a 
value that is far greater than the sum of the 
efficiency of the several units. They stand not 
only for a wealth of medical experience and 
knowledge, but for a united presentation of that 
which is the heart and the common ground of 
Christian truth. 

2. A sustained attempt must be made to 
secure the services of trained Chinese phj^sicians 
in all our hospitals and other branches of medical 
missionary work, and to accord them positions 
of full responsibility and trust. There is no 
student of the missionary enterprise who will not 
agree with this in theory, but so far as we have 
gone at present, it would be ridiculous to pretend 
that the policy of missions towards promoting 
the full development of Chinese leadership and 
initiative is carried out at the expense of 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 
a qualified Chinese doctor on their hospital staff, 
much less entrusted the lives of their repre- 
sentatives to his care — whilst in many other 
centres the Chinese doctor is regarded merely 
G* 



202 CHINA AND MODERN MEDICINE 

as the employee of 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 
as their European or American confreres, and 
regarded as true colleagues and fellow-members 
of the great medical fraternity. The most 
efficient of them must be promoted to admini- 
strative posts, where their responsibility will be 
as great and as independent as the foreign members 
of the staff, and where they will be given equal 
opportunity to try out their ideas and make their 
own mistakes. 

Where this is done, and where the hospital is 
so equipped as to offer them proper facilities for 
their medical work, there is every reason to 
hope that their services may be secured. Of 
115 men who completed their medical training 
between the years 1906 and 1919 at the Union 
Medical College, Hankow, the Medical Depart- 
ment of the University of Nanking, or at the 
Tsinan Medical College, more than 100 have 
served as internes or assistants in mission 
hospitals, and the great majority are still 
doing so — and that in spite of the fact that 
only a comparatively small percentage of them 
were under any obligation to return to such 
work. 



THE OUTLOOK TO-DAY 203 

3. The work that still waits to be done in 
China urgently demands a large increase of 
medical men and women from the home countries. 
They are needed for pioneer work ; for medical 
education ; for public health developments ; and, 
most of all, for the staffing of the existing 
hospitals, eighty per cent of which were only 
able to report the presence of a single missionary 
doctor each during the year 1919. 

This kind of work calls pre-eminently for the 
Honours men and women of our medical schools. 
It requires a professional experience and keenness 
which are able to take full advantage of the 
enormous field of clinical research which China 
presents, and to make a thoughtful contribution 
towards the solution of some of her innumerable 
problems. But most of all it requires a depth 
of culture and refinement, and a solidarity of 
Christian character, which can regard with 
sympathy a point of view often far removed 
from its own, and can display humility and self- 
effacement even when circumstances are most 
trying. 

If China did not also offer a sphere of useful 
service for the man of humble attainments, 
many of us would soon go home. But in the vast- 
ness of her need there is room for every well- 
qualified medical practitioner who is prepared 
to devote himself to the redemption of her people 
and the relief of her distress, and who is sufficiently 



204 CHINA AND MODERN MEDICINE 

young and elastic to adapt himself to an entirely 
new environment. 

God give us men ! A time like this demands 
Strong minds, great hearts, true faith and 
ready hands. 

Surely it is high time that the professors of 
our home medical colleges should bear in mind 
the vast needs of Asia, and should constantly 
present the facts of the situation to their classes. 
Cannot we appeal to them to lay before their 
most promising students, year by year, the 
great adventure of science and of service to 
which the pathetic cry of the suffering millions 
of China is summoning men and women ? And 
furthermore, is it unreasonable to ask that more 
direct lines of communication be established 
between the profession at home and its members 
in distant outposts ? Why should not some of 
the leading physicians and surgeons of 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- 
ditions of medical life and practice out here — 
and give us the opportunity of sharing in their 
experience and skill ? Better facilities should at 
the same time be provided in the laboratories 
and wards of the large hospitals of the West, 
so that medical men from China on furlough, or 
Chinese medical graduates proceeding to Europe 



THE OUTLOOK TO-DAY S05 

or America for post-graduate study, should have 
full opportunity of being brought into touch 
with the latest methods of investigation and 
treatment, and of securing expert advice and 
assistance in attacking the unsolved medical 
problems of the Far East.^ 

4. This great and beneficent service for China 
can never be satisfactorily accomplished until 
Christian people in the homelands recapture 
the spirit of the men who founded and endowed 
our o^vn great institutions of healing — such as 
Rahere and Thomas Guy and others like them — 
and are prepared to employ a similar munificence 
on behalf of the East. Numbers of our mission 
hospitals and medical schools here in China 
are suffering to-day from impaired efficiency 
and retarded progress on account of inadequate 
financial support. The furlough of the missionary 
doctor, which should be largely devoted to the 
replenishing of his professional and spiritual 
resources, is too often taken up with the effort 
to secure funds for the maintenance of beds and 
cots in his wards or the completion of his hospital 
buildings. This should no longer be, now that 
we have reached a day when the unity of the 
world and the brotherhood of its people are 

^ The China Medical Board ha.s already generously awarded a 
large number of fellowships to medical missionaries on furlough 
and Chinese medical graduates, to enable them to pursue post- 
graduate study in North America or Great Britain. 



206 CHINA AND MODERN MEDICINE 

subjects which constantly occupy our thoughts 
and our conversation. 

China is no longer an alien land. She has 
become our neighbour, our fellow-counsellor 
around the Table of Versailles, a member with 
us in the Council of the League of Nations. And 
if she suffers, we too must suffer with her. 

If this battle for the redemption of China is 
worth our fighting, it is worth our sacrifice also. 
Such sacrifice has already been given by many 
humble followers of the Christ, who gladly lived 
upon small incomes voluntarily reduced, in order 
that China might share the richest blessings 
they possessed. 

The healing of 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 
philosophy of the Christian life, that the seed 
should die in order that it might bring forth 
fruit ? That was what the Cross of the Son of 
God meant. And after the Cross came the 
Resurrection. 



APPENDICES 



I BIBLIOGRAPHY 

* Specially valuable for descriptive information. 
t Out of print, but obtainable from libraries. 

i American and Canadian books obtainable through Mr A. F. Bird, 22 Bedford 
Street, Strand, London, W.C.2. 

I GENERAL BOOKS ON MEDICAL MISSIONS 

*'\The Appeal of Medical Missions. R. Fletcher Moorshead, M.B., 

RR.C.S. Oliphants. 1913. 

*The Way of the Good Physician. Henry T. Hodgkin, M.A., M.B. 

United Council for Missionary Education. 1915. Price Is. 

*XMedical Missions : The Twofold Task. Walter R. Lambuth, M.D. 

Student Volunteer Movement, New York. 1920. Price 

6s. 6d. net. 

XA Crusade of Compassion for the Healing of the Nations. Belle 

J. Allen, M.D. Central Committee on United Study of 

Foreign Missions, West Medford, Mass. 1919. Price 4s. net. 

jThe Healing of the Nations. J. Rutter Williamson, M.B. 

Student Volunteer Movement, New York. 
XThe Ministry of Healing. William B. Lipphard. American 
Baptist Pub. Society. 1920. Price 28. 6d. net. 
Conquest by Healing. Edited by Dr Thoma^s Cochrane. London 
Missionary Society. 1918. Price 6d. 



II BOOKS ON MEDICAL WORK IN CHINA 

*^The Medical Missionary in China. William Lockhart, F.R.C.S. 

Hurst & Blackett, London. 1861. 
*X Breaking dovm Chinese Walls. Elliott L Osgood, A.M., M.D. 

Fleming H. Re veil Co. 1908. 
^Thirty Years in Moukden. Dugald Christie, C.M.G. Constable 

& Co. 1914. Price 83. 6d. 
^^Wesleyan Medical Missions in China. W. Arthur Tatchell, 

M.R.C.S., L.R.C.P. Robert Cullev, London. 1909. 
%A Glimpse of the Heart of China. £ldward C. Perkins, M,D. 

Fleming H. ReveU Co. 1911. 
*XHeal the Sick. 0. L. Kilborn, M.D. :Migsionary Society of 

Methodist Church, Toronto. 1910. 

207 



208 CHINA AND MODERN MEDICINE 

Dr Apricot of Heaven Below. Kingston De Gruche. Marshall 
Bros. 1911. Price 4s. 
*%Medicine in China. Report of China Medical Commission of 
the Rockefeller Foundation, 61 Broadway, New York. 1914. 

Ill BIOGRAPHICAL 

*XThe Life, Letters and Journals of the Rev. and Hon. Peter Parker, 
M.D. Rev. George B, Stephens, D.D, Boston Congrega- 
tional Sunday School and Pub. Society. 
^Memorials of James Hendersoyi, M.D. Nisbet & Co. 1875. 
'*'j Memorials of B. Harold A. Schofield. A. T. Schofield, M.D. 

Hodder & Stoughton. 1885. 
*\John Kenneth Mackenzie. ^MrsBryson. Fleming H. Re veil Co. 1891. 
\Fred C. Boherts of Tientsin. Mrs Bryson. H. R. Allenson. 1895. 
*-\The Beloved Physician of Tsang CJwu. Rev. J. Peill. Headley 
Bros. 1908. 
Sydney Bupert Hodge. Rev. J. K. Hill. Robert Culley. 1908. 
Price Is. 6d. 
*1[Arthur Jackson of Manchuria. A. J. Costain. Hodder & 
Stoughton. 1911. 
Healing and Saving — The Life Story of Philip Bees. W. Arthur 

Tatcheli, M.R.C.S., L.R.C.P. Kelly. 1914. Price 2s. 
Herbert Stanley Jenkins, M.D., F.B.C.S. Rev. Richard Glover, 
D.D. Carey Press. 1914. Price 3s. 6d. 
* Cecil Bohertson'of Sianfu. Rev. F. B. Meyer, D.D. Carey 

Press, 1914. Price 3s. 6d. 
Dr Isabel Mitchell of Manchuria.. F. W. S. O'Neill. Clarke 
& Co. 1917. Price 3s. 6d. 

IV SCIENTIFIC AND STATISTICAL BOOKS 

^Surgical Practice amongst the Chinese. Peter Parker, M.D. 

Sutherland & Knox. 1846. 
Diseases of China. W. H. Jefierys, M.D., and J. L. Maxwell, Jr., 

M.D. Blakiston's Son & Co., Philadelphia. 1910. 
1[ Chinese Materia Medica and Natural History. F. Porter Smith, 

M.B. American Presbyterian Press, Shanghai. 1871. 
^ Notes on Chinese Materia Medica. Daniel Hanbury, F.L.S. 

1862. 
] Chinese Materia Medica, Vegetable Kingdom. Rev. G. A. Stuart, 

M.D. American Presbyterian Pres", Shanghai. 1911. 
An Enquiry into the Scientific Efficiency of Mission Hospitals in 

China. H. Balme, F.R.C.S. (Reprinted from China Med. Jl. 

Hospital Supplement, Nov. 1920.) Obtainable from U.C.M.E. 

Price 7^d. post free. 
China Mission Year Book. Published annually in Shanghai. 

Obtainable from London Missionary Society, or from Com- 
mittee of Reference and Counisel, 25 Madison Avenue. New 

York. Price lOs. 6d. 



APPENDICES 309 

V SOME SCIENTIFIC ARTICLES 

(a) Chinese Medical Practice 

Treatise on CJiinese Midwifery. W. Lockhart, F.R.C.S. Dublin 

Journal of Medical Science. 1842. 
Description of Chinese Anatomical Plates. W. Lockliart, F.R.C.S. 

Chinese Repository, vol. ix. p. 194. 
Chinese System of Anatomy and Physiology. W. A. Harland. 

Trans. China Branch, Royal Asiatic Society. 1847. 
La Medecine en China. J. G. Kerr, M.D. Gazette Hebdom. de 

MMecine. 1859. 
The Medicine and Medical Practice of the Chinese. J. Henderson, 

M.D., F.R.C.S.E. Proceedings North China Branch, Royal 

Asiatic Society. 1864. 
Chinese Medicine. J. G. Kerr, M.D. China Review. 1872. 
Chinese Use of SJuxd and Iodine Plants in Consumption. D. J. 

Macgowan M.D. Proceedings North China Branch, Royal 

Asiatic Society. 1872. 
Chinese Toxicology. D. J. Macgowan, M.D. Proceedings North 

China Branch, Royal Asiatic Society. 1874. 
Bibliography of Chinese Materia Medica. J. C. Thomson, M.D. 

China Medical Journal. 1890. 
Early History of Syphilis in China. G. Thin, M.D. Edinburgh 

Medical Journal. 1868. 
Chinese Dentistry. J. G. Kerr, M.D. and G. 0. Rogers. China 

Review. 1877. 
Chinese Arts of Healing. J. Dudgeon, M.D. Chuiese Recorder, 

vols, ii., iii. and iv. 
Smallpox in China. J. C. Thomson, M.D. China Med. Jl. 1887. 
Native Practice and Practitioners. J. C. Thomson, M.D. China 

Medical Journal. 1890. 
A Modern Chinese Anatomist. J. Dudgeon, M.D. China Medical 

Journal. 1893. 
A Chapter in Chinese Surgery. J. Dudgeon, M.D. China Medical 

Journal. 1895. 
Needling Painful Spots. J. Cantlie, F.R.C.S. Jl. Trop. Med. 1916. 
A Chinese ChemisVs Shop. G. King. Far Eastern Review. 1919. 
Notes on Chinese Medicine. K. C. Wong, M.D. China Med. Jl. 1918. 
Chinese Medical Literature. K. C. Wong, M.D. China Med. Jl. 1918. 
Chinese Medical Schools and State Examiiuitions. K. 0. Wong, M.D. 

China Medical Journal. 1919. 

(b) General and Physiological 

Chinese Patients and their Prejudices. S. H. Chuan, M.D. China 

Medical Journal. 1917. 
Chinese Superstitions relating to Childbirth. Queenie Tsay. China 

Medical Journal. 1918. 
Demon Possession. E. R. Wagner, M.D. China jMed. Jl. 1898. 
EviU of Chinese Foot-binding. J. P. Maxwell, M.D., F.R.C.S. 

China Medical Journal. 1916. 



no CHINA AND MODERN MEDICINE 

Physiological Standards in China. G. D. Whyte, M.D. China 

Medical Journal. 1912 and 1918. 
Anthropometry of Chinese Students. E. M. Merrins, M.D. China 

Medical Journal. 1910. 
Anatomical Supplement to Chiyia Medical Journal, July 1920. 
Pelvimetry and Cephalometry of Chinese. M. E. Garner, M.D. 

China Medical Joun^al. 1918. 
Chemical Investirjation of Alimentary Canal in Chinese. G. D. 

Whyte, M.D. Cliina Medical Journal. 1916. 
A Study of Chinese Foods. S. D. Wilson, Ph.D. China Medical 

Journal. 1920. 
Nutritive Value of Soy Bean Products. W. H. Adolph, Ph.B., and 

P. C. Kiang, M.D. China Medical Journal. 1920. 
Diseases of China. J. Dudgeon, M.D. Glasgow Medical Journal. 

1877. Also J. L.Maxwell, M.D. Jl. of Trop. Med. 1916. 
Disease Incidence in China. A. Hedblom, M.D. China Medical 

Journal. 1917. 
Some Vital Statistics in China. W. G. Lennox, M.D. China 

Medical Journal. 1919. 
Memorandum on Medical Education in China. Wu Lien-teh, 

M.D. China Medical Journal, 1914. 
The Sanitary Organization of China. A. Stanley, M.D. China 

Medical Journal. 1913. 
Medical Progress in China since, the Republic. Wu Lien-teh, M.D. 

Lancet. May 29th, 1920. 

(c) Clinical and Pathological 

Leprosy in China and East. B. Hobson, M.B. Proceedings China 

Branch, Royal Asiatic Society. 1852. 
Classification of Fevers in Central China. E. H. Hume, M.D. 

China Medical Journal. 1910. 
A Non-malarial Remittent Fever, and its Hcemaiazoon. E. W. von 

Tungelmann, M.D. China Medical Journal. 1897. 
Ascites associated with Splenomegaly. H. S. Houghton, M.D. 

China Medical Journal. 1910. 
Splenomegaly — Report on 104 Ca^es. G. D. Whyte, M.D, China 

Medical Journal. 1915. 
Some Diseases the Parasitic Causes of which are Obscure. J. L. 

Maxwell, M.D. China Medical Journal. 1913. 
Ankylostomiasis. A. C. Bryson, M.B., B.S. China Medical 

Journal. 1913. 
Spread of Asiatic Schistosomiasis. Pi. T. Leiper, D.Sc. and E. L. 

Atkinson. China Medical Journal. 1915. 
Cases of Schistosomum Infection. O. T. Logan, M.D., Jl. of Trop. 

Med., 1906; E. C. Peake, M.D., Jl. of Trop. Med., 1909; 

A. C. Hutcheson, M.D., China Med. Jl., 1914. 
Goundou and AinMim in Soiith China. J. P. Maxwell, M.D., 

F.R.C.S. Journal of Tropical Medicine. 1900. 
Opisihorchis Sinensis Infection in Cantonese. C. M. Heanley, M.B., 

B.S. Journal of Tropical Medicine. 1008. 



APPENDICES ^11 

Discovery of New Blood Parasite. E. C. Peake, M.D. China 

Medical Journal. 1918. 
Investigations into Relation of the Tarhagan to Plague. Wu Lien- 

teh, M.D. Journal of Tropical Medicine. 1913. 
Nervous Diseases in China. A. C. Reed, M.D. China Medical 

Journal. 1915. 
Thrombo- Angiitis Obliterans in China. G. D. Whyte, M.D. China 

Medical Journal. 1917. 
8pri7ig-Vomiting Sickness of Chinese. R. Chalmers, M.D. China 

Medical Journal. 1917. 
Epidemic Cholera in Canton. W. W. Cadbury, ]\LD. and J. A. 

Hofmann, M.D. China Medical Journal and Journal of the 

American jMedical Association. 1914. 
Tht 1918 Pandemic of Influenza in Canton. W. W. Cadbury, M.D. 

China Medical Journal. 1920. 
Eczematoid Epidermophyton Infection in China. H. Dold, M.D. 

China Medical Journal. 1919. 
Typhoid Vaccine in Various Diseases. W. W. Cadbury, M.D. 

Journal of the American Medical Association. 1919. 
Duodenal and Gastric Ulcers in China. C. C. Elliott, M.D. China 

Medical Journal. 1917. 
Surgery in China. J. C. Thomson, M.D. China Med. Jl. 1892-3. 
Aseptic Surgery in an Inland Hospital. 0. T. Logan, M.D. China 

Medical Journal. 1916. 
Calculus in China. J. Dudgeon, ^LD. Medical Times and Gazette. 

1876. Also articles in China Med. Jl. 1890, 1894, etc. 
Obstetrical Experiences in a Chinese City. Mabel C. Poulter, M.B., 

Ch.B. China Medical Journal. 1916. 
Trachoma among Chinese in France. E. J. Stuckey, B.Sc. 

H. Tomlin, M.D. and C. A. Hughes, M.D. China Med. Jl. 1919. 
The Health of Missionary Families in China. W. G. Lennox, M.D. 

China Medical Journal. 1921. 

VI PERIODICALS 

China Medical Journal. Published bi-monthly by China Medical 
Missionary Association, 5 Quinsan Gardens, Shanghai. Recent 
copies can be seen at the Library of British Medical Associa- 
tion, Strand, and a complete file at the Missionary Research 
Libra^^^ New York. Old volumes may be consulted in the 
British Museum Reading Room. 

Medical Missions at Home and Abroad. Published monthly by 
London Medical Missionary Association, 49 Highbury Park, 
N.5. Price Id. 

Quarterly Paper. Published by Edinburgh Medical Missionary 
Association, George Square, Edinburgh. 

Nurses Near and Far. Published quarterly by Nurses' Missionary 
League (Miss H. Y. Richardaon, Secretary, 52 Lower Sloane 
Street, S.W.I). Price 3d. 

Mercy and Truth. Published monthly by Church IMissionary 
Society. Price 2d. 



212 CHINA AND MODERN MEDICINE 



II INFORMATION REGARDING MEDICAL 
MISSIONARY SERVICE IN CHINA 

1. VocATioiJT. A strong sense of vocation, and an impelling desire 

to undertake such work as a definite service for God and for 
humanity, are the first essentials of the medical missionary 
enterprise. This enterprise has no financial inducements 
to offer ; on the contrary, it makes constant demands for 
the exercise of faith and self-denial. For that reason it 
is not to be lightly entered upon. But the man or woman 
who engages in it as a result of clear conviction and Christian 
experience will find that it possesses compensations which 
more than suffice. 

2. Professional training. Students who are lookmg forward 

to this service are required in the first place to obtain a 
recognized medical qualification. In view of the demands 
that will be made upon their professional ability, and of the 
probability that they may often be deprived of the oppor- 
tunity of medical consultation, it is recommended that this 
initial training should be as thorough and complete as 
possible, students taking a University degree, wherever 
practicable, in preference to a College diploma. 

3. Financial assistance during training. In addition to the 

open scholarships and bursaries offered at the various medical 
schools in the home lands, other opportunities of securing 
financial assistance towards the heavy cost of medical 
training are occsisionally afforded to students who purpose 
to become medical missionaries. The London and Edin- 
burgh Medical Associations each maintain hostels for such 
students and make annual grants towards part of their 
expenses ; whilst the Society for the Promotion of Chris- 
tian Knowledge also offers bursaries for medical students 
who intend to work in connection with the Church of 
England. ^ 

4. Post-graduate work. It is of the utmost importance that 

students should obtain suitable post-graduate experience 
before proceedmg abroad. Medical missionary work is to 
be regarded as a life-servdce, and for that reason the urgency 
of the need abroad should never be allowed to obscure the 
importance of thorough preparation. Unless exceptional 

• Full particulars can be obtained from Dr H. Melville Churchill, London 
Medical Missionary Association, 51 Highbury Park, London N.5 ; Dr H. F. Lech- 
mere Taylor, Edinburgh Medical Missionary Association, 56 George Square, 
Edinburgh ; or the Secretary, S.P.O.K., 6 St Martin's Place, London W.O.S. 



APPENDICES 21 S 

circumstances {e.g. the student's age) make it impossible, a 
minimum of two years should be devoted to post-graduato 
work, one at least being spent in resident appointments, 
and the remainder in such study as will be most suitable 
for the particular kind of work that is in contemplation. 

5. Vaeieties oe medical woek, and special preparation. 

Broadly speaking, medical missions in China may be divided 
into three classes : — 

(a) The pioneer station, or up-country hospital. This represents 

the type of work in which most medical missionaries are 
engaged, and is largely surgical in character. A resident 
appointment as House Surgeon is therefore an invaluable 
preparation, whilst special experience in ophthalmology, 
m tropical diseases (especially helminthology), in hospital 
administration (such as is given in connection with the 
D.P.H. course), and in midwifery (particularly cases of 
obstructed labour), is exceedingly useful. The doctor in 
charge of such a hospital is responsible for all pathological 
work, and also for the admini.'^tration of the institution ; 
a knowledge of laboratory technique and of account-keeping 
is therefore of great service. 

(b) The base hospital in the large treaty ports, etc. This work 

is offering an increasing opportunity for specialization, 
particularly when such hospital is operated on a " union " 
basis. Students destined for this type of medical mission 
work should direct their post-graduate training accordingly, 
and, in addition to experience in general medicine or surgery, 
should prepare themselves in one or other of the specialities 
(not forgetting Radiology). 

(c) The medical college. The work of medical education in China 

to-day demands the same specialization and the same expert 
training as is needed for similar posts in the home country, 
together with some experience if possible as a demonstrator 
or teacher, and an aptitude for original work. 

6. Theological training. Medical missionaries are not advised 

to attempt to add the study of theology to the long medical 
curriculum, but an adequate course of study in Biblical 
Exegesis, Christian Apologetics and Comparative Religion, 
if procurable; will greatly enhance their usefulness as members 
of the missionary force. Experience in Christian service is 
also an invaluable and necessary preparation. 

7. Language study. A medical missionary's hope of getting into 

close touch with his patients and helpers depends upon his 
free use of their language, and it is strongly advised that 
the first two years of residence in China should be kept free 
from medical responsibility and devoted to language study. 
Such a course does not prevent a man from keeping up some 
professional work, provided it does not involve any encroach- 
ing upon the time allotted to the study of Chinese. 



214 CHINA AND MODERN MEDICINE 

8. ;Medical service apabt from missions. China does not yet 

present many opportunities for medical work on behalf of 
the Chinese people apart from missionary service, though 
a few practitioners at the large ports, who are familiar with 
the Chinese language, include a number of Chinese patients 
in their clientele. As familiarity with western medicine 
spreads, and Chinese medical schools and hospitals increase, 
it is possible that new openings will occur for the service of 
European or American physicians who have no connection 
with missionary societies. 

9. Information. Intending medical missionaries are recommended 

to get into early communication with the Secretaries of the 
particular Mission or other organization under which they 
contemplate working. Information regarding medical work 
in any part of China, or concerning the various vacancies 
requiring reinforcements, can always be obtained on appli- 
cation to the Secretary of the Advisory Board of Medical 
Missions, Edinburgh House, 2 Eaton Gate, London S.W.I, 
who will also supply details regarding conditions of service, 
furloughs, etc. 

Information concerning medical education can be obtained 
from the following addresses : — 
Peking Union Medical College 

China Medical Board, 61 Broadway, New York, U.S.A. ; 
or c/o London Missionary Society, 48 Broadway, 
London, S.W.L 
Shantung Christian University, Tsinan 

19 Fumival Street, London, E.G. 4; and 156 Fifth 
Avenue, New York, U.S.A. 
Moukden Medical College 

121 George Street, Edinburgh. 
West China Union University, Chengtu 

Methodist Foreign IVIission Board, 150 Fifth Avenue, 
New York; or Canadian Methodist Mission, 299 
Queen Street West, Toronto ; or c/o Friends' Foreign 
^Mission Association, 15 Devonshire Street, Bishopsgate, 
London, E.C.2. 
Haitian- Yale Medical College, Changsha 

5 White Hall, Yale Station, New Haven, Conn., U.S.A.; 
or c/o Wesleyan Mission House, 24 Bishopsgate. 
London, E.C.2. 
St John's University, Shanghai 

281 Fourth Avenue, New York, U.S.A. 
Canton Christian College 

156 Fifth Avenue, New York, U.S.A. ; or c/o London 
Missionary Society, 48 Broadway, London, S.W.I. 
iV. China Union Women's Medical College, Peking 

Koom 710, 150 Fifth Avenue, New York, U.S.A. 
Hackett Medical College for Women, Canton 

Presbyterian Woman's Board, 156 Fifth Avenue, New 
York. U.S.A. 



APPENDICES 215 

III CHINA MEDICAL MISSIONARY 
ASSOCIATION 

The China Medical Missionary Association was founded in 1886, 
and includes within its membership all physicians resident in China 
who are engaged in, or in sympathy with, the work of medical 
missions. 

The Headquarters of the Association are situated at 5 Quinsan 
Gardens, Shanghai, the Executive Secretary being Dr R. C. Beebe, 
formerly of Nanking. 

The Policy of the Association is well expressed in the following 
Resolutions, adopted at the triennial Conference held in Peking 
in January 1913 : — 

1. That in establishing medical colleges and hospitals our sole 

object is to bring the blessings of healing to the souls and 
bodies of the people of China, and to give a thorough training 
in medicine and surgery to young men and women of educa- 
tion and intelligence, enabling them, as fully qualified 
doctors, to be of the highest servdce to their country. 

2. That we have no desire to create permanently foreign insti- 

tutions, and that our aim and hope is that these medical 
colleges will gradually and ultimately be staffed, financed 
and controlled by the Chinese themselves. 

3. That we are desirous of bringing our teaching work into line 

with the regulations of the Ministry of Education, and in 
all ways to co-operate with and assist the Government of 
the Republic in medical education, so that a strong and 
thoroughly equipped medical profession may be established 
in this great land. 

The Operations of the Association include the following : — 

1. The publication of the China Medical Journal. 

2. The holding of periodical medical conferences. (These are 

at present held biennially. ) 

3. The maintenance of the following special Councils and Com- 

mittees : — 

Council on Medical Education. 
Council on Publication and Translation. 
Council on Public Health Education. 
Committee on Medical Research. 
Committee on Hospital Administration. 



216 CHINA AND MODERN MEDICINE 



IV NATIONAL MEDICAL ASSOCIATION 
OF CHINA 

The National Medical Association of China was formed in 1915, 
with Dr F. C. Yen of Harvard as first President. Its membership 
in 1920 was 450 — men and women. 

The Objects of the Association are as follows : — 

1. To promote goodwill and union among Chinese practitioners 

of western medicine. 

2. To maintain the honour and the interests of the medical pro- 

fession. 

3. To expedite the spread of modem medical science in China, 

and to arouse interest in public health and preventive 
medicine among the people. 

4. To co-ordinate, and co-operate with, the existing medical forces 

in China, Chinese and foreign, in the working out of the above 
objects. 

Membership of the Association is divided into the following 
three classes : — 

1. Regular members — who must be graduates in medicme of foreign 

universities or colleges, or of recognized medical colleges in 
China, and who must be acquainted with at least one western 
language. 

2. Associated members — graduates of medical colleges in China, 

who do not possess an acquaintance with any western 
language. 

3. Honorary members — medical men and women of any nationality, 

who have rendered some signal service to China, and are 
elected by a special vote of tlie Association. 

The National Medical Association meets biennially, at the same 
time as the China INIedical ISIissionary Association, some sessions 
of the two Associations being held jointly. It also publishes a 
quarterly medical journal, which is printed both in Chinese and 
English. The Central Office of the Association is situated at 
34 Nanking Road, Shanghai, the English Secretary being Dr W. S. 
New. 



APPENDICES 217 



V MEDICAL CURRICULUM IN CHINA 

The following course of study, extracted from the requirements 
of the Premedical and Medical Departments of the Shantung 
Christian University, may be regarded as typical of what is followed 
at the more modem medical schools recently established in China 
by British and American organizations. The curriculum of the 
Chinese Medical Schools is somewhat more restricted at present, 
and has no separate premedical course. 

Premedical Cour^se 
First Tear— 

Inorganic Chemistry (lectures and laboratory), 6 hours per 

week 
General Physics (lectures and laboratory), 5 hours per week 
Elementary Botany and Zoology (laboratory), 7 hours per 

week 
Chinese Literature and Essays, 4 hours per week 
English, 4 hours per week 
Psychology, 2 hours per week 
Mathematic^, 1 hour per week for six months 

Second Year — 

Chemistry — Qualitative Analysis and Organic Chemistry 

(laboratory courses), 9 hours per week 
Physics (Mechanics, Electricity, Heat and Light), 4 hours 

per week 
Advanced Zoology (laboratory), 8 hours per week 
Chinese Literature and Essays, 4 hours per week 
English, 4 hours per week 

Medical Course 
First Year — 

Anatomy (including dissection of whole body), 16 hours per 
week 

Histology, 9 hours per week 

Embryology, 9 hours per week for 8 weeks 

Physiological Chemistry, 12 hours per week for second half- 
year (laboratory course) 

English, 5 houi-s per week 

Second Year — 

Applied Anatomy, 3 hours per week for first half-year 
Physiology (experimental), 11 hours per week 
Materia Medica, Pharmacy, and Pharmacology, 8 hours per 
week 



218 CHINA AND MODERN MEDICINE 

Bacteriology and Serology, 9 hours pel week for fii^o half- 
year 
Pathology (laboratory course), 11 hours per week (six months) 
English, 6 hours per week 

Third Year — 

Pathology (continued), 11 hours per week for 3 weeks 
Medicine (lectures and demonstrations), 5 hours per week 
Surgery (lectures and demonstrations), 5 hours per week 
Therapeutics, 4 hours per week for first half-year 
Physical Diagnosis, 4 hours per week for first half-year 
Laboratory Diagnosis and Parasitology, 6 hours per week 
Clinical Medicine and Surgery (out-patient practice), 13 hours 

per week for second half-year 
Obstetrics, 3 hours per week for second half-year 
English, 4 hours per week 

Fourth Year — 

Medicine, 4 hours per week 
Surgery, 5 hours per week 
Obstetrics, 3 hours per week for first half-year 
Ophthalmology, 4 hours per week 
Dermatology and Syphilology, 2 hours per week 
Pediatrics, 3 hours per week for second half-year 
Clinical Medicine, Surgery and Specialities (wards and out- 
patient departments), 12 hours per week 
English, 4 hours per week 

Flft/i Year— 

Clinical Medicine, Surgery and Specialities (class divided into 

three groups, rotating through year, and being responsible 

for all clinical and pathological investigations on patients), 

18 hours per week 
Advanced Pathology, 4 hours per week for first half-year 
Surgical Pathology, 4 hours per week for second half-year 
Preventive Medicine, 2 hours per week 
Nervous and Mental Diseases, 1 hour per week 
Gjmecology, 1 hour per week 

Operative Surgery, 2 hours per week for first half-year 
Anaesthetics, 1 hour per week for second half-year, in addition 

to practical experience 
Diseases of Ear, Nose and Throat, 1 hour per week 
Badiology, 1 hour per week 
Medical Jurisprudence, 1 hour per week for 2 months 



APPENDICES 219 



VI NURSES' ASSOCIATION OF CHINA 

The Nui-ses' Association of China was founded in 1909, and at 
its last conference, held in Shanghai in 1920, was able to report 
a total membership of 183 foreign and 48 Chinese nurses. 

The Objects of the Association are as follows : — 

1. To promote fellowship amongst its members ; to advance the 

interests of the nurse's calling ; and to afford mutual help 
and comfort in times of illness, discouragement or misfortune. 

2. To raise the standard of hospital training in China by the 

adoption of a uniform course of study and uniform ex- 
aminations for Chinese nurses. 

The Operations of the Association include the following : — 

1. The publication of a quarterly Chinese journal for nurses. 

2. The translation and publication of nursing text-books. 

3. The registration of such nurses' training schools as can meet 

the requirements of the Association as regards moral standard, 
hospital discipline and intellectual training of their nurses, 
and are prepared to adopt the uniform course of study and 
examinations as prescribed by the Association. 

4. The conducting of all nurses' examinations at the termination 

of their courfe of training, and the issuing of the diploma 
of the Association to such candidates as secure not less than 
60 per cent marks in each paper. (An honours certificate 
is granted to candidates securing 80 per cent. ) 

5. The holding of periodical nurses' conferences. 

The Course of Study at registered training schools covers a 
period of at least three years, and includes the following subjects : — 

First Year — 

Elementary Anatomy and Physiology ; Hygiene and Ele- 
mentary Bacteriology ; Chinese Dietetics ; Bandaging ; 
Materia Medica ; Toxicology ; and general nursing 
principles. 

Second Year — 

Medical nursing, with diseases of circulatory, respirator}', 
digestive and urinary systems ; Fevers ; Surgical nursing, 
including fractures, bums, septic conditions, haemorrhage, 
preparation and care of operating theatre, sterilization, 
care of instruments, etc. ; Nursing of children, medical 
and surgical. 

Third Year— 

Ophthalmic nursing ; Gynecological and obstetric nursing 
(for women nurses) ; Genito-urinary nursing (for men 
nurses) ; Ambulance and first aid. 



220 CHINA AND MODERN MEDICINE 

The Examinations of the Associidion are confined to such 
candidates as possess certificates from their training schools, 
guaranteeing that they have been under training for at least three 
years, have regularly attended classes for instruction, and have 
already given complete satisfaction in their ward work and general 
conduct. Papers are set in the following subjects : — 

1. Anatomy and Physiology 

2. Medical Nursing and Children's Diseases 

3. Surgical Nursing and Bacteriology 

4. Materia Medica 

5. Dietetics 

6. Ophthalmic Nursing 

7. Genito- Urinary Nursing and First Aid (men only), or 
Obstetrics and Gynecology (women only) 

Full information regarding the Association or concerning nursing 
work in China can be obtained from the Hon. Secretarj% ^liss Batty, 
China Inland Mission, Shanghai. 



INDEX 



Abercrombie, Dr, 45 

Adolph, Prof. W. H., 166 

Amoy, 48 

Anaesthesia, 43, 44, 66 

Anatomical investigation, 1C4 

Anatomv, 22, 66, 159 

AnMng, 189 

Anti-foreign feeling, 53, 58, 63, 184 

Assistants, training of, 89 

Atterbury, Dr, 113 



B 



Bacteriological investigation, 105, 166 
Bathing facilities, 87, 105, 197 
Beadle, Rev. Dr (quoted), 44 
Bedding and clothing, 105, 135 
Benevolent associations, 82 
Blindness in China, 29, 37, 75, 96 
Blood diseases, 75, 168 
Board of Education, 132 
Boone, Bishop, M.D., 50 
Boone, Dr H. W., 50, 114 
Boxer uprising, 58 
Branch dispensaries, 79 
Bridgman, Rev. E. C, 36, 41, 154 
British Advisory Board, 124 
Brotherhood, 185 







Calculus, 43, 169 
Cantlie, Dr James, 114 
Canton, 96, 116, 120, 127, 140 

First dispensaries, 38 

Hospital, 40, 43, 169 
Chang Po-ling, 187, 193 
Changsha, 118, 120, 126, 188 
Charms, 84 
Chaulmoogra oU, 96 
Chen, Dr S. P., 110, 189 
Chengtu, 116, 126 
Child-birth, 57, 94, 152 
China Centenary Conference, 33 
China Medical Board, 120, 132, 205 
China Medical Journal, 158 
China Medical Missionary Association. 

104, 130, 131, 158, 177 
Chinese Church, 194. 196 
Chinese Medical Colleges, 112, 118, 132 
Chinese medicine, 160 

Empirical knowledge, 21 



Chinese medicine — continued 
Lack of science, 20, 61 
Usage of drugs, 21, 162 
Chinese pharmacopcEia, 23, 163 
Chinese philosophy, 23, 26 
Chinese physicians, 21, 23, 28 
Cholera, 21 
Chou Dynasty, 22 
Chouhan, 63 

Christianity, spread of, 68, 72, 91, 185 
Christie, Dr Dugald, 52, 114, 126 
Ch'uan, Surgeon- General, 149 
Chuchow, 176 
Clinical investigations, 166 
Cochran, Dr S., 169 
Cochrane, Dr Thomas, 114 
Colledge, Thos. Richardson, 36, 37, 38, 

107, 154 
Communal service, 35, 145, 186 
Confidence, cultivation of, 44, 63, 88. 

184 
Confucian ethic, 31 
Coombs, Dr Lucinda, 57, 139 
Cooper, Sir Astley, 36 
Co-operative efforts, 114, 125, 190, 200 
Council on Medical Education, 124, 130 
Council on Public Health Education, 

177 
Cousland, Dr P. B., 131 
Gumming, Dr W. H., 48 
Curriculum — 
Medical, 217 
Nursing, 149, 219 



Davenport, Dr C. J. (quoted), 103 

Deaf and dumb, 96 

Diet, 87, 165 

Diseases of China, 66, 167 

Dislocations, 30, 66 

Dispensaries, 79 

Dissection, 22, 132 

Drugs, Chinese, 162 

Dudgeon, Dr J., 51, 161 



B 



Early marriage, 174 

East India Company, 37, 88 

Economic problem, 1 72 

Edinburgh Medical Missionary Society, 

45 
Education ,medical 20, 107, 195 

221 



222 CHINA AND MODERN MEDICINE 



Educative influence of hospitals, 101, 

196 
Embrey, Miss, 166 
Epidemics, 29, 170, 174, 181 
Equipment of hospitals, 64, 75, 87, 105, 

197 
Evangelistic services, 72, 92 
Examinations, absence of, 22 
Nursing, 149, 220 



Family doctors, 28 

Fevers, 169 

Financial support, 188, 205 

Foochow, 50, 57, 114 

Formosa, 50 

Fowler, Dr H., 95 

Fractures, 66, 92 

Fulton, Dr Mary, 116, 139 

Furloughs, 205 



Q 



Gauld, Dr W,, 51 

General practitioners, co-operation of, 

56 
German Medical Colleges, 118 
Gibb, Dr J. G., 115 
Glllison, Dr, 114, 131 
Glaucoma, 40, 76 
Goddard, Dr F. W., 169 
Golden Mirror of Medical Practice, 21 
Graduates — 

Medical, 131, 202 

Nursing, 146, 153 
Guy's Hospital, 43, 45 



Hackett Medical College, 116 

Hall, Dr Francis J., 115 

Hanbury, Daniel, 164 

Hanchong, 65 

Hangchow, 95, 97, 114, 116, 118, 152 

Hankow, 53, 114, 116, 124, 202 

Harvard Medical School, 118 

Health Exhibitions, 177 

Helminthology, 159 

Henderson, Dr James, 156, 161 

Hepburn, Dr J. G., 48 

Hoare, Bishop, 99 

Hobson, Dr Eenjamin, 45, 46, 96, 15G 

Hodge, Dr S. R., 33, 103 

Hongkong, 45, 46, 140, 152 
College of Medicine, 113 
University of, 118,127 

Honorific tablets, 43, 67 

Horder, Dr T. G., 95 

Hospitals — 

Accommodation of, 77 
Chinese, 82, 102, 189 
Educative influence, 101, 196 
Equipment of, 64, 75, 87, 105, 197 



Hospitals — continued 
Ideal, 99 
Lack of, 28 
Old-time, 85, 135 
Roman Catholic, 78 
Special, 94 
Hostels, 199 

Howard, Dr Leonora, 57 
Huchowfu, 200 
Hue, M. L'Abb6, 20 
Hu King-eng, Miss, 111 
Hume, Dr E. H,, 126 
Hunan, 63, 126, 188 
Hunter, Dr J. M., 61 
Hwang-Ti, 161 
Hygiene, 53, 101, 175 



Imperial Medical College, 107 

Incidence of disease, 183 

Influenza pandemic, 173 

Insane, 96 

Insect-bome disease, 105 

Intensive work, 85 

International Plague Conference, 177 

Intestinal parasites, 167 

Irwin, Dr, 58 

Isolation blocks, 105 

Itinerating tours, 68 



Jackson, Dr Arthur, 126, 174 

Japan, 48, 49 

Japanese Medical Colleges, 118 

Jardine, W., 41 

Jefferys, Dr W. H., 159 

Johnson, Miss Frances, 137 



Kahn, Dr Ida, 111 
Kang-Hsi, 51 

Kerr, Dr J. G., 96, 104, 108 
Kiang, Dr P. C, 166 
Kilborn, Dr 0. L., 62 
King, Dr Y. May, 110 
King, Mrs, 57 
Kiu-kiang, 111, 152 
Killing, 97 

Kum-li-fow Hospital, 46 
Kuo, P. W., 193 
Kwan-tao, Dr, 108 



Laboratory work, 76, 105 

Laparotomies, 162 

Lay, G. T., 41 

Leadership, Chmese, 80, 193, 201 

League of Nations, 18, 172, 206 

Lepere, 94, 156 



INDEX 



223 



Lew-Ian, 21 

Li Hung Chang, 67, 112 

Literature, scientiflc, 46, 53, 109, 123, 

131, 150, 175 
Lithotomy, 43 
Livingston, Dr, 38 

Lockhart, William, 46, 46, 50, 51, 155 
Logan, Dr 0. T., 169 



M 

McAll, Dr P. L., 131 
Macao, 37, 45 

Ophthalmic hospital, 38 
McCartee, Dr D. B., 49, 51, 110 
Macgowan, Dr D. J., 49 
McKechnie, Miss Elizabeth M., 136 
Mackenzie, Dr Kenneth, 57, 112 
Main, Dr Duncan, 95, 97, 114, 152 
Malignant growths, 43 
Manchuria, 51, 126, 174 
Mandarin, education in, 123 
Manson, Sir Patrick, 113, 168 
Martyrs, medical, 59 
Materia Medica, Chinese, 53, 162 
Maternity training, 111, 152 
Maxwell, Dr J. L., 51, 53. 98 
Maxwell, Dr J. L. CJr.), 159 
Measurements, Chinese, 165 
Medical education, 20, 107, 195 
Medical Missionary Society in China, 
155 

Foundation, 41 

Manifesto, 42 

Suggestions for, 31, 41 
Medical Missions — 

Content of, 42, 155 

Contribution of, 31 

Definition of, 33 

Future policy, 199 

Methods of, 34 

Objective of, 32, 33, 196 

Eesults of, 180 
Medical practice (Chinese), 22, 23, 62 
Medical profession (Chinese), 20, 22, 

61, 118, 201 
Mental diseases, 96 
Metaphysics, 26 
Metazoa, 168 
Modem medicine — 

Demand for truth, 15 

Trusteeship, 17 
Moorshead, Dr Fletcher, 196 
Morgan, F. A., 163 
Momson, Robert, 38 
Mortality, 176, 178 
Moukden, 114, 116, 118, 126, 177 
Municipal Health Department; 1 75 



N 



Nanchang. 112 
Nanking, 116, 124, 200, 202 
National Medical Association, 118, 177, 
216 



Ne&l, Dr J. B., 163, 166 
Niles, Dr Mary, 140 
Niugpo, 49, 50 
Nurses' Association, 134, 147 
Nursing, 64, 87, 105, 120, 134 

Graduates, 146, 153 

Male, 150 

Maternity, 152 

Night duty, 146 

Pioneering difficulties, 135 

Probationers, 144 

Training Schools, 134, 144, 190 



Officials, Chinese, 44, 53, 67, 96, 188 
Old-time hospitals, 85 
Ophthalmic hospitals, 38, 40 
Opium patients, 66, 97 
Osgood, Dr D. W., 114 
Osgood, Dr Elliott I., 176 
Out-patient department, 66, 68, 70 



Pakhoi, 95 

Parasitic infections, 75 

Parker, Peter, 39, 40, 43, 44, 107, 154, 

156, 188 
Pathological investigations, 166 
Peake, Dr E. C, 169 
Pearson, Dr A., 38 
Peill, Dr A, D., 80 
Peiyang Medical College, 113 
Peking, 51, 57, 102, 114, 116, 189 
Peking Union Medical College, 114, 121, 

174 
Permsylvania University, 127 
Peter, Dr W. W., 172, 177 
Pharmacopoeia, Chinese, 23, 162 
Philosophy, Chinese, 23, 26 
Physicians, Chinese, 21, 23, 28 
Physicians, qualified, 117, 181, 201 
Physiological investigations, 164 
Pioneer efEorts, 61, 65, 135 
Plague, 174 

Plague Conference, International, 177 
Policy, future, 199 
Polk, Dr Margaret H., 116 
Population, density of, 77, 78, 80, 171 
Post-graduate study, 204 
Pre-medical instruction, 130 
Preventable suffering, 29 
Preventive medicine, 101, 170 
Provincial statistics. 78 
Public Health measures, 29, 177, 186 
Pulse, 25 



Qualitative work, 190 
Quantitative results, 181 



224 CHINA AND MODERN MEDICINE 



B 



Becruits, need for, 80, 208 
Eed Cross Society, 187 
Registration of practitioners, 62, 132 
Eeifsnyder, Dr Elizabeth, 136 
Research, 132, 154 
Roberts, Dr F., 113 
Rockefeller Foundation, 119, 172 



S 



St John's University, 127 

Schofield, Dr R. Harold A., 54 

Science — 
Absence in China, 21 
Relation to medicine, 16 
Scientific investigations, 159 

Scientific work of hospitals, 102 

Shanghai, 45, 50, 114, 127, 156, 175 

Shansi, 64, 133, 175 

Shantung, 51, 124, 140, 189, 191 

Shantung Christian University, 125, 
144, 189 

Shen-Nung, 161 

Shensi, 65 

Shoemaker, Dr Arthur, 164 

Siaokan, 95 

Smallpox, 21, 29 

Smith, Dr F. Porter, 53 

Social conscience, 31, 144, 187 

Soochow, 116, 118, 199 

Spiritual influence, 31, 90 

Stanley, Dr Arthur, 175 

Statistics, 77, 78, 181, 188 

Stenhouse, Dr J. M., 115 

Sterilizing, 105, 197 

Stevens, Mrs, 140 

Stone, Dr Mary, 111, 152 

Stuart, Dr Q. A., 163 

Student assistants, 109 

SufEering, preventable, 29, 57 

Sun Yat Sen, Dr, 114 

Superstition, 22, 31, 61 

Surgical practice, 43, 65, 89, 90, 162 

Swatow, 60 



Taylor, Dr C, 50 
Taylor, Dr Van Someren, 114 
Taylor, J. Hudson, 52 
Temples of medicine, 83 
Tetanus, 30 

Thomson, Dr Joseph C, 38, 160 
Tientsui, 57, 113, 187 
Translation work, 46, 53, 109, 123, 131, 
150, 175 



Trask, Dr Sigoumey L., 57 

Trees, sacred, 83 

Trusteeship, 17, 27 

Truth- 
Religious, 51 
Scientific, 15 

Ts'ai, Admkal, 148 

Tsang Chou, 80 

Tsinan — 
Medical School, 116, 124, 131, 1S3, 

166, 202, 217 
Museum and Institute, 176 
University Hospital, 144, 189 

Tuberculosis, 97, 167, 170 



Vaccination, 38 
Venereal disease, 167 
Vernacular, education in, 123 



W 



Wang, C. T., 193 

Wang Fun, 109 

Ward orderiies, 138 

Ward services, 92 

Water supply, 105 

Welton, Dr W., 50 

Wenham, Dr H, V., 115 

West China University, 126 

Whitewright, Rev. J. S., 176 

Whyte, Dr Duncan, 164, 169 

Wilson, Prof. S. D., 166 

Wilson, Dr William, 65, 163 

Women physicians, 56, 58 

Women's hospitals, 50, 94 

Women's Medical Colleges, 116, 127, 

195 
Woo, Dr S. M., 177 
Wu Lien-teh, Dr, 110, 118, 129, 174, 

177 



X-Rays, 105 



Tale Mission, 118, 120, 126, 188 

Yen, Dr F. 0., 110, 126 

Yen Hsi-shan, Governor, 133, 175 

Yin and I'^ang, 26 

Y.M.C.A., 177 

Young, Dr 0. W., 175 

Tuan-Shih-kai, President, 148 



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China and 
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