Septembek 22, 1922] 



SCIENCE 



319 



New York in winter, and usually very dry. 

 One does not find here, therefore, the strictly 

 tropical diseases, except as they may be im- 

 ported from central and south China. In gen- 

 eral, the diseases usually met with in the med- 

 ical wards are less different than one might 

 expect from what is seen in the United States. 

 Tuberculosis, and especially pulmonary tuber- 

 culosis, is very common. There are many acute 

 infections of the respiratory tract, but lobar 

 pneumonia is probably somewhat less common 

 than in northern United States. Typhoid 

 fever, in spite of much that is said about the 

 Chinese having an inherited or acquired im- 

 munity to it, is common and the mortality is 

 about what we expect in America. Syphilis 

 abounds in all its manifestations. It has been 

 repeatedly stated that syphilis of the central 

 nervous system is rare among the Chinese, but 

 more careful studies have disproved this point, 

 and the extraordinarily interesting neurological 

 clinic in Peking contains its full quota of 

 syphilitic cases. Dysentery, both bacillary and 

 amcebie, occurs with great frequency in the 

 summer and autumn, and malaria, usually the 

 tertian form, is not uncommon. Scarlet fever 

 and small pox are seen often; relapsing fever 

 and typhus fever are not at all unusual; and 

 leprosy is sometimes seen. The infection wihich 

 appears most often, however, and which is at 

 the same time new to those of us educated in 

 America, is kala-azar. Every patient with a 

 large spleen is suspected of ha\'ing kala-azar, 

 and four to six patients undergoing treatment 

 in the wards is not unusual. There are many 

 cases of acute and chronic nephritis, similar to 

 what we seen in the west, but one gets the 

 impression that instances of essential hyper- 

 tension are far less common in China than in 

 America. Simple goitre is endemic in parts 

 of the country around Peking and one sees 

 enormous tumors, but exophthalmic goitre, 

 while it occurs, is rather strikingly unusual. 

 Diabetes, which was also formerly held to be 

 very rare in China, is found quite frequently 

 if routine examinations for sugar are made, but 

 it usually occurs in patients past middle age 

 and runs typically a mild course, the glycosuria 

 disappearing with only slight alteration of diet. 

 Heart disease is common, and the types met 



with are usually the chronic myocardial cases 

 in older people, or cases on a syphilitic basis 

 with an aortitis and perhaps a lesion of the 

 aortic valve. Acute rheumatic fever is dis- 

 tinctly uncommon in Peking and as a result 

 rheumatic heart disease is comparatively rarely 

 seen. Cases of beri-beri come to the clinic 

 occasionally, but they almost always occur in 

 patients who have come from the south, for the 

 disease does not seem to be indigenous in 

 North China. Neoplasms, benign and malig- 

 nant, of all varieties are common and one sees 

 many of them in stages that are more advanced 

 than we are accustomed to nowadays in the 

 west. A oin-hosis of the liver with ascites, said 

 to occur characteristically in fanners, is another 

 interesting and new type of disease entity. 

 Finally, in addition to many cases of organic 

 neurological disease, there are numerous pa- 

 tients with all sorts of neuroses and psychoses. 

 In general, therefore, the medical clinic in 

 Peking is marked particularly by the great 

 variety of disease. One finds most of the dis- 

 eases that we are accustomed to see in America, 

 and in addition a good many new types. 



What makes the clinic especially stimulating 

 and interesting, however, is the possibility of 

 studying the cases carefully. The number of 

 hospital beds available for medical patients is 

 not nearly sufficient to allow all those who 

 apply to the out-patient department and who 

 are in need of institutional care, to be ad- 

 mitted, and a careful selection has to be made. 

 Those who are particularly in need of hospital 

 treatment are, of course, immediately referred 

 to the wards, no matter what they are suffering 

 from, but under other circumstances the prin- 

 ciple which determines whether or not a pa- 

 tient shall be admitted depends on the fact that 

 the hospital is essentially a teaching institution. 

 The cases taken into the wards are, therefore, 

 chosen in large part because they are particu- 

 larly suitable for teaching purposes or because 

 they offer problems for special investigation. 

 The result of this method of selection, which is 

 determined by the size and character of the 

 hospital, is a medical clinic of unusually inter- 

 esting cases. All of the patients are studied 

 in great detail by the house staff and in many 

 instances special observations are made by 



