D864:d; 
 1877 
 
 UC SOUTHERN REGIONAL LIBRARY FACILITY 
 
 G 000 005 392 6 
 
 O 
 
 la - 
 
 
 O ,/ 

 
 THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 
 OF CALIFORNIA 
 
 LOS ANGELES
 
 
 DISEASES of CHINA; 
 
 CAUSES', CONDITIONS, AND PREVALENCE CONTRASTED 
 WITH THOSE OF EUROPE. 
 
 JOHN DUDGEON, M.D. 
 
 P E K I N. 
 
 G L A S G O ^V : 
 rrp^ DUNN & WRIGHT 176 BUCHANAN STREET, 3^ 
 
 And 102 STIRLING ROAD. /f (^ 
 
 1877. 
 
 J^-U 

 
 THE 
 
 
 DISEASES OF CHINA5 
 
 THEIR 
 
 CAUSES, CONDITIONS, AND PREVALENCE, CONTRASTED 
 WITH THOSE OF EUROPE. 
 
 Br 
 JOHN DUDGEON, M.D., 
 
 PEKIN, 
 
 GLASGOW: 
 
 DUNN & WRIGHT, 17G BUCHANAN STREET, 
 
 AND 102 STIRLING KOAD. 
 
 1877.
 
 Ukuy 
 
 110 . 
 
 Read nEFORE the MEDICO-CHIEUEGHCAL SOCIETY OF GLASGOW, Febrcarv Snp, 
 1877, AND Reprinted from '-THE GLASGOW MEDICAL JOURNAL' of April 
 AND July, 1S77.
 
 THE DISEASES OF CHINA 
 
 THEIR CAUSES, CONDITIONS, AND PREVALENCE, CONTRASTED 
 WITH THOSE OF EUROPE. 
 
 BY JOHN DUDGEON, M.D. PEKIN. 
 
 The subject of the present paper is a large and important one, 
 and the time at my disposal will only admit of a very cursory 
 glance at so large a theme. My object is to point out some 
 of the more obvious of the differences in the diseases of the 
 east and the west, and if possible to indicate the causes that 
 are operating to produce these changes. On account of the 
 great antiquity of the Chinese nation, the vitality of the 
 Chinese, the great population, territory and range of climate, 
 the field in a medical point of view is specially interesting. 
 What, however, is predicated as true of China will hold true 
 to a greater or less extent of all Asia, and so in like manner, 
 we might safely argue from any one European country to all 
 the rest. The question of disease becomes, therefore, of 
 importance in relation to race, so similar and yet so different 
 are the Oriental and Occidental types of disease. The 
 Asiatic customs and social peculiarities, in my opinion, con- 
 duce to a higher vitality and a greater freedom from acute 
 and inflammatory affections. On that continent life is more 
 quiet and easy ; the Asiatic drinks less stimulating pota- 
 tions, eats simpler food, keeps better hours, marries earlier, 
 takes more care of himself ; his passions are more subdued, 
 and his whole life and its actions more under the control of 
 reason and religion. Race thus modifies disease, and vice
 
 versa. The climate and physical features of a countiy, and 
 the food and the diseases which depend thereupon and which 
 destroy or impair vitality, are the principal influences direct- 
 ing the development of the permanent characters of a race, 
 and the chief agents consequently by which race is propa- 
 gated and type constituted. Physiological peculiarities are 
 more acquired than primitively impressed. The acquired 
 and transmitted qualities, with the existing social customs, 
 are amply sufficient factors for tlie production of every variety 
 or degree of vitality which may distinguish any race. These 
 peculiarities affecting stature, health, and duration of life 
 are more dependent upon the combined influences of food 
 and customs, acting through many ages, than mere climate 
 alone. Simple hygienic precautions which we find efficacious 
 in one country are useful in others, and with proper atten- 
 tion to such rules the deadly effects of climate disappear. 
 The cultivation of temperance in all things, general sober- 
 ness of life, and all else that would prove useful to us in 
 Eiu'ope in enabling us to remain vigorous to resist malign 
 influences, is of equal value to us in the East. "We are in 
 the habit of speaking of a certain invariableness in the type 
 of disease — like causes producing like effects — that disease 
 retains this type in all forms of civilisation, in all climes and 
 all ages. Very few diseases have appeared, very few have 
 disappeared. Some have become graver in certain localities, 
 countries, and civilisations than others, but sporadic cases of 
 any disease assume the same type as the same disease in its 
 epidemic or endemic form. Although this is undoubtedly 
 true, it is nevertheless also true that many diseases which 
 were either rare or almost unknown have sprung into no- 
 toriety and have assumed severer forms, and have added 
 greatly to our mortality bills. Although this invariableness 
 of the type of disease still exists in certain nadons and indi- 
 viduals, we are accustomed to speak of the rise of such dis- 
 eases as small-pox, diphtheria, cholera, and syphilis ; of the 
 extension of certain diseases to regions where they were 
 before miknown, as, for example, rubeola into the South Sea 
 Islands ; and of the entire disappearance or great diminution
 
 of diseases once prevalent, as e.g., ague, leprosy, and small- 
 pox in our own country, by means of drainage, better cultiva- 
 tion of the soil, improved modes of living, discovery of vac- 
 cination, &c. And so we find disease bounded by both time 
 and space, developed in some parts of the earth, undeveloped 
 in others ; some developed in all parts, some confined ex- 
 clusively to certain regions and completely absent from 
 others, and all modified by the peculiarities already adverted 
 to. Notwithstanding, however, this amelioration in the 
 symptoms and total abolition of certain diseases, caused by 
 our improved civilisation, this same civilisation, as exhibited 
 in our present modes of life and surroundings — the true 
 causes and explanation of the so-called change of type of 
 which we so often hear — have produced a large train of 
 diseases that either did not exist, or existed only to a very 
 limited extent a century ago, such, e.g., as the various nervous, 
 cardiac, and, generally speaking, acute diseases. It cannot 
 be altogether true, as is sometimes asserted, that these dis- 
 eases may have existed, but were unknown owing to the 
 imperfect state of medical knowledge and our means of 
 diagnosis at that time. There would seem to be a law of 
 the increase and diminution or total disappearance of certain 
 affections in proportion to the state of civilisation. If this 
 be so, I fear our present review will not prove favourable to 
 our highly civilized and artificial life and its luxuries. The 
 great strides made by European nations, and ourselves in 
 particular, in trade and international intercourse with the 
 ends of the earth, by virtue of our discoveries and inventions, 
 whatever else may have been done in adding to the sum of 
 human happiness and comfort, have not tended, either among 
 ourselves or nations lower in the scale of civilisation, to 
 longevity or the diminution of disease, but rather the 
 reverse. The immediate efi'ect is naturally that of propa- 
 gating zymotic and other diseases, and that frequently, too, 
 of a more vu'ulent type than may previously have existed, 
 into countries to which the spirit of commerce, colonisation, 
 and civilisation may have led us. The ultimate efi'ect will 
 doubtless be to become better acquainted with the etiology
 
 of disease, and so by applying the means of cure or preven- 
 tion, to stamp out, modify, and limit many of our present 
 well-known diseases. To enable tlie reader to understand 
 and contrast the conditions of disease in China with those of 
 Europe, it will be necessary to describe as briefly as possible 
 the various matters recognised as influencing or causing 
 disease, such as the sanitary state of the country, the food, 
 drink, habits, and social customs of the people ; for it is here, 
 I think, where the chief difierences will be found to exist, and 
 so by contrast and inference to point out some of the causes 
 of prevalent diseases in the West, and the errors of modern 
 European life. It is in this department of the controllable 
 diseases that our profession ought to take, and I am happy 
 to say is taking, the initiative, as the prime ministers of the 
 health of the nation. It is ours to lay down the law to our 
 patients, the community, and the state ; to teach what our 
 medical science and experience have made plain to us, and 
 to show how the various phenomena of disease from these 
 social causes may be modified or altogether avoided. We 
 have, unfortunately, no powers to compel their acceptance 
 but we can appeal to reason, common sense, and self-interest, 
 and I believe we could do more in this direction than we are 
 at present doing. I dismiss the argument that such a course 
 would be opposed to our self-interest as not entitled to a 
 moment's consideration, and as quite opposed to the ideal 
 of our profession. 
 
 Climate. — From the gi-eat extent of Chma proper, or the 
 eighteen Provinces, stretching from about 20° to 42° of lati- 
 tude, and 97° to 122° of East longitude, and with a surface of 
 over 500,000 square miles (not to speak of the still greater 
 Chinese Empire, stretching through 11'^ of longitude, and 
 40*' of latitude), we have every degree of climate and tem- 
 perature, from the cold of Sweden to the heat of Italy. The 
 country resembles, in the North at least, the climate of the 
 American Atlantic States. In such a vast extent of territory 
 we may expect to find all the diseases to which we are accus- 
 tomed in Europe, and although my own experience is almost 
 solely derived from Pekiu and North China, still I shall make
 
 free use of the results and observations of others in Central 
 and Southern China, such as we find in these increasingly 
 valuable Customs' half-yearly medical reports, and those of 
 the various mission hospitals. The country is traversed 
 from East to West by two mighty rivers, both of which 
 occasion frequent and destructive inundations. The Chinese 
 have greatly improved the advantages furnished them by 
 their rivers for irrigation and navigation by digging canals. 
 The Himalaya mountains may be said to divide Asia into 
 North and South portions totally different from each other. 
 China and North-Eastern Asia generally resemble more the 
 northern part, and from its elevated position, bordering on 
 snowy mountains, and the regions of intense cold, China 
 has a pretty rigorous climate, especially in the northern 
 half. The monsoons of the tropics are felt but slightly, 
 except in the extreme South. On the whole the climate 
 may be said to be salubrious, invigorating, and favourable 
 to longevity, without the great rigour of more northern 
 regions and the enervating influences of the more southern. 
 The average temperature of the whole empire is lower than 
 that of any other country in the same latitude. More than the 
 half is mountainous, chiefly in the South and West — the great 
 plains are in the East and N.E. Cultivation is carried to a 
 great extent everywhere — there is no meadow or pasture 
 land. It is the most fertile of all the countries of Asia, 
 though it owes much of its productiveness to its inhabitants. 
 So much for a few general preliminary remarks on the 
 geography and climate of the country as a whole. Other 
 points of more interest medically will be referred to in the 
 course of the paper. 
 
 Sanitary Condition, Sewage, Drainage, and Typhoid Fever. — 
 China may be said, in a word, to be totally destitute of 
 sanitary science. Take the following as a specimen of the 
 condition of sanitation at Canton. Dr Wang is speaking of 
 typhoid fever, and he says he saw only two cases during a 
 period of more than 10 years. He has seen many cases of 
 remittent and intermittent fevers, but never one of typhoid. 
 It may therefore be safely affirmed that this disease is not
 
 at all prevalent, although we should expect a different state 
 of things, as the causes that are usually supposed to produce 
 typhoid fever are in full operation. In Canton large num- 
 bers of the natives are daily using water and inhaling air 
 charged with the impurities of human excreta, apparently 
 with utter impunity. River water is greatly used, and that 
 used by the boat population along the different jetties is 
 extremely filthy, and must be largely contaminated with 
 human and other impurities. They do not suffer from 
 diarrhoea and fever more than others, but rather less. The 
 filthiness of the creeks which ramify into different parts of 
 the city are much worse than this. He gives one illustration 
 of a creek near the foreign settlement which has been under 
 his observation for some years. It is narrow, crowded with 
 boats — innumerable houses on each side — the alvine dejec- 
 tions and other impurities of thousands of inhabitants along 
 it are daily discharged into the stream, yet the water, too 
 dirty even for washing, is daily used for culinary purposes 
 without being filtered, or is precipitated with alum as is done 
 elsewhere. Here we should expect the prevalence of such 
 diseases as typhoid and diarrhoea among the inhabitants 
 occurring often enough to excite attention, but their very 
 impunity is one of the reasons for their continuing to use the 
 water. He adds, a detailed examination of this creek and 
 the disgusting habits of the inhabitants would almost un- 
 settle one's ideas of the connection between typhoid fever 
 and polluted water. I can myself corroborate every word 
 of this as witnessed at Tientsin, in the North, where a similar 
 condition of things exists. Or take another witness, Dr 
 Reid, at Hankow, in Central China, on the Great River 
 Yangtse. Speaking of the same fevers of the intermittent 
 and remittent type which are so prevalent in China, the 
 latter especially, he says — " The failure to discover any type 
 of exanthematous fever is scarcely what might have been 
 anticipated, knowing the filthy condition of the houses and 
 streets, the density of the population, and the poverty in 
 many quarters of the native city. It might have been pre- 
 sumed that the haunts of enteric fever at all events would
 
 have come to light, seeing that the products whence its 
 organisms are supposed to be derived and nourished abound 
 in many directions. This will be readily acknowledged if 
 allusion be made to two of the more active and constant 
 sources of impurity — viz., the emanations from the latrines 
 and drains. The latrines are of course numerous — con- 
 structed without regard to cleanhness, and nothing is used 
 to interfere with the results of decomposition. Their con- 
 tents are allowed to accumulate for three or four weeks until 
 the large, deep open troughs underneath are filled, and they 
 are then disposed of to the farmer or gardener and carried 
 to the jetties in uncovered buckets, often during the day. 
 While the process of emptying the troughs is going on the 
 neighbourhood is saturated with odours of the most intense 
 description, and which defy the tolerance of even! well- 
 blunted olfactories. The boys in an adjoining school, who 
 never smelt fresh air, were obliged to have their nostrils 
 stopped or compressed during successive days to exclude 
 the stench. Notwithstanding the apparent undesirable 
 character of the locality, in some cases private dwellings 
 and even restaurants doing a thriving business, may be seen 
 attached to the latrines, and only separated by a wooden 
 partition insufficient to oppose the entrance of polluted aii*. 
 The drains are blocked up with accumulations of mud and 
 debris. From the want of means to obviate the regurgita- 
 tion of gases from the cesspools of the streets, connected 
 with the courtyard or interior of the houses, these drains 
 must contribute largely towards increasing the impurity of 
 the houses. In the poorer quarters the open ditches are half 
 filled with decomposing refuse and garbage, and exposing 
 their nauseous contents close by the doors or even under 
 the floors of the houses." He further adds — " These various 
 prolific sources for the development of organic germs have 
 been specially referred to in connection with the absence of 
 enteric fever, because it may happen that in time evidence 
 may be collected to prove or contradict an important theory 
 in relation to this fever, that where malaria exists there is 
 neutralisation or tolerance of the enteric poison." At Chefoo,
 
 10 
 
 Dr Meyers reports "that the water is decidedly imsatisfac- 
 tory, full of organisms, owing to the total want of circum- 
 scribed cemeteries and the water percolating through the 
 soil. The surroundings of the wells, moreover, are filthy, 
 combined with dirty buckets and dirty water-carriers. Per- 
 sons long resident here appear to suffer but little inconveni- 
 ence from this state of affairs. There is no drainage, but at 
 the same time I must confess that this appears to exer- 
 cise no injurious influence over the sanitary state. There is 
 total absence of all those deleterious effects which might be 
 justly supposed to follow so dangerous a disregard of sani- 
 tary laws." Amoy, according to Drs Miiller and Mans on, is 
 superlatively dirty, streets narrow, irregular, and filthy in 
 the extreme, and redolent of every impurity. Pigs and dogs 
 are the sole representatives of the elaborate machinery of 
 sanitation in use in European towns, and a scientific sani- 
 tarian, with only home experience to guide him, would con- 
 fidently predict the origin of epidemics and death. Yet the 
 Chinese manage to live and thrive where he would hardly 
 dare lodge his pigs. There is no typhus, no typhoid, or 
 other disease, considered the inevitable consequence of de- 
 fective sanitation, although Amoy, and indeed all Chinese 
 towns, are full of typical typhus dens. Luckily filth, over- 
 crowding, and bad food are not the only factors necessary 
 for the manufacture of a typhus epidemic. Were they so we 
 should live here (China) in perpetual dread. And these are 
 not the only fevers whose absence we have remarked, with 
 the exception of smallpox, we have met with no representa- 
 tive of the class of continued fevers which claims so large a 
 number of victims in Europe. No case has been met with 
 in either Amoy or Formosa of scarlet fever, measles, relap- 
 sing fever, or diphtheria. The petechial fevers, with the 
 exception mentioned, are entirely awanting. Considering 
 this and reflecting on the rarity of the atheromatous and 
 fatty degeneration, with the numerous dangerous diseases 
 they entail, we may be at a loss to account for the mortality. 
 If we think, however, of smallpox mortality, 1 in 3 from the 
 unmodified form, part of the difficulty vanishes, and then add
 
 11 
 
 malarial diseases, remittent fever, ague, diseases of the spleen 
 and liver, anaemia and its consequences, and to these add 
 cholera and leprosy, and we have sufficient causes for a con- 
 siderable mortality. Another writes (Mr Porter Smith, of 
 Hankow) — "Chineseutter disregard of sanitary science among 
 an otherwise highly civilised and accomplished race is one 
 of the worst facts. They take kindly to the purple, but 
 never to the fine linen. The cleanest and whitest garment 
 next the skin would be a strange perversion of the order of 
 wearing their apparel, but nevertheless they possess public 
 baths." 
 
 Dr Somerville, of Foochow, a graduate of our University, 
 says : — " I have to add my testimony as to the total disre- 
 gard of anything like sanitary arrangements. Dirt of all 
 kinds finds its way through the non-dovetailed and shrunken 
 planks of the floor, and when a house is burnt or blown 
 down, the foundation is seen to be a mass of filth in a decom- 
 posing state. There is nothing like drainage, and the traffic 
 in night soil, the formation of manure pits, and the watering 
 of fields with liquid ordure obtain here as elsewhere. In 
 short, we have all the generally recognised factors of 
 zymotic disease, with a high temperature to favour the 
 fermentative and putrefactive processes. Yet we enjoy a 
 high standard of health, and there has been no epidemic 
 affecting foreigners at this port for at least eleven years.'' He 
 was led to make these remarks by the remarkable fact, that 
 four cases of typhoid fever occurred during 1872-73. There 
 had been no case at the anchorage for three years, and in 
 eleven years' practice there he had seen only seven or eight 
 cases altogether before the present series. There was no 
 evidence that the fever had been communicated fi-om one 
 patient to another, and he sets down the form therefore as 
 sporadic. He adds, " We have a mass of evidence favouring 
 the view that the poison of typhoid is communicated 
 through contaminated water, and I think that cases like the 
 present, where no such mode of diffusion is probable, are 
 deserving of record." And he further adds, very cautiously, 
 as if he felt misgivings about the received connection
 
 12 
 
 between contagion and the communication of typhoid, as 
 explaining the whole case : " I think the purpose of these 
 reports (Customs' Half-Yearly Medical Eeports) for the 
 present is best served by collecting material for future use. 
 I, therefore, content myself with stating these facts, and 
 refrain from generalising from them, more especially as the 
 subject of sanitation is at this moment engaging the atten- 
 tion of our best authorities in all parts of the world." 
 
 The foregoing remarks hold good regarding all large 
 native cities. Drains for surface water are general in 
 Chinese towns, but, for the most part, they have been 
 allowed to get choked up and broken down, and then they 
 become the receptacles, as open ditches, of the city garbage 
 and filth, and become a terrible nuisance. The condition of 
 the capital resembles, in many respects, other Chinese cities, 
 but in many important particulars it is quite different. In 
 regard to drains, Pekin stands unrivalled among the cities 
 of the world as far as their age, extent, former admirable 
 adaptation and present ruinous condition are concerned. We 
 have two large sewers on all the main streets, with branches 
 to all the lanes. They drain into the city moat, and these 
 into the Peiho, or canal leading thereto. Those that are free 
 in parts of their course are sure, after heavy rains, to open 
 somewhere into the streets, deluging them with putrid mud 
 and filth, entering the drain at a distant point, and then 
 again repeating the above act. By and bye the mud dries, 
 and is used for repairing the roads. With all our filth and 
 dirt there is a wonderful immunity, even from fevers. The 
 police, who water our streets from these cesspools, and 
 utilise the dirty water and urine collected in the houses 
 and shops during the day, are among the most robust 
 and' healthy of our population, provided they are not, 
 at the same time, opium smokers. The beggars, a very 
 numerous class, who sleep in the streets nearly all the 
 year round, congregate in the very centres of pollu- 
 tion, and even, to some extent, contest with dogs, priority 
 of claim to the refuse of the dunghill, not only survive, but 
 flourish, and most of them look fat and sleek. The mouths
 
 13 
 
 of our lanes, waste places, and tumble-down, or unoccupied 
 houses and shops are our most pulluted regions, and the 
 common place of resort of the neighbourhood for males. 
 The reason assigned for the innocuousness of this sad con- 
 dition of things in China are, among others, the following : 
 — There are our prevailing winds in most parts of China, 
 which act as diluents, and prevent the too great accumula- 
 tion of noxious effluvia, ready to ripen into activity. There 
 is also the sandy, absorbent nature of our soil, in the North 
 at all events. The apparently objectionable and disagree- 
 able plan of watering the streets from the foul fluids of the 
 drains and domestic urinals carries good in it. These 
 collections of decaying organic matter are moved and pre- 
 vented from accumulating in too large quantities, and when 
 thrown on the streets the greater part of it is absorbed by 
 the dry soil. The operation is always performed after sun- 
 down, to prevent too much evaporation. I am unable to 
 say whether this is from economical or sanitary considera- 
 tions, most probably the former. After sunrise the streets 
 are nearly as dry as before. Our weather is very dry in the 
 North, frequently seven or eight months without either rain 
 or snow. In summer, after heavy drenching rains of several 
 inches, the dust will be plentiful on the third day, so dry 
 and absorbent is the soil. Another reason, and this is 
 doubtless the chief one, is the high value of human manure, 
 and the assiduity therefore with which it is collected for 
 agricultural purposes. Large numbers of the people in this 
 way obtain a living. Its high value and the great poverty 
 of the people are our safeguards. It is carried outside the 
 city walls, and is dried and caked, or pulverised. The dung of 
 the herbivorous domestic animals is dried for argol, and used 
 as fuel. Human excrement so prepared is the most expensive 
 of manures. Much that is recommended at home in the way 
 of ventilation, water supply, and disinfection of privies is 
 in China rendered unnecessary. All the advantages claimed 
 for the dry earth system are gained here free of expense to 
 the individual or public. The industrious and frugal habits of 
 the Chinese, and even their very poverty, thus work to theii-
 
 u 
 
 advantage (all sanitary measures more than repay their 
 cost), for it compels them to utilise all excrementitious 
 matter. Every particle of every kind of manure, besides 
 rags, paper, etc., are collected and preserved with the 
 greatest care. The private privies, which are all out of 
 doors, are visited daily by these manure collectors, and so 
 great is the demand for it, that no payment is made to these 
 scavengers. Foreigners pay a trifle monthly to guarantee 
 respectability, cleanliness, and regularity on the part of the 
 collector. The healthiness of our foreign settlements in 
 China is, in a great measure, owing to the absence of water 
 closets in the dweUing-liouses, which, in Europe, are a fruit- 
 ful source of disease. Gases, such as sulphuretted and 
 carburetted hydrogen, are not so injurious to health when 
 given off in the open air, as when escaping from sewers. 
 China is, par excellence, the country of bad smells, and yet, 
 as we have seen, the people do not seem to suffer from 
 them, but, on the contrary, rather like them. 
 
 The removal of excreta and the disposal of sewer water is 
 the sanitary problem of the day in this country. Our sewers 
 allow transference of gases and organic molecules from house 
 to house and place to place; occasionally, by bursting, leakage, 
 or absorption, the ground is contaminated, and the water 
 supply is constantly in danger of being poisoned and con- 
 taminated ; and all these dangers are greater from being 
 concealed and being beyond individual control. Fevers and 
 cholera are thus possibly propagated from house to house. 
 In China we are entirely free from this danger. It would 
 seem advisable that our water closets should be in an out- 
 building or projection from the main house, and should be 
 placed at the top of the house, with a tube passing to the 
 outer air. When placed in the basement the closet air is 
 certain to be drawn into the house. For use in the bath 
 room, a solution of sulphate of iron 4 parts, carbolic acid, 1 
 part to 30 parts of water, has been recommended as a good 
 disinfectant by Dr Jamieson. Each time it is used two 
 ounces of the solution should be poured in. By this means 
 the air Avould be rendered perfectly pure, or at most faintly
 
 15 
 
 imjDregiiated with carbolic acid. The great expense at- 
 tending the use even of the cheajDest disinfectant wouhl 
 seem to preclude the use of this method for the large sewers 
 of our cities. This, however, is denied, and it is asserted 
 that certain antiseptic agents, even in a highly diluted form, 
 would gain the object in view. It does not seem impossible 
 in large manufacturing towns to ventilate the sewers by con- 
 necting them with factory chimneys. These same chimneys, 
 as well, probably, as those of ordinary houses, in seasons of 
 epidemics at least, or by spray-producing machines or other 
 mechanical appliances, might disinfect closes, houses, and 
 whole localities and towns. 
 
 Houses. — Let me now say a few words about houses in this 
 connection. In China they are, with few exceptions, of only 
 one storey. The streets are narrow ; those in the capital are 
 an exception to this rule. These narrow streets serve the 
 purpose of warding off the great heat of summer — mat 
 awnings being frequently stretched across them ; in winter 
 they protect equally from cold winds and increase the 
 general warmth and comfort. The houses are, as a rule, 
 arranged in com'ts, the principal ones invariably facing the 
 south, by which they get the cool winds in summer and the 
 w^armth of the sun's rays in winter. The houses of the 
 better classes of officials, temples, &c., are lofty and hand- 
 some. The arrangements of the houses, requu-ed by their 
 style of architecture and family relations, necessitate numer- 
 ous courts, and thus cover a considerable area. No houses 
 infringe on the privacy of others. They are usually sur- 
 rounded by verandahs, rendered necessary by the great heat 
 of summer. The better class are built of substantial brick, 
 the poorer ones, and especially in the country, with sun- 
 dried bricks. The roofs are massive, being covered with 
 closely-overlapping tiles, with a thick layer of mud and lime, 
 and with wood, slate, or straw underneath, which effectually 
 keeps out the cold in winter and the heat in summer. Venti- 
 lation is perfect in summer, but rather defective in winter. 
 The poor people like to have low ceilings to lessen the space 
 to be heated. The houses usually consist of two brick gables.
 
 with the otlier two sides filled in with windows and doors. 
 With the exception of the introduction of our chimneys and 
 wooden floors, foreign changes have not been improvements 
 on the best sort of native houses. Our houses, all under one 
 roof and of several storeys, with the exception of economy, 
 perhaps, in heating, are liable to serious objections in the 
 matter of fresh air, free ventilation, and, if need be, isolation. 
 The better class of houses are usually raised several feet 
 above the ground, and the surrounding courtyards being 
 thus lower, afford excellent drainage in rainy weather. In 
 China there are no sunk flats or cellars. The foundations are 
 usually of stone, and the lower parts of the corners of the 
 gables and cornices are also of this material ; all the rest is of 
 brick. In the country the sun-dried brick houses have almost 
 invariably a band of slate, wood, or more frequently straw, 
 running round the house, to prevent the damp ascending and 
 mouldering the bricks. The plan proposed of having a 
 chamber in the foundations of the houses in this country 
 communicating with the chimneys from the lower storey, and 
 where they would begin, is, I think, strongly advisable, and 
 would thus ensure that all foul gases and diseased germs 
 arising from the soil would be carried out of the house. To 
 prevent the ascent of air from the soil, the basement should 
 be paved or concrete used, or, as lately recommended by Dr 
 Richardson, the houses should be raised on arches. Chinese 
 houses and courtyards, of the better class at least, are floored 
 with brick, which prevents emanations from rising, the 
 water in the courts from being absorbed to any great extent 
 and tends greatly towards draining off the rain water. 
 From the condition of the great bulk of the houses of the 
 lower classes both in town and country — the houses having 
 earth floors and a damp subsoil under or around them — 
 we should, of course, expect rheumatism and neuralgia to be 
 very prevalent. And so they are. Among the Mongols, 
 living m tents, rheumatism is the most commonly met with 
 aff'ection. The cases, however, are entirely muscular, the 
 acute variety being rarely heard of, and one practitioner 
 states never met with, although frequent enquiry was made
 
 17 
 
 amongst the Cliinese sufferers. The causes of chronic 
 rheumatism are not far to seek in a population lowered by 
 malaria, bad diet, damp dwellings, and especially great and 
 sudden changes of temperature. The absence of the acute 
 form is attributed to the rapid elimination through the skin, 
 and likewise also to the more sluggish, inactive disposition 
 of the Chinese, rendering the system less liable to be roused 
 to produce acute symptoms. Another professional brother 
 reports at his port " rheumatism takes almost invariably the 
 chronic form, caused by the damp and undrained situation of 
 native houses." Dr Smith, of Hankow, thinks the vegetable 
 diet, poverty of nitrogen in rice, and scarcity of red flesh 
 tend to its development. At Newchwang, Dr Watson reports 
 — " The people suffered from rheumatism and ague after the 
 heavy rains, but in spite of insufficient food and the un- 
 healthy character of the country, no very great increase of 
 mortality among natives took place during the summer." 
 
 The warming of houses is another point of importance. 
 Chinese houses have no chimneys. In the North of China, 
 where the winter is long and severe, the houses are provided 
 with kangs, or earthen platforms, covered with large square 
 bricks, having flues running under them through which the 
 heated air and smoke, if any (for they burn anthracite coal), 
 passes, and after traversing the kang finds an exit in front 
 into the room, and uniting with the heatof the fire, increases 
 the heat of the room. Among the upper classes these bed 
 platforms are sometimes heated from the outside, which is 
 a decidedly preferable plan. The floors, too, are sometimes 
 heated in this way, the flues being arranged under them in 
 the same way and heated from without. This union of 
 kitchen, fireplace, and bed is a matter of great moment to 
 the poor and the delicate, whether young or old, who suffer 
 greatly from insufficient clothing and improperly or im- 
 perfectly heated houses. Among the very poor it dispenses 
 with much bedclothing. The bedclothing of such consists 
 generally of their every-day wearing apparel loosely laid 
 over them at night, with the addition of a cotton mattress. 
 They sleep with the head to the outside of the kang, the
 
 18 
 
 reason assigned being that in this position it avoids the 
 danger of the clothes catching fire, and puts the head — the 
 heavenly part of man — in a freer and more honourable 
 position. With the head to the wall the impure air and 
 feeling of restriction and confinement would prove injurious. 
 We have at Pekin several beggars' houses or small inns 
 and an Imperial House of Refuge so heated in the winter 
 season. The latter is gratuitous, and a very small pittance, 
 about a farthing for a night's lodging, is demanded by the 
 keepers of the former. The windows are well papered and 
 oiled. In the centre is a large fireplace for warming the 
 room and the beggars, and suj^plying them with hot water. 
 The beggars squat or lie down on the stove bed-places, with 
 simply a mat stretched upon it, and they without any bed- 
 clothes, in fact generally without any clothes at all. I have 
 seen as many as fifty, each bolstering up his neighbour, on 
 such a kang. The temperature is kept about 70°. The air 
 of these rooms is, of course, extremely disgusting, but 
 they are tolerably clean. During the day the beggars, who 
 for the most part are fat and well-looking, pursue their pro- 
 fession on the streets of the city, and at night again return 
 to their heated ovens. Although the atmosphere in these 
 places is loathsome, it is still a matter of great consideration 
 that they are able to obtain lodging in a warm room for the 
 night when the thermometer is often near zero, especially 
 when they have no blanket or coverlet to protect themselves. 
 In some places a coverlet suspended from the roof is let down 
 upon them at night. The mortality in the Imperial House 
 of Refuge is very great. In the latter place the beggars are 
 supplied with two meals of millet per day. 
 
 From this description you will observe that the Chinese 
 houses and bed-places in the North, at least, closely resemble 
 the Roman hypocaust, the floors being warmed by pipes and 
 smoke flues under them. A plan similar to this might very 
 beneficially be introduced into our own country in one-storey 
 houses or the basement floors of others. In winter these 
 kangs would prove eminently serviceable for the very young 
 and delicate of whatever age among the poorest classes who
 
 V.) 
 
 cannot aftord eitlior siiflieient clothing or bedding. They 
 might be so arranged that our bitumenoiis coal would prove 
 no drawback, and I feel certain that our great mortality 
 among certain classes -from bronchitis, pneumonia, pleurisv, 
 congestion of the lungs, &c., Avould be greatly lessened. 
 The pawnshop, and afterwards the ginshop, are too often 
 the receptacles of the clothing charitably dispensed to the 
 poor in winter. The frugal and economic Chinese, if placed 
 in our position here, might even consider the propriety and 
 feasibility of utilising the waste steam of our great factories 
 for heating the dwellings of the neighbouring poor. The 
 American cylinder stoves, now so universally used by 
 foreigners in North China, are well adapted for heating- 
 purposes. They heat thoroughly, and are greatly to be pre- 
 ferred to the extravagant and poorly heating English fire- 
 place. The water evaporating apparatus provides against 
 headache, &c., from overdryness of the atmosphere. Chinese 
 houses are on the whole well lighted, two sides being almost 
 always composed of doors and windows. The light is well 
 diffused, and there is no glare — oyster shells in the South, and 
 Corean or other paper in the North, being the article with 
 which the windows are glazed. Glass is being extensively 
 introduced. An important factor in the health of the 
 Chinese is their being so much in the open air. The male 
 portion of the people, even those of om' own profession, in- 
 cluded along with the barbers and chiropodists, carry on their 
 trades and callings on the public streets. They live much 
 in the streets and in the open air — the whole side of their 
 shops being freely exposed. In this way many of the evils 
 and dangers of our crowded workshops, arising from impure 
 air, from whatever cause, are avoided. 
 
 Water Supply. — Another topic demanding a passing notice, 
 as playing a most important part in sanitation and causation 
 of disease is the tvater supply. The water supply in China is 
 derived chiefly from rivers and wells. The water obtained 
 from rivers is manipulated in various ways, passed through 
 filters, allowed to settle, and the organic matter is preci- 
 pitated by chemical agents, alum being in most common use.
 
 20 
 
 But whatever be the water, and wheresoever the eupply, it 
 is invariably boiled by the Chinese. The Chinese, as a rule, 
 do not drink cold water. We have already pointed out how 
 strongly it is contaminated with filth and garbage in the 
 great centres of population on the great rivers, and that the 
 supply is almost invariably drawn from the public places. of 
 resort. In Pekin the supply is partly from wells and partly 
 from springs at the Summer Palace Gardens, the water being 
 led into the city, a distance of eight or more miles, in a 
 canal. It runs through lakes, and ultimately through the city 
 moat. Our ice supply in winter is derived from this quarter. 
 The water is soft and sweet, and is equal to our Loch 
 Katrine water. The wells in the city are numerous, and 
 placed at short distances, generally on alternate sides of the 
 streets, from which the neighbouring householders, Avho have 
 not wells on their own compounds — and nearly all large com- 
 pounds have one or more — and animals are plentifully sup- 
 plied. The refuse water at these wells is used for watering 
 the streets. Wells are to be found along all the roads of 
 China at every short distance to supply the wants of travel- 
 lers and the domestic animals. The wells are usually farmed 
 out. The water-carriers have their legs bandaged from the 
 knee downwards, with the object of strengthening and sup- 
 porting their calves, and so aiding them in following out 
 their occupation. The device is effective against varicose 
 veins, or as they express it, " the falling down of the belly 
 of the legs." Varicose veins are very uncommon among the 
 Chinese. Ignorant of the true circulation, they suppose 
 them to be tendinous tumours, and so express them. May 
 not the practice of tight garter-tying, among the fair sex 
 especially, obstructing the circulation, cause this condition 
 of things, which is pretty common in the West ? The Chinese 
 tie their trousers and stockings together at the ankle with- 
 out any bad results, and with the additional advantage of 
 keeping in the heat and keeping out the cold. From the 
 universal prevalence of water and these wells, I need hardly 
 say that rabies is extremely or comparatively rare, consider- 
 ing the vast number of dogs, each householder possessing
 
 21 
 
 one or more. Dogs are never muzzled. Gravel and cal- 
 culus, too, are among the rarest of affections in China. 
 Only in Canton has calculus been found at all, and there it 
 seems to exist to a considerable extent. The reason has 
 not yet been explained, for the same conditions, river water, 
 boiled and used in cooking or in infusion of tea, are univer- 
 sal over China. In Canton, from 1854 to the end of 1875, 432 
 cases of stone were operated upon at the Mission Hospital 
 there. The total weight of stone removed was 408 ounces, 
 or 25^ lbs. The gouty diathesis appears to have little to do 
 with the prevalence of stone at Canton, as gout is not met 
 with among the native population. And not only is stone 
 absent, but all other urinary or renal diseases are compara- 
 tively rare, certainly much less common than in Europe. 
 Only one case of diabetes was seen at Hankow in five years 
 out of thousands of patients. This immunity from renal 
 disease is attributed to some extent to opium. But opium 
 smoking, although very prevalent, and the consumption of 
 the drug increasing and extending, can only explain this 
 freedom from renal and other diseases to a limited extent. 
 We shall point out further on some other and more evident 
 reasons. The original badness and filthiness of the water at 
 the open ports on great rivers and adjoining large native 
 towns — and, as a rule, the foreign concessions are situated 
 below the native cities — has frequently been made the pre- 
 text among our countrymen out there for indulging in vari- 
 ous medicated waters. The seductive cocktail and brandy 
 and soda, &c., &c., in a warm climate, and with high animal 
 living, have had much to do with the high foreign death-rate 
 — liver disease, aneurism, heart disease, heat apoplexy, &c., 
 of which we hear from time to time. There is no doubt that 
 the best treatment to which to subject all water, especially 
 where there is any suspicion, is to boil it, and by so doing 
 to destroy all the living organisms. If we must swallow 
 myriads of insects in almost every drop of water, it is as 
 well that they should be cooked. It has been established 
 that living protoplasm is certainly destroyed by sudden ex- 
 posure to a high temperature, say 140 F. when in the moist
 
 22 
 
 state. It is only for a very few minutes that contagious 
 matter can stand the temperature of boiling- point — its 
 destruction is merely a question of sustained boiling. And 
 it cannot be too distinctly understood that dangerous quali- 
 ties of water are not obviated by the addition of wine or 
 spirits. I certainly think that we, as a people, and still more 
 our American brethren, drink too much cold water. The 
 Chinese, who have seen foreigners drink down large tumbler- 
 fuls of water at meals, attribute it to the necessity of putting 
 out the fire in the stomach caused by our beef-eating pro- 
 pensities. The Chinese have water freely exposed in their 
 earthenware utensils or kangs. They tell us never to drink 
 water on which the sun has shone, no matter how thirsty, 
 for besides that it hath at that time pernicious qualities, it 
 is often full of the spawn or ova of innumerable insects. 
 Simple hot water and tea are the common every-day bever- 
 ages of the Chinese. The imiversal use of hot water as a 
 beverage is remarkable. Our own old writers on health 
 have also recommended as an immediate remedy in flatu- 
 lence and palpitation of the heart, and indigestion gene- 
 rally, the use of hot water and the recumbent position. 
 '' Cold water is an enemy to concoctions, and the parent of 
 crudities." And here, as in other matters, it would be well 
 always to remember that before the process of digestion can 
 commence, the matters introduced into the stomach must 
 take the temperature of that organ. And the experience of 
 not a few will doubtless corroborate the Chinese practice, 
 that when overheated, physically fatigued, or mentally ex- 
 hausted, a glass of hot water will refresh them more than 
 wine ; the latter exasperates the evil, the former mitigates 
 it by its softness and coolness. It might probably be sup- 
 posed that owing to this extreme care, observed by all 
 classes regarding water, intestinal worms would be very 
 infrequent in China. The reverse, I am sorry to say, is 
 the case. The tape and round worms are very common — 
 male-fern in the former, and santonine lozenges in the 
 latter, have been most successful remedies. Numerous 
 patients have been relieved of several tens of feet of the one,
 
 23 
 
 and hundreds of the others. They are supposed to cause 
 toothache, necrosis, consumption, &c. ; and the native treat- 
 ment is always, of course, directed against this supposed 
 cause. Both the taenia and lumbrici are supposed to be 
 caused by eating macaroni or vermicelH, and the native 
 faculty strictly forbids the use of these substances, which 
 seem in the system to be converted into woi-ms. The people 
 everywhere indulge in pork, raw vegetables, unripe and 
 uncooked fruit, and, I presume, the annuals are carried into 
 the system through these channels. The taenia solium, 
 which is so prevalent, is certainly owing to the consumption 
 of pork, imperfectly cooked or quite raw ; for we know that 
 the cysticercus cellulosa, the embryonic state of the taenia, 
 exists in the pig. 
 
 Baths. — A word as to Baths. Numerous'public baths exist 
 in all large Chinese towns. They are known during the day 
 by a red lantern, lighted at night, raised on a lofty pole. The 
 water is usually changed once daily. The utmost care is 
 exercised in admittincj to the baths. The floors and the 
 baths themselves are heated from underneath by stoves. 
 Private baths in wooden tubs may be had to order. An 
 ordinary bath costs Id, and during the last month of the 
 year about 3d. Cold bathing is never resorted to, and it is 
 to this use of warm water, to their temperate habits, and 
 partly also to their non-use of flannel, that we must attribute 
 the absence of prickly heat (lichen tropicus) in summer. 
 Europeans are greatly afflicted by this troublesome eruption, 
 the sensibility of the skin being greatly increased by stimu- 
 lants. The looser garments of the Chinese may also 
 operate beneficially. The Chinese are not much given to 
 baths. A little water satisfies them ; for their ablutions they 
 are content with just as much scalding water as will cover 
 the bottom of a flat brass basin. The greasy commissioner 
 Yeh, on his way as a prisoner to Calcutta, indulged in a bath, 
 truly a la Chinoise, when he called for a teacupful of warm 
 water. They never wash their hands or face with cold 
 water, but use a loosely woven cotton handkerchief or 
 cloth, wrung out of hot water, with which they wipe their
 
 24 
 
 hands and face in the morning, and also after meals in good 
 families. The Chinese dread the effects of water, especially 
 cold water. It would be cruel to think of disarming the 
 beggars of their foul coat by means of a hot bath, because 
 they would certainly die from inability to resist the cold. 
 The thievish air would gain admittance at every pore. As 
 practitioners, we must eschew water dressings, baths, fomen- 
 tations et hoc genus omne, if we wish to remain in attendance 
 and inspire respect and confidence. The people abhor not 
 only the touch, but the taste of cold water. The Chinese 
 suppose Europeans are obliged to bathe daily on account of 
 the insupportably bad odours which are emitted from their 
 cuticles. Hot or warm baths, especially in tropical countries, 
 are by far the safest and really the most cooling in summer. 
 The strong reaction after a cold bath makes the feeling of 
 heat tenfold worse. There are various diseases, especially 
 of the liver, where cold bathing might prove dangerous, as 
 tending to congestion of internal viscera, and which are there- 
 fore contra-indicated. 
 
 Beverages. — Speaking of the water supply, leads me 
 naturally to speak of the beverages or drinks of the 
 Chinese, and here also there are some useful lessons 
 for our guidance to be learned. The Chinese are a sober, 
 temperate people. Although China has much fermented 
 liquor, she has neither beer from malt, nor wine from 
 grapes. She is emphatically a sober country; though 
 wine is cheap, and there is no tax upon it, and no re- 
 striction in its sale or manufacture, and though nearly all 
 classes use it, few comparatively drink to excess. That 
 which is the common disfigurement of life in our cities and 
 towns, is a rare sight in China, even in her seaports. The 
 rice wine, not unlike our sherry or Cape, is served up hot 
 in small cups — the common spirit or samshoo, distilled 
 usually from millet, is never heated. Taking our drinks hot, 
 besides being more natural and rendering them easy and 
 ready of absorption, we know what we are doing, not like 
 iced wine Avhich people are induced to drink, deprived of 
 the advantage of knowing when they have got enough. It
 
 25 
 
 is indeed a very rare thing to see a drunk Chinaman, and a 
 drunk woman would be a wonder. During a residence of 
 twelve years in the country I have not seen five cases of 
 intoxication. And yet the Chinese, apparently so abstemious, 
 consume no inconsiderable quantity of spirits. The great 
 consumption of spirits in Western countries is often ofi"ered 
 as an apology for opium-smoking in China. There would be 
 force in this argument if China abstained from intoxicants, 
 for in addition to her opium and spirits, she has also her 
 stimulating tea, betel nut, and tobacco. But although a 
 little spirits is usually consumed after meals nearly all over 
 China, the very badness and want of fragrance of the native 
 spuit, which contains much fusel oil, has kept the people 
 sober and temperate. In no country perhaps is wine, of a 
 decidedly intoxicating nature, so generally and yet so mode- 
 rately partaken of as in China. I have seen not a few cases 
 of dyspepsia and stricture of the oesophagus caused by addic- 
 tion to spirits, the latter cases of course uniformly fatal in 
 the long run. The only treatment which the Chinese have 
 devised for this formidable complaint is bread saturated 
 with the blood of decapitated criminals. The absence of 
 renal and hepatic disease is referred in part to their com- 
 paratively temperate habits. With tropical heat in sum- 
 mer, the variableness of the weather, particularly in spring 
 and autumn in most places, the poverty of the people, and 
 their general exposure to the inclemencies of the seasons, it 
 is remarkable to find hepatic disease so rare. Great care in 
 preserving from chills, an object easily obtained, as we shall 
 see, by the nature of the Chinese clothing, along with 
 proper diet and temperate habits, are the chief prophylactic 
 means against "liver." We find the Chinese, too, almost 
 absolutely free from diseases of the heart and blood vessels 
 — fatty degeneration, for example, which is the usual form of 
 heart disease induced by alcohol. We have noted the 
 absence of serious changes in the liver and kidneys, as, 
 for example, diabetes and Bright's disease. Delirium tremens 
 is also unknown in China. 
 
 And here allow me to make a very few observations
 
 26 
 
 on aneurism, heat apoplexy, and syphilis in this connec- 
 tion. Aneurism, as we all know, is of increasing fre- 
 quency in England. During the last 20 years the total 
 number of deaths have been more than doubled, and they 
 have been wholly confined to males above 20 years of age. 
 There has been no increase among females or young people. 
 Heart disease and aneurisms are now among the most ap- 
 pallingly frequent diseases of early manhood. The profes- 
 sion has been greatly exercised in the East to discover 
 causes of degeneracy among the Europeans in the prime of 
 . life. French surgeons ascribe it to changes caused by 
 malaria. As a cause leading to degeneration, syphilis, by a 
 pretty common consensus of opinion, occupies a foremost 
 place. Rheumatism and alcoholism are said to produce the 
 same arterial inflammatory changes as syphilis. With the 
 Chinese, and rice-eating people generally, aneurism is the 
 least common affection. In Shanghai, our principal port in 
 China, the ratio of deaths from disease of the heart and great 
 vessels, to the number of deaths from all causes, is higher 
 than in Europe. In 1873 there were 7 deaths at Shanghai, 
 7 in 6 months of '71 and '72, 5 in '72, 16 in 3 years. No case 
 has of late years, at any rate, been seen at the Chinese hos- 
 pital in Shanghai. The simple habits of living of the Chinese, 
 their phlegmatic and unexcitable natures, probably give 
 them immunity from this disease. 
 
 Our present high-pressure European life, with its mental 
 overwork and incessant worry, intensified by other influ- 
 ences, nearly if not quite as potent, such as excessive use 
 of alcohol, inattention to diet, pure air, and by animal 
 excesses, must have much to do, I should think, with heart 
 disease and aneurism, not to speak of such other affections 
 as paralysis, dementia, diabetes, and renal disturbance. 
 This overwork and over-anxiety, by the very exhaustion of 
 the body which they cause, call for stimulants, and soon other 
 diseases set in which too frequently place the patient beyond 
 medical skill. Physical overwork is also characteristic of 
 modern Hfe. Excessive physical exertion is quite unneces- 
 sary to maintain or promote health. The 1000 miles in 1000
 
 k 
 
 27 
 
 hours sort of exercise , numerous of our games and exercises, 
 such as football, boxing, rowing, leaping, running, &c., in- 
 dulged in to an extreme degree — and I fear such is only too 
 truly the case — are well adapted to increase over-action of the 
 lieart, and consequently subject the individuals to frequent 
 and sudden congestion of the lungs and other vascular 
 organs ; to aneurism, at one time called post-boy's malady, 
 hypertrophy of the heart, &c. When extra force is put 
 forth it is too frequently at the expense of the organism it- 
 self We have also a combination of the mental and physi- 
 cal, so well brought out in Dr Richardson's work on the dis- 
 eases of modern life, as exemplified in long journeys to and 
 from business — our railways facilitating living out of town 
 away from office and places of business. There is the rush- 
 ing to catch a train morning and evening, a mode of life 
 possessing many elements of danger and many annoyances, 
 and in this way both the nervous and vascular systems 
 sufier. To the former belong unnecessary anxiety, restless- 
 ness, timidity, and sleeplessness, irritability of temper, recur- 
 ring fits of exhaustion ; to the latter irregularity of the cir- 
 culation, irritability of the heart, cold extremities, imperfect 
 secretions, want of muscular power — a host of circumstances 
 connected with railway travelling which contribute to injure 
 and shorten life and comfort. I might have referred here to 
 other causes all tending in the same direction, such as poli- 
 tical excitement, excitement of war, religious revivals, con- 
 tests of creeds, speculations of philosophy, publication of 
 daily newspapers, the flashings of the electric telegraph, and 
 other such like influences, from all of which disturbing 
 and disease-influencing and disease-producing causes in 
 China we are fortunately completely free. 
 
 Some of our Chinese maxims bearing upon the heart and 
 its afi'ections are the following : — Do not employ yourself in 
 any thoughts and designs but what lead to virtue ; keep 
 peace in the heart (anger and sorrow are supposed to 
 damage the internal viscera, injuring the liver, and thereby 
 preventing the secretion of the active principle of the blood 
 and the source of the vital spirits— injuring the lungs, and
 
 28 
 
 thereby causing haemoptysis, and finally consumption, and 
 paralysing the oesophagus and stomach) ; besides, reflect 
 often upon the happiness of your .condition — know the value 
 of health, and study to preserve it. 
 
 I have referred to anger, and here, in passing, I would 
 remark that the Chinese themselves trace almost all their 
 diseases to anger or to wine. The former stands first. That 
 man is indeed rich in physical power who can afford to be . 
 angry. We hear of and often see people red or white with 
 rage, and as a result of this, when long-continued, intermit- 
 tency of the heart, paralysis, apoplexy, congestion of the 
 liver must ensue. 
 
 Regarding heat apoplexrj, in 1872 no fewer than ten deaths 
 occurred at Shanghai. Intemperance is recognised by all 
 as a powerfully predisposing cause. In regard to these 
 cases, it was found on enquiry that in nearly every instance 
 these patients indulged freely in alcoholic liquors. The 
 dangerous effects of exposure arc controllable by proper pre- 
 cautions and by prudence in eating and drinking. Insola- 
 tion is quite unknown among the natives, even among 
 labouring classes, who go through severe physical exertion, 
 and often with their heads quite unprotected from the 
 sun. 
 
 A word or two on syphilis in this connection may not be 
 inappropriate — " that one moral and physical blot of our 
 civilisation, tinging many diseases, if not causing some, pro- 
 ducing many forms of cachectic feebleness and impaired 
 physical build, probably the most controllable, but at the 
 same time the most prolific of injury." Our profession re- 
 cognises this disease as predisposing to arterial degenera- 
 tion — the so-called syphilitic arteritis. The diseases of the 
 heart and blood vessels among our troops in China and 
 Japan have been traced to this cause. There is in the army 
 an excessive mortality and invaliding from aneurismal dis- 
 ease, said to be developed in China. The virus of syphilis 
 is said to be more violent and severe there than the same 
 disease when contracted in Europe. There may be other 
 reasons in diet, intemperance, and exposure, to account for
 
 29 
 
 this. Syphilis is more frequently met within private European 
 practice in the East than in England. But I should think 
 that diseases resulting from vicious and licentious habits are 
 not so violent in their effects in China as in countries where 
 the use of animal food and higher living render the system 
 more susceptible to the noxious consequences of the virus. 
 1 have seen hundreds of cases of patients with syphilis and 
 enthetic disease generally at Pekin, and bad though they 
 undoubtedly were, I suppose they were not worse than what 
 may be seen here among our lowest classes where cleanli- 
 ness is not next to godliness. I have always found the 
 Chinese cases most amenable to treatment. I have come 
 across not a few cases of cancer of the penis resulting from 
 unclean connexion. There is no doubt that cases of phy- 
 mosis, on account of the irritation set up by the discharges 
 and secretions inside the prepuce, predispose to epithelial 
 cancer of the penis. All the cases I saw, and in most of 
 which I operated, had this origin. Strange to say, one of 
 my patients was a Mohammedan who had not been circum- 
 cised in youth. It was interesting to me, as tending to con- 
 firm the view advocated by Travers, that the Jews (and he 
 might have added the Mohammedans also) know nothing of 
 this disease. This immunity is attributed to the beneficial 
 results of circumcision. And in these days when so much is 
 spoken and written about our Contagious Diseases Acts, it 
 might be well to have recourse to the alternative of circum- 
 cision. I feel sure it would be attended with the best results, 
 and would diminish very largely all the various diseases of 
 the genital organs, and would abolish altogether phymosis, 
 paraphymosis, and cancer of that organ. 
 
 After this long digression, I return to the question of 
 beverages. Wherever European civilisation has gone, intem- 
 perance among the native races has followed. We have invari- 
 ably impressed them with our bad example. It is so in China 
 to a small extent already at the ports, and we know that the 
 Hindoos, formerly the most temperate of races, and in whose 
 ordinary food spirits form no part, if indeed they are not for- 
 bidden by their religion, are rapidly becoming addicted to
 
 30 
 
 flriiik. Those ■who are host able to judge cnndemn alcoliol 
 as a preventive against cold, and equally so against heat. 
 The heat of the tropics is not so well borne where spirits are 
 indulged in, and they certainly predispose to insolation. 
 Warm tea in the tropics is admitted by all to be the best 
 beverage, and the experience of several hundred millions in 
 China confirms this opinion. Spirits are no necessity in 
 health, and as now used by mankind they are infinitely more 
 powerful for evil than good, and a clear view of their effects 
 must surely lead to a lessening of their excessive use which 
 now prevails in this country especially. In the words of the 
 late Dr Parkes — " There is no question that more disease is 
 directly and indirectly produced by drunkenness tlian by 
 any other cause, and that the moral as well as the physical 
 evils proceeding from it are beyond all reckoning, and yet 
 the attempts of the Legislature to set some bounds to 
 intemperance have been and are opposed with a bitter- 
 ness which could only be justified if the degradation and 
 not the improvement of mankind was desired." As a 
 matter of public health, it is highly important that our 
 profession should throw its great influence into the scale 
 of moderation. 
 
 Tea and iced beverages, indulged in by the Chinese in 
 summer, such as acidified apricot or rice conge or soup, are 
 certainly preferable to all the so-called " gently stimulating 
 liquids." They never take milk— there being no pasturage or 
 cows except for ploughing, milk has never become an article 
 of diet with the Chinese. Among the Mongols — the nomadic 
 tribes of the North — milk of course is a chief beverage. Hot 
 water alone is plentifully drunk all the year round, but tea 
 is par excellence the beverage of the people. It is most 
 commonly taken very hot, and always made by uping and 
 adding to it well boiled and boiling water. This seems the 
 secret of making good tea, apparently so little understood 
 out of China and Russia. And we should not so often have to 
 complain of bad tea if we were more careful about the quality 
 of the water. Its stimulant and restorative action are aided 
 when drunk hot. It is followed by no depression, and ouglit
 
 .",L 
 
 to be much more extensively used, and not as a meal — I ouglit 
 to say never as a meal — as is so frequently the case three or 
 four times daily by our factory girls and poor classes, and 
 which is productive, when so used, of the very worst results. 
 The Chinese drink it very frequently during the day, and it 
 is always offered to guests on entering a house, but it never 
 takes the place of a regular meal. Resting places exist 
 every few miles, or more frequently, all over the coun- 
 try along the roads, where the tea the Chinaman loves 
 is to be found. Many of our people, I fear, resort to 
 the public-house merely to quench thirst. Fountains, 
 the gift frequently of the philanthropic, are springing 
 up in all our large towns, and these might beneficially 
 be still more increased. Were the Chinese innocuous 
 draught to be supplied cheaply, or even in some cases gra- 
 tuitously to the poor, for example, the necessity of assuaging 
 thirst by being driven to strong drink would be saved. No 
 man is deprived by our laws of the means of his lawful gra- 
 tification, but certainly great advantages would result from 
 the Chinese plan. I am obliged to confess thab I cannot 
 see the rationale of so much denunciation of tea drink- 
 ing, usually merely a cup, by our profession, when taken 
 as in the kettledrum, or at any other time in the afternoon, 
 or immediately before or after dinner. A thousandfold 
 more evil has sprung, in my opinion, from the morning or 
 afternoon's glass of wine, and the sherry cobbler, or sherry 
 and bitters, or brandy, &c., so frequently had recourse to as 
 a fillip just before dinner, and frequently so recommended. 
 
 Speaking of beverages leads me to say a word about 
 tobacco and opium. Tobacco, unknown in the last dynasty 
 (1368-1644), or only to a very limited extent towards its 
 close (the middle of the 17th century), is now nearly as 
 universal as tea, and has spread with marvellous rapidity. 
 It was a crime punishable with death, the same quaint 
 reason urged by Sovereigns of Europe and Popes of Rome 
 being urged by the Chinese Emperor, namely, that men 
 appeared like devils emitting smoke from their mouth and 
 nostrils. Now eighty percent, of the whole population of both
 
 32 
 
 sexes, above twelve years of age or so, may be seen with the 
 pipe. It is hardly every out of their mouths, especially among 
 the women. The native tobacco is mild in the extreme, 
 and probably few bad effects result from smoking it ; at any 
 rate these are reduced to a minimum by the extensive use 
 of the water pipe, which seems worthy of imitation by smokers 
 here for the coolness and comparative purity obtained. The 
 water absorbs a large proportion of the nicotine and other 
 deleterious properties of the weed. As smoked by our 
 people, some of these constituents travel along the stem of 
 the pipe into the smoker's mouth and sometimes down to 
 his stomach. We hear complaints of dyspepsia, dryness of 
 the mouth, sore throat, amaurosis sometimes, various ner- 
 vous diseases, long retention of images on the retina after 
 the objects have disappeared, affections of the heart, irre- 
 gularity in its action producing fliintness, &c. Cigars are 
 worse than pipes on account of the more ready and rapid 
 absorption of the nicotine. Chewing, which seems almost 
 expelled, at least from good society, is manifold worse 
 than smoking ; snuff-taking is very common among both 
 Mongols and Chinese ; the snuff being usually highly 
 flavoured with various odoriferous substances. I cannot 
 say I have seen any bad effects from tobacco smoking among 
 the Chinese. If our people will smoke — and I suppose it 
 may be useful in some cases in preventing the bad effects 
 of over-action and extra excitement of the heart — I would 
 at least advise them to use long clean clay pipes, to abjure 
 the black cutty or blackened meerschaum which have lost 
 all their absorbent power. 
 
 I am sorry I cannot speak in the same terms of opium, 
 of all our luxuries the surest destroyer of health, property, 
 position, and life ; of all our vices the most insidious and 
 most difficult to throw off; one of the quietest and least 
 obtrusive, yet that which beyond all others tells most seri- 
 ously in the long run on national life and prosperity. This 
 is hardly the place to enter a protest against opium con- 
 sumption, but in considering health and disease among the 
 Chinese, it is impossible to shut out this factor. Whole
 
 chapters, if not volumes, might be profitably taken up with 
 the consideration of this subject in all its various aspects, 
 but the medical is alone of interest to us at present. The 
 effects of opium accord well with the Chinaman's natural 
 temperament, which leads to patience and love of peace, 
 rather than rude blows and lighting. There is no just com- 
 parison between the man who indulges in excess of wine 
 and the one who takes a pipe of opium ; the latter is more 
 like the habitual dram drinker, whose depraved and vitiated 
 appetite now craves for the powerful stimulant. Opium is 
 preferable to spirits, for it does not brutalise ; it does not 
 excite the fierce passions of men, but by enervating, soothes 
 them. The habit is easily acquired ; a fortnight's regular use, 
 and it will require an almost super-human effort to cast it off. 
 This is one of its most characteristic peculiarities. The 
 gnawiug agony of the unsatisfied craving is maddening ; 
 physical strength is prostrated ; the mind weakened, and a 
 few seconds after the opium pipe has touched his lips, the 
 smoker is relieved for the time being of all his sufiering. 
 He anticipates his craving and flies to the stimulant ; if 
 deprived beyond the usual period he gapes, yawns, and 
 discharges mucus from his eyes and nose, and is perfectly 
 miserable and good-for-nothing. There are rare cases of 
 great determination throwing off the evil habit; body 
 and mind are usually too weak for the execution of the pur- 
 pose. The 9urse of the habit, like drunkenness, falls with 
 special severity upon the poor; half of the labouring man's 
 wages are spent on this single article. We can imagine the 
 misery at home — his constitution ruined, family reduced to 
 poverty, situation and character lost, beggary his inheri- 
 tance, and thieving his portion. He brings a variety of 
 physical evils upon himself, dyspepsia, inveterate constipa- 
 tion, dysentery and diarrhoea of an intractable character 
 threatening the life of the confirmed smoker who would 
 renounce the vice, and too frequently it is so without the 
 renunciation of the pipe ; spermatorrhoea follows with its 
 long train of evils affecting his posterity and the popula- 
 tion of the country. I cannot take time to pourtray all the
 
 34 
 
 physical evils which we fmd following in the wake of the 
 smoker. The good he derives in chest affections, such as 
 cough, chronic bronchitis, ordinary diarrhoea and dysentery, 
 when not caused by the drug itself, are for a time at least 
 substantial gains, although I fear it renders the radical cure 
 of many of these affections in the long run more difficult, 
 in reducing vitality and the resistance of the body to dete- 
 riorating influences. This part of the subject might form a 
 paper itself. Fortunately for China none of the other nar- 
 cotics have as yet obtained a footing, such as chloral, 
 chlorodyne, chloroform, ether, and absinthe, that regularly 
 carry ofi" so many victims in Europe, and are sapping the 
 constitutions of large numbers of the very best of our 
 people.* 
 
 Food, — From drinks we pass naturally to consider next 
 the food of the Chinese. Few countries produce such a 
 variety of cheap and good foods as China, and fewer still 
 that will bear comparison with her people in the art of 
 cookery. Their food is of a mixed kind, although the vege- 
 table diet from its cheapness prevails. The chief animal 
 food eaten is pork, combined, as in the North bordering on 
 the grass lands of Mongolia, with mutton. Pigs and ducks 
 are their favourites, because easily reared, and the flesh is 
 more savoury and contains much fat. Earth worms and 
 snails, rats, kittens and puppies, though frequent in the 
 pages of travellers, are fortunately rare in Chinese markets 
 and on Chinese cookstalls. The cow or ox being regarded 
 as semi-sacred (because used in sacriflce to the Supreme 
 Being at the Temple of Heaven, and also used in agricul- 
 ture), comparatively little beef is eaten. In seasons of 
 drought edicts are issued against the slaughtering of bul- 
 locks. If the filthy habits of the pigs in China induced 
 trichinee, the most disastrous results would ensue, for pig life 
 there is simply revolting. Rice, or rice and sweet potatoes, 
 flavoured with pickled vegetables or salt fish, is the staple 
 
 * See paper by the writer, read at the Social Science Association at 
 Liverpool, Sept. 1876, on "Some of the Physiological Actions of Opium in 
 Relation to Health."
 
 35 
 
 food at Amoj. At Newcliwang, in the far north, it is prin- 
 cipally boiled millet, a simple, cheap, and nourishing article 
 of diet, possessing all the essential elements of nutrition, 
 occasionally partaken with vegetables. Six people can live 
 well upon this fcire for four dollars monthly. Dr Watson 
 there says, all who can afford it drink a little coarse spirit, 
 but so sparingly that it is rare to find a drunk person. It is 
 much the same all over China — rice predominating chiefly 
 in the south — and rice, alternated with flour or millet, among 
 the better classes in the north. These are combined with 
 oils, fresh and salted vegetables which supply in abundance 
 all the elements for healthy nutrition. It is remarkable 
 they should have hit naturally upon such a diet ; the legu- 
 minous seeds supplying the nitrogenous matter, and animal 
 and vegetable fats remedying the want of fat in the rice. This 
 diet therefore seems to give them the four essentials for the 
 proper maintenance of the body. Of course there are vast 
 multitudes to whom rice would be a great luxury, and whose 
 diet consists of little more than sweet potatoes and salted 
 vegetables. 
 
 The Chinese partake usually of two meals, one early in 
 the forenoon and one late in the afternoon. Late heavy 
 dinners and suppers, with copious vinous potations, are 
 utterly unknown. The hour for dinner parties is usually 
 two or three o'clock in the afternoon, sometimes earlier. 
 Dyspepsia is one of their most common maladies. The 
 vegetable food is bulky, and the quantity of raw and unripe 
 fruit and vegetables which they consume, combined with so 
 much hot water and tea, confections, pastry, &c., are well 
 calculated to produce dyspepsia. This indigestion exists 
 chiefly in the form of flatulence, with some disturbance 
 necessarily to the heart. They usually style the various 
 forms as a blocking up of the entrance to the stomach ; 
 cardialgia, or more frequently by '-' liver air." Dyspepsia 
 seems far too common among so poor and abstemious a 
 people. One facetious writer has called it " The remorse of 
 a guilty stomach." One of these Chinese dyspeptics com- 
 plained once to one of our brethren, saying that she could
 
 oat nothing, and was subject constantly to pain, and he 
 found that she had just eaten three or four hard boiled eggs 
 — then had taken some Chinese medicine — then several 
 potions of hot water, and at that very moment was steep- 
 ing the red wood of her rouge powder box for a final 
 draught! 
 
 Foreigners in China, and the same holds good of Euro- 
 peans at home, err on the side of eating and drinking too 
 much. It is remarkable that every animal but man keeps to 
 one dish, and some one has said that as many dig the grave 
 with their teeth as with the tankard, and another that if 
 the secret of rejuvenisation be ever discovered, it will be 
 found in the kitchen. I should be far from advocating a too 
 meagre diet, especially in the climate in which we live in 
 China. By experience, in winter at all events, and in the 
 north, we find our wants are even greater than in England. 
 But there can be no doubt, I think, that the excessive use 
 of animal food is one of our national weaknesses. It has 
 assumed an importance which it does not deserve. It is 
 with some the main article at all meals. All the conditions 
 of a good nutritious diet may be found in what is much 
 cheaper. Need I instance good porridge and milk in our 
 own country. The old Roman gladiator's chief food was 
 barley cakes and oil. Our modern meals have ceased to indi- 
 cate what is doubtless the origin of the word. Full animal 
 diet three times daily combined with various liquors, must 
 induce many diseases, and predispose if not excite to inflam- 
 matory attacks, from all of which the abstemious Asiatic is 
 free. If this kind of diet be combined with want of exer- 
 cise, and the persons living in rather a high temperatiu-e, 
 as is the case with many of our Europeans at the open ports 
 in China, I fear it is but natural we should look for some of 
 the maladies already mentioned. I have read of the defini- 
 tion of an Englishman in India, as an individual who eats 
 beef, drinks- brandy, and has no religion ; or as a witty Irish 
 medical man, a friend of my own, once put it — " Europeans 
 come to China, and they eat, and they drink, and they drink, 
 and they eat, and then they die, and afterwards write home
 
 that the climate killed them!"' The temperate in eating 
 and drinking, and who exercise discretion in exposing them- 
 selves to the sun's rays in tropical countries, keep their 
 health as well there as at home. The following are a few 
 of the Chinese precepts in dietetics : Do not offend in 
 quantity — breakfast early — make a hearty meal about noon 
 — eat slowly and masticate thoroughly — do not gratify the 
 appetite so as to rise from the table quite satiated — sup 
 betimes and sparingly — let the food be tender and well- 
 dressed — do not sleep till two hours after taking food, and 
 begin meals by taking a little tea. It is recommended to 
 avoid smelling musk and youDg orange blossoms, which 
 contain imperceptible insects, for fear of such vermin finding 
 a way up to the brain. The air is full of imperceptible 
 germs of various small insects which we suck into the 
 stomach with our breath, but they cannot be hatched there 
 for want of a fit medium, whereas the insects which lay 
 their little ova in the mealy cup of flowers, may be drawn 
 up by the nose with a ferment proper to hatch them. Food, 
 moreover, should be taken a little warm, with the view of 
 keeping up the internal warmth, for the radical moisture is 
 apt to be weakened and evaporate in water and sweat. In 
 summer, especially, are the spirits much spent and the kid- 
 neys weakened. This is a quotation from a book on the Art 
 of procuring Health and Long Life, published in 1697; 
 translated by one of the Jesuits ; to be found in Du Halde IL, 
 p. 236, and as you will observe broaching the germ theory. 
 
 Clothing. — A few remarks on clothing come next for con- 
 sideration. In the material of her fabrics and the shape of 
 her clothes, for both sexes and all ages, China will not suffer 
 in comparison with other nations. In some respects she 
 has the decided superiority ; her clothes are well adapted 
 for the climate and the character of the people. The dress, 
 which is of the most becoming and simple kind, can be 
 adapted with remarkable ease to quickly altered atmospheric 
 conditions, and in this respect tliey teach us a useful lesson 
 in exercising great carefulness in adapting our clothing to 
 sudden changes of temperature. The sameness of our
 
 38 
 
 clothing appears very ridiculous to tliem. The Chinaman's 
 material is changed with the changing season, but the 
 fashion never changes. All Oriental countries are similar 
 in this respect. In winter to strip a Chinese of his clothes 
 might be compared to skinning an onion — the layers 
 are so numerous, and yet his dress remains the same. 
 Without changing the entire suit, he takes off or puts 
 on as occasion requires. In the spring and autumn 
 this is particularly necessary. The morning and even- 
 ing dress is hardly suited for midday, and vice versa. 
 The black-haired race is destitute of shirts, flannels, and 
 anti-cholera belts. Their style of dress, coupled with their 
 style of living, renders some of these foreign requisites 
 unnecessary. Our abdomens are not half so well protected 
 from sudden cold, &c., as those of the Chinese. Diarrhoea, 
 dysentery, colic, &c., are frequently prevented in summer 
 among our Europeans, especially new-comers, by the adop- 
 tion of such belts or bandages. How much mischief is 
 created by our failure to clothe ourselves seasonably ? A good 
 old rule was, not to lay aside winter garments before a warm 
 May, and to put them on before a cold November. Our 
 people certainly err greatly in leaving off winter clothes 
 too early, and not putting them on early enough in autumn. 
 Adjusting dress, according to the vicissitudes of the weather 
 here, in this ever-varying climate, where often "in one 
 monstrous day all seasons mix," is, though difficult, a matter 
 to be carefully attended to if we are to enjoy good health. 
 One has said that " if we are careful, glass will last as long 
 as iron," and Boerhaave has remarked that " only fools and 
 beggars suffer from cold ; the latter not being able to pro- 
 cure sufficient clothes — the former not having the sense to 
 Avear them." Our dress is rendered utterly unsuitable if 
 almost any part of it be touched. We cannot accommodate 
 it to the varying changes of a variable climate like ours 
 without destroying its harmony in most cases. I need not 
 refer particularly to our errors of dress, some of which have 
 been held up to ridicule, and deservedly so by the Chinese, 
 such as tight lacing, tight and stitF colhirs, neckties, sleeves
 
 39 
 
 and vests, cravats, tight and hard boots, high heels, the long 
 traiHng dresses of the gentler sex, the low necked dresses 
 and short sleeves, or rather no sleeves of evening parties ; 
 a practice, let me add, which cannot be supported by one 
 single argument, and which, coupled with heated rooms, 
 iced drinks, hot beverages, chilly lobbies and halls, and all 
 in our winter weather, is most absurd and is certainly the 
 fruitful cause, sooner or later, of much bronchial and pul- 
 monary mischief. There is also exposure of the chest in 
 men — insufficient protection of the abdomen where waist- 
 coat and trousers meet — the dark clothes worn in summer — 
 the crape and black mourning so generally and so long worn 
 in the light of devotion to the departed — bad ventilation 
 through waterproofs, galoshes, and many other points ; not 
 to speak of the more than questionable good taste displayed 
 in short jackets, cut-away coats and tight fitting trousers. 
 The Chinaman's long robes, which are the rule, button close 
 up to the neck, and stretch down almost to the feet, and 
 envelope the whole body. A painting or sculpture, which 
 exposed anything but the head and perhaps the hands, 
 would be set doAvn as barbarous and gross. In summer, a 
 long cotton or silk robe is the chief part of the dress ; in 
 winter, cotton-wadded garments among the middle and 
 lower classes, and the various furs among the higher classes 
 prevail. Nothing could be more neat and tasteful than the 
 ladies' dresses in China, whether of the higher or lower 
 classes. Crinoline and chignons have always been amystery 
 to them. In our campaigns in hot climates, the thick coat 
 and heavy hat, or small forage cap, have destroyed by 
 sunstroke and apoplexy, more lives than the enemy's swords 
 or bullets. Chinese tailors, let me say, sit at their boards, 
 and so are saved from those troubles to which the sons of 
 the needle with us are exposed from their stooping and 
 cramped position. And as to their shoes, the top and sides 
 are made of calico, silk, satin, or velvet, and the soles of 
 several layers of thick paper, rags or felt, protected some- 
 times by a thin outer sole of leather. They are soft and 
 easy to the feet, and these plagues of over-civilisatiuu, corns
 
 40 
 
 and bunions, are almost unknown. The winter shoe is 
 padded with cotton. The Chinese can dispense with boards 
 in their houses, as from the thickness of the sole, one or 
 sometimes two inches, they may be said to carry their floor- 
 ing constantly with them; it raises them above the dirt, 
 damp and wet. These thick soles suit their dignified gait, 
 and the only evil which I have found from their use, is the 
 necessity for constant paring of the toe nails — a regular 
 craft of chiropodists existing in all Chinese towns for this 
 purpose. It can be readily understood that ingrowing nail 
 and the evils of overparing frequently present themselves. 
 Chinese police in the winter are supplied with large sheep- 
 skin coats which keep out the cold thoroughly. In regard 
 to head-dress, in summer they wear generally white straAV 
 hats, which permit a current of air to pass freely round the 
 head, or they have besides large rims which hang down 
 and shade the face, neck and shoulders. In winter, they 
 wear a cap of silk or satin, or a warm soft one of felt. Many 
 expose their heads to the most violent sunshine without the 
 slightest danger, or protect themselves with only a hand- 
 kerchief or fan, but such have been born and brought up in 
 the country. Sunstroke, or heat apoplexy, are unknown at 
 Pekin. No cases of these affections have occurred among 
 foreigners, and we have missionaries of the Protestant, 
 Koman Catholic, and Greek Church, some of whom having 
 adopted the Chinese dress, go about as the Chinese do with 
 impunity without any head covering. 
 
 In the precepts laid down in the native work already 
 referred to for regulating the actions of the day, it is said, 
 "wind is to the air Avhat anger is to the passions, therefore 
 avoid air coming through narrow passages." The proverb 
 is — avoid a blast of wind as carefully as the point of an 
 arrow — during perspiration do not leave off clothes, or ex- 
 pose yourself to fresh air, and the abdomen, even in sum- 
 mer, is to be protected. Change linen frequently, but do 
 not put on clothing that has just been dried in the sun. 
 Clothes stowed away in boxes with camphor are always 
 freely aired before being put on, because of the anaphro-
 
 41 
 
 disiac effect of that substance. The Chinese dress, as a 
 whole, is invuhierable. Can this be said of ours ? 
 
 Disposal of the Dead. — Let me add a Avord as to the 
 Chinese disposal of the dead. China has no public cemeteries 
 in our sense, if we except, perhaps, such as those of the 
 Eunuchs, of the Emperors of a dynasty, and of the official 
 ground set apart for the interment, at the imperial expense, 
 of children deposited at the mortuaries outside the city 
 gates for the poorest of the people who own no land, and 
 for those who die away from home without relatives. 
 All interments are made in private ground, and none is 
 allowed within the walls proper^of cities. It is interesting to 
 note this fact in Chinese civilisation. In respect to this 
 subject we have the testimony of Philologus of Ravenna, 
 the first physician in the west, perhaps, who censures the 
 pernicious custom of having public burying places in popu- 
 lous cities, " which taint the atmosphere with cadaverous 
 streams and frequently occasion fatal distempers. I am 
 astonished " he says, " that the moderns should approve of 
 a practice which the wisest nations of antiquity prohibited 
 by the most solemn laws." Well-to-do families in cities, 
 possess private burying grounds outside, and these are gene- 
 rally covered with grass and planted with firs, cypresses and 
 willows. There is no crowding of the dead. In the country, 
 among the agricultural classes, every one seems to possess 
 a bit of land, the dead are buried frequently in the culti- 
 vated fields of the family. The mounds, although religiously 
 tended, disappear in the course of time under the influence 
 of tillage, the weather and the encroachment upon them 
 year by year, of the crops. China, in this way, may be said 
 to be one vast cemetery, the whole aspect of the country is 
 so studded with mounds. That we do not live entirely 
 among the tombs is owing to their gradual disappearance 
 from the face of the soil. There is one practice, however, 
 which must be condemned, and that is the habit among the 
 better classes of keeping the dead for weeks, months, and 
 sometimes years and generations, from motives of respect- 
 ability, feelings of affection, or temporary inability to inter
 
 42 
 
 with becoming decency, suitable to their position and rank. 
 In seasons of epidemics, such as cholera, smallpox, or diph- 
 theria, this practice is most dangerous. After death, diviners 
 and priests are called in, and a protracted chanting of prayers, 
 weeping, howling, singing, burning of incense, a beating of 
 gongs, bells and drums, is kept up, and I have seen the 
 most disastrous consequences follow this custom. There is 
 this to be said, on the other hand, that the coffins are of 
 substantial wood, very thick, and are well covered with 
 cement, so that they are in most cases air tight. Cre- 
 mation is sometimes had recourse to 'in the case of 
 Buddhist priests of note. European towns suffer from 
 the contaminated air over or near cemeteries. The trees, 
 plants, grass and crops which obtain in China in or around 
 their burying places, must be very useful in the absorption 
 of deleterious substances. 
 
 Exercises and Trades. — Such is the state of civilisation in 
 China, that it may be said there are no particular trades 
 specially injurious to life. Their shops, places of business, 
 and such few industries and manufactories as they have, are 
 all carried on out of doors, or in the free open air. As a 
 rule, they rarely have recourse to exercise, in our sense of 
 the word. Among the Manchus, archery is compulsory, and 
 occasionally among the soldiers, we see them practising 
 fencing, wrestling, throwing the stone, &c. The Chinese 
 and Manchus alike are greatly given to shuttlecock, at 
 which they are most expert, and a great deal of time and 
 pains are bestowed upon bird catching, training, airing, 
 teaching to sing, carrying in cages or on sticks, pigeon 
 flying, and above all, kite flying, pastimes in which adults 
 play the principal part. A most elaborate system of medi- 
 cal gymnastics obtains in China, called kung-fu, which ia 
 both preventive and curative of disease. We find this 
 system principally practised by the Tauist priests, who 
 were the first alchemists in the world. For centuries they 
 have been in search of the philosopher's stone. They have 
 practised healing by magic, charms, friction, &c., and many 
 books have been written on the art of procuring health and
 
 43 
 
 long life. In ancient times, curing by pressure and friction 
 formed one of the thirteen departments of the great Medi- 
 cal College. A most interesting article might be -written 
 on this subject alone. The Chinese thus first gave the idea 
 of the 3Iovement Cure, which is now practised in most Euro- 
 pean countries, founded on the anatomical basis of the 
 Swedish physician Ling. The system was first brought to 
 European notice last century, through an article by one of 
 the Jesuits in their memoires. At the present day curative 
 and prophylactic gymnastics are to a large extent in the 
 hands of the barbers. Besides shaving the head, which, by 
 the by, is done without the use of soap, hot water being 
 only used — and plaiting the queue, they clean the eyes, 
 ears, and nostrils of their customers ; they put the eyebrows 
 in order, and perform generally what is known in Europe as 
 macer or massage. By extending the limbs, and gently 
 rubbing them with the palm of the hand, the circulation is 
 promoted, and tone and suppleness is given to the muscles. 
 The operation generally consists of tapping, kneading, 
 pinching, chafing, and pommelling the body all over, pro- 
 ducing the most delightful sensations and proving very 
 bracing. I have known adults put to bed every night by 
 their attendants so operating upon them. 
 
 Epidemics. — A word as to epidemics. And first small-'pox. 
 This disease is endemic; it is never absent, although in 
 certain years and certain seasons it is much more virulent. 
 It prevails most generally in winter, and unfortunately this 
 is just the season, from superstitious ignorant notions, when 
 the Chinese will not vaccinate. Children only in China take 
 small-pox, but then all take it, Avith very few exceptions. 
 The Chinese laugh at the idea of foreign adults contracting 
 this disease. The poison is supposed to be communicated 
 from the parents to the foetus; all therefore possess the 
 small-pox germ in their constitutions, and only waiting for 
 development — often compared to a flint which requires but 
 to be struck to emit fire. The disease is very fatal. At 
 Canton, in one epidemic, or rather a more than usually 
 virulent endemic attack, 20 to 30 per cent, of the unvacci-
 
 44 
 
 Dated died ; at another time, as many as from 40 to 50 per 
 cent. The mortahty was very inconsiderable among the 
 vaccinated. There are some fifty or sixty professional 
 vaccinators in Canton. About half of the children get pro- 
 tected in this way. The Chinese have taken wonderfully 
 to vaccination, and it is productive of the best results. 
 They have made its practice coincide with their own 
 theories, and although there is thus an air of mystery thrown 
 around it, the success of the operation is not invalidated. 
 They are most particular in regard to the lymph, the con- 
 dition of the child, the season of the year, &c., and their 
 great care is rewarded with great success. The whole sub- 
 ject is full of interest, and useful lessons might even here 
 be learned by us, but space forbids our entering upon it. 
 Their rule is to vaccinate in three distinct places in each 
 arm, and the operation may be termed the hypodermic one. 
 It was introduced into China in 1805. In this country we 
 can hardly now realise the blessings of Jenner's discovery. 
 This disease has been known in China since about the end 
 of the 9th century of our era, and therefore much about the 
 same time as in Europe. Inoculation in China has been 
 known and practised since the Sung dynasty (a.d. 960 — 
 1127). 
 
 Diphtheria existed as an epidemic at Peking in 1866, 
 and is more or less always present, and proves very fatal. 
 I have known of twenty-four deaths in a family of twenty- 
 six individuals within one month. I have not heard of it 
 elsewhere in China. Our brethren at the ports all note its 
 absence. Its origin goes back to 1821, and is attributed to 
 the import of lucifer matches. 
 
 There was an epidemic of Jaundice at Peking in the 
 autumn of 1861, and no fewer than 370 applied at the hos- 
 pital for relief. This epidemic was not owing to any 
 particular article of diet, but to sudden changes of tem- 
 perature. 
 
 Cholera visited China in 1862 and 1863, and was pretty 
 general all over the country. Since that time no epidemics 
 have been witnessed. In 1863, at Canton, from 700 to 1200
 
 45 
 
 died daily for three weeks, and on the 14th July the deaths 
 reached 1500 in twenty-four hours. About 15,000 or 20,000 
 in the two months in the autumn of 1862 were carried off at 
 Peking, and probably as many at Tientsin. It followed the 
 course of the river, attacking the various towns on the 
 banks, and lastly reached the capital. A severe epidemic 
 occurred in China in 1820-23. At Ningpo, 10,000 were then 
 carried off. It prevailed at Amoy in 1842. It has been 
 known in China, as in India, from time immemorial. It was 
 described 2500 B.C. by the very name which it now bears, 
 viz., Iiivo-luan^ an expression meaning something huddled up 
 in a confused manner inside the body, which is evidenced 
 by the vomiting and purging. No doubt the term is also 
 applied to what we designate as English cholera. The 
 Chinese reckon two forms of this disease, the wet and dry, 
 according as there is the presence or absence of vomitino- 
 and purging. The latter or dry, is considered the most fatal 
 form. 
 
 It only remains now to note a few remarks on some 
 of the other more frequent diseases in China, not 
 already referred to, and first in importance comes phthisis. 
 Diseases of the chest are, on the whole, remarkably rare in 
 China. We have already referred to their immunity from 
 heart diseases. Other diseases of the chest, such as pleurisy, 
 pneumonia, acute bronchitis, are hardly known, and phthisis 
 is far from being so common as in this country. The author 
 of the Middle Kingdom, the oldest resident in China, re- 
 marks thus : — '' Diseases of the viscera, of an acute inflam- 
 matory nature, are not so fatal or rapid, nor does consump- 
 tion carry oif so many as in the United States." At Canton, 
 in the south, Dr Wang says, " phthisis is tolerably prevalent, 
 but by no means so common as in Europe and America." 
 Dr Kerr, many years a missionary practitioner there, con- 
 firms this opinion. " It is difficult," Dr Wang says, '* to say 
 why it should be so, as the causes which produce consump- 
 tion, such as bad air, insufficient food and exercise, bad 
 hygiene, &c., must be much more operative, and must exist 
 to a much greater extent here than in the more civilised
 
 46 
 
 countries of Europe and America." One thing ought to be 
 mentioned, he says, in connection with this question (if 
 pneumonia and bronchitis have anything to do with the 
 genesis of phthisis), that the Chinese here are not liable to 
 acute affections of the chest. At an earlier period he 
 writes that he saw only one case of acute bronchitis — the 
 only case of acute affection of the lungs in three years. 
 Idiopathic pleurisy and pneumonia he had never seen; 
 and hasmoptysis in men and especially women is by no 
 means such a sure sign and precursor of phthisis as it 
 is in Europe. Chronic bronchitis is common, and so also, 
 to a certain extent, is asthma. I can endorse most fully 
 and heartily every word of this — it is an exact descrip- 
 tion of our pulmonary practice at the capital. Dr Wang 
 further iftdds, and I now quote his very words : — " The rarity 
 of consumption among country people, and the greater 
 exemption from it of the labouring class in the city, not- 
 withstanding that they are badly housed, and badly fed, 
 must be attributed to exercise and life in the open air, and 
 I am inclined to think, that their food, though poor in 
 quality, is not, as a rule, insufficient in quantity. Still I 
 cannot quite understand why phthisis is not more prevalent 
 than it is among them, especially the country poor, whose 
 food often seems not more than sufficient to support life. 
 Scrofula, another form of the disease" — and here I agree 
 with him too — " is often seen in the hospital. The whole 
 subject," he adds, "deserves investigation." 
 
 Chest affections at Shanghai are not generally severe, 
 and the cases seen are mostly imported. In Formosa, 
 phthisis is common, but of a very chronic nature. Acute 
 disease of the respiratory organs is extremely rare at Amoy; 
 pneumonia and severe bronchitis are almost unknown among 
 resident Europeans there. Dr Smith, at Hankow, reports : 
 " The natives spit blood with little or no provocation at all, 
 and with but very little evil consequences ; consumption is 
 comparatively infrequent," and he suggests '•' that it may 
 be owing to the great frequency of chronic bronchitis." 
 Dr Reid, also of Hankow, is rather inclined to combat this
 
 47 
 
 view, when he considers the great prevalence around him, 
 and in China generally, of the usually recognised causes of 
 the disease. It is certainly staggering to one not thoroughly 
 acquainted with the Chinese constitution, and even then, 
 one is very apt to make one's practice almost unwittingly 
 square with our theories and preconceived notions. After 
 commenting on the various causes that exist predisposing and 
 exciting to the disease, such as we have already enumerated, 
 in the great want of sanitary science, he adds — ''if con- 
 sumption did not follow as a consequence of all this, we 
 should have a result different from what has been observed 
 in other parts of the world, Avhere like predisposing con- 
 ditions are found." But unfortunately for his argument, we 
 have it frequently in this country, where few, if any, of the 
 causes emunerated at Hankow obtain. His causes, I may 
 as well state, are these — that more than half tlie town 
 population are debarred from exercise, and rarely, if ever, 
 inhale fresh air ; that the country people chiefly live on a 
 vegetable diet, and often partake of it in insufficient quantity 
 for the purpose of nutrition ; that the subsoil in many places, 
 and at certain seasons, is saturated with moisture ; that the 
 general health is deteriorated by the action of malaria, and 
 lastly, on the strength of his colleague, Mr Porter Smith, 
 that haemoptysis is acknowledged to be a common occur- 
 rence. He further adds, — " supposing phthisis to be rare, 
 its rarity cannot be ascribed to the absence of a special 
 tubercular diathesis among the Chinese, since the researches 
 of Grerman pathologists have demonstrated that this disease, 
 in the vast majority of cases, is, at its outset, a cheesy dege- 
 neration of inflammatory products, and that this may super- 
 vene on any inflammation of the lungs, although most 
 frequently following chronic catarrhal pneumonia ; and fur- 
 ther, that tubercle is a secondary result, produced by the 
 action of cheesy morbid products on the organism. This 
 tendency to cell hyperplasia and cheesy degeneration is 
 fostered by causes which deteriorate the health, whether 
 acting from without or from within the body, and both 
 classes are frequent enough in China." It is no doubt
 
 48 
 
 frequent — Dr Reid saw 118 cases out of over 5200; but even 
 on his own showing and enumeration of causes, I think 
 Dr Reid would agree with me, that it is after all not so pre- 
 valent as we should have expected, and certainly not so 
 common as in this country where, as already remarked, the 
 same causes are neither so numerous nor so severe. The 
 Chinese hardly know what acute inflammation means, and 
 all admit that even phthisis is very chronic. I have also 
 seen many cases of haemoptysis that have not been speedily 
 followed by its ordinary consequences. No doubt such 
 patients may, and do eventually succumb, but it is very 
 chronic. Bronchial catarrh is exceedingly common every- 
 where in China, and of course particularly .in the northern 
 half of the country, and especially during the long and 
 severe winter. This affection becoming chronic, which is 
 the normal condition, simulates phthisis, and this may ex- 
 plain, perhaps, the frequency of this affection noted at Han- 
 kow ; although we are told special care was exercised in each 
 case to guard against a wrong diagnosis. Speaking of the 
 naval forces in Chinese waters during and after the first 
 opium war, Dr Wilson says — "We had only one undoubted 
 case of phthisis, and that in an officer whose case had 
 clearly originated in England." Bronchitis, he tells us, 
 though not common, occurred more frequently, but was 
 seldom met with as an original disease having much power 
 and apart from common catarrh ; and when it has given 
 rise to pulmonary abscess, without doubt being confounded 
 Avith phthisis. One thing, he says, is certain, that idiopathic 
 affections of the lung are not common at Hong-Kong, and 
 tubercular phthisis originating here has hitherto been all 
 but unknown, if ever witnessed, at least in the naval force. 
 This exemption, he adds, is in conformity with what has 
 been noted in other miasmatous districts — where there is the 
 prevalence of ague, consumption is not rife. 
 
 Dr Reid lays considerable stress upon the proved con- 
 nection between phthisis and abundance of soil-moisture 
 and drainage, and quotes one authority to prove that the 
 death rate of phthisis, in certain English towns, depends upon
 
 49 
 
 the efficiency of the drainage, and Mr Simon declares, that 
 " dampness of soil is an important cause of phthisis to the 
 population living on the soil." On this ground, if on no 
 other, Hankow, and many other places in China, ought to 
 be hot-beds of the disease. If, then, as Dr Reid himself 
 asks, the disease be rarely met with in China, will it show 
 that certain elements now supposed to be powerful agents 
 in rendering phthisis prevalent among a population, have 
 been over-estimated as regards their e\dl influence on the 
 bod}-, or that some other conditions exist which modify or 
 neutralise them ? 
 
 A certain antagonism has been supposed by some French 
 surgeons in Algeria and some American writers, to exist 
 between ague and phthisis. Where the one prevails the 
 other is either absent or very rare ; and certainly the obser- 
 vations made in China would seem to bear out this doctrine, 
 Ague is very prevalent in the centre of China along the 
 course of the great river Yangtse, which is, Nile-like, subject 
 to periodical risings and overflowings. It is also very com- 
 mon in the south, most probably the most frequently met 
 with disease there. At Peking, the soil being sandy and ab- 
 sorbent, and there being little damp or marshy ground, ague 
 in ordinary years is one of the rarest affections. The heat 
 there is extreme for six weeks in summer, and the rain- 
 fall is copious at that time. The streets of the city and parts 
 of the surrounding country are frequently for days and weeks 
 under water. During the great inundations of 1870 and 
 following years in Chihli, ague rose to the first place in point 
 of numbers. In Shanghai, from April, 1860, to July, 1861, 
 28,000 cases were seen ; ten were for pulmonary consumption 
 (seven were well marked), and 1400 were for ague. Tubercle 
 is common, but is confined entirely to the abdominal organs. 
 My experience at the capital all points towards the same 
 conclusion. In Formosa, one practitioner disputes this sup- 
 posed antagonism, and notes forty-seven cases of phthisis in 
 twelve months, and 718 cases of malarial disease. During 
 the summer of 1872, he notes again 340 cases of intermittent 
 fever, and 38 cases of chronic phthisis. At another part of
 
 50 
 
 the same island, during the same time, 20 cases of consump- 
 tion were observed. It might, however, be a question, if 
 malaria do not entirely neutralise it, does it not modify it ? 
 If so, this might account for the prevalence of the one, and 
 comparative infrequency of the other. Or is this great im- 
 munity from consumption (for such we must all admit) where 
 ague is rife, to be accounted for on other grounds, such, for 
 example, as that of heat alone, predisposing, according to a 
 well-known and fully-recognised division of diseases, into 
 abdominal and thoracic, the former predominating in the 
 southern and hot, and the latter in the northern and colder 
 regions 1 
 
 Time forbids my entering on a detailed statement of the 
 other diseases generally met with in China. Suffice it to 
 sum them all up very briefly. Leprosy, both tubercular 
 and anassthetic, is common in the centre and south of China, 
 and it has been known from the most ancient times. A few 
 cases have been observed of both forms in the north. Lazar 
 houses exist — it is not considered contagious. It is looked 
 upon as incurable, and is attributed to the exhalations aris- 
 ing- from low damp ground. — Lymph scrotum and elephan- 
 tiasis are also found abundantly in the south. — There is a 
 good deal of anaesthesia in the north of China proper, not 
 connected with leprosy. The people, and particularly the 
 Mongols, suffer greatly from rheumatism, caused to a large 
 extent by the practice of sleeping on the ground in tents as 
 the nomadic hordes do, and under the eaves of the houses 
 or verandahs, or in the cold kangs, as in China. The tem- 
 porary loss of sensation in such cases is, doubtless, attribut- 
 able to causes similar to those operating in the causation of 
 neuralgia and rheumatism. Diaphoretics are found peculiarly 
 useful. Dr Wilson remarks that malarious districts have 
 seemed to dispose, if not excite, to attacks of rheumatism, 
 but this he did not iind to be the case at Hong-Kong ; and, 
 therefore, he asks if the neuralgic affections have not been 
 set down as rheumatic i The former, he says, are not un- 
 common in malarious positions where the more open and 
 injurious effects of the poison are very rarely manifested. I
 
 51 
 
 may here notice that cases of acute rheumatism have not 
 been observed. — Whooping cough is not known as a distinct 
 disease by the Chinese, although their medical works describe 
 such a disease. It is classed with ordinary cough, and its 
 infectious character is not dreamt of. It is not a prevalent 
 aflfeation. — Scarlet fever is also barely recognised. When it 
 does exist it is usually classed with measles. The latter dis- 
 ease is invariably mild, and I never heard of a fatal case. It 
 may be a question how far small-pox, which is universally 
 prevalent and endemic, has modified or altogether done away 
 with such infantile diseases, so common and fatal in this 
 country. The Chinese sleep on cotton wadded mattresses, 
 so that Dr Salisbury's theory of mildewed straw beds as 
 causing measles does not obtain in China. — The absence of 
 typhoid has been remarked as something very peculiar in 
 view of the physical conditions everywhere existing, and of 
 the habits of the people. Milk has been shown in this country 
 to be a fruitful source of typhoid fever ; but in China milk 
 forms no part of the diet of the people, and here again we 
 have one important factor less in the causation of disease. 
 Scrofula is often seen in China, as evidenced in suppuration 
 of glands, hip-joint disease, and also in spinal curvature, but 
 not so frequently as in our large towns in this country. 
 These affections are found most commonly among women, 
 who, owing to their small feet and the retirement to which 
 custom condemns them, are deprived 5f exercise and exposure 
 to fresh air, two things which are absolutely essential to 
 health, and whose absence is the principal cause of the stru- 
 mous constitution, and much of the phthisis at home with us. 
 With regard to the small feet, it is remarkable that few direct 
 evil consequences, such as necrosis of the bones, or ulcera- 
 tion, etc., result from this barbarous mode of binding these 
 members ; but the indirect results are very great, as witnessed 
 in the strumous constitutions, the ansemia and its lono- train 
 of dependent diseases, such as amenorrhoea and other uterine 
 disorders. Such diseases, peculiar to the sex, are, I suppose, 
 more prevalent throughout China than in any other country, 
 and nowhere is the desire for children — sons at any rate — so
 
 iy2 
 
 great. Aua3inia is the fruitful source of much of the disease 
 in China, and has been by some considered the characteristic 
 and important pathological feature of the Chinese constitu- 
 tion. This condition is caused, in addition to the reasons 
 already advanced, by ague, deficient and improper food, 
 dj'spepsia, itself the effect as well as the cause sometimes of 
 this condition, andby too long continued suckling of their chil- 
 dren. — Boils and carbuncles are very common — one man 
 is reported as having had as many as 200 during one season. 
 Toothache is not very common — supposed, as already said, to 
 be caused by worms — the population at large has very sound 
 teeth, accounted for by their simple dietary. Shock is 
 unknown. No patients, anywhere, bear operations with 
 more fortitude, and owing to their lymphatic temperament, 
 they are followed with less inflammation than usual in Euro- 
 pean practice. Time fails to quote case after case illustrating 
 this point, and also the recuperative power of the Chinese 
 system— recovering from the most fearful accidents, wounds, 
 injuries, burns, operations, &c., with great ease and rajpidity. 
 Many cases that would be adjudged here as hopeless, or as 
 incurable without surgical interference, get well there. 
 Men, to all appearance mortally wounded, have recovered, 
 making one almost doubt whether there really is such a 
 thing as a wound necessarily fatal ; men with the small intes- 
 tines basking in the sun for hours or days, and covered over 
 with dirt ; extraction of calculi filling up the whole bladder, 
 and which, by all the rules of surgery, ought to have ended 
 fatally ; three musket balls extracted from one individual, 
 two of them having passed through the left lung, etc. The 
 way in which operations are borne is perfectly astonishing. 
 Where chloroform has been administered it has attracted 
 universal admiration, and the accounts circulated of this 
 wonderful medicine have not been less wonderful — the ex- 
 traordinary " sleeping medicine," by which^a person could be 
 rendered dead and afterwards brought to life. This has, in- 
 deed, excited their surprise and attention, and it is declared 
 twelve parts wonderful — ton being the natural number. The 
 Chinese require a large amount to render them unconscious,
 
 53 
 
 and their insensibility occurs without ahnost any preliminary 
 excitement. Without chloroform they neither cry nor wince, 
 and this is not to be accounted for, as is often done, so much 
 by a less acute nervous system, but rather to moral training. 
 Their religions systems teach indifference to bodily suffer- 
 ing or to life itself. I have hardly ever met a case in man 
 or woman where objection was offered to taking medicine, 
 or submitting to an operation, provided the latter did not 
 necessitate parting with a member. The idea of the 
 sacredness of the body and the necessity of keeping it 
 entire — dismemberment being considered a sin against one's 
 parents from whom the body was received — of course mili- 
 tate against amputations, and render dissection at present 
 impossible. We have just said that operations are followed 
 with less inflammation than usual in European practice. 
 The Chinese constitutions are essentially anti-phlogistic. 
 Primary aftections of internal organs are seldom encountered, 
 and so strikingly is this the case all over the empire, that the 
 order oi ■phlegmasice of Cullen, forming in other places so large 
 a portion of human maladies, might almost be struck out of 
 the nosological catalogue without even an exception in favour 
 of hepatitis, generally considered the peculiar and overwhelm- 
 ing morbid product of the East. All inflammatory diseases, as 
 remarked by Dr Wilson in 1858, in China and India, assume 
 a far more passive than active form, and require less de- 
 pletion than similar diseases in temperate climates. '• The 
 most sanguine physician," remarks another, " would never 
 ch-eam of bleeding a Chinese." Their diseases are chronic 
 and adynamic. The Mohammedans and Mongols, who live 
 largely upon mutton and meat, generally present more of the 
 inflammatory type, and much more resemble Europeans in 
 their diseases. — Skin diseases, especially scabies, psoriasis, 
 lepra, eczema and pityriasis, are excessively common. — Nerv- 
 ous diseases are remarkably infrequent, and supposed to be 
 owing to the apathetic, peace and quietness-loving charac- 
 ter of the people. The Chinese speak of the heart, seldom 
 of the head, of which they know almost nothing. — Apoplexy 
 among the aged ofiicials, properly predisposed to it by their
 
 54 
 
 obesity, and tlie necessity of performing the nine prostra- 
 tions before the Emperor so frequently, is not very nncom- 
 mon, and of course there is paralysis, chiefly in the form of 
 hemiplegia. Paraplegia, general paralysis, softening of 
 the brain and chorea, are quite uncommon. Epilepsy is 
 met with, and a few cases of idiocy and imbecility have 
 been seen. There are no lunatic asylums, and the presence 
 of much insanity is highly improbable, considering the high 
 estimate entertained of foreign medicine, which would draw 
 to our hospitals such cases if they existed, and from a review 
 of their whole condition, we should certainly not expect to 
 find it prevalent. — Cancrum oris or stomatitis is common, 
 of course in young, unhealthy, anemic, pot-bellied, scrofu- 
 lous-looking children. — Goitre is very frequent in the north 
 among both sexes. It is found also on the plains and in 
 our large cities, and frequently in the absence of the sup- 
 posed ordinary producing causes. They have for centuries 
 been aware of the power exercised by seaweed ever tumours 
 of this and other classes. — Abscesses, ulcers, simple tumours, 
 necrosis of bones, especially of the left lower jaw, are 
 exceedingly common, in fact constitute a large proportion 
 of our practice. — Diseases of the eye are, of course, very com- 
 mon, the chief being conjunctivitis, leucoma,entropium, ptery- 
 gium, corneal ulcers, and trichiasis. — Throat affections are 
 common — their universal plan of counter irritation outside, 
 by pinching the skin of the throat, is curious. — Hernia is 
 more common in China among men than probably in any 
 other country. The native faculty and people are ignor- 
 ant of its condition or cause, and suppose it to be a 
 collection of air, and so frequently puncture it. — Fistula 
 in ano and hagmorrhoids, the former called the drip- 
 ping or leaking ulcer, are terribly common. — Constipa- 
 tion is very common. — In summer, diarrhoea and dysen- 
 tery are very frequent, caused chiefly by eating the early 
 unripe fruits and vegetables, and in too great a quantity, 
 and probably also by exposure at night and sudden and 
 severe vicissitudes of temperature. There is much less 
 prostration under attacks of dysentery amongst the natives
 
 than among Europeans. Chinese diarrhoea and dysentery, 
 if not among opium smokers, are generally very mild and 
 very amenable to simple treatment, and, as already stated, 
 congestion and inflammation of the liver, so fatal to 
 foreigners, are very rarely, if ever, met with among 
 them. Liver diseases are generally considered to be the 
 effect of climate, but China rather disproves this. I think 
 they are more likely owing to errors of diet. Some of our 
 brethren have drawn attention to a close connection between 
 typhoid and certain forms of malarious fevers. A question 
 which does not yet seem settled is, can typhoid originate 
 de novo from the decomposition of fsecal accumulations and 
 the like ; or, in other words, is it of spontaneous develop- 
 ment? There is some evidence collected in China which 
 seems to point to the latter. — Harelip is not very common, 
 and where it does exist, there is no desire to have it reme- 
 died. They think it cannot be cured, and are generally 
 afraid to meddle with what is natural, and has been received 
 from one's parents. They are wonderfully free, as a people, 
 from deformities, monstrosities, and such like. The Chinese 
 never intermarry with one of their own name, and this may 
 account for the absence of any diseases supposed to be 
 depending upon or derivable from consanguinity. And 
 what is the salvation of any country is early marriage, which 
 is universal in China, from the desire to have sons to hand 
 down their names and worship at their tombs. The children 
 are suckled at the breast for about three years. It is aston- 
 ishing what a greatly increased amount of the milk secre- 
 tion is obtained in China, even by European mothers, by the 
 consumption of a regular daily quantity of well-made rice 
 or millet gruel. The introduction of rice was opposed in 
 Ireland, because of its supposed property of preventing 
 fertility. China is opposed to the potato on the same 
 grounds. Infant mortality here is said to be very high, 
 and improper food to be the cause j)ar excellence. The 
 Chinese substitute for breast milk is a pap made of rice, 
 flour and sugar, with which the child's gums are smeared. 
 There is no registration in China, and there are no means of
 
 56 
 
 arriving at an estimate of the mortality of either infants or 
 adults in Chinese cities, except by numbering them as they 
 pass out of the city gates. In every house there is supposed 
 to be a list of the inmates hung up, subject to the inspec- 
 tion of the police. Whatever the rate of infont mortality 
 may be, we do not think it is so high as in Europe. Many of 
 the same causes affecting the adult must also have their 
 favourable effect on their offspring. One thing is certain, 
 infanticide does not prevail to the extent so generally be- 
 lieved among us ; and in the North, whence Europe derived 
 her ideas chiefly from the Jesuits of last century, it does 
 not exist at all. Disinfection, separation or isolation in cases 
 of disease, are but little practised. When had recourse to, 
 fire is the usual instrument. Poverty too often prevents 
 this expensive process from being carried out, and the worst 
 results are to be feared from the purchase of second-hand 
 clothes. Infection is, no doubt, thus frequently propagated, 
 through the pawn-shops especially, which everywhere 
 exist, and are extensively patronised by the poorer classes? 
 and are the hot-beds of infection. On the accession of cold 
 weather, when the winter garments are withdrawn from 
 these establishments, we invariably have an outburst of 
 small-pox which lasts over the winter, proving very fatal — 
 sadly pitting or blinding those who recover. It might prove 
 interesting to classify and tabulate the diseases of China 
 according to the order of frequency, as seen at the ports, in 
 the Mission hospitals for the Chinese, and among Europeans, 
 as seen in .private practice. The hospital and customs' half- 
 yearly reports would furnish the data, but space forbids. 
 The following very brief statement may suffice : — 
 
 At Peking, in the extreme north, in 1865 and 1866, for 
 example, out of 3157 and 8066 patients respectively, the 
 leading affections were— asthma and chronic bronchitis, 252 
 and 885 ; dyspepsia, 349 and 634 ; rheumatism, 140 and 200 ; 
 ulcers, 144 and 378 ; scabies, 152 and 1074 ; conjunctivitis, 
 236 and 342 ; diarrhoea, 45 and 54 ; dysentery, 20 and 138 ; 
 neuralgia, 51 and 224; phthisis and tabes mesenterica, 
 33 and 171: struma. 50 and 132: affections of the ear.
 
 57 
 
 08 and 122 ; abscesses, 95 and 190; ague, 4 and 31 respec- 
 tively. 
 
 At Chefoo,in the north, on the sea, probably our best sani- 
 tarium in China, the order runs — dyspepsia, eye disease, skin 
 disease, and winter cough. 
 
 At Hankoio, in the centre, Dr Reid reports in one year, 
 out of 5213 patients — chronic rheumatism, 288 ; ague, 118 ; 
 phthisis, 118 ; bronchitis, 250 ; dyspepsia, 246 ; diarrhoea, 80 ; 
 conjunctivitis, 132 ; eczema, 113 ; ulcers, 138 ; scabies, 334. 
 In another report, he states the order to be, and all of the 
 most chronic kind — rheumatism, dyspepsia, malaria disord- 
 ers, bronchitis, phthisis, conjunctivitis, ulcers, dysentery and 
 scabies. 
 
 Dr Porter Smith, of the same place, in 1864-65, out of 
 18,764 patients, catarrh and bronchitis were represented by 
 2876 cases ; rheumatism, 2506 ; skin diseases, 2624 ; ulcers, 
 2100 ; eye diseases, 3769, of which 1433 were for conjuncti^dtis 
 alone. 
 
 At Foochoiv, in the south, in the summer of 1871, out of a 
 foreign population of 1774 there were seen 309 cases, and the 
 order was the following — dyspepsia, 64 ; diarrhoea, 43 ; 
 gonorrhoea, 28 ; ague, 22 ; dysentery, 17 : primary syphilis, 
 16. 
 
 At Simtow, further south, the figures stood— ague, 101 ; 
 ulcers, 89 ; secondary syphilis, 87 ; dyspepsia, 80 ; ophthal- 
 mia and chronic bronchitis, each 64 ; rheumatism, 57 ; anas- 
 mia, 44. 
 
 At Canton, in the extreme south, the leading affections 
 were — ague, 46 ; diarrhoea, 39 ; rlieumatism, 13 ; boils, 14. 
 
 In Formosa, also in the south, the cases stood for the 
 summer six months of 1872 — 197 cases of quotidian ague ; 
 94 of tertian ; 49 of quartan ; 118 of remittent fever; 82 of 
 chronic rheumatism ; 148 of enlarged spleen ; 68 of dysjoep- 
 sia ; 67 of chronic ulcers ; 96 of chronic conjunctivitis ; of 
 diarrhoea, 25 ; ana3mia, 44 ; chronic bronchitis, 39 ; phthisis, 
 38 ; v/orms, 30. 
 
 This must suffice to give a general idea of the prevail- 
 ing diseases in the three regions of China, and, with the
 
 58 
 
 exception of Hankow and Peking, all bordering on the 
 coast. 
 
 Remittent and intennittent fevers, as om* remarks may 
 have already indicated, are extremely common in the south, 
 and form by far the largest proportion of the diseases pecu- 
 liar to these regions. Among our forces in China, in 1842, 
 periodic fever with chronic fluxes, partly dysenteric and partly 
 diarrhoeaic, were the great endemic affections which attacked 
 them. These fluxes often succeeded attacks of fever, were 
 frequently reciprocal mth, and appeared to be \-icarious of, 
 them. Rice is largely cultivated in the wann, moist south, 
 and it is to this marshy, SAvampy land, we owe the presence 
 of so much fever. Dr Wilson has thrower out the supposition 
 in the form of a query, that the exhalations from paddy fields 
 under regular management, and jdelding healthy products of 
 vegetable growth, may give rise to intermittent, while the 
 stronger poison exhaled from marsh land, tlu-ough processes 
 of rapid and multiplied destruction of vegetable matter, may 
 occasion the more concentrated and fatal remittent fever. He 
 thinks if the surface could be deprived of its malarious ema- 
 nations, and the diseases now inoperative Avere to remain so, 
 Hong-Kong (and this would hold true of China generall}^) 
 AA^ould be one of the most salubrious spots in the Avorld. Much 
 has been done in this dii'ection since these remarks Avere 
 written, Avhen Hong-Kong became a colony of om's. The 
 above Avriter dAvells somcAvhat largely on this subject, and 
 from its oaa^i interest and its close connection Avith the scope 
 of this paper, I make no apology for giAang a summary of the 
 Adews enunciated. In his Medical Notes on China he states 
 that that country ought to be one of the most salubrious, as 
 it is naturally one of the most favoured, portions of the earth's 
 sm'face. What is detrimental is believed to be chiefly the 
 wilful Avork of man's hands, or of his neglect and perverse 
 ignorance. Certainly some diseases, such as ague, fluxes, 
 ulcers and sldn affections, might be reduced in frequency and 
 force if the people abandoned some of their agi'icultural and 
 economic usages. He mentions the substitution of Avheat for 
 rice cultivation as the first simj^le and most poAverful instru-
 
 50 
 
 merit. Wherever land can be got to bear rice it is eagerly 
 employed for that pm'pose. This would do away with marsh 
 land, and by virtue of the absorbent natm-e of the soil, for our 
 expensive and laborious drainage he sees scarcely any call in 
 China. As they have long ago adopted one American article 
 (tobacco), and universally use it, he advises the use of the 
 potato, a native of the same country, which at present is ex- 
 cluded from Chinese diet. Next in order of importance are 
 the measures requued to correct the more limited morbific 
 influence created and dihgently fostered by man, and not the 
 product of the soil and climate. He would recommend entire 
 change of plan of the towns and structure of the houses; 
 would ^aden streets, make sewers and gutters, and render 
 compidsory the speedy removal of dirty and rapidly-decom- 
 posing matters from narrow, croAvded lanes. He adds that it 
 may well excite surprise that such positions do not prove much 
 more unhealthy than they are, and become every year abso- 
 lutely pestilential. And this becomes more sm-prismg when 
 viewed in connection with the domestic and personal habits 
 of the people, and here entire change is required to secure great 
 increase of health and enj oyment. The one word " cleanliness " 
 expresses the want. Itch, which is so universal, and cutaneous 
 diseases generally would thus be got rid of. The want of this 
 virtue must be other^vise mjurious to health. If we bear in 
 iTiind the utter absence of all sanitary science, which we have 
 attempted briefly to pourtray, the narrow streets, pent-up 
 houses, dense population, Avant of ventilation, earthen floors, 
 absence of cellars, sewers and other channels for under-groimd 
 purification, stagnant pools and pits of putrefaction m all 
 chrections, Avith a liigli atmospheric heat for half the year, it 
 is astonishing that the country is not sAvept incessantly by 
 fearful epidemics, and ere long depopulated. And we should 
 expect the people to be stiU more unhealthy, and the ravages 
 of disease A^ery much greater, if we consider then- food, mala- 
 ria, extensive use of opium and tobacco, and some would add 
 Aveak tea, then- Avant of personal cleanhness, no body hnen, 
 almost no washable clothes, and the use of the same ganiients 
 day and night, and A\dien unfit for outside Avear, receiving
 
 60 
 
 another layer, each layer gradually niovmg iiiAvarcIs a stage 
 until thrown off, etc. 
 
 Nqw, if all tliis be true — and no one who knows China "wall 
 fail to admit the truth of the description — we may well ask, is 
 theu' general freedom from disease, and especially acute disease, 
 and the general health, vitaHty and activity they exhibit not alto- 
 gether very remarkable ? If western sanitary science could re- 
 lieve them almost enth'cly of the affections already indicated as 
 prevaihng, without planting the diseases of modern Em'opean 
 life, we should have a coimtry the most populous, the pm'est 
 from disease in the world ; and at the same tune it is but 
 reasonable to expect that many of their uncontrollable epidemic 
 or endemic diseases would be greatly lessened and moderated. 
 Small-pox would disappear before vaccination, and the world 
 might then have some hope of stamping out this loathsome 
 disease. 
 
 Dr Wilson explains the absence of many diseases which are 
 elsewhere frequent and occasion much mortahty, but which 
 in China are comparatively uncommon and imimportant, by 
 saying that perhaps the endemic diseases, periodic fever, flux 
 and small-pox, being the chief destructive agents, absorb and 
 occupy the place of other morbific powers, and that theu' in- 
 fluence is such as not to tolerate the rival action, or even to 
 any extent the inferior operation of the more ordhiary causes 
 of disease. Like Aaron's rod among the wands of the magi- 
 cians, they swallow up antagonists which, though feeble m 
 then* presence, are formidable elsewhere. 
 
 Concluding Remarks. — I have thus attempted, as briefly as 
 possible, to give a notion of the causes and conditions of dis- 
 eases in China, and the extent to wliich they prevail. I tliuik 
 it is impossible to overrate the influence of climate, food, cus- 
 toms and habits on health as well as on disease. The pecu- 
 liarities of the Cliuiese in these respects have been acting in 
 imbroken order through long series of years. The endemic 
 diseases, as suggested above, may too, to some extent, have 
 had their influence in checldng or neutralising the morbific 
 germs of other chseases, or at least giving the people a certam 
 amount of protection. "We know the natives are less susceptible
 
 61 
 
 to malarious and other nialigu inllucuces than Europeans, but 
 this cause does not, I think, explain all the phenomena. There 
 are many useful lessons to be learned from a study of Chinese 
 character and habits as aflfectmg health. The one word 
 sohrieiy might smn up the most obvious of the causes of the 
 favom'able conditions as to health and duration of life which 
 obtain in China. Napoleon said intemperance was incom- 
 patible mth gi-eatness. A review of the conditions of disease 
 in China leads us to believe that msobriety, in its widest accep- 
 tation, is mcompatible mth health and freedom from disease. 
 Sobriety is defined by one to be — that we should neither eat 
 nor drink more than is necessary for our constitution, in order 
 to perform the functions of the mind with ease. The true 
 rule of diet to every man, according to another writer, is his 
 natm'al undepraved appetite. Excess is an enemy to nature 
 — moderation in every affection and enjoyment is the way to 
 preserve health. The Chinese partake sparuigly of flesh, in 
 ]uany cases from sheer poverty, in other cases from religious 
 motives, and in others again to prevent " fires " (inflamma- 
 tions), as they express it, from originatmg in the system and 
 setting up chseased action. Buddhism, with its doctrine of 
 the transmigration of souls, has rendered an important aid to 
 health by inducing among its priests total abstinence from 
 animal food, and general temperance in this respect among 
 the people as a whole. In certain diseases in our o^Yn country 
 our physicians prescribe low diet and absence of animal food, 
 and -with reason and advantage. A trial of a similar regime 
 in health might be equally profitable for both soul and body. 
 If temperance — that is, sufficient for wants but not for luxu- 
 ries — in eating and drinking were more strictly observed, 
 we might hear less frequently of high fevers, acute diseases 
 and general inflammations. It is here, perhaps, where 
 Europe might with great advantage assimilate herself more 
 to Asia, and by so doing acquire much that would prove 
 useful in enabling her people to resist morbific influences. 
 And as Cornaro expresses it, there would then be the absence 
 of all those "distempered humours which bring on defluxions." 
 He enjoins a sober regular life as the onh^ happy one in its
 
 G2 
 
 consequences; and he exhorts and beseeches all men of sense 
 and resolution to possess themselves of this source of health, 
 more valuable than all the riches of the universe. We never 
 realise what a state might be if its citizens -were temperate 
 in all things. Taking just enough to live upon is the rigid 
 natural law. By obeying this law as nearly as possible we 
 should be comparatively free from the external cause of the 
 induced diseases, and better, or at least well, protected against 
 the consequences of those diseases springing from uncontrol- 
 lable causes. As already stated, although the most sober of 
 peoples, the Chinese drink no inconsiderable quantity of spirits, 
 but excess is almost unknown. They form no exception, there- 
 fore, to the rule that all nations have practically repudiated 
 the doctrine of Avater being the simple salutary beverage de- 
 signed by nature. From a pretty large and extended ex- 
 perience in China, I can, however, confidently assert that the 
 aqueous regime has guaranteed the best health and longest 
 term of residence there among Em-opeans, and the more 
 slowly we de^-iate, if at all, from this com-se the better. Tea. 
 Yvdll be found the most wholesome beverage, promoting health 
 and happmess by doing away "\^'ith noxious and intoxicating 
 potions. So far its introduction has been accompanied -with 
 the most salutary consequences, and it is behoved that its ex- 
 tensive consumption will most effectually counteract drunken- 
 ness and promote health. The author of the Bide to Khiva 
 correctly puts it when he says, " This beverage (tea) becomes 
 an absolute necessity when riding across the Steppes in mid- 
 winter, and is far superior in heat-giving propei-ties to any 
 T\dnes and spuits. In fact, a traveller would succumb to the 
 cold in the latter, when the former \vi\l save his hfe." Tea has 
 been the national beverage of a thu'd of the population of the 
 globe for the last 1500 years. The use of boiling and boiled 
 water, either alone or "\\dth a Httle tea in it, is characteristic of 
 the people, and has been productive of much good and of the 
 prevention of much disease. The astringency of the tea, lilve 
 the use of betel nut in India, has been a corrective against 
 dysentery and diarrhoea, and the boihng of the water has 
 obviated typhoid fever, diarrhoea, calculus, and other diseases.
 
 63 
 
 We cannot lay too much stress on regularity in everything 
 — hom-s of sleeping, eating, working and exercise. With 
 the Chinese there is the perfect appropriation of the sunhght 
 in preference to artificial illumination. They rest, work and 
 sleep in periods that precisely accord with the periodicity of 
 nature. They rethe early to rest, opium smokers excepted. 
 The streets of Chinese towns are deserted shortly after sunset. 
 They rise early ; the Emperor and his court at or shortly after 
 midnight. The business of the emphe for the day is all 
 transacted long before we should think of getting up. Some 
 of then- fairs are held before, or just at, sunrise. The value 
 of regular hom*s and of rest is Httle thought of here, and too 
 little inculcated. The almost invariable answer given by 
 aged persons as to the cause of then- longe\dty is early hours 
 and regular habits ; and some one, merely looking at the sub- 
 ject in its commercial aspect, has made a calculation of the 
 saving in gas and candles which such a course would bring 
 about, and it is simply astounding. The Chinese are 
 always struck with our activity in everything — we cannot 
 even walk slowly ; and although we have enough of tune and 
 money, it may be, we must stiU be going a-head, rushing and 
 bustling, little thinking that " nourishing our heart," as they 
 call it, is any concern of ours. Above all things, the Cliinese 
 enjoin peace of mind and quietness of body — avoidance of 
 anger, fear, grief, anxiety and the violent exercise of the 
 passions generally, to which are ascribed more than half their 
 disease. The Westerns seem a riddle to them — they fail to 
 understand us. We have carried industry and competition to 
 an extreme. Our social exigencies override our philosophies. 
 Competition in business, speculation, reHgious controversies 
 party pohtics, etc., undermine om' health and increase our 
 mortality retm'ns. The Chinese do everything quietl}'' and 
 methodically, without the slightest exertion or fuss. They 
 seldom do anythmg for themselves which can be done by 
 another. They have few ups and downs in theh world. 
 Fate regulates everything, and so they are content with their 
 lot. If they have wealth they use it ; if none, they do with- 
 out it. Tliev live on in one unbroken routine Worrv is
 
 64 
 
 unknown. General indolence and ease, disinclination to bo 
 troubled about matters, a desii'e to let things take their 
 course, trusting that all A^dll come right, are their characteris- 
 tics. This state of feeling, partly inculcated by their various 
 rehgious systems and occasioned partly by the chmate, and 
 in accordance ^Aatli their unstimulating food and al^^^H^ious 
 habits, conduce most effectively to the permanence of their 
 institutions and indispose them for any change in their cus- 
 toms. I must forbear enlarging further on this subject, as 
 this paper has already exceeded the Hmits assigned to it. We 
 trust some of the views advanced may have the effect of 
 directing the profession to a consideration of our habits of Hfe 
 and civilization generally as bearing upon the question of 
 health, antl the causation, conditions and prevalence of dis- 
 ease. 
 
 DUNN AND WEIGHT, PEINTERS, GLASGOW
 
 ,i52p(e- ■' -- r^i 
 
 UNIVERSITY OF CALIFORNIA LIBRARY 
 
 Los Angeles 
 This book is DUE on the last date stamped below. 
 
 AUG 2 9 1967 
 AUG 2 7 RECTI 
 
 ^: 
 
 '^ 
 
 [2 WKS FROM RECtlPT 
 
 yULO 9 199 
 
 JiQN-.^ENtVvAtlLE 
 
 Form L9-100m-9,'52(A3105)444
 
 • 
 
 3 P58 00349 
 
 '58