June 25, 1915] 



SCIENCE 



941 



probably has tbe largest death rate of any 

 country in the world is probably correct. The 

 responsibility for this lies fundamentally in 

 the lack of knowledge of both personal and 

 public hygiene on the part of the Chinese 

 people, and in the lack of properly trained 

 physicians, nurses and sanitarians to dissemi- 

 nate such knowledge. The tremendous mor- 

 tality from which the Chinese suiler is, in the 

 main, due to diseases of parasitic origin. 

 Tuberculosis is widespread, and hookworm and 

 syphilis compete with it as the important 

 causes of death. In addition to these persist- 

 ent causes, recurrent waves of epidemic disease 

 carry death and destruction to various parts 

 of the great Chinese Empire. Cholera, typhus 

 fever and the plague may be mentioned in 

 this connection. An attack of smallpox is taken 

 for granted by the natives, just as it was in 

 the western world before the introduction of 

 vaccination. The report contains no informa- 

 tion as to the prevalence of the degenerative 

 diseases which are increasing so ominously in 

 the United States, but it is safe to assume that 

 they also are present and doing their share 

 of destruction. The most hopeful feature of 

 the health conditions in China lies in the fact 

 that the prevalent causes of death are dis- 

 eases of infectious origin, many of whose 

 causes are already known and many of which 

 have been almost stamped out, or at any rate 

 considerably restricted, by modern methods of 

 sanitation. The fact also that there are signs 

 that the more intelligent among the Chinese 

 themselves show evidences of an awakening 

 interest in public health matters is of great 

 significance. 



The present condition of native Chinese 

 medicine and surgery produces effects more 

 serious and more widespread than the report 

 of the commission would indicate. Doubtless 

 this aspect of the subject has been purposely 

 somewhat lightly touched upon; for the report, 

 to produce its best results in China, must of 

 necessity avoid engendering antagonism. The 

 conditions of knowledge and practise in China 

 to-day are not unlike those which obtained in 

 ancient Greece and Eome. No regulation of 

 practise, in our sense of the word, exists. Any 



ignorant fakir can practise, and practise is 

 purely empirical. The Chinese prejudices 

 against the dissection of the human body have 

 prevented the development of medicine upon a 

 sound basis of anatomy and pathology, and 

 have resulted in an ignorance concerning these 

 subjects that would be laughable were its re- 

 mote effects on the public not so terrible. It 

 would be difficult to estimate, according to 

 those who have lived in China, the amount of 

 suffering which results from the lack of knowl- 

 edge of the Chinese practitioner; and this is 

 not confined to remote country districts, many 

 large cities containing not a single medical 

 practitioner trained in western methods. The 

 few Chinese who have been so trained are 

 mainly connected with the missionary hos- 

 pitals and are, most of them, graduates of 

 second-grade Japanese schools with low en- 

 trance requirements. 



The medical schools of China have in the 

 main developed in connection with the hos- 

 pitals as the result of the urgent need for as- 

 sistants in hospital work. In a sense, there- 

 fore, the development of the Chinese medical 

 school has followed along the developmental 

 lines of the British medical school, rather than 

 the German or the American one. The schools 

 which exist at the present time are, most of 

 them, conducted in association with mission- 

 ary hospitals and each is usually supported by 

 the cooperation of several missionary societies. 

 In addition to these schools, there are a few 

 government schools, mostly under Japanese 

 influence, and a few independent schools affili- 

 ated with American universities such as those 

 associated with Harvard, the University of 

 Pennsylvania and Tale. It is clear from the 

 report of the commission that, as in this coun- 

 try, the medical schools have grown up hap- 

 hazard at various points, doubtless as the re- 

 sult of very real needs, but, nevertheless, with- 

 out careful study of the country as a whole in 

 its geographical and educational relation to 

 medical training. Practically none of the exist- 

 ing medical schools is adequately equipped ac- 

 cording to western standards. Most of the 

 schools lack the financial resources so neces- 

 sary to maintain a high-grade medical school. 



