942 



SCIENCE 



[N. S. A^OL. XLT. No. 1069 



Practically none of them possess an adequate 

 corps of properly trained instructors able to 

 devote their entire time to the work. The in- 

 fluence of political, sectarian and in some in- 

 stances personal domination, have been detri- 

 mental to the best development of some of the 

 schools. The availability of properly qualified 

 students has not always been considered in the 

 development of Chinese medical schools, nor 

 has cooperation with the Chinese themselves 

 always been developed as it might. ~There are 

 too many weak schools, and in certain places 

 duplication of effort is to be observed. 



The hospitals in China are administered for 

 the most part by the missionary societies. 

 There are a few Chinese Red Cross and gov- 

 ernment hospitals maintained by foreign 

 organizations other than the religious ones. 

 Many of the hospitals are well constructed 

 along modern lines, but a large number are 

 housed in remodelled dwellings which are more 

 or less unsatisfactory for hospital purposes. 

 The possibility of constructing satisfactory 

 hospitals is not lacking, for building material 

 is available and cheap almost everywhere in 

 China, and labor is likewise cheap. From the 

 standpoint of the construction of modern 

 plants there are, however, some serious draw- 

 backs which scarcely come into account with 

 us. The lack of public sewage systems, the 

 absence of public water supplies even in the 

 large cities, and the lack of gas and electricity 

 in most parts of China make difficult, but by 

 no means impossible, satisfactory hospital con- 

 ditions. The main difficulties at present have 

 to do with the human rather than the mechan- 

 ical factors. Practically no Chinese hospital in 

 existence is sufficiently supplied with properly 

 trained physicians. Even more important is 

 the lack of properly trained nurses. The prej- 

 udices of the Chinese themselves interfere 

 with smooth and satisfactory administration. 

 The dislike of bathing (a peculiarity not con- 

 fined to the Chinese), the filthy habits, the 

 vermin-infested clothing of the patients, and 

 the fact that in many hospitals a patient is 

 allowed to bring members of his family per- 

 manently into the hospital with him, do not 

 add to the ease of administration. In the dis- 



pensaries too, most of which act as feeders to 

 the hospital, the same lack of physicians and 

 nurses is apparent. It is, I think, a fair criti- 

 cism that in many instances the western 

 physicians in charge of Chinese hospitals have 

 deferred too much to the customs of the 

 Chinese people under the mistaken assump- 

 tion that this was necessary in order to gain 

 their patronage. There is ample evidence in 

 the report that the opposite point of view, 

 namely, that admission to the hospital is a 

 privilege which the Chinese must pay for by a 

 compliance with the western rules of hygiene, 

 works out well in the end. Indeed, it is obvi- 

 ous that the function of a hospital, not only in 

 China, but anywhere in the world, is not only 

 to administer to the individual patients, but 

 also to spread through them a knowledge of 

 the methods of personal and public hygiene. 

 This certainly can not be done by catering to 

 their unhygienic habits. 



The cause underlying the lack of sufiieient 

 medical and nursing help in Chinese hospitals 

 is worthy of consideration. It is, apparently, 

 not entirely a financial question, though the 

 salaries paid are, we think, too low. It is poor 

 policy to pay a professional man so low a 

 salary that he spends important energy in ma- 

 king both ends meet which he should be spend- 

 ing on his professional work. It is probable, 

 however, that other reasons than mere salary 

 play an important part in the difficulties 

 attendant upon obtaining physicians and 

 nurses for medical work in the Chinese Em- 

 pire. So far as the physicians are concerned it 

 must be pointed out that the changes in med- 

 ical education of the past twenty years, with 

 the natural growth of hospitals and public 

 health work, have resulted in a diminution of 

 the physicians graduating, with a great in- 

 crease in the opportunities. It is likely, there- 

 fore, that the supply of missionary physicians 

 for China will he limited to the comparatively 

 small proportion of medical graduates whose 

 religious fervor or adventurous spirit is ap- 

 pealed to by the great opportunities which un- 

 doubtedly exist in the east. The same will 

 doubtless be true of the nursing profession. 



The question of the standards of medical 



