confidently be counted on for a much larger effect in the future and this combined with more adequate railway facilities will surely foster a greater feeling of nationhood and of closeness of relationship between the various provinces.

We have seen something of the various physical problems which China faces. It is significant that the greatest physical feat of the ancient Chinese, the Great Wall, which was executed to shut out foreign intruders, has been broken down in all essential respects, and China is today fairly ready for foreign assistance in solving her problems, if it be friendly and not predatory.

The solution of Chinese physical problems largely depends on education; the education of the people to furnish the background of general enlightenment and the education of the native leaders upon whom must rest the responsibility for carrying out in detail such plans as may be formed for the alleviation of the conditions I have referred to. In order to determine just what remedial methods should be followed, there should be first a thorough study of present conditions by the best consulting engineers and scientists who can be secured. There is at the present time, it seem to me, a most important function for foreign experts to fill in connection with the development of China, and their work is a necessary preliminary and hence it is all important that China seek and use the assistance of such men, although it is also true that her need for such assistance will be temporary, and the application of the remedies, which they in their wisdom suggest after a study of the field, will still depend upon native talent.

The new national flag of China embodies, I believe, some significant lessons in the present connection. The sewing together of five stripes of silk to form one flag is easy, but to make a united nation of five peoples so widely separated, linguistically and geographically, in a country so greatly accidented by mountains, and so harassed by flood and famine, and so lacking the ways of quick transport and general modern education which must precede the development of resources and of ways of communication, requiring native captains of industry and native leaders of all sorts-a very

much greater task. It is just here that one of the functions of our mission colleges in China comes in-to train these leaders in situ, without loss of connection with China; for they need to know China as well as Western science and institutions and methods. They need to be qualified and unselfish, then the five points of the compass assumed by the Chinese may be rightly adopted-for the north, east, south and west will then all be centered around the common pole of service to China, and from the provinces to Peking and from Peking to the most distant provinces, the people will be united in an efficient, peaceful and helpful state, at least within the boundaries left them by their at present more powerful and predatory neighbors.

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