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The only institutions of government in China today which have stood firm through the revolution's storm and stress and which seem certain to be permanent, are the two great organizations founded and built up by Robert Hart-the customs, China's one stable source of known revenue, and the postal service, which is spreading new ideas and stimulating popular intelligence throughout the land. These services afford careers to perhaps 20,000 Chinese.

Of late, some of the new leaders among the Chinese have expressed keen resentment because Hart did not train their native fellow countrymen to fill the highest posts in the customs. Rather than display this resentment, these critics might render more useful aid to their country at this crisis by devoting their energies to imitating in other departments of administration the efficient and incorruptible public service which Hart built up. Here is their best field of present reform! Let them imitate the example ready to their hands! It is true that Hart did not train up Chinese to become commissioners of customs at the treaty ports. In the sixties he announced publicly his purpose to do so through the Tung Wen Kwan Colleges at Peking and Canton. That nothing came of this purpose is the fault of the native officials, who degraded those colleges into mere sinecures for permanent, idle (but salaried) "students" so called! Prior to the revolution, there were no cadets to be found of the social standing and birth requisite to make responsible and incorruptible chiefs of the customs offices. Such Chinese young men as chose to come forward did not possess the inherent qualities or the native education to enable them to acquire the prestige necessary for dealing with Chinese official colleagues of the old school, or to exercise due authority over their staffs or among native and foreign merchants at the ports of trade. Besides, the customs service was legally in its nature and origin, a mixed institution, to be conducted under foreigners and in foreign methods. And as with time loans to China were made, the lenders even stipulated that the customs revenues which were pledged as security must be administered according to the existing system and without organic change. In a word Chinese

official ideals of integrity must first be raised, as they will be; and when that time comes, the customs service will require no foreign stiffening. Sun Yat Sen has taken a juster view of Hart's achievements than some others of his native critics.'

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The key of Hart's life of patience and loyalty with the Chinese and of his fidelity to duty, was a simple one. To me he wrote in 1867, thinking of slow China, early in his career:

We have not wings, we cannot soar,
But we have feet to scale and climb
By slow degrees, by more and more.
Therefore, learn to labor and to wait.

And on the pad on his office desk, Miss Bredon tells us, not long before quitting China he had left these characteristic lines:

If thou hast yesterday thy duty done,

And thereby cleared firm footing for today,
Whatever clouds may dark tomorrow's sun,
Thou shalt not miss thy solitary way!

* Further and plainer language on this topic may be found in Bland's Recent Events and Present Policies, p. 209.

'Sun Yat Sen and the Awakening of China, by Dr. James Cantlie, p. 248, Dr. Sun calls Hart "the most trusted as he was the most influential of 'Chinese.'

999

THE JOURNAL OF RACE DEVELOPMENT, VOL. 4, NO. 1, 1913

THE WESTERNIZING OF CHINESE MEDICAL

PRACTICE

By Charles W. Young, M.D., Professor of Bacteriology and Pathology, Union Medical College, Peking

Before considering the process and status of the westernizing of Chinese medical practice, it is well to be oriented as to what it is that is being changed. Briefly what is Chinese medical practice?

Let us approach this question with open mind. It is easy to ridicule what is not understood. Racial prejudice is not confined to the Chinese and if we take the trouble to study the original sources, not only much of interest will be found, but some information of real value. Often it is stated in strange terms and based on bizarre theories, but the experience of centuries is behind it and parts deserve investigation by modern methods of research.

In our glance at Chinese medicine it is to be remembered that Chinese civilization is in the stage occupied by the European nations in the middle ages. It has been in much the same condition of suspended animation for two milleniums. Thus if we get a view of Chinese medicine it will be one of that practiced by them in the times of the Greeks and Romans. More than that it is extremely interesting to note that the theories of cosmogony of the Chinese run parallel to those of the Greeks, and that the theories of pathology of each are based on those of cosmogony. To illustrate: The Greeks believed that the universe was composed of four elements, viz., earth, air, fire and water, and that consequently the human organism was composed of these primitive substances. Health was conditioned on the proper proportion or balance of these constituents; disease on the disproportion or loss of balance. These views of Empedocles (fifth century B.C.) in a modified form permeate not only the pathology of the Greeks and Romans, but of all writers up

to the eighteenth century. To this was added the so-called humoral theory, i.e., that the body fluids consist of blood, phlegm, yellow and black bile; and that to these correspond the four elements noted above, fire, air, water and earth, and the four conditions of matter, warm, cold, moist and dry. The predominence of one fluid over the others produce different temperaments, viz.; sanguine, phlegmatic, bilious or choleric and melancholic.

The Greeks, knew very little of human anatomy. They feared the dead and their religion enjoined immediate burial. Their knowledge of anatomy came from dissection of animals, including apes, and from observations during surgical operations.

The ancients did not differentiate between tendons, ligaments, and nerves. They believed that arteries contained air and conveyed it to the various organs.

While in Greece there was a well-defined medical cult, in Rome anyone who wished could declare himself a physician. There were no laws, which complied with, guaranteed the capacity of the practitioner, and medical responsibility was extremely limited.

I have taken time to enumerate these matters because of the striking similarity to Chinese theories and practices. As with the Greeks, the theory of cosmogony agreed on, pathology and treatment are perfectly rational. To the Chinese the universe is composed of five elements, metal, earth, fire, wood, water, each derived in turn from the succeeding. Corresponding to these are the five conditions cold, windy, hot, dry, moist. Health depends on the balance or correct proportion of these elements. Moreover there are added the great dual influences, the Yin and Yang, or female and male, negative and positive, dark and light. The Yin (elemental moisture) resides in the solid or semi-solid viscera, the liver, heart, lungs, spleen, and kidney. The Yang rules the contractile hollow organs, the large intestine, small intestine bladder, gall-bladder and stomach. The liver corresponds to wood, the heart to fire, the spleen to earth, the lungs to metal, and the kidneys to water. Each solid organ has a hollow viscus as its assistant or minister; thus the liver is

assisted by the gall-bladder, the heart by the small intestine, the spleen by the stomach, the lungs by the large intestine and the kidneys by the urinary bladder. The liver is the seat of the soul; the gall-bladder of strength and courage. The lungs regulate temperament, and so on.

Diagnosis rests mainly on the examination of the pulse and the inspection of the face and tongue. The pulse is palpated with greatest care and detail. The patients' wrists are felt in turn by the physician with the three fingers of the opposite hand, each finger revealing the condition of a different pair of organs. Light and heavy palpation differentiate respectively between the hollow viscera and their corresponding or governing solid organs. Fifty-one chief types of pulse are recognized. The face is minutely inspected. There are thirty-seven appearances of the tongue.

For the treatment of disease the Chinese have a very extensive materia medica. Many of their drugs are also used in the West, as calomel and other forms of mercury, arsenic, copper sulphate, iron, sulphur, sodium sulphate, alum, ammonium chloride, rhubarb, pomegranate root, camphor, aconite, cannabis indica, musk, ginger, licorice, anise, cinnamon, gentian, cardamons, peppermint, aloes, orange peel, castor oil, and digitalis. In addition there are many inert or disgusting substances, e.g., insects, snakes' skins, recent and fossil bones of animals, and faeces of men and animals. But the Chinese are not peculiar in this. The London Pharmacopoea, the first in England, was compiled by the Royal College of Physicians in 1618. It contained crabs' eyes, pearls, oyster shells, and coral, each supposed to have different qualities. It also recommended formulae containing faeces of men, dogs, mice, geese and other animals, calculi, human skull and the moss growing on it, blind puppies and earthworms. Not until 1721 were important changes made and even that edition retained dogs' excrement, earthworms, and the moss from human skulls.

Chinese prescriptions contain many ingredients, usually nine or ten, often fifty. The same was true in the West one or two hundred years ago. The ingredients of the prescrip

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