NOTES ON A TRIP HOME BY CHINA AND AMERICA.
By
a
Peripatetic Contributor.
Trra establishment of the two fine lines of Pacific steamers, and the opening of the trans-continental railway from San Francisco to Omaha, have rendered the home journey via China and America so easy and pleasant, that the number of Indian officers who choose that route has already become con-
siderable, and is
to increase yearly, till tlie new road familiar as the old Cape voyage was to our the P. and O. is to modern home-goers. As,
becomes almost
sure
as
predecessors or however, the novelty
of the
thing
has not
yet
worn
off,
a
few
the medical aspects of the countries traversed may be interesting to your readers, and induce them to follow? slight and superficial as such glimpses as are alone possible in a hurried journey must of necessity be?our footsteps when the
stray notes
on
welcome furlough comes. Wo left Calcutta by one of Messrs. A pear and Co.'s excellent opium steamers, and reached Penang after a pleasant trip of The beauties of the betel-nut island are too well seven days. known to need
description, and our stay was too short to allow visiting its medical institutions. Two days more brought us to Singnpur, where, although our stay was only 26 hours, the kindness of one of the local physicians enabled us The to see most that was interesting of its medical lights. profession is officially represented by a principal civil medical officer and two colonial surgeons, and non-officially by about eight local practitioners. The principal medical officer's duties are chiefly administrative, and embrace Penang and Malacca as well as Singapur, but he is also health officer at the latter port. The colonial surgeons divide the executive work between them, one having the European hospital and jail, the other the pauper hospital, leper asyium, &c. The European hospital, which can accommodate from 30 to 40 in-patients, we did not see, but we carefully inspected the pauper hospital. The name is somewhat a misnomer, since all patients who can pay, and these are a considerable number, are charged a dollar a day for board and treatment. It was originally founded by a rich Chinaman, named Tan King Ching, for the benefit of his own countrymen, but was taken over by Government some years ago, and is now open to all, and supported from the common funds. The buildings consist of nine blocks, forming roughly two squares, one within the other, but sufficiently apart for efficient ventilation. One block contains the shop, quarters for resident officials, &c., six of the others are large wards of 60 beds encli, another the eye ward has 40 beds, and the last contains two wards for females. The of
our
THE INDIAN MEDICAL GAZETTE.
68
general plan of all the wards is irucli the same. The floors are tiles, or concrete, and. the walls are well tarred
either of asphalt,
a height of six feet from the ground. Chinamen are extremely dirty in their personal habits, and the wards have to he flooded and well scoured daily. Ventilation is effected by ample entrance apertures on a level with the floor, and a ridge roof for the escape of foul air, The sleeping arrangements in the older wards consist of one long wooden bed, extending the whole length of the ward, sloping slightly from the centre to each side like a double school desk, on which the patients sleep side by side in two rows?a very bad plan, as it tends to overcrowding, and the patients huddle together even when the ward is not full. New beds are, however, being supplied. They are simple in the extreme, and would be admirably adapted for Indian hospitals. They consist of three 6-feet planks, laid abreast on two simple wooden trestles, and can be taken
to
down
or
put up in
a
few seconds.
Each is furnished with
a
wooden
pillow, which forms a box to hold the patient's mugs, medicines, or other small articles. The hospital can accommodate 430 patients, and we found 3G0 in the wards, all Chinamen or Malays. The prevailing diseases are intermittent fevers, which yield readily to quinine, and bowel complaints. Cholera is rare, but appeared last year for the first time for eight or nine years, and was pretty severe. We could learn nothing as to how it originated. Dysentery is not generally severe when it originates in Singapur, but many bad cases come from Batavia and the dense and unhealthy jungles of Siam. Consumption is frequent, and the cases are commonly very rapidly fatal when once softening has begun. Eye diseases are rife, the dirty habits of the Chinese and their habit of everting and scraping the eyelids causing most of them ; and we saw some 40 or 50 cases of granular lids, entropium, keratitis, leucoma, and amaurosis. One of the female wards had been given up to a series of cases of gangrenous ulcers, similar in all respects to those described by Dr. Beaumont in the Indian Medical Gazette for December 1873, as raging near Indore in an epidemic form. as
Some 20 cases, in all stages, were under treatment, and in Dr. Beaumont's experience, repeated application of strong
nitric acid is found to be the
only mode of cure, although have found that pure chloride of zinc answers equally well. The ulcers are not considered to be contagious, but have been we
confined almost
entirely to ill-fed men working in the jungles? following the experience of Central India. Surgical cases are sufficiently common, accidents being numerous, and when riots occur, as they not unfrequently do, much surgery results, both Chinamen and Malays being very savage when rousod, although they are quiet enough at other times. Like the natives of India, they bear operations remarkably well. Opium is largely smoked by the Chinese in the Straits Settlements, and cases of imbecility and premature decay from its excessive use are common. Syphilis is very prevalent, and in this respect also
it is said that 50 per cent, of the women in many of the stews diseased. The Contagious Diseases Act is opposed as costly and inefficient in view of the above fact, and the objectors are
?5,000 is too much to pay for working it?to which the supporters of the Act reply that so far the supervision and working of the regulations have been faulty, but that under new regulations recently made things will improve. At present the lock hospital, though it contains 50 beds, has seldom
complain
more
that
than 25 patients.
Leprosy, especially in its tubercular form, leper hospital furnishes a neat, clean,
and the
home for the unfortunate sufferers, some of whom are sent in by the authorities, while others apply voluntarily for treatment. We saw several typical cases of great interest, one of them a hoy, said to be thirteen years of age, but looking less, who had had the dis ase four years, and whose mother bad died of it. Heredity is often noticed iu the Straits, and many people still
1875.
contagious. No specific treatment hospital, but great attention is paid to cleanliness, and a liberal diet is provided. Ulcerations are treated with carbolized oil, which answers well; and patients almost invariably improve while in hospital, though the disease is apt to re-commence with a return to home squalor and bad
believe that the disease is is
employed
in the
food. The jail i3 a beautifully kept and well ordered building, capable of holding 1,000 prisoners. It is, however, situated on low ground so near the water, that drainage must be difficult in rainy weather. Europeans are confined in large and comfortable cells; Asiatics in large airy wards. The work is intramural, and consists of stone-breaking, four cubic feet per man being the daily tale; shot-drill (now stopped for Europeans) as a punishment; stone cutting, forging, cane chair making, printing in English, Chinese, and Malay, mat making, &c., &c., all admirably done. The dry earth system of conservancy i3 rigorously enforced, and is a great success, a contractor giving 8,000 cocoanuts monthly for the refuse. These are used in the mat-making department and as food, Six and a half days took us to IIong-Kong, where (having wo were able to see every thing. Our a few days to spare) first visit was to the jail, which, as becomes a crown colony, is much more European or English in its construction and arrangements than eastern jails usually are. Too much praiso can hardly be given to the exquisite cleanliness and admirable discipline which prevail, but here its merits (in our opinion) end. on
It is built almost in the centre of the town, is surrounded by other buildings, and is narrow, confined, dark,
all sides
and dismal in the extreme. It is built on the corridor system with small cells, a few of them solitary, but the majority intended for from three to five prisoners. Wooden floors have been used hitherto, but these absorb much damp when washed, now being replaced by concrete, which in our experience is really as bad, though the bad effects are longer The exercise yards are small and in becoming manifest. confined, and as the labour is almost entirely limited to oakum picking, stone breaking, and shot-drill, the prisoners must have a very unpleasant time of it, compared with thoso Whether this is not an advantage as a in Indian Jails. deterrent from crime, we will not discuss ; and, as we failed to get any health statistics, it is impossible to say that con-
and are
finement under such conditions in such a climate is or is not to European prisoners; but we should think it must
injurious
From the jail wo went to the lock hospital, a fine new building high up on a hill side. The contagious diseases' regulations are most efficiently worked under the superintendence of the (Sikh) police and the colonial surgeon. There are somo 800 prostitutes in the town, and syphilis was formerly severe. The hospital has accommodation for 70 patients, but has seldom more than from 20 to 25 beds occupied, and such cases be.
ai'e
non-specific. So thoroughly are the examinations syphilis has now become quite exceptional the registered professionals?so raro that up to the tiino
almost all
that
conducted,
among of our visit
(in May) there had been no admission this year and only two for gonorrhoea in a garrison of 1,050 men. There is still, however, a certain amount of clandestine prostitution, and women of this class are more frequently
from
syphilis,
diseased.
This
has led to a few cases among the sailors who are moro addicted to roving, and have moro money at command than the soldiery. Very severe cases of the syphilis are still met with now and then, both
on
is very common, and comfortable
[Mabch 1,
the
station,
natives (chiefly Chinese) and merchant seamen, and
among
we saw in the civil hospital a Europoan sailor covered with sores, ono of which had ulcerated into the uluar artery, and nearly
caused death by haimorrhage. This civil hospital wa9 originnlly a mission house, and the building, though the best is made of it, is quite unsuited for hospital purposes, being
Maiich 1,
NOTES ON A TKIP HOME BY CHINA AND AMERICA.
1875.]
confined anil shut in, and the wards 6mall and low in A grant of $30,000 has, however, been obtained flic roofs. for a now one, and a good site selected above the lock The cases
hospital.
terest, except
typical
cases
one
of
under treatment were of no special infever. This is rare, but several
typhoid
liavo been seen.
Chinese hospital, built
a
few
From the civil we went to the
years ago, partly a grant in aid from
by voluntary Government, licence tax on gambling houses as a 6op to the Cerberus of Exeter Hall. Management, patients, doctors, and treatment are all Chinese, the only foreign innovation being cleanliness, which is seen to by the health officer in an occasional visit. The building was fairly clean, but as the large wards are partitioned off into bunks accommodating two patients each, it is difficult to keep it so, and, judging by the abundant smells, ventilation is imperfect. The cases contributions, but chiefly by paid out of the proceeds of the
under treatment
were
and other chest diseases, and sore eyes. There is
for the most part Chinese?phthisis paralysis, and dropsies, ulcerated
legs, surgical department, tho Chinese? doctors and patients alike?having n horror of the knife They call us knife doetors, and like the natives of India, come to our hospitals readily enough for surgical assistance, though they generally employ their own physicians in medical cases. They have one and all a horror of amputation, or any operative proceeding which removes any part of the natural body. Superfluities in the shape of tumours, stone, or supernumerary fingers or toes they are glad to get rid of. This arises from their belief in successive existences, and the consequent desire to commence each new one complete in all their parts. It is for this reason also that strangling is considered a more honourable punishment than decapitation, which involves a risk of re-appearing on the scene with the wrong head. The extreme frequency of suicide, often for apparently trifling causes, and the general indifference to death, no doubt depend on the same belief. If one's present lot is miserable, luck may turn, and a pauper coolie be born a mandarin, thus reversing Hamlet's to take arms against assay of verdict and making it nobler troubles and by opposing end them than to suffer the slings and arrows of outrageous fortune." Tho dispensing department occupies a couple of very dirty kitchens, in which are ranged Ion" ovens accommodating many dozens of decoction for each patient. Most of the pots, one of" which is set apart to be pretty elaborate, and two men were seemed prescriptions busily employed in chopping and slicing roots and drugs. "When the decoction has been swallowed, the refuse of the pot is cast into a compartment in a long trough labelled with tho patient's name and prescription, and is duly inspected by the physician at his next visit, to see that it is all right, after which it is thrown into the stxeet in the hope that it may be smelt at by the horse on which tho Tien i-star ridej, a celestial spirit? the Chinese Hygeia?which goes about at night conferring benefits on mortals. Tills are pretty largely used, but decoctions and infusions seemed to be most popular. The Moxa seems to be the universal counter-irritant, and acupuncture is in constant of diseases. The hospital is much confined, use for all sorts bein" closed in on two sides by high scarps in the disentegrated and on the other two by houses. This points of the mountain, sides was formerly the cause of an immense hill the of scarping amountof fever in Hong-Kong, severe cases occurring whenever but the place lias been a new cutting was made ; gradually and as building has progressbecoming drier and more healthy, no
"
ed less
little?during tho last few frequently tapped,
numerous
which
we
and less visited
years
new
sources
of infection
are
and cases of fever are now much less than formerly. The other institutions
severo were
the
military
and naval
hospitals.
By
curious perversion of the fitness of things, tho former is situated on board the Mceanee, a condemned frigate of the old school, which makes an admirable hospital, while tho what seems
a
69
latter is a handsome building on a bluff at the ea9t esd of the station?airy and unconfined, and well fitted with all modern appliances. It was built by the Hong-Kong merchants for a seamen's hospital, in the days when the trade was carried on in sailing vessels, which remained in harbour for weeks at a time, and was sold to the Admiralty recently, the opening of the Suez Canal having rendered it unnecessary, by revolutionising the carrying trade, which is now almost confined to steam vessels which remain for a day or two only, and most of which carry surgeons. From Hong-Kong
Canton, which, as an excellent cities, should be seen by all who can spare the time?two or three days?necessary to visit itSteamers leave Hong-Kong daily, and there are two or three European hotels. Lists in English and Chinese of the chief places of interest can be obtained at the British Consulate, and by pointing to the Chinese character of the place he wants to see, the traveller will be taken round by his chairmen with perfect ease and comfort, though he knows nothing of Chinese. In this way we saw the great hall of competitive examination, where some 10 to 12,000 candidates for the Bachelor's degree are examined at a time, each shut into a little room or stall, type
of the
larger
we
visited
Chinese
where he can communicate with no one, and where he must remain till his thesis is finished ; the temple of horrors, where the Chinese punishments, flnying alive, boiling in oil, sawing in two,
brazing in a mortar, &c., &c., are done to the life in carved wood; the Yamun or official house of the British Consul, the temple of the 500 disciples of Buddha, and many other
interesting sights.
The most interesting of all, however, was the mission hospital. While questioning the theological necessity of mission work
generally,
and
dissenting altogether
from
many of the
doctrines commonly taught by missionaries, especially of the Calvinistic schools, we have always held that those who believe (or accept) these doctrines are bound by the strongest ties to do all in their power to spread them; and have always believed that medical missions are infinitely more likely to succeed than preaching stations. Whether they do so or not is another matter; but even the missionaries themselves admit that the converts so far are few, and the annnal report for 1873?which mere
records one conversion?can only say that some of the patients " manifest an intelligent and hopeful interest in the truths of
Christianity,"
and that "it is reasonable to suppose that some effecting that change in public sentiment
of them will aid in
which must of
precede
Christianity
the downfall of idolatry and the
acceptance
"
There can be no doubt, however, that as medical institutions, calculated by the good work they do to promote kindly and grateful feelings towards foreigners, and respect and admiration
for their skill and humanity in the native mind, these mission hospitals do immense good ; and the more they or others like them can be multiplied and developed the sooner will the barriers the nations be broken down, and the faster will which
separate spread of
A civilization and modern ideas in China. will shew Canton the of annual the last hospital at report glance how much can be done by one hard-working and conscientious man. During the year 1873 there were treated 19,7ol outpatients, of whom 4,219 were women ; 1,105 in-patients, 357 of them women ; while 276 children were vaccinated, and 1,087 be the
hundred and fifty-six of these were operations performed. One to our Indian categories, but many major operations according of the others, though minor, were of great practical importance. The major list includes 27 stone extractions by lithotomy, and 15 by lithotrity ; 47 operations for cataract; 14 for artificial pupils ; 1 amputation ; several cases of removal of necrosed bone, tumours, &c., &c., while among the minor are no less than 380 for entropium, 57 for fistulae, 32 for hydrocele, 15 for piles,
THE INDIAN MEDICAL GAZETTE.
70
phymosis, and many others. Stone, almost entirely in form, is very common ; no less than 322 cases having been operated 011 in the last, 15 years. Of these 263 were cases of lithotomy, with 22 deaths, or 836 per cent., while 59 were cases of crushing, with 5 deaths, or 8'48 per cent.
14 for
its uric acid
Xast year, however, there was but one death among the 27 cases cut for stone, while all the lithotrity cases were cured?results as brilliant as they could well be. The lateral operation is
invariably chosen, and as in the practice of most Indian Surgeons, no tube is used. Should hjemorihage occur, Dr. Kerr, instead of plugging the wound and so dilating it, introduces a catheter to allow escape of urine, and then plugs the rectum. He assured us that this is borne comparatively well, while it favours instead of retarding the healing of the wound. Among Other interesting operations, was the removal of an immense tumour, weighing 4^ pounds, from the parotid space. Much careful dissection was required, and a good deal of blood w as lost, but the patient made a good recovery, and great part of the wound healed by first intention. The hospital is a plain and unpretentious building, without any advantages of site or modern refinements, but is kept in excellent order and repair. It accommodates 96 patients in eight wards 011 the ground floor, and has several additional wards for special cases or for patients who for the sake of privacy are willing to pay a small rent. Religious services are held daily, and it is a condition of admission
almost
Besides his relithat all who are able to do so shall attend. and hospital work, the superintendent, conducts medical
gious
classes for native students, and has prepared several valuable works 011 chemistry, materia medica, symptomatology, and skin diseases in Chinese.
introducing
a
These cannot fail to be of great value in of our western progress to the natives,
knowledge
of whom are great readers, and although strong conservatives, ready enough to profit by any tiling of which they can
most
realize the value.
The
missionary
societies and the
profession
may well be proud of such men as Kerr of Canton, Dudgeon of Pekin, and others, who with abilities and experience equal to or
surpassing those of many men of world-wide fame, are content to work on, unknown and unlionoured, in the great cause of humanity, for the sake and in the name of the first and greatest of medical missionaries.
[Maiicii 1,
1875.
By
a
Peripatetic Contributor.
Trra establishment of the two fine lines of Pacific steamers, and the opening of the trans-continental railway from San Francisco to Omaha, have rendered the home journey via China and America so easy and pleasant, that the number of Indian officers who choose that route has already become con-
siderable, and is
to increase yearly, till tlie new road familiar as the old Cape voyage was to our the P. and O. is to modern home-goers. As,
becomes almost
sure
as
predecessors or however, the novelty
of the
thing
has not
yet
worn
off,
a
few
the medical aspects of the countries traversed may be interesting to your readers, and induce them to follow? slight and superficial as such glimpses as are alone possible in a hurried journey must of necessity be?our footsteps when the
stray notes
on
welcome furlough comes. Wo left Calcutta by one of Messrs. A pear and Co.'s excellent opium steamers, and reached Penang after a pleasant trip of The beauties of the betel-nut island are too well seven days. known to need
description, and our stay was too short to allow visiting its medical institutions. Two days more brought us to Singnpur, where, although our stay was only 26 hours, the kindness of one of the local physicians enabled us The to see most that was interesting of its medical lights. profession is officially represented by a principal civil medical officer and two colonial surgeons, and non-officially by about eight local practitioners. The principal medical officer's duties are chiefly administrative, and embrace Penang and Malacca as well as Singapur, but he is also health officer at the latter port. The colonial surgeons divide the executive work between them, one having the European hospital and jail, the other the pauper hospital, leper asyium, &c. The European hospital, which can accommodate from 30 to 40 in-patients, we did not see, but we carefully inspected the pauper hospital. The name is somewhat a misnomer, since all patients who can pay, and these are a considerable number, are charged a dollar a day for board and treatment. It was originally founded by a rich Chinaman, named Tan King Ching, for the benefit of his own countrymen, but was taken over by Government some years ago, and is now open to all, and supported from the common funds. The buildings consist of nine blocks, forming roughly two squares, one within the other, but sufficiently apart for efficient ventilation. One block contains the shop, quarters for resident officials, &c., six of the others are large wards of 60 beds encli, another the eye ward has 40 beds, and the last contains two wards for females. The of
our
THE INDIAN MEDICAL GAZETTE.
68
general plan of all the wards is irucli the same. The floors are tiles, or concrete, and. the walls are well tarred
either of asphalt,
a height of six feet from the ground. Chinamen are extremely dirty in their personal habits, and the wards have to he flooded and well scoured daily. Ventilation is effected by ample entrance apertures on a level with the floor, and a ridge roof for the escape of foul air, The sleeping arrangements in the older wards consist of one long wooden bed, extending the whole length of the ward, sloping slightly from the centre to each side like a double school desk, on which the patients sleep side by side in two rows?a very bad plan, as it tends to overcrowding, and the patients huddle together even when the ward is not full. New beds are, however, being supplied. They are simple in the extreme, and would be admirably adapted for Indian hospitals. They consist of three 6-feet planks, laid abreast on two simple wooden trestles, and can be taken
to
down
or
put up in
a
few seconds.
Each is furnished with
a
wooden
pillow, which forms a box to hold the patient's mugs, medicines, or other small articles. The hospital can accommodate 430 patients, and we found 3G0 in the wards, all Chinamen or Malays. The prevailing diseases are intermittent fevers, which yield readily to quinine, and bowel complaints. Cholera is rare, but appeared last year for the first time for eight or nine years, and was pretty severe. We could learn nothing as to how it originated. Dysentery is not generally severe when it originates in Singapur, but many bad cases come from Batavia and the dense and unhealthy jungles of Siam. Consumption is frequent, and the cases are commonly very rapidly fatal when once softening has begun. Eye diseases are rife, the dirty habits of the Chinese and their habit of everting and scraping the eyelids causing most of them ; and we saw some 40 or 50 cases of granular lids, entropium, keratitis, leucoma, and amaurosis. One of the female wards had been given up to a series of cases of gangrenous ulcers, similar in all respects to those described by Dr. Beaumont in the Indian Medical Gazette for December 1873, as raging near Indore in an epidemic form. as
Some 20 cases, in all stages, were under treatment, and in Dr. Beaumont's experience, repeated application of strong
nitric acid is found to be the
only mode of cure, although have found that pure chloride of zinc answers equally well. The ulcers are not considered to be contagious, but have been we
confined almost
entirely to ill-fed men working in the jungles? following the experience of Central India. Surgical cases are sufficiently common, accidents being numerous, and when riots occur, as they not unfrequently do, much surgery results, both Chinamen and Malays being very savage when rousod, although they are quiet enough at other times. Like the natives of India, they bear operations remarkably well. Opium is largely smoked by the Chinese in the Straits Settlements, and cases of imbecility and premature decay from its excessive use are common. Syphilis is very prevalent, and in this respect also
it is said that 50 per cent, of the women in many of the stews diseased. The Contagious Diseases Act is opposed as costly and inefficient in view of the above fact, and the objectors are
?5,000 is too much to pay for working it?to which the supporters of the Act reply that so far the supervision and working of the regulations have been faulty, but that under new regulations recently made things will improve. At present the lock hospital, though it contains 50 beds, has seldom
complain
more
that
than 25 patients.
Leprosy, especially in its tubercular form, leper hospital furnishes a neat, clean,
and the
home for the unfortunate sufferers, some of whom are sent in by the authorities, while others apply voluntarily for treatment. We saw several typical cases of great interest, one of them a hoy, said to be thirteen years of age, but looking less, who had had the dis ase four years, and whose mother bad died of it. Heredity is often noticed iu the Straits, and many people still
1875.
contagious. No specific treatment hospital, but great attention is paid to cleanliness, and a liberal diet is provided. Ulcerations are treated with carbolized oil, which answers well; and patients almost invariably improve while in hospital, though the disease is apt to re-commence with a return to home squalor and bad
believe that the disease is is
employed
in the
food. The jail i3 a beautifully kept and well ordered building, capable of holding 1,000 prisoners. It is, however, situated on low ground so near the water, that drainage must be difficult in rainy weather. Europeans are confined in large and comfortable cells; Asiatics in large airy wards. The work is intramural, and consists of stone-breaking, four cubic feet per man being the daily tale; shot-drill (now stopped for Europeans) as a punishment; stone cutting, forging, cane chair making, printing in English, Chinese, and Malay, mat making, &c., &c., all admirably done. The dry earth system of conservancy i3 rigorously enforced, and is a great success, a contractor giving 8,000 cocoanuts monthly for the refuse. These are used in the mat-making department and as food, Six and a half days took us to IIong-Kong, where (having wo were able to see every thing. Our a few days to spare) first visit was to the jail, which, as becomes a crown colony, is much more European or English in its construction and arrangements than eastern jails usually are. Too much praiso can hardly be given to the exquisite cleanliness and admirable discipline which prevail, but here its merits (in our opinion) end. on
It is built almost in the centre of the town, is surrounded by other buildings, and is narrow, confined, dark,
all sides
and dismal in the extreme. It is built on the corridor system with small cells, a few of them solitary, but the majority intended for from three to five prisoners. Wooden floors have been used hitherto, but these absorb much damp when washed, now being replaced by concrete, which in our experience is really as bad, though the bad effects are longer The exercise yards are small and in becoming manifest. confined, and as the labour is almost entirely limited to oakum picking, stone breaking, and shot-drill, the prisoners must have a very unpleasant time of it, compared with thoso Whether this is not an advantage as a in Indian Jails. deterrent from crime, we will not discuss ; and, as we failed to get any health statistics, it is impossible to say that con-
and are
finement under such conditions in such a climate is or is not to European prisoners; but we should think it must
injurious
From the jail wo went to the lock hospital, a fine new building high up on a hill side. The contagious diseases' regulations are most efficiently worked under the superintendence of the (Sikh) police and the colonial surgeon. There are somo 800 prostitutes in the town, and syphilis was formerly severe. The hospital has accommodation for 70 patients, but has seldom more than from 20 to 25 beds occupied, and such cases be.
ai'e
non-specific. So thoroughly are the examinations syphilis has now become quite exceptional the registered professionals?so raro that up to the tiino
almost all
that
conducted,
among of our visit
(in May) there had been no admission this year and only two for gonorrhoea in a garrison of 1,050 men. There is still, however, a certain amount of clandestine prostitution, and women of this class are more frequently
from
syphilis,
diseased.
This
has led to a few cases among the sailors who are moro addicted to roving, and have moro money at command than the soldiery. Very severe cases of the syphilis are still met with now and then, both
on
is very common, and comfortable
[Mabch 1,
the
station,
natives (chiefly Chinese) and merchant seamen, and
among
we saw in the civil hospital a Europoan sailor covered with sores, ono of which had ulcerated into the uluar artery, and nearly
caused death by haimorrhage. This civil hospital wa9 originnlly a mission house, and the building, though the best is made of it, is quite unsuited for hospital purposes, being
Maiich 1,
NOTES ON A TKIP HOME BY CHINA AND AMERICA.
1875.]
confined anil shut in, and the wards 6mall and low in A grant of $30,000 has, however, been obtained flic roofs. for a now one, and a good site selected above the lock The cases
hospital.
terest, except
typical
cases
one
of
under treatment were of no special infever. This is rare, but several
typhoid
liavo been seen.
Chinese hospital, built
a
few
From the civil we went to the
years ago, partly a grant in aid from
by voluntary Government, licence tax on gambling houses as a 6op to the Cerberus of Exeter Hall. Management, patients, doctors, and treatment are all Chinese, the only foreign innovation being cleanliness, which is seen to by the health officer in an occasional visit. The building was fairly clean, but as the large wards are partitioned off into bunks accommodating two patients each, it is difficult to keep it so, and, judging by the abundant smells, ventilation is imperfect. The cases contributions, but chiefly by paid out of the proceeds of the
under treatment
were
and other chest diseases, and sore eyes. There is
for the most part Chinese?phthisis paralysis, and dropsies, ulcerated
legs, surgical department, tho Chinese? doctors and patients alike?having n horror of the knife They call us knife doetors, and like the natives of India, come to our hospitals readily enough for surgical assistance, though they generally employ their own physicians in medical cases. They have one and all a horror of amputation, or any operative proceeding which removes any part of the natural body. Superfluities in the shape of tumours, stone, or supernumerary fingers or toes they are glad to get rid of. This arises from their belief in successive existences, and the consequent desire to commence each new one complete in all their parts. It is for this reason also that strangling is considered a more honourable punishment than decapitation, which involves a risk of re-appearing on the scene with the wrong head. The extreme frequency of suicide, often for apparently trifling causes, and the general indifference to death, no doubt depend on the same belief. If one's present lot is miserable, luck may turn, and a pauper coolie be born a mandarin, thus reversing Hamlet's to take arms against assay of verdict and making it nobler troubles and by opposing end them than to suffer the slings and arrows of outrageous fortune." Tho dispensing department occupies a couple of very dirty kitchens, in which are ranged Ion" ovens accommodating many dozens of decoction for each patient. Most of the pots, one of" which is set apart to be pretty elaborate, and two men were seemed prescriptions busily employed in chopping and slicing roots and drugs. "When the decoction has been swallowed, the refuse of the pot is cast into a compartment in a long trough labelled with tho patient's name and prescription, and is duly inspected by the physician at his next visit, to see that it is all right, after which it is thrown into the stxeet in the hope that it may be smelt at by the horse on which tho Tien i-star ridej, a celestial spirit? the Chinese Hygeia?which goes about at night conferring benefits on mortals. Tills are pretty largely used, but decoctions and infusions seemed to be most popular. The Moxa seems to be the universal counter-irritant, and acupuncture is in constant of diseases. The hospital is much confined, use for all sorts bein" closed in on two sides by high scarps in the disentegrated and on the other two by houses. This points of the mountain, sides was formerly the cause of an immense hill the of scarping amountof fever in Hong-Kong, severe cases occurring whenever but the place lias been a new cutting was made ; gradually and as building has progressbecoming drier and more healthy, no
"
ed less
little?during tho last few frequently tapped,
numerous
which
we
and less visited
years
new
sources
of infection
are
and cases of fever are now much less than formerly. The other institutions
severo were
the
military
and naval
hospitals.
By
curious perversion of the fitness of things, tho former is situated on board the Mceanee, a condemned frigate of the old school, which makes an admirable hospital, while tho what seems
a
69
latter is a handsome building on a bluff at the ea9t esd of the station?airy and unconfined, and well fitted with all modern appliances. It was built by the Hong-Kong merchants for a seamen's hospital, in the days when the trade was carried on in sailing vessels, which remained in harbour for weeks at a time, and was sold to the Admiralty recently, the opening of the Suez Canal having rendered it unnecessary, by revolutionising the carrying trade, which is now almost confined to steam vessels which remain for a day or two only, and most of which carry surgeons. From Hong-Kong
Canton, which, as an excellent cities, should be seen by all who can spare the time?two or three days?necessary to visit itSteamers leave Hong-Kong daily, and there are two or three European hotels. Lists in English and Chinese of the chief places of interest can be obtained at the British Consulate, and by pointing to the Chinese character of the place he wants to see, the traveller will be taken round by his chairmen with perfect ease and comfort, though he knows nothing of Chinese. In this way we saw the great hall of competitive examination, where some 10 to 12,000 candidates for the Bachelor's degree are examined at a time, each shut into a little room or stall, type
of the
larger
we
visited
Chinese
where he can communicate with no one, and where he must remain till his thesis is finished ; the temple of horrors, where the Chinese punishments, flnying alive, boiling in oil, sawing in two,
brazing in a mortar, &c., &c., are done to the life in carved wood; the Yamun or official house of the British Consul, the temple of the 500 disciples of Buddha, and many other
interesting sights.
The most interesting of all, however, was the mission hospital. While questioning the theological necessity of mission work
generally,
and
dissenting altogether
from
many of the
doctrines commonly taught by missionaries, especially of the Calvinistic schools, we have always held that those who believe (or accept) these doctrines are bound by the strongest ties to do all in their power to spread them; and have always believed that medical missions are infinitely more likely to succeed than preaching stations. Whether they do so or not is another matter; but even the missionaries themselves admit that the converts so far are few, and the annnal report for 1873?which mere
records one conversion?can only say that some of the patients " manifest an intelligent and hopeful interest in the truths of
Christianity,"
and that "it is reasonable to suppose that some effecting that change in public sentiment
of them will aid in
which must of
precede
Christianity
the downfall of idolatry and the
acceptance
"
There can be no doubt, however, that as medical institutions, calculated by the good work they do to promote kindly and grateful feelings towards foreigners, and respect and admiration
for their skill and humanity in the native mind, these mission hospitals do immense good ; and the more they or others like them can be multiplied and developed the sooner will the barriers the nations be broken down, and the faster will which
separate spread of
A civilization and modern ideas in China. will shew Canton the of annual the last hospital at report glance how much can be done by one hard-working and conscientious man. During the year 1873 there were treated 19,7ol outpatients, of whom 4,219 were women ; 1,105 in-patients, 357 of them women ; while 276 children were vaccinated, and 1,087 be the
hundred and fifty-six of these were operations performed. One to our Indian categories, but many major operations according of the others, though minor, were of great practical importance. The major list includes 27 stone extractions by lithotomy, and 15 by lithotrity ; 47 operations for cataract; 14 for artificial pupils ; 1 amputation ; several cases of removal of necrosed bone, tumours, &c., &c., while among the minor are no less than 380 for entropium, 57 for fistulae, 32 for hydrocele, 15 for piles,
THE INDIAN MEDICAL GAZETTE.
70
phymosis, and many others. Stone, almost entirely in form, is very common ; no less than 322 cases having been operated 011 in the last, 15 years. Of these 263 were cases of lithotomy, with 22 deaths, or 836 per cent., while 59 were cases of crushing, with 5 deaths, or 8'48 per cent.
14 for
its uric acid
Xast year, however, there was but one death among the 27 cases cut for stone, while all the lithotrity cases were cured?results as brilliant as they could well be. The lateral operation is
invariably chosen, and as in the practice of most Indian Surgeons, no tube is used. Should hjemorihage occur, Dr. Kerr, instead of plugging the wound and so dilating it, introduces a catheter to allow escape of urine, and then plugs the rectum. He assured us that this is borne comparatively well, while it favours instead of retarding the healing of the wound. Among Other interesting operations, was the removal of an immense tumour, weighing 4^ pounds, from the parotid space. Much careful dissection was required, and a good deal of blood w as lost, but the patient made a good recovery, and great part of the wound healed by first intention. The hospital is a plain and unpretentious building, without any advantages of site or modern refinements, but is kept in excellent order and repair. It accommodates 96 patients in eight wards 011 the ground floor, and has several additional wards for special cases or for patients who for the sake of privacy are willing to pay a small rent. Religious services are held daily, and it is a condition of admission
almost
Besides his relithat all who are able to do so shall attend. and hospital work, the superintendent, conducts medical
gious
classes for native students, and has prepared several valuable works 011 chemistry, materia medica, symptomatology, and skin diseases in Chinese.
introducing
a
These cannot fail to be of great value in of our western progress to the natives,
knowledge
of whom are great readers, and although strong conservatives, ready enough to profit by any tiling of which they can
most
realize the value.
The
missionary
societies and the
profession
may well be proud of such men as Kerr of Canton, Dudgeon of Pekin, and others, who with abilities and experience equal to or
surpassing those of many men of world-wide fame, are content to work on, unknown and unlionoured, in the great cause of humanity, for the sake and in the name of the first and greatest of medical missionaries.
[Maiicii 1,
1875.
