Sun Yat-sen: from medicine T. Kue-Hing Young,
to
revolution
md
Mar. 12, 1975 marks the 50th anniversary of the death of Sun Yat-sen, founder of the Chinese Republic and a physician turned revolutionary. The son of a poor farmer in southern China, Sun is today revered by Chinese of all political shades as the one who overthrew the Manchu dynasty in 1911 and started China on her way to becoming a modern nation.
Early influences Sun was born Nov. 12, 1866. He travelled to Honolulu at the age of 13 to live with his brother, a prosperous shopkeeper.1 It was in Hawaii, then still an independent kingdom, that Sun first came into contact with Western culture. An Anglican school exposed him to ideas of Christianity and West¬ ern democracy, but his enthusiasm for these ideas displeased his traditionalist brother, who decided to send him home when he reached the age of 16. On his return to China Sun quickly came into conflict with his family. In a scandalous incident well known to most Chi¬ nese schoolboys, Sun broke the arm of a wooden statue of Buddha in the local temple, in a desire to prove to the superstitious worshippers that their idol was unable to protect itself from a mere mortal, let alone answer their prayers. Ostracized in his village, Sun con¬ tinued his secondary education in Hong Kong, a British colony. It was then the end of the Sino-French War (18831885), in which China once again was defeated by the Europeans. The young student vowed then to overthrow the weak and corrupt Manchu dynasty. It was also in Hong Kong that Sun was formally converted to Christianity.
Medical student days In 1886 Sun returned to China, where he enrolled at the missionary hospital medical school in Canton. Es¬ tablished in 1866 by Dr. John G. Kerr, a native of Ohio and a Presbyterian missionary, this school was the first modern school in China to offer formal instruction in "Western medicine". Kerr had succeeded Dr. Peter Parker, the first American medical missionary to China, who in 1835 had opened the first hospital in Canton.2 Why did Sun study medicine? Charles Hager, the missionary who baptized Sun in Hong Kong, later recalled the circumstances surrounding Sun's decision:
was as yet no modern university in China, and the missionary institutions
were then the sole doors to European knowledge, especially the natural sciences. Sun studied in Canton only for a year, for in 1887 he returned to Hong Kong to enrol in the new College of Medicine for Chinese. This school, which was better equipped than the medical school in Canton and provided instruction in English, was the predecessor of the medical faculty of the University of Hong Kong.4 As a stu¬ dent, Sun was of the highest calibre, and he won the unanimous admiration of his teachers, especially the Englishmen Drs. James Cantlie and Patrick Manson, who became his lifelong Not forgetting his roots, Sun Perhaps if there had been a satisfactory friends. with his classical Chinese by up kept in at that time Hong theological seminary a tutor from Canton. hiring private to one and some in or Canton, sup¬ Kong It was probably more legend than port him, Sun Yat-sen might have become the most famous preacher of his time, by fact that Sun experimented with bombs the magnetic power of personal contact in the college's chemistry laboratory, with men in winning them to Christ. After but as a student his intense interest in several months of inactivity he decided to politics persisted. As a result he became take up the study of medicine, which has associated with known Chinese radicals always been held in high esteem and next who sought sanctuary in the British to the ministry by the Chinese. At his personal request I gave him a letter to colony. In 1892 the College granted its first the venerable Dr. J. G. Kerr, asking him if he would not remit a part of the medi¬ diplomas. Out of an original class of cal fees, which were at that time about 12, Sun and another student were the twenty dollars a year.3 only two to graduate.
Years later Sun wrote that he had intended to "use the school to advance his ideas, and the profession to reach the masses." And no doubt Sun did become acutely aware of the sorry state of China. Subdued militarily and humiliated diplomatically time and again by the imperialist powers, the Chinese government under the Manchus was rotten and hopelessly backwards in terms of technology and science. Many politically conscious Reprint requests to: Dr. T. Kue-Hing Young, people saw in Western learning the Community Health Center, 3765 Sherwood Dr. only remedy to China's sickness. There Regina, Sask. S4R 4A9 614 CMA JOURNAL/MARCH 8, 1975/VOL. 112
Medical career Sun's graduation posed a problem. What would he do next? Such a ques¬ tion hardly presents itself to medical graduates today, but in Sun's time there was no market for his services as a Western-trained physician. Western medicine was not trusted by the Chi¬ nese people, who used it as a last resort and only if provided free of charge. Outside the mission hospitals there were hardly any practitioners. Further¬ more, Sun's diploma was not even rec-
ognized by the Hong Kong govern¬ legal status was virtually the same as that of any self-proclaimed traditional herbal physician.5 Encouraged by his teachers, Sun moved to adjacent Macao, a Portuguese enclave, where he opened an apothecary's shop. He dispensed both Chinese herbs and Western drugs. In exchange for free drugs and free treat¬ ment of patients, Sun was allowed to practise surgery in a local Chinese hos¬ pital. Of this period, Sun's teacher ment. His
Cantlie wrote:
Sun commenced practice, and I encour¬ aged him especially in surgical work. When major operations had to be done, I went on several occasion to Macao to assist him, and there in the presence of the governors of the hospital, he per¬ formed important operations requiring skill, coolness of judgement, and dexter¬
ity.6 However, Sun
was soon
barred from
practising European medicine because of the lack of Portuguese qualifications.
In 1893 he returned to Canton and started another combined ChineseWestern practice. At the height of his career he organized, with his friends, three branch shops in the city and nearby rural areas. Early in 1894 Sun planned a trip north. He had prepared a petition outlining his reform ideas for submission to Viceroy Li Hung-chang, but Sun also wanted to apply for a position at the military medical school in Tientsin.7 This school, known as Peiyang (North Ocean), had been opened in 1881 by the missionary Dr. John Ken¬ neth MacKenzie, and was under the patronage of the viceroy.8 Sun's re¬ quest for an interview,' however, was rebuffed. He then left China for Hawaii. The conclusion of the Sinothe most Japanese War that year humiliating to date because Japan was once China's vassal helped Sun make up his mind. From then on he was determined that the road to China's salvation lay in revolution from below, and not in gentlemanly reform from above.
Yagabond revolutionary After 1894 Sun abandoned medicine. He directed his energies to organizing the antidynastic movement. He trav¬ elled around the world to solicit sup¬ port from overseas Chinese communi¬ ties and planned occasional abortive attempts at insurrection in various pro¬ vincial cities in southern China. Hunted by Chinese agents wherever he went, the fugitive was finally kidnapped in London in 1896 and detained in the Chinese Legation, waiting to be smuggled back to China to face torture and
execution, but he managed
to bribe the
legation's English servant to pass a distress note to Cantlie and Manson, who were then living in London. His two former mentors appealed vigorously to the Foreign Office and pressed for the captive's release. Sun instantly became an international celebrity. After his release Sun remained in London for a few months and, in the fashion of Karl Marx, avidly studied in the library of the British Museum. On Oct. 10, 1911, after nine previous un¬ successful attempts, Sun's revolutionary forces finally raised arms in Wuhan, in central China. A chain reaction spread across the nation, and province after province declared its independence from the Peking court. Sun, then in the United States, ended his exile and, like Lenin, hurried home to re¬ ceive his honours. On New Year's Day 1912 Sun was inaugurated as provision¬ al president of the Republic of China at Nanking. However, the North was still largely under the Manchus, and the real power behind the throne lay in the military strongman Yuan Shih-kai. In an attempt to achieve unity Sun compromised. He magnanimously resigned the presidency in favour of Yuan, who in return forced the Man¬ chu emperor to abdicate and decree the cessation of hostilities. Frustrated China's
hopes experiment with parliamen¬ tary democracy was shortlived. The
ambitious Yuan soon came into con¬ flict with the Nationalists in the Na¬ tional Assembly. A "Second Revolu¬ tion", launched in 1913 to unseat Yuan and to "protect the Constitution", was unsuccessful and ex-president Sun had to flee once again. He went into exile in Japan but, with the death of Yuan in 1916, Sun returned to action. In the power vacuum left behind by Yuan, the country was in chaos, with the various provincial warlords vying for control of Peking. Meanwhile the Bolshevik revolution of 1917 had changed the face of Russia. Sun was much impressed. He saw in Soviet Russia a model for China, where a revolution had failed. He reorganized his Nationalist Party, re¬ ceived Soviet political and military advisers, and opened party membership to the then nascent Chinese Communists. He built up a power base in Canton and planned a northern expedition to conquer the warlords and reunify the country. In 1925 he travelled north to negotiate with the Peking government, but on his way he became ill. He was taken to the hospital of the Peking Union Medical College, then the most advanced medical institution in the country, with an international
staff and financial support from the Rockefeller Foundation. Sun was swol¬ len with ascites. A laparotomy revealed widespread peritoneal metastases from a primary hepatoma. Terminally ill, he was taken home, where he soon died. Under the stipulation that no organs be removed, the family reluctantly con¬ sented to a partial autopsy, which was performed by the American pathologist James R. Cash, under the watchful eyes of armed Chinese guards.9 Sun's political legacy Sun Yat-sen died in 1925, disillusioned. His revolution had resulted only in the substitution of a decadent monarchy with a nominal republic where despotic regional warlords ruled supreme. Little did Sun know that after his death the long-suffering Chinese people would still have to endure an¬ other 25 years of devastating civil war and foreign invasion. Sun's political writings were embodied in his "San Min Chu I", or the Three People's Principles of nationalism, democracy and socialism. How¬ ever, Sun was primarily a political leader rather than a philosopher; he had "different ideas at different times, even conflicting ideas at the same time.... He picked up many ideas somewhat indiscriminately and wound up as a syncretic thinker rather than a systematic one."10 The last few years of his life were the most controversial because of his flirtation with Communism. After his death his doctrines were interpreted by both the Chinese Communists and Nationalists, each to serve their own purpose.11 Revolution
.
the
"Medicine is
a
greater medicine? social science, and
politics nothing but medicine on a grand scale." This famous adage of Rudolph Virchow aptly sums up Sun's illustrious career. Sun abandoned a medicine that treats only individuals for a medicine that salvages nations. Throughout history there have been physicians who have risen above the inertia and apathy of the profession to strive for radical, revolutionary solu¬ tions to societal ills. Sun Yat-sen was but one in a lineage that includes JeanPaul Marat (France),12 Frantz Fanon (Algeria)13 and Ernesto (Che) Guevara (Cuba).14 It may be argued that there is an inherent contradiction between the humanity of medicine, which aims to save lives, and the cruelty of revolu¬ tion, which necessitates the sacrifice of many innocent people. However, in a society beset by widespread poverty, ignorance and exploitation, the wonders of curative medicine
are
rendered
CMA JOURNAL/MARCH 8, 1975/VOL. 112 615
impotent in the face of overwhelming disease; even the effectiveness of public health measures is severely curtailed. The exemplary progress in health care in China today, 50 years after the death of Sun Yat-sen, did not come about without fundamental changes in the country's social and political fabric. When Dr. Sun closed his shops in 1894, China lost one mediocre physician but gained instead a practitioner of another, perhaps greater, medicine.
References 1. LINEBARGER P: Sun Yat-sen and the Chinese Republic. New York, AMS Pr, 1969, p 115 2. CADBURY WW, JONES MH: At the Point of
a Lancet: One Hundred Years of the Canton Hospital. Shanghai, Kelly, 1935 3. HAGER CR: Doctor Sun Yat-sen, some personal reminiscence. Missionary Herald (J3oston), April 1912 4. STOCK FE: Medical education and practice in Hong Kong. Lancet 2: 714, 1962 5. SCHIFFRIN H: Sun Yat-sen and the Origins of the Chinese Revolution. Berkeley, U of Cal Pr, 1970, p 31 6. CANTLIE J, JONES CS: Sun Yat-sen and the A wakening of China. London, Manson-Bahr & Alcock, 1912, p 31 7. SHARMAN L: Sun Yat-sen, His Life and its Meaning. New York, Day, 1934, p 32
P.RturauMe . ANTIBIOTICS IN CHILDREN. Main Lecture Theatre, Women's College Hospital, Toronto. March 26, 1975. Information: Ontario Medical Foundation, 242 St. George St., Toronto, Ont. M5R 2P4 SECOND ANNUAL DAY IN CLINICAL NEURO. SCIENCES. McMaster University Medical Centre, Hamilton. April 2, 1975. For family physicians and internists. Information: Dr. Andrew Talalia, Dept. of Surgery, McMaster University Medical Centre, 1200 Main St. W., Hamilton, Ont. LBS 4J9 UPDATE PEDIATRICS. Third annual postgraduate symposium. Seminars on current pediatric prob. ems. Misericordia Hospital, Edmonton. Apr. 2-4, 1975. Information: Dr. C.T. Fried, Misericordia Hospital, 16940.87 Ave., Edmonton, Alta. ESTHETIC PLASTIC SURGERY. The Weilesley Hospital, Toronto. April 4-5, 1975. Information: The Director, Division of Postgraduate Medical Education, University of Toronto, Toronto, Ont. M55 lAB CLINICAL PHARMACOLOGY OF ANTIMICROBIAL AGENTS. Toronto Western Hospital. April 5, 1975. Information: The Director, Division of Postgraduate Medical Education, University of Toronto, Toronto, Ont. M55 lAB GYNECOLOGIC ENDOSCOPY. Christmas Seal Auditorium, 10th Ave. and Willow St., Vancouver. Apr. 7-8, 1975. Information: Division of continuing education in the health sciences, P.A. Woodward Instructional Resources Centre. University of British Columbia, Vancouver, BC V6T iWS MEDICAL RECORD KEEPING. Victoria Hospital, London. April 9, 1975. Information: Assistant Dean. Continuing Education, Faculty of Medicine, University of Western Ontario, London, Ont. N6A 3K7 DERMATOLOGY CLINICAL DAY. Royal Victoria Hospital, Montreal. Apr. 9, 1975. Information: Secretary, Postgraduate board, RVH, 687 Pine Ave. W, Montreal, Que. H3A lAl PEDIATRIC OPHTHALMOLOGY. The Hospital for Sick Children, Toronto. April 10.11, 1975. Information: Dr. Clement McCu loch, Dept. of Ophthal. rnology, University of Toronto, 1 Spadina Cres. Toronto, Ont. M55 2J5 REFRESHER COURSE FOR PRACTISING OPHTHAL. MOLOGISTS. University of Toronto. April 10.11, 1975. Information: The Director, Division of Post. graduate Medical Education, University of Toronto, .oronto, Ont. M55 lAB
S
TRAUMA TO THE UPPER LIMB. Four Seasons Sheraton Hotel, Toronto. April 10-12, 1975. Information: The Director, Division of Postgraduate Medical Education, University of Toronto, Toronto, Ont. M5S lAB FETAL MONITORING WORKSHOP. McMaster University Medical Centre, Hamilton. April 11-12, 1975. Information: Dr. S. B. Effer, Associate Professor, Dept. of Obstetrics & Gynecology, McMaster University Medical Centre, 1200 Main St. W.. Hamilton, Ont. LBS 419 EIGHTH ANNUAL SPRING SEMINAR. Ontario chapter of the College of Family Physicians of Canada in cooperation with the Ontario Medical Association section on general practice. Inn on the Park, Toronto. Apr. 12, 1975. Topics: methods of remuneration; problem-oriented records; efficient use of ancillary personnel. Information: Dr. M.H. Humphrys, Chairman, Professional and public policy committee, CFPC, Ontario chapter. 30 Church St. N, St. Marys, Ont. NOM 2V0 ANESTHESIA FOR FAMILY PHYSICIANS. University of Toronto. April 14-18, 1975. InformatIon: The Director. Division of Postgraduate Medical Education. University of Toronto, Toronto, Ont. M55 lAB ACUTE AND CHRONIC POISONING. Downtowner Hotel. Owen Sound, Ont. Apr. 16. 1975. Sponsors: lntari& Medical Foundation and College of Family Physicians of Canada. Ontario chapter. Information: Dr. JI. Leeson. Box 88, Wiarton. Ont. NOH 2T0 GYNECOLOGIC ENDOCRINOLOGY. Montreal General Hospital. Apr. 17-18, 1975. Information: Secretary, Postgraduate board, MGH, 1650 Cadar Ave.. Montreal, Oue. H3G 1A4 JOURNEES CHIRURGICALES DE L'H.TEL-DIEU. H8tel-Dieu de Montreal. Les 18-19 avril 1975. Renseignements: Directeur du Service d.ducation m.dicale continue, Universit6 de Montreal, C.P. 6207, Succursale A, Montreal, Ou.. H3C 3T7 CLINICAL, THERAPEUTIC AND INTERPRETATIVE ASPECTS OF HEMOPHILIA AND HEMOSTASIS. Medical Sciences Bldg., Rm 1747, UWO campus. London. April 18, 1975. Information: Assistant Dean, Continuing Education, Faculty of Medicine, University of Western Ontario, London, Ont. N6A 3K7 MALADIES INFECTIEUSES ET ANTIBIOTIQUES. H6pital Saint-Luc, Montreal. Le 19 avril 1975. Renseignements: Directeur du Service deducation m.dicale continue, Universit. de Montreal, C.P. 6207, Succursale A, Montreal, 0u6. H3C 3T7
8. WONG KG, Wu LT: History of Chinese Medicine, second ed. Shanghai, National Quarantine Service, 1936, pp 441, 479 9. Bowaas JZ: Western Medicine in a Chinese Palace: Peking Union Medical College, 19171951. New York, Macy Foundation, 1972, p 113 10. TaNG SY, FAIRBANK JK: China's Response to the West: A Documentary Survey, 1839-1923. New York, Atheneum, 1965, p 258 11. LaNG SC, PALMaR ND: Sun Yat-sen and Communism. New York, Praeger, 1960 12. BAYSON HP: The medical career of JeanPaul Marat. Proc R Soc Med 39: 39, 1945 13. ADAMS P: The social psychiatry of Frantz Fanon. Am J Psychiatry 127: 809, 1970 14. HARPER GP: Ernesto (Che) Guevara, physician - revolutionary physician - revolutionary. N Engi J Med 281: 1285, 1969 REFRESHER COURSE. Spring session. Royal Victoria Hospital and Montreal Children's Hospital. Apr. 21-25, 1975. Information: Secretary, Postgraduate board, RVH, 687 Pine Ave. W Montreal, Que. H3A lAl CURRENT TRENDS IN THE TREATMENT OF INFECTIOUS DISEASE. St. Joseph's Hospital, London, Ont. April 23, 1975. Information: Assistant Dean, Continuing Education, Faculty of Medicine, The University of Western Ontario, London, Ont. N6A 3K7 COLPOSCOPY AND EARLY CERVICAL NEOPLASIA. Ewart Angus Theatre, McMaster University Medical Centre, Hamilton. Apr. 24-26, 1975. Information: Ms. Lorraine Putnins, Conference Coordinator, Conference Office, Rm. 3H8, McMaster University Health Sciences Centre, 1200 Main St. W, Hamilton, Ont. LBS 4J9 OFFICE TREATMENT IN FAMILY PRACTICE, 1975. 20th annual clinical day. Toronto East General and Orthopsedic Hospital. Apr. 25. 1975. Information: Dr. J.R. Topp, Suite 301, 20 Wynford Dr., Don Mills, Ont. ORIENTATION WORKSHOP. For practice-eligible candidates taking 1975 certification examination of the College of Family Physicians of Canada. McMaster University Medical Centre, Hamilton. Apr. 25-26, 1975. Information: Dr. iC. Reid, Associate professor, Department of family medicine, Mc. Master University Clinic, Henderson General Hospital, Concession St., Hamilton, Ont. L8V 1C3 DROGUES, ALCOOL ET AUTRES TOXICOMANIES. H6tel Bonaventure, Montreal. Le 26 avril 1975. Renseignements: Directeur du Service d'.ducation medicale continue, Universit. de Montreal. C.P. 6207, Succursale A, Montr6al, Ou.. H3C 3T7 CREATIVE SEXUALITY. Study seminar on sex counselling with Dra. Noam and Beryl Chernick. Westbury Hotel, Toronto. Apr. 30-May 2, 1975. Information: Creative Sexuality, Suite 400, 73 Richmond St. W, Toronto, Ont. M5H 2A1 OPHTHALMOLOGY SPRING CLINICAL DAY. University Hospital, London, Ont. May 2, 1975. Information: Assistant Dean, Continuing Education, Faculty of Medicine, The University of Western Ontario, London, Ont. N6A 3K7 CHEST DISEASES. Clinical pital, London, Ont. May Assistant Dean, Continuing Medicine. The University London, Ont. NBA 3K7
day. University Hos7, 1975. Information: Education, Faculty of of Western Ontario,
CARDIOLOGIE EN PRATIQUE G.NERALE. Institut de Cardiologie de Montreal. Lea 8-10 mai 1975 Renseignements: Directeur du Service d'.ducation medicale continue, Universit. de Montreal, C.P. 6207, Succursale A, Montreal, Ou.. H3C 3T7
SUPPLEMENT D'EMP
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CONTINUING EDUCATION PROGRAMS FOR PHYSICIANS IN CANADA
L'Association M6dicale Canadienne publiera son premier suppl6ment semestriel au Journal, une liste des cours d'6ducation m6dicale permanente offerts aux m6decins au Canada. Ce directoire sera publi6 . Ia fin de mai et couvrira a p6riode s'6tendant du ler juin au 31 d6cembre 1975. Tous abonn6s au Journal de l'AMC recevront le suppl6ment gratis. Les nonabonn6s pourront obtenir des exemplaires de: . ELI LILLY & CO. (CANADA) LTD. 3650 Danforth Ave. Scarborough, Ont. Box 4037, Terminal A Toronto 116, Ont.
The Canadian Medical Association will be publishing its first semiannual supplement to the Journal listing the continuing medical education courses available to physicians in Canada. This directory will be published at the end of May and will cover the period from June 1 to December 31, 1975. All subscribers to CMAJ will receive the supplement free of charge. Nonsubscribers may obtain copies of this issue from: . ELI LILLY & CO. (CANADA) LTD. 3650 Danforth Ave. Scarborough, Ont. Box 4037, Terminal A Toronto 116. Orit.
616 CMA JOURNAL/MARCH 8, 1975/VOL. 112
to
revolution
md
Mar. 12, 1975 marks the 50th anniversary of the death of Sun Yat-sen, founder of the Chinese Republic and a physician turned revolutionary. The son of a poor farmer in southern China, Sun is today revered by Chinese of all political shades as the one who overthrew the Manchu dynasty in 1911 and started China on her way to becoming a modern nation.
Early influences Sun was born Nov. 12, 1866. He travelled to Honolulu at the age of 13 to live with his brother, a prosperous shopkeeper.1 It was in Hawaii, then still an independent kingdom, that Sun first came into contact with Western culture. An Anglican school exposed him to ideas of Christianity and West¬ ern democracy, but his enthusiasm for these ideas displeased his traditionalist brother, who decided to send him home when he reached the age of 16. On his return to China Sun quickly came into conflict with his family. In a scandalous incident well known to most Chi¬ nese schoolboys, Sun broke the arm of a wooden statue of Buddha in the local temple, in a desire to prove to the superstitious worshippers that their idol was unable to protect itself from a mere mortal, let alone answer their prayers. Ostracized in his village, Sun con¬ tinued his secondary education in Hong Kong, a British colony. It was then the end of the Sino-French War (18831885), in which China once again was defeated by the Europeans. The young student vowed then to overthrow the weak and corrupt Manchu dynasty. It was also in Hong Kong that Sun was formally converted to Christianity.
Medical student days In 1886 Sun returned to China, where he enrolled at the missionary hospital medical school in Canton. Es¬ tablished in 1866 by Dr. John G. Kerr, a native of Ohio and a Presbyterian missionary, this school was the first modern school in China to offer formal instruction in "Western medicine". Kerr had succeeded Dr. Peter Parker, the first American medical missionary to China, who in 1835 had opened the first hospital in Canton.2 Why did Sun study medicine? Charles Hager, the missionary who baptized Sun in Hong Kong, later recalled the circumstances surrounding Sun's decision:
was as yet no modern university in China, and the missionary institutions
were then the sole doors to European knowledge, especially the natural sciences. Sun studied in Canton only for a year, for in 1887 he returned to Hong Kong to enrol in the new College of Medicine for Chinese. This school, which was better equipped than the medical school in Canton and provided instruction in English, was the predecessor of the medical faculty of the University of Hong Kong.4 As a stu¬ dent, Sun was of the highest calibre, and he won the unanimous admiration of his teachers, especially the Englishmen Drs. James Cantlie and Patrick Manson, who became his lifelong Not forgetting his roots, Sun Perhaps if there had been a satisfactory friends. with his classical Chinese by up kept in at that time Hong theological seminary a tutor from Canton. hiring private to one and some in or Canton, sup¬ Kong It was probably more legend than port him, Sun Yat-sen might have become the most famous preacher of his time, by fact that Sun experimented with bombs the magnetic power of personal contact in the college's chemistry laboratory, with men in winning them to Christ. After but as a student his intense interest in several months of inactivity he decided to politics persisted. As a result he became take up the study of medicine, which has associated with known Chinese radicals always been held in high esteem and next who sought sanctuary in the British to the ministry by the Chinese. At his personal request I gave him a letter to colony. In 1892 the College granted its first the venerable Dr. J. G. Kerr, asking him if he would not remit a part of the medi¬ diplomas. Out of an original class of cal fees, which were at that time about 12, Sun and another student were the twenty dollars a year.3 only two to graduate.
Years later Sun wrote that he had intended to "use the school to advance his ideas, and the profession to reach the masses." And no doubt Sun did become acutely aware of the sorry state of China. Subdued militarily and humiliated diplomatically time and again by the imperialist powers, the Chinese government under the Manchus was rotten and hopelessly backwards in terms of technology and science. Many politically conscious Reprint requests to: Dr. T. Kue-Hing Young, people saw in Western learning the Community Health Center, 3765 Sherwood Dr. only remedy to China's sickness. There Regina, Sask. S4R 4A9 614 CMA JOURNAL/MARCH 8, 1975/VOL. 112
Medical career Sun's graduation posed a problem. What would he do next? Such a ques¬ tion hardly presents itself to medical graduates today, but in Sun's time there was no market for his services as a Western-trained physician. Western medicine was not trusted by the Chi¬ nese people, who used it as a last resort and only if provided free of charge. Outside the mission hospitals there were hardly any practitioners. Further¬ more, Sun's diploma was not even rec-
ognized by the Hong Kong govern¬ legal status was virtually the same as that of any self-proclaimed traditional herbal physician.5 Encouraged by his teachers, Sun moved to adjacent Macao, a Portuguese enclave, where he opened an apothecary's shop. He dispensed both Chinese herbs and Western drugs. In exchange for free drugs and free treat¬ ment of patients, Sun was allowed to practise surgery in a local Chinese hos¬ pital. Of this period, Sun's teacher ment. His
Cantlie wrote:
Sun commenced practice, and I encour¬ aged him especially in surgical work. When major operations had to be done, I went on several occasion to Macao to assist him, and there in the presence of the governors of the hospital, he per¬ formed important operations requiring skill, coolness of judgement, and dexter¬
ity.6 However, Sun
was soon
barred from
practising European medicine because of the lack of Portuguese qualifications.
In 1893 he returned to Canton and started another combined ChineseWestern practice. At the height of his career he organized, with his friends, three branch shops in the city and nearby rural areas. Early in 1894 Sun planned a trip north. He had prepared a petition outlining his reform ideas for submission to Viceroy Li Hung-chang, but Sun also wanted to apply for a position at the military medical school in Tientsin.7 This school, known as Peiyang (North Ocean), had been opened in 1881 by the missionary Dr. John Ken¬ neth MacKenzie, and was under the patronage of the viceroy.8 Sun's re¬ quest for an interview,' however, was rebuffed. He then left China for Hawaii. The conclusion of the Sinothe most Japanese War that year humiliating to date because Japan was once China's vassal helped Sun make up his mind. From then on he was determined that the road to China's salvation lay in revolution from below, and not in gentlemanly reform from above.
Yagabond revolutionary After 1894 Sun abandoned medicine. He directed his energies to organizing the antidynastic movement. He trav¬ elled around the world to solicit sup¬ port from overseas Chinese communi¬ ties and planned occasional abortive attempts at insurrection in various pro¬ vincial cities in southern China. Hunted by Chinese agents wherever he went, the fugitive was finally kidnapped in London in 1896 and detained in the Chinese Legation, waiting to be smuggled back to China to face torture and
execution, but he managed
to bribe the
legation's English servant to pass a distress note to Cantlie and Manson, who were then living in London. His two former mentors appealed vigorously to the Foreign Office and pressed for the captive's release. Sun instantly became an international celebrity. After his release Sun remained in London for a few months and, in the fashion of Karl Marx, avidly studied in the library of the British Museum. On Oct. 10, 1911, after nine previous un¬ successful attempts, Sun's revolutionary forces finally raised arms in Wuhan, in central China. A chain reaction spread across the nation, and province after province declared its independence from the Peking court. Sun, then in the United States, ended his exile and, like Lenin, hurried home to re¬ ceive his honours. On New Year's Day 1912 Sun was inaugurated as provision¬ al president of the Republic of China at Nanking. However, the North was still largely under the Manchus, and the real power behind the throne lay in the military strongman Yuan Shih-kai. In an attempt to achieve unity Sun compromised. He magnanimously resigned the presidency in favour of Yuan, who in return forced the Man¬ chu emperor to abdicate and decree the cessation of hostilities. Frustrated China's
hopes experiment with parliamen¬ tary democracy was shortlived. The
ambitious Yuan soon came into con¬ flict with the Nationalists in the Na¬ tional Assembly. A "Second Revolu¬ tion", launched in 1913 to unseat Yuan and to "protect the Constitution", was unsuccessful and ex-president Sun had to flee once again. He went into exile in Japan but, with the death of Yuan in 1916, Sun returned to action. In the power vacuum left behind by Yuan, the country was in chaos, with the various provincial warlords vying for control of Peking. Meanwhile the Bolshevik revolution of 1917 had changed the face of Russia. Sun was much impressed. He saw in Soviet Russia a model for China, where a revolution had failed. He reorganized his Nationalist Party, re¬ ceived Soviet political and military advisers, and opened party membership to the then nascent Chinese Communists. He built up a power base in Canton and planned a northern expedition to conquer the warlords and reunify the country. In 1925 he travelled north to negotiate with the Peking government, but on his way he became ill. He was taken to the hospital of the Peking Union Medical College, then the most advanced medical institution in the country, with an international
staff and financial support from the Rockefeller Foundation. Sun was swol¬ len with ascites. A laparotomy revealed widespread peritoneal metastases from a primary hepatoma. Terminally ill, he was taken home, where he soon died. Under the stipulation that no organs be removed, the family reluctantly con¬ sented to a partial autopsy, which was performed by the American pathologist James R. Cash, under the watchful eyes of armed Chinese guards.9 Sun's political legacy Sun Yat-sen died in 1925, disillusioned. His revolution had resulted only in the substitution of a decadent monarchy with a nominal republic where despotic regional warlords ruled supreme. Little did Sun know that after his death the long-suffering Chinese people would still have to endure an¬ other 25 years of devastating civil war and foreign invasion. Sun's political writings were embodied in his "San Min Chu I", or the Three People's Principles of nationalism, democracy and socialism. How¬ ever, Sun was primarily a political leader rather than a philosopher; he had "different ideas at different times, even conflicting ideas at the same time.... He picked up many ideas somewhat indiscriminately and wound up as a syncretic thinker rather than a systematic one."10 The last few years of his life were the most controversial because of his flirtation with Communism. After his death his doctrines were interpreted by both the Chinese Communists and Nationalists, each to serve their own purpose.11 Revolution
.
the
"Medicine is
a
greater medicine? social science, and
politics nothing but medicine on a grand scale." This famous adage of Rudolph Virchow aptly sums up Sun's illustrious career. Sun abandoned a medicine that treats only individuals for a medicine that salvages nations. Throughout history there have been physicians who have risen above the inertia and apathy of the profession to strive for radical, revolutionary solu¬ tions to societal ills. Sun Yat-sen was but one in a lineage that includes JeanPaul Marat (France),12 Frantz Fanon (Algeria)13 and Ernesto (Che) Guevara (Cuba).14 It may be argued that there is an inherent contradiction between the humanity of medicine, which aims to save lives, and the cruelty of revolu¬ tion, which necessitates the sacrifice of many innocent people. However, in a society beset by widespread poverty, ignorance and exploitation, the wonders of curative medicine
are
rendered
CMA JOURNAL/MARCH 8, 1975/VOL. 112 615
impotent in the face of overwhelming disease; even the effectiveness of public health measures is severely curtailed. The exemplary progress in health care in China today, 50 years after the death of Sun Yat-sen, did not come about without fundamental changes in the country's social and political fabric. When Dr. Sun closed his shops in 1894, China lost one mediocre physician but gained instead a practitioner of another, perhaps greater, medicine.
References 1. LINEBARGER P: Sun Yat-sen and the Chinese Republic. New York, AMS Pr, 1969, p 115 2. CADBURY WW, JONES MH: At the Point of
a Lancet: One Hundred Years of the Canton Hospital. Shanghai, Kelly, 1935 3. HAGER CR: Doctor Sun Yat-sen, some personal reminiscence. Missionary Herald (J3oston), April 1912 4. STOCK FE: Medical education and practice in Hong Kong. Lancet 2: 714, 1962 5. SCHIFFRIN H: Sun Yat-sen and the Origins of the Chinese Revolution. Berkeley, U of Cal Pr, 1970, p 31 6. CANTLIE J, JONES CS: Sun Yat-sen and the A wakening of China. London, Manson-Bahr & Alcock, 1912, p 31 7. SHARMAN L: Sun Yat-sen, His Life and its Meaning. New York, Day, 1934, p 32
P.RturauMe . ANTIBIOTICS IN CHILDREN. Main Lecture Theatre, Women's College Hospital, Toronto. March 26, 1975. Information: Ontario Medical Foundation, 242 St. George St., Toronto, Ont. M5R 2P4 SECOND ANNUAL DAY IN CLINICAL NEURO. SCIENCES. McMaster University Medical Centre, Hamilton. April 2, 1975. For family physicians and internists. Information: Dr. Andrew Talalia, Dept. of Surgery, McMaster University Medical Centre, 1200 Main St. W., Hamilton, Ont. LBS 4J9 UPDATE PEDIATRICS. Third annual postgraduate symposium. Seminars on current pediatric prob. ems. Misericordia Hospital, Edmonton. Apr. 2-4, 1975. Information: Dr. C.T. Fried, Misericordia Hospital, 16940.87 Ave., Edmonton, Alta. ESTHETIC PLASTIC SURGERY. The Weilesley Hospital, Toronto. April 4-5, 1975. Information: The Director, Division of Postgraduate Medical Education, University of Toronto, Toronto, Ont. M55 lAB CLINICAL PHARMACOLOGY OF ANTIMICROBIAL AGENTS. Toronto Western Hospital. April 5, 1975. Information: The Director, Division of Postgraduate Medical Education, University of Toronto, Toronto, Ont. M55 lAB GYNECOLOGIC ENDOSCOPY. Christmas Seal Auditorium, 10th Ave. and Willow St., Vancouver. Apr. 7-8, 1975. Information: Division of continuing education in the health sciences, P.A. Woodward Instructional Resources Centre. University of British Columbia, Vancouver, BC V6T iWS MEDICAL RECORD KEEPING. Victoria Hospital, London. April 9, 1975. Information: Assistant Dean. Continuing Education, Faculty of Medicine, University of Western Ontario, London, Ont. N6A 3K7 DERMATOLOGY CLINICAL DAY. Royal Victoria Hospital, Montreal. Apr. 9, 1975. Information: Secretary, Postgraduate board, RVH, 687 Pine Ave. W, Montreal, Que. H3A lAl PEDIATRIC OPHTHALMOLOGY. The Hospital for Sick Children, Toronto. April 10.11, 1975. Information: Dr. Clement McCu loch, Dept. of Ophthal. rnology, University of Toronto, 1 Spadina Cres. Toronto, Ont. M55 2J5 REFRESHER COURSE FOR PRACTISING OPHTHAL. MOLOGISTS. University of Toronto. April 10.11, 1975. Information: The Director, Division of Post. graduate Medical Education, University of Toronto, .oronto, Ont. M55 lAB
S
TRAUMA TO THE UPPER LIMB. Four Seasons Sheraton Hotel, Toronto. April 10-12, 1975. Information: The Director, Division of Postgraduate Medical Education, University of Toronto, Toronto, Ont. M5S lAB FETAL MONITORING WORKSHOP. McMaster University Medical Centre, Hamilton. April 11-12, 1975. Information: Dr. S. B. Effer, Associate Professor, Dept. of Obstetrics & Gynecology, McMaster University Medical Centre, 1200 Main St. W.. Hamilton, Ont. LBS 419 EIGHTH ANNUAL SPRING SEMINAR. Ontario chapter of the College of Family Physicians of Canada in cooperation with the Ontario Medical Association section on general practice. Inn on the Park, Toronto. Apr. 12, 1975. Topics: methods of remuneration; problem-oriented records; efficient use of ancillary personnel. Information: Dr. M.H. Humphrys, Chairman, Professional and public policy committee, CFPC, Ontario chapter. 30 Church St. N, St. Marys, Ont. NOM 2V0 ANESTHESIA FOR FAMILY PHYSICIANS. University of Toronto. April 14-18, 1975. InformatIon: The Director. Division of Postgraduate Medical Education. University of Toronto, Toronto, Ont. M55 lAB ACUTE AND CHRONIC POISONING. Downtowner Hotel. Owen Sound, Ont. Apr. 16. 1975. Sponsors: lntari& Medical Foundation and College of Family Physicians of Canada. Ontario chapter. Information: Dr. JI. Leeson. Box 88, Wiarton. Ont. NOH 2T0 GYNECOLOGIC ENDOCRINOLOGY. Montreal General Hospital. Apr. 17-18, 1975. Information: Secretary, Postgraduate board, MGH, 1650 Cadar Ave.. Montreal, Oue. H3G 1A4 JOURNEES CHIRURGICALES DE L'H.TEL-DIEU. H8tel-Dieu de Montreal. Les 18-19 avril 1975. Renseignements: Directeur du Service d.ducation m.dicale continue, Universit6 de Montreal, C.P. 6207, Succursale A, Montreal, Ou.. H3C 3T7 CLINICAL, THERAPEUTIC AND INTERPRETATIVE ASPECTS OF HEMOPHILIA AND HEMOSTASIS. Medical Sciences Bldg., Rm 1747, UWO campus. London. April 18, 1975. Information: Assistant Dean, Continuing Education, Faculty of Medicine, University of Western Ontario, London, Ont. N6A 3K7 MALADIES INFECTIEUSES ET ANTIBIOTIQUES. H6pital Saint-Luc, Montreal. Le 19 avril 1975. Renseignements: Directeur du Service deducation m.dicale continue, Universit. de Montreal, C.P. 6207, Succursale A, Montreal, 0u6. H3C 3T7
8. WONG KG, Wu LT: History of Chinese Medicine, second ed. Shanghai, National Quarantine Service, 1936, pp 441, 479 9. Bowaas JZ: Western Medicine in a Chinese Palace: Peking Union Medical College, 19171951. New York, Macy Foundation, 1972, p 113 10. TaNG SY, FAIRBANK JK: China's Response to the West: A Documentary Survey, 1839-1923. New York, Atheneum, 1965, p 258 11. LaNG SC, PALMaR ND: Sun Yat-sen and Communism. New York, Praeger, 1960 12. BAYSON HP: The medical career of JeanPaul Marat. Proc R Soc Med 39: 39, 1945 13. ADAMS P: The social psychiatry of Frantz Fanon. Am J Psychiatry 127: 809, 1970 14. HARPER GP: Ernesto (Che) Guevara, physician - revolutionary physician - revolutionary. N Engi J Med 281: 1285, 1969 REFRESHER COURSE. Spring session. Royal Victoria Hospital and Montreal Children's Hospital. Apr. 21-25, 1975. Information: Secretary, Postgraduate board, RVH, 687 Pine Ave. W Montreal, Que. H3A lAl CURRENT TRENDS IN THE TREATMENT OF INFECTIOUS DISEASE. St. Joseph's Hospital, London, Ont. April 23, 1975. Information: Assistant Dean, Continuing Education, Faculty of Medicine, The University of Western Ontario, London, Ont. N6A 3K7 COLPOSCOPY AND EARLY CERVICAL NEOPLASIA. Ewart Angus Theatre, McMaster University Medical Centre, Hamilton. Apr. 24-26, 1975. Information: Ms. Lorraine Putnins, Conference Coordinator, Conference Office, Rm. 3H8, McMaster University Health Sciences Centre, 1200 Main St. W, Hamilton, Ont. LBS 4J9 OFFICE TREATMENT IN FAMILY PRACTICE, 1975. 20th annual clinical day. Toronto East General and Orthopsedic Hospital. Apr. 25. 1975. Information: Dr. J.R. Topp, Suite 301, 20 Wynford Dr., Don Mills, Ont. ORIENTATION WORKSHOP. For practice-eligible candidates taking 1975 certification examination of the College of Family Physicians of Canada. McMaster University Medical Centre, Hamilton. Apr. 25-26, 1975. Information: Dr. iC. Reid, Associate professor, Department of family medicine, Mc. Master University Clinic, Henderson General Hospital, Concession St., Hamilton, Ont. L8V 1C3 DROGUES, ALCOOL ET AUTRES TOXICOMANIES. H6tel Bonaventure, Montreal. Le 26 avril 1975. Renseignements: Directeur du Service d'.ducation medicale continue, Universit. de Montreal. C.P. 6207, Succursale A, Montr6al, Ou.. H3C 3T7 CREATIVE SEXUALITY. Study seminar on sex counselling with Dra. Noam and Beryl Chernick. Westbury Hotel, Toronto. Apr. 30-May 2, 1975. Information: Creative Sexuality, Suite 400, 73 Richmond St. W, Toronto, Ont. M5H 2A1 OPHTHALMOLOGY SPRING CLINICAL DAY. University Hospital, London, Ont. May 2, 1975. Information: Assistant Dean, Continuing Education, Faculty of Medicine, The University of Western Ontario, London, Ont. N6A 3K7 CHEST DISEASES. Clinical pital, London, Ont. May Assistant Dean, Continuing Medicine. The University London, Ont. NBA 3K7
day. University Hos7, 1975. Information: Education, Faculty of of Western Ontario,
CARDIOLOGIE EN PRATIQUE G.NERALE. Institut de Cardiologie de Montreal. Lea 8-10 mai 1975 Renseignements: Directeur du Service d'.ducation medicale continue, Universit. de Montreal, C.P. 6207, Succursale A, Montreal, Ou.. H3C 3T7
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CONTINUING EDUCATION PROGRAMS FOR PHYSICIANS IN CANADA
L'Association M6dicale Canadienne publiera son premier suppl6ment semestriel au Journal, une liste des cours d'6ducation m6dicale permanente offerts aux m6decins au Canada. Ce directoire sera publi6 . Ia fin de mai et couvrira a p6riode s'6tendant du ler juin au 31 d6cembre 1975. Tous abonn6s au Journal de l'AMC recevront le suppl6ment gratis. Les nonabonn6s pourront obtenir des exemplaires de: . ELI LILLY & CO. (CANADA) LTD. 3650 Danforth Ave. Scarborough, Ont. Box 4037, Terminal A Toronto 116, Ont.
The Canadian Medical Association will be publishing its first semiannual supplement to the Journal listing the continuing medical education courses available to physicians in Canada. This directory will be published at the end of May and will cover the period from June 1 to December 31, 1975. All subscribers to CMAJ will receive the supplement free of charge. Nonsubscribers may obtain copies of this issue from: . ELI LILLY & CO. (CANADA) LTD. 3650 Danforth Ave. Scarborough, Ont. Box 4037, Terminal A Toronto 116. Orit.
616 CMA JOURNAL/MARCH 8, 1975/VOL. 112
