Indian hemp or hyocyamus. The Chinese do use the latter to induce sleep.

Their

China has officials corresponding to our coroners. training is based on an official codex published in 1248 A.D. —a time at which Europe possessed nothing of the kind. Although it contains many absurd tests such as abounded in Europe a few centuries ago, it also has some shrewd methods of determining the cause or manner of death. Only the exterior of the body is examined.

Medical practice is ranked low among the callings in China. Physicians are considered a little above priests but below diviners and school teachers. After gaining a familiarity with the medical classics, an apprenticeship with an experienced practitioner is considered necessary. If the novitiate can point back to several generations of successful physicians, his reputation will probably be greater from the start. Professional visits are made only on specific invitation and several physicians are likely to be called in rapid succession, and discarded with their treatment unless immediately successful. The bearing of this on cases that require time and careful observation and supervision can be appreciated. Fees are small and the cost of treatment is likely to be the subject of bargaining. Medical ethics it must be confessed are not very high. Probably it is this that causes physicians to be held in comparatively low esteem. A work on medical ethics published during the Ming dynasty says:

When a patient is severely ill, treat him as thou wouldest wish to be treated thyself. If thou art called to a consultation, go at once and do not delay. If he ask thee for medicine, give it to him at once and do not ask if he be rich or poor. Use thy heart always to save life and to please all; so will thine own happiness be exalted. In the midst of the darkness of the world be sure there is someone who is protecting thee. When thou art called to an acute illness and thinkest with all thy might of nothing but making money out of the patient, if thy heart be nor filled with love of thy neighbor, be sure that in the world there is someone who will punish thee.

This is good, but with it contrast the Hippocratic oath:

I swear by Apollo the physician, and Esculapius and Hygiea and Panacea and all the gods and goddesses, that according to my ability and judgment, I will keep this oath and this stipulation

I will follow the system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to anyone if asked, nor suggest any such counsel; and in like manner I will not give to any woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my art. Into what

ever houses I enter, I will go into them for the benefit of the sick, and will abstain from every act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge as reckoning that all such should be kept secret. While I keep this oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men in all times! But if I should trespass and violate this oath, may the reverse be my lot!

We must remember that it is the spirit of Hippocrates that has animated the profession in the West from the earliest times and has preserved it from becoming mercenary. To elevate medicine in China to the plane it occupies with us is one of the great tasks before us.

While in China anyone may become a medical practitioner by hanging out his shingle, there are some restrictions. Section 297 of the criminal code orders that

Whenever an unskillful practitioner in administering medicine or using the puncturing needle, proceeds contrary to the established forms, and thereby causes the death of a patient, the magistrate shall call in other practitioners to examine the medicine or the wound, and if it appears that the injury done was unintentional the practitioner shall then be treated according to the statute for accidental homicides, and shall not be any longer allowed to practise medicine. But if designedly he depart from the established forms, and deceives in his attempt to cure the malady in order to obtain property, then according to its amount, he shall be treated as a thief; and if death ensure from his malpractice, then, for thus having used medicine with intent to kill, he shall be beheaded (translation in Williams' Middle Kingdom).

A few years ago a law was enacted requiring examination and registration of all practicing western medicine but it has not been enforced.

It is said that during the T'ang Dynasty (618-907 A.D.) medical schools flourished throughout the empire but they have disappeared, the only trace being the T'ai I Yüan or

Imperial Medical College in Peking. This institution trains the court physicians and also gives other practitioners the opportunity of study. In the Imperial Court there are nine physicians, specialists in the nine classes of diseases that affect the pulse violently or feebly; viz.: those arising from cold; those from female diseases; those from cutaneous diseases; those requiring acupuncture; diseases of the eyes; diseases of the mouth and its parts; and lastly diseases of the bones (Williams' Middle Kingdom).

While there are no medical diplomas or licenses in China, there is a custom which answers much the same purpose. When a patient is cured he often presents to the physician, a laudatory tablet. This bears a quotation from the classics or is couched in the flowery classical language. It is a testimonial; and the front, as well as the interior of the house of the physician is hung with many of these boards. This method is that of announcing a successful career rather than licensing the trained but untried novitiate. There is some reason in the practice and it is natural that it should have grown up where there is no system of examination or licensing at the end of the preliminary training.

What has been said thus far applies to those who may be called ethical Chinese physicians. Besides these, but not sharply marked from them (as is also the case with us) is a great army of charlatans, who by vehemently affirming the excellence of their wares, or their great wisdom, by psychologically the same methods of those in the West delude the ignorant. It is this class that gives the worst name to Chinese medicine. The best is painfully inadequate, but this, like ours, is limited only by the gullibility of its dupes. To this or another class, as you choose, belongs the third group of practitioners the priests. Many temples or shrines are sought for their reputed cures and often are hung thick with the lauditory scrolls above mentioned. Usually the suppliant drops his fee into the receptacle, and then holding burning incense in his hands, prostrates himself before the image or other object of devotion. He then draws a bamboo slip from the bundle presented by the priest. The number on the slip corresponds to that of a printed formula

on a rack nearby. This prescription is taken to any druggist who fills it. Essentially this is not greatly different from some cults that may be met in any of our own cities today, but it especially reminds us of the miracle-working shrines of Europe.

This description on Chinese medicine has been given in order that we may have some understanding of the atmosphere into which western medicine is being introduced.

The record of the early contact of China with western Asia and Europe is very imperfect and that of the introduction of western medicine still more so. The earliest account that I can find of western physicians in China is that the Persian records show that in the thirteenth century the Great Kahn had Christian physicians attached to his court. "This is interesting for the Mongol history, which in one place says that Aisie (perhaps Isaiah) was a Fuh-Lin man (Frank) a linguist, astrologer and physician, actually asserts that he served Kyuk Khan and that subsequently in 1263 was chief physician and astrologer to Kublai; in 1273 he is once styled a Mussulman and his hospital at Peking was officially called the Broad Charity." (E. H. Parker's China and Religion, p. 181). This hospital was opened in 1272.

The records are much clearer regarding the services of certain Jesuit fathers who were attached to the court of K'ang Hsi, who reigned from 1662 to 1723. It is recorded that in 1692 they cured the emperor of an attack of fever after his life was despaired of by his own doctors. This cure was by means of quinine. The new medicine was tried on several of the courtiers before the emperor was permitted to taste it. The attempt of the same emperor "to introduce western anatomy by means of a translation of the anatomy of Pierre Dionis by the Jesuit P. Perennin, was frustrated through the opposition of the native doctors" (Neuberger's History of Medicine, vol. i, p. 63). In his memoirs, Father Ripa (p. 42-43) who went to Peking as an artist in the court of K'ang Hsi, tells of a lay brother who attended the twentieth son of the emperor and gave a favorable prognosis, but the boy died. He was "kicked, cuffed and beaten so

severely by the order of the emperor that he fell seriously ill." He further says, "I was acquainted with some medical men who attended one of the imperial family," and were flogged and imprisoned for unsuccessful treatment. Taught by these and many other occurrences, the Jesuits who were in the emperor's service as mathematicians, painters, watchmakers, surgeons, and in other capacities would never undertake to serve him as physicians. But he records that Father Rod accompanied the same emperor to Jehol as surgeon. Father Ripa fell from his horse and was treated by a "Tartar surgeon" (p. 67). He says, "to confess the truth, although the mode of treatment was of a barbarous description, and some of the remedies appeared useless, I was cured in a very short time." Because of fear of encroachment by the countries to which they belonged, the Roman Catholic missionaries were driven from the country. The next contact with the West began with the East India Company in Canton. In 1805 Mr. Alexander Pearson introduced vaccination at Canton and before he left in 1832 saw a large vaccine institution established. Fifteen years later, (1820), Robert Morrison, the first Protestant missionary to China, opened a dispensary for Chinese in connection with Mr. Livingstone, surgeon to the East India Company. It was conducted by Chinese practitioners of the old school. In 1827, Mr. T. R. Colledge, also surgeon to the East India Company opened and conducted a hospital at Macao. It was supported by the Company and by private merchants. More than 6000 cases, especially diseases of the eye were treated in the five years of its existence. His greater service, perhaps, was his advocacy to the missionary societies of the use of physicians as pioneers in missionary work. All these men that have been mentioned were British, but it remained for an American Society, the American Board of Commissioners for Foreign Missions, to send the first medical missionary to China. This was the Rev. Peter Parker, M.D., who opened an ophthalmic hospital in December, 1834. From his work grew the Medical Missionary Society in China, founded three years later, and which still continues its good work in Canton. In 1852, Dr. Parker was appointed