which a close fitting wheel is worked by the feet or hands. The use of acids and reagents is unknown, for they imply more knowlege of chemistry than the Chinese possess. Vegetable substances, as camphor, myrrh, ginseng, rhubarb, gentian, and a great variety of roots, leaves, seeds, and barks, are generally taken as pills or decoctions. Ginseng and rhubarb are extensively administered, a dose would hardly be considered complete without them.

The people sometimes cast lots as to which one of a dozen doctors they shall employ, and then scrupulously follow his directions whatever they may be, as a departure there from would vitiate the sortilege. Sometimes an invalid among the poor will go to a doctor, and ask for how much he will cure him, and how soon the cure can be performed. He states the diagnosis of his case, the pulse is examined, and every other symptom investigated, when the bargain is struck, and a portion of the price paid. The patient then receives the suitable medicines, in quantity and variety better fitted for a horse than a man, for the doctor reasons that out of a great number it is more likely that some will prove efficacious, and the more he gets paid for, the more he ought to administer. A decoction of a kettle-full of simples is drunk down by the sick man, and he gives up both working and eating; if, however, at the expiration of the time specified he is not cured, he scolds his physician for an ignorant charlatan who cheats him out of his money, and seeks another, with whom he makes a similar bargain, and probably with similar results. Sagacious observance of cause and effect, symptoms and pains, gradually give a shrewd physician great power over his ignorant patients, and some of them become both rich and influential a skilful physician is honored as the "nation's hand."

;

There is a regular system of fees among the profession, but the remuneration is often left to the generosity of the patient. New medicines, pills, powders, and salves, are advertised and puffed by flaunting placards on the walls of the streets, but the Chinese have not adopted the system of puffing new nostrums by publishing a long list of recommendations from patients. Some of these handbills are abominably indecent in their details. The various ways devised by persons to dispose of their medicines exhibit the ingenuity of the Chinese. Sometimes a man, having spread a mat at the side of the street, and marshal

PRACTICE OF PHYSICIANS.

187

led his gallipots and salves, will commence a harangue upon the goodness and efficacy of his preparations in loud and eloquent tones, until he has collected a crowd of hearers, some of whom he manages to persuade will be the better for taking some of his potions. He will exhibit their efficacy by first pounding his naked breast with a brick till it is livid, and then immediately healing the contusion by a lotion, having previously fortified the inner parts with a remedy; or he will cut open his flesh and heal the wound in a few moments by a wonderful elixir, all of which he alone has to sell. Others, more learned or more professional, erect a pavilion or awning, fluttering with signs and streamers, and quietly seat themselves under it to wait for customers; or content themselves with a flag perched on a pole, setting forth the potency of their pills. Dentists make a rosary or necklace of the rotten teeth they have obtained from the jaws of their customers, and perambulate the streets with these trophies of their skill. In general, however, the Chinese enjoy good health, and when ill from colds or fevers, lie abed and suspend working and eating, which in most cases allows nature to work her own cure, whatever doses they may take. They are perhaps as longlived as most nations, though sanatory statistics are of course wanting to enable us to form any indisputable conclusions on this head.

The classes of diseases which most prevail in China are ophthalmic, cutaneous, and digestive; intermittent fevers are also common. The great proportion of affections of the eye which are met with has often attracted observation. Dr. Lockhart, in his report of the hospital at Chusan, ascribes it partly to the inflammation which often comes on at the commencement of winter, and which is allowed to run its course, leaving the organ in an unhealthy condition, and very obnoxious to other diseases. This inflammation is beyond the skill of the native practitioners, and sometimes destroys the sight in a few days. Another fruitful source of disease is the practice of the barbers of turning the lids over, and clearing their surfaces of the mucus which may be lodged there. He adds, "If the person's eyes be examined after this process, they will be found to be very red and irritated, and in process of time chronic conjunctivitis supervenes, which being considered proof of insufficient cleansing, the practice is persisted in, and the inner surface of the lid becomes covered with granulations. In other cases, it becomes indurated like

thin parchment, and the tarsal cartilages contract and induce entropium." Dense opacity of the cornea itself is frequently caused by this barberous practice, or constant pain and weeping ensues, both of which materially injure the sight, if the patient does not lose it. The practice of cleansing the ears in a similar way frequently results in their serious injury, and sometimes destruction. When the ill effects of such treatment of these delicate organs must be plain to every observing person in his own case, it is strange that he should still allow the operation to be repeated.

The physicians in charge of the missionary hospitals so successfully established at Canton, Amoy, Hongkong, and other places in China, have attended more to diseases of the eye than any other class of maladies, and the number of cases brought under their notice consequently bears an undue proportion to the whole catalogue. The forms of these diseases most common are ophthalmia and opaque cornea, of which, out of 2190 cases treated by Dr. Parker at Canton in 1836, there were 375, or nearly one sixth of them of the various species of acute, chronic, purulent, and rheumatic ophthalmia, and ophthalmitis; and the same proportion of opaque and ulcerated corneas. Of the total number of cases, 160 had cataracts, 171 were operated upon for entropium, and 148 had lost both eyes. At Amoy, out of 571 cases of eye diseases, there were 233 or about three sevenths, afflicted with conjunctivitis, much of which may be ascribed, probably, mediately or immediately, to the dealings of the barbers. At Chusan, a still greater proportion of affections of the lids and cornea, referrible to this same practice, was noticed, there being, out of 1554 cases registered in 1840, more than eight hundred of them diseases of these parts. Cataracts are common, especially among aged persons, and their frequency is ascribable, mainly, to the inability of the natives to couch them.

Asthma, even in boys, frequently occurs at Amoy, and consumption at Canton and Chusan. Intermittent fevers are common at the south, and more or less wherever the cultivation of rice is carried on near villages and towns. Elephantiasis is more frequent at Chusan than Canton, where leprosy seems to exist as its equivalent. This loathsome disease is regarded by the Chinese as incurable and contagious. Lazar houses are provided for the residence of the infected, but as the allowance of poor patients is

DISEASES MOST COMMON IN CHINA.

189

insufficient for their support, they go from street to street soliciting alms, to the great annoyance of every one. As soon as it appears in an individual, he is immediately separated from his family and driven forth an outcast, to herd with others similarly affected, and get his living from precarious charity. The institution of lazarettoes is praiseworthy, but they fail of affording relief on account of the mismanagement and peculation of those who have their supervision; and those who cannot get in are obliged to live in a separate part of the city. Lepers can intermarry among themselves, but on account of poverty and other causes, they do not often do so, and the hardships of their lot soon end their days. This disease will probably exist among the Chinese until houses are built more above the ground, better ventilation of cities, and improvement in diet, are adopted, when it will disappear as it has in southern Europe.

Diseases of the viscera of an acute inflammatory nature are not so fatal or rapid among the Chinese as Europeans, nor do consumptions carry off so large a proportion of the inhabitants as in the United States. Dyspepsia has been frequently met at Amoy, and is ascribed by Dr. Hepburn to the abundant use of salt provisions, pickled vegetables, and fish, irregularity in eating, opium smoking, and immoderate use of tea; though it may be questioned whether the two last reasons are more general and powerful at Amoy than Canton, where dyspepsia is comparatively rare. The diseases which result from vicious and licentious habits are not as violent in their effects as in countries where a greater use of animal food and higher living render the system more susceptible to the noxious consequences of the virus.

The existence of tumors and unnatural growths in great abundance and variety, which the establishment of the missionary hospitals has brought to notice, is satisfactorily accounted for by the inability of the native practitioners to remove them. Those which had a healthy growth increased until a morbid action supervened, and consequently sometimes grew to an enormous size. A peasant named Hu Lu went to England in 1831, to have an abdominal tumor extirpated weighing about 70 lbs.; he died under the operation. None so large have been removed at the hospitals in China, but great numbers of smaller ones on the neck and trunk have presented, and in most cases been safely removed. No patients bear operations with more fortitude than the Chinese,

and owing to their lymphatic temperament, they are followed with less inflammation than is usual in European practice. Goitre is common in the mountainous regions of the northern provinces, attended with its usual accompaniment of mental weakness or idiocy; Dr. Gillan estimated that nearly one sixth of the inhabitants met in the villages on the high land passed through by the embassy on its way to Jeh ho, were afflicted with this deformity; which, however, is said not to be so considered by the villagers themselves.

The Asiatic cholera has been almost as great a scourge in China as any other country in the world, but no data are available to show its progress. It raged at Ningpo in May, 1820, and an intelligent native doctor informed Mr. Milne (Repository, Vol. XII., p. 487), that it was computed that ten thousand persons were carried off by it in the city and department of Ningpo, during the summers of 1820-23. In 1842, it prevailed at Amoy and Changchau fu, and their vicinity, when more than a hundred deaths daily occurred at the former place, for six or seven weeks. It has never taken an epidemic form at Canton, but sporadic cases constantly occur. It raged violently at Hangchau fu, the provincial capital of Chehkiang, in 1821 and 1822, persons often dropping down dead in the streets, or dying in an hour or two after an attack; many myriads were computed to have fallen victims, and the native doctors finding their remedies useless, gave up all treatment. It carried off multitudes in Shantung and Kiangsu during the same years, and was as fitful in its progress in China as in Europe, going from one city to another, passing by towns apparently as obnoxious as those visited. The plague is said to have existed in southern China about the beginning of the sixteenth century, but it has not been heard of lately.

Small-pox is a great scourge, and although the practice and utility of vaccination have been known for twenty-five years past at Canton, its adoption is still limited even in that city. It was first introduced in 1820, by Dr. Pearson, of the East India Company's establishment, and native assistants were fully instructed by him in the practice. Vaccination has now to a greater or less degree extended over all the eastern provinces, and the government has given its sanction and assistance; and it is chiefly owing to the heedlessness of the people in not availing them