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MEDICAL
EXPERIENCES OVER 20 YEARS IN CHINA
A lecture by Dr. Clarence Holleman, January,
1942
(A photocopy of the original document was provided to me
by former members of the Amoy Mission,
Dr. and Mrs. Jack and Joanne Hill)
Gentleman,
It is a great privilege to be here. There is nothing in my professional
life that I have missed so much as the opportunity to exchange opinions
with and learn from my professional colleagues. It is all very well to
read religiously the various periodicals and medical books, but there
is a great gulf between reading and hearing that can be bridged only by
diligent application to ones' studies. I do not flatter myself that I
can make any contribution to your medical knowledge but I can, perhaps,
tell you a few interesting facts out of some twenty years experience in
China.
To do so, I must really begin several months before we sailed for China.
While I was a resident surgeon in Cleveland, my wife and I were one day
taking a Sunday afternoon walk through the colored district. We had a
hearty laugh when we came across a sign reading:
DR. BLACK — SPECIALIST IN ALL DISEASES
I laughed then and I have laughed since, but little did I realise that
only a few months later I would be setting myself up to be just that,
except for the sign. Specialist in all diseases— with a spot of dentistry
thrown in for good measure.
Eleven days after our arrival at the seaport of Amoy,
I was hurried in-land to the place which was to be my home for the next
ten years. I took with me an emergency kit of a knife, scissors, several
hemostats, and various simple remedies, particularly Quinine. The word
soon went out that the foreign doctor had arrived. A few days later I
got my first case. A primipara who had been in labor for 96 hours and
was practically in extremis. Here I was—the first doctor to arrive in
that region since the dawn of history. I didn’t realize it at the time,
but the thought has frequently come to me since—these million or more
people have never since history began, had a doctor. 1 was the first,
and my first case one that was practically hopeless. My stock in trade
was a scissors and a few hemostats and some quinine. To administer a large
dose of quinine, puncture the head with the scissors and evacuate the
contents, apply hemostats to the scalp and extract the fetus took only
a short time. But you can sweat a lot of blood in a minute.
While I am on this subject of obstetrics, I might as well lump several
experiences I had during the years. It is not strange that among a population
of a million there should be many cases of abnormal obstetrics. Not all
came to me, of course, but I had more than I wanted. Later I had a Chinese
assistant who was most sympathetic with these women. We made an agreement
that we would never refuse a call on a woman in labor. One day as we were
walking along the road, he made the remark that he could understand Phthallic
worship in India. He said, "A woman who has to pass through the valley
every time she has a child is entitled to have her organs of generation
worshipped."
One night I was called to manage a transverse presentation. The hand,
arm and shoulder were already delivered when I arrived. That was not unusual.
What did astonish me was to find the entire room, bed, patient, and everything
in the room covered with ashes of rice straw. I had never seen anything
that looked so filthy.
Page 2
In my first misguided enthusiasm, I began to clean up the room, but as
I was working, the thought struck me that things were not so bad as they
appeared. After all, ashes and charcoal have been used in all ages and
all countries as purifying agents. The dirty mud floor that had never
been washed was no doubt better off for its layer of ashes. I might not
have chosen this manner of cleaning, but a worse might have been used.
I concentrated my attention on a thorough local cleansing, and successfully
performed a version and extraction. The patient recovered.
It is a custom among certain Chinese to tie an old grass sandal to the
cord to prevent its retraction into the vagina. The first time I came
across this custom, I was called out to see a patient who war; reported
to have a retained placenta for three days. Several midwives had boon
unable to obtain the placenta. It was just one of those lucky cases. Apparently
the placenta was already lying in the lower uterine segment, for just
the suggestion of a Crede easily delivered it. It is often the small things
which cause the greatest reactions. This one case did more to spread my
reputation than many more difficult cases had done.
[Monkey
Business!] Not all experiences are serious. One day a
barber, whose home was in another district, asked me to care for his daughter
who was in difficult labor. I went. At the outside of the door as I entered,
I noticed a monkey tied to the door post. I thought at the moment that
this was rather unusual but had no time to inquire into the matter then.
The case proved to be a simple low forceps and I was soon ready to go
home. As I was walking down the street, I overtook a man leading the monkey.
Curiosity overcame me and I asked the man why the monkey had been there.
"Oh," he said, "Don't you know? Those people from Choanchiu
[Quanzhou] think that if there is a monkey at the door the baby will come
more easily." Well I never had come up against competition like that,
so I asked the next logical question. "How much did your monkey earn?"
My ego was somewhat deflated when he replied that the monkey had received
$5.00 and I reflected that my fee had been only $2.00.
The subject of obstetrics
naturally leads to some discussion of the sequellae of labor. The old-style
midwives are called, "Tie the cord old women." If they would
only confine their activities to tying the cord, then it would not be
so bad. But, as is the case with ignorance everywhere, their boldness
is proportional to their ignorance. Those whose practice is fairly active
have beautiful, long, sharp, pointed fingernails. When they meet a case
of Dystochia, they sweep those fingernails around in the vagina with a
magnificent disregard of anatomy. Small matters like the rectum and the
bladder don't concern them and they have never apparently heard of the
bony pelvis. Cases of vasico-vaginal and recto-vaginal fistula due to
this and other causes are common in our practice.
I shall not go into technical details of the treatment of these fistnlae.
In some cases the entire posterior bladder wall is gone and, not infrequently,
the scarring due to infection is very severe. It is quite impossible to
repair some of them—some are easy. I suppose our success was about average.
I had one case of stone formation in such a fistula which was in the shape
of a dumbell weighing nearly a pound. Half was in the vagina and half
in the bladder.
Page 3
The question of bladder stone has been the subject of a lot of theorizing.
It is my own belief that the formation of bladder stone is dependant on
the food the people eat— or rather the composition of the soi1 and water
on which the food grows. I have myself, closely investigated several districts
not fifty miles apart, in which the living conditions and eating habits
of the people were identical. In some regions, stone is prevalent, in
others, it is rarely if over encountered. If stone ordinarily had its
origin in infection, it is difficult to see why It should be common in
some places and rare in others, while other conditions in the two regions
are identical.
In my ten years up-country, I have done over one hundred operations for
stone and seen many others who refused to come for operation. The largest
stone I recovered weighed 4? ounces. My youngest case was 1? years and
the oldest was seventy-four. I don't know of any class of patients who
are so thankful as these miserable sufferers, and there are few operations
so easy to perform. I remember one small boy of nine years. He spent his
time, along with several other boys, leading his water buffalo from place
to place to crop the grass. His life was made doubly miserable by the
incessant pain and frequent micturation and by the taunts of his companions
who pointed their fingers at him and made jeering remarks every time he
had to make water. He was discharged from the hospital on the tenth dry.
I saw him many times after that and have never seen anyone so transformed.
He was as good as any other boy.
I have nearly always done the suprapubic operation. We have a litho-trite with which I have crushed a few small stones, but I don’t like the idea. Actually, most of our stones could not in any case be crushed. I have, in several instances, tried to crush a stone after its removal and have found it impossible.
The first ten years of my practice were spent amongst the most primitive conditions. It was necessary to learn the language, build a hospital, get a staff and work up a practice. No hospital…build one. I personally supervised the masons and carpenters and learned the language of the trade in the process. Even today I could supervise the building of a house in the Chinese language bettor than I could in English. No one had ever seen water piping—nor had anyone ever seen any in the up-country place. There were no roads then and no motor cars to run on them. So over the mountains for a distance of one hundred miles the pipes and equipment were carried on the backs of coolies. No one ever cut a pipe or threaded one. I did it myself and installed running water and flush toilets in a hospital of sixty beds. Finally after three years, it was complete. We had our opening exercises. "Joyful completion" is the Chinese word for it. Speeches and firecrackers—especially firecrackers. Tens of thousands of them from early morning to late at night. The whole culminated at night by a Dragon parade.
We had a hospital—but
no staff. Twenty years ago there were practically no doctors in China
and few medical schools. The solution naturally was to train your own.
So I took six students. To them I owe reasonable knowledge of anatomy,
physiology, pathology and the branches. We dissected still-born babies.
Three trips through Gray’s Anatomy and the same through Howell’s physiology
have made a few facts stick in my head, although it is marvelous how much
the human brain is capable of forgetting. It was said of Oliver Wendall
Holmes that, when he was professor at the Harvard Medical College, he
occupied not a chair but a settee. I went him one better by occupying
a whole living room suite. Naturally those boys did not got much didactic
training, but they did get a great deal of practical training from the
beginning, and at any rate were infinitely bettor than anything that had
been there before.
Page 4
Most of my students have continued to read and even today are doing well.
One is a surgeon in one of our hospitals who, with confidence, sets himself
at amputations, hernae, appendixes, ovarian cysts and Caesarian sections.
Two others are in charge of small 50 bed hospitals and making a real contribution
to their country’s welfare. There is a fourth who was a particularly
brilliant student whom I assisted to attend regular medical college. Three
years ago ho graduated with honors from John Hopkins Medical College,
School of Hygiene, and is at present Vice-Minister of Health in the National
government and in charge of health education propaganda for the entire
country.
The missionary life has its sacrifices, but also its rewards.
It was with such
a staff as this that I undertook to do my first operation for ovarian
cyst. The students had had only six months training and my knowledge of
the Chinese language was only very elementary. Many months before the
completion of the hospital this woman came to see me for the first time.
The diagnosis of Ovarian Cyst was an easy one. Since her abdomen was already
very large she was tapped and told to come back later when the hospital
was completed; not without a prayer that she would decide to come. About
six months later she came again, she was again tapped and sent home. Finally
she came back for the third time in spite of the fact that all her relatives
and friends had warned her not to go for she was sure to be killed by
the foreign devil. This time the hospital was completed and we had a moderate
equipment. There was then no longer evading the patient's importunities
and we proceeded to carry out our promise. In any case it hardly seemed
appropriate that I should have less faith than she had.
At last the day had arrived.
With one-eye on the belly and the other on the anesthetist, a knife in
one hand and a prayer in the other, I went ahead with the operation. My
wife was scrub up nurse (she had had six months nurses training before
we came to China, but she at least understood English and I am sure she
prayed even harder than I did). Well, the case was not difficult at all
and we got along alright, but I have often wondered since where I got
the nerve to attempt it and have even wondered whether I was not too foolhardy
after all.
Osteomyelitis of the lower jaw is common. These cases illustrate just how far such a condition may progress if not properly cared for. I have once removed the entire lower jaw in one piece, once the entire jaw in two pieces, and have had at least a dozen cases where I removed the entire half jaw. The inflammation starts in a carious tooth and elevates the periosteum as it travels along until finally the entire jaw becomes carious. One of these people is a ludicrous but sad sight.
Every good thing
has an end. After ten years building up a hospital and a staff, we had
attained to 15,000 clinic calls per year and a staff which could at least
look after most of the work. On the morning of May 29, 1929, our work
came to an end with a bang. That morning we were suddenly attacked by
a Comm. army who captured the city and thoroughly looted it. All of our
hospital equipment was either destroyed or stolen and our staff was scattered.
I, myself, had the pleasure of being their involuntary guest for some
time, but finally managed to escape. My wife and children and the other
missionaries in the station, disguised in Chinese clothes, managed to
escape by undergoing danger and privation, not the least of which was
enjoying the hospitality of a leper home for a night.
The closing of our hospital in-land coincided with the furlough of the
doctor in charge of our hospital [Hope Hospital]
in Amoy. I was accordingly appointed superintendent
of that hospital and have been there ever since. Amoy
has several claims to fame. It was the home of the famous warrior, Coxinga,
who was half Japanese and half Chinese. In the next to the last edition
of the Encyclopedia Britannica, it is mentioned as the "dirtiest
city on earth." It is also here that the father of tropical medicine,
the famous Sir Patrick Manson, began his life’s
work. It was in Amoy that he discovered the
cause of Elephantiasis, and it was here too that he first formulated the
Mosquito Theory of the transmission of malaria— a theory which was later
proven a fact by Sir Leonard Rogers of India. Here too, he found the eggs
of the lung fluke in the sputum of a patient who expectorated on the floor
of his office.
He was spoken of by the Chinese as the "Four Eyed Doctor" because he wore spectacles. Sir Patrick was a physician appointed to the Customs Service to look after the health of the foreign members of the Customs staff. He apparently was not satisfied with the little work this gave him and it appears that a committee composed of foreign members of the business and missionary community rented a building for hospital purposes and invited Dr. Manson to be superintendent. We had in our hospital library, the first annual report of that hospital, dated 1871, in which appears Dr. Manson's report of the first operation he did for elephantiasis of the scrotum on a man who had three times attempted suicide because of his condition. We also have a first edition of his original brochure on Elephantiasis.
Elephantiasis is an interesting disease. It is transmitted by the mosquito. The work is easily visible to the naked eye and the larvae under the low power microscope look like large worms. It is well known that the larvae appear in the peripheral circulation only at night time, but not so well known that if a man habitually works during the night the larvae appear during the sleeping hours in the daytime.
Our hospital is of 150 bed capacity with a branch of 35 beds. When I came home in 1950, we had a staff of 22 full time Chinese doctors and I was the only white doctor. We had two American nurses and Chinese nurses to the number of 65.
We have most of
the diseases with which you are all familiar. In addition, we have some
which you may not have seen in any abundance. Our hospital admits yearly
some 150 Typhoid patients. We can mostly tell these folks at a glance
and send them directly to the Typhoid Ward. Occasionally we make a mistake
and send a case of Influenza or Tuberculosis there temporarily.
Some years ago, one of our staff made a review of some 1400 Typhoid cases
including all those who died in the first 24 hours. These figures are
about the same as those given in the textbooks.
Our treatment is practically dietary with a liberal use of intravenous glucose for toxic cases. We try to give a high caloric, high vitamin diet, but do not succeed as we should like—largely because the cost is too great. My experience with many operations for bullet wounds and other acute emergencies has convinced me that most food becomes liquid in the upper part of the intestine and that there is no contraindication to a pretty solid diet, provided it is liquifiable.
Soft rice and other cereals, bread, milk, fruit juices, eggs, soy bean curd and soy bean milk are our standbyes. Just before I left, chloromyetin began to be used with truly miraculous results.
Page 6
There are many aides of the Typhoid problem that might be interesting
to discuss, particularly extraordinary variability in the symptoms and
course in succeeding years. It may be due to the presence of different
strains of bacteria from year to year, or to difference in virulence in
the same strains from year to year. Some years nearly every patient has
a severe initial cough— it is this type of case no doubt, which is responsible
for the term, "Typhoid Pneumonia." In the last two years at
least, this has not been a marked symptom. Similar statements have been
made about headache, deafness, and chills. Some years a fair percentage
have been ambulatory for two or three weeks before admission. This in
no case makes for a more favorable prognosis. In fact, my impression is
that the contrary is true. It must be understood that all these symptoms
may be present any year, but in some years they predominate. The typical
"Rose Spot" I have not seen in the Chinese patient. This is
no doubt, due to the pigment in their skin.
The common complications
are particularly hemorrhage and perforation. I have operated on several
cases of perforation —they all died. The new antibiotics should change
that picture.
One patient was admitted about a month after recovery from Typhoid fever.
She had a gradually enlarging abdomen suggestive of Ovarian Cyst. Aspiration
of the contents gave us a gray pus out of which we recovered a pure culture
of Typhoid Bacilli. The abscess was marsupialized and packed. The patient
recovered. This had probably been a minute perforation or a broken gland.
Another patient with Ovarian Cyst went through a typical course, except
that the fever refused to come down. A diagnosis of Infected Cyst was
made. The condition of the patient forbade laparotomy, so it was marsupialized
under local anesthesia. She made a prompt recovery and the cyst sac was
subsequently removed.
On the surgical side, we have most of the conditions you have. In the first hospital where I was, ulcer of the stomach and duodenum was exceptionally common. This place was famous for eating dry cooked rice at least twice daily. Those who could afford it took it three times dally. Elsewhere one meal of dry cooked rice is the rule. I think the preponderance of ulcer in the first place was due to this eating habit. Perforation is not uncommon and pyloric stenosus is common. Surgery for this condition is not yet accepted by public opinion to a large extent. Although we have several cases of Gaatro-enterostomy.
Fibroid of the uterus is common as are the various kinds of cancer. We did about 30 to 40 Hysterectomies.
Appendicitis is rarely met with in the in-land, but is fairly common in the port cities. We average about 25 cases of acute appendicitis or abscess yearly among 2,000 admissions. I suppose the cause of the urban preponderance of appendicitis is dietary.
Perhaps the outstanding
surgical condition met with is Cyst of the Ovary, both simple and malignant,
cyst-adenoma and solid tumors. Their surgical removal is usually simple—
it is their size that makes them different from what you usually meet
with in America. I have annually from ten to twenty, at least half of
which weigh between 25 and 50 pounds. The largest I have removed weighed,
with its contents, 58 pounds. My predecessor had one weighing 84 pounds,
and I believe one has been reported that weighed 208 pounds.
Page 7
Ovarian cyst with twisted pedicle is commonly met—usually several days
after the acute episode. I have operated on two cysts which had no pedicle
whatever, presumably they had been twisted early in their history. In
one case I had made a diagnosis of possible pancreatic cyst because it
was almost entirely above the umbilicus, but on opening the abdomen, I
found a typical ovarian cyst with its wall adherent to the root of the
mesentery and absent ovary on one side.
I have had one case
of Complete Gangrene of the Uterus and appendages in a woman 8 ? months
pregnant. I saw this person first at 6 months. Her story then was that
just after her last period her husband left for an extended trip. When
she was three months pregnant he returned, having in the meantime contacted
acute G. C. Urethritis. Less than a week after his return his wife had
all the symptoms of acute G. C.: discharge, painful and frequent micturation
and a few days later severe abdominal pain.
This was the only time I saw her until her admission to the hospital 8^
months pregnant. She reported that she had felt no movement for over two
weeks. After examination a diagnosis of Dead fetus was made. Attempts
to induce labor with bougies and vaginal packing and pituitrin were quite
without result after 24 hours. It was therefore decided to do an abdominal
section. On opening the belly, the uterus was found to be black and adherent
to the peritoneum and viscera its entire surface. Section to deliver the
macerated fetus was quite bloodless. The adnexa were found to be one mass
with the uterine body. It was slowly stripped from the surrounding structures.
The parietal peritoneum was literally stripped off in large patches—I
estimated several tens of square inches. The uterus was found gangrenous
up to the cervico-vaginal junction with the bladder pulled high up on
the surface of the uterus and also partly gangrenous.
Hysterectomy was done in the course of which a large rent was made in the fundus of the 'bladder. With a scissors, about 1/4 of the bladder was excised, a catheter was inserted from within the bladder, and the hole in the bladder was closed. The abdomen was closed in a routine manner and the customary postoperative treatment was given. The patient had been in poor pre-operative condition. One would naturally expect severe shock from such an extensive procedure, but I was astonished at the prompt recovery of the patient. This is a common occurrence in abdominal surgery of this sort. The body apparently has had opportunity to prepare its defensive forces by this preliminary try-out. She was discharged after three weeks.
This case presents several interesting points:
1. I suppose the whole condition was subsequent to the infection with the Gonnococcus which took place three months after the patient became pregnant. The question it presents is: What was the path by which the infection traveled to produce a peritonitis and eventual gangrene of the uterus? Most gynecologists, among them Curtis of Chicago, insist that the infection travels by continuity along the mucus surfaces. Did this? How did it get around the fetus and membrane?
2. I enlisted the services of the literary research department of the American College of Surgeons. I received many abstracts and original articles on the subject of gangrene of the uterus. No case of a similar nature was reported. The nearest like it was a case of gangrene secondary to a criminal abortion at five months. That patient died. I wrote this case up at that time, sent the papers by the uncertain mail of China and never heard from them again.
Page 8
When one spends approximately one third of one's life under a mosquito
net, it is natural that he should wish to say a word about that greatest
curse of China and probably of the whole world—MALARIA. History tells
us of the influence of malaria on the course of human events, but does
not tell us so much of the influence of malaria on humanity today. Take
a look at the miserable, emaciated, yellow faced, malaria ridden Chinese
soldier in any army in South China, and then consider what chance such
a man may have against the well-nourished and malaria free Japanese or
white soldier.1 I have a very good Chinese doctor friend who worked for
the government on the Burma road. He tells of busdrivers who became frantic
with fear at the prospect of spending the night in a malarious valley,
and who would do almost anything to reach the mountains before night falls.
Our foreign friends there speak of their mosquitoes as, "The three
musqueteers." "One for all and all for one." Two hold open
the hole in the net while the third crawls through. Malaria is one of
the greatest difficulties the administrators of the Burma road had to
contend with.
Our modern patron saint, Sir William Osier, is said to have remarked that, "He who knows syphilis knows all." I have often paraphrased that remark by saying, "He who knows malaria may not know all, but he knows an awful lot."
Malaria certainly has the faculty of similating other illnesses to a remarkable degree. Even after one has spent many years making its aquaintance, he is likely to be tripped up.
Dysentery, cholera,
appendicitis, influenza, typhoid fever, tuberculosis, heat stroke, and
apoplexy are some of the conditions which may be confused with it. Even
to one who is on the alert, malaria may sometimes present diagnostic difficulties.
I remember well a Lieutenant of the U.S. who was brought in by the ship's
doctor. The man had been ill for about seven days, at first only slightly,
but during the last two days more severely so. Fever, until the last day,
had not been over 102 and that at irregular intervals. He had had no chills.
Headache and general aching pains had been severe most of the time. The
young doctor was a recent graduate and knew all his laboratory procedures
and had done them all. White counts, Red counts, differential counts and
prolonged search for malaria parasites on successive days had given him
no clue to the true diagnosis. He was up a stump and brought us the patient.
A glance immediately brought malaria to my mind. Tired eyes, occasional
delirium, yellow skin and sclerae, dry lips, rapid pulse, dehydration,
and irregular fever chart. The young doctor was quite indignant when I
said the patient's diagnosis was MALARIA. He had made repeated smears
and had found no plasmodia.
I think there is where many diagnoses go wrong. It is not always easy
to find the bugs, and, although we always look for them, I have nevertheless
learned to give the patient the advantage of the doubt, even if they are
not found. After a long search, I finally found one which I thought was
a plasmodium. The doctor did not agree. So we continued our search for
about 1/2 hour and finally came on one field with three typical parasites,
and the diagnosis was finally made. The patient was really in dangerous
condition, but he pulled through.
On one occasion,
a medical colleague was prepared to do an appendectomy. He did a preliminary
differential count and found the plasmodia.
Page 9
Headache, delirium, unconsciousness and vomiting— the latter frequently
severe and continuous, lasting days— are common symptoms and are probably
duo to cerebral irritation due to blocking of the cerebral capillaries
as well as to the toxins of the disease. Diarrhea, vomiting, and abdominal
pain may be due to blocking of the Splachinic capillaries.
Just to show that
experience does not prevent mistakes, I mention a British member of the
Customs Service who had been ill with the ordinary symptoms of influenza
for three days—during all of which time he kept at his work. He had headache,
slight fever, loss of appetite and generalized body pains. He did not
feel ill enough to "bother the doctor." He finally called me
Saturday afternoon. His trouble was apparently typical influenza and this
disease was prevalent at the time. But I remember saying to myself, "You
can never tell, better make a smear in any
case." However, it was Saturday afternoon, the laboratory technician
had gone out. Sunday morning I forgot about the slide, in any case I didn't
seriously consider malaria. Sunday afternoon the man became delirious
and passed black urine. A hasty trip to the laboratory was rewarded by
finding plenty of parasites in the slide made Saturday afternoon. Vigorous
treatment saved the man's life.
A Chinese office
worker suddenly became unconscious at 3 p.m. His co-workers had not noticed
any premonitory symptoms. He had not complained of feeling ill. He had
a temperature of 105°. His blood was full of plasmodia.
It took me years to get rid of the idea that Malaria is a disease of chills
and fever. That is, of course, true of typical acute Tertian Malaria,
but that is not the typo I have been describing. Malignant Sub-tertian
malaria presents quite a different picture—it is a deadly, insidious
disease. Chills, if they arc present, are typical and of irregular occurance
as is the fever.
Just one word about malarial spleen. It is the result of Chronic Untreated
Malaria. These spleens are sometimes of tremendous size. I have seen many
that fill the entire abdomen and buldge over the iliac crest on the right
side.
My first decade having ended in an explosion, it was appropriate that my second should end the same way. In May 1938, Amoy was captured by the Japanese after three days of fighting. I shall never forget the sights I saw then. The Chinese garrison was hopelessly outnumbered and outarmed and finally surrounded. The sight of 10 to 40 Chinese soldiers being captured in a building— marched out to the street and compelled to kneel to kiss the Japanese flag, after which they were forced to run in a body to the edge of the water and, just as they were jumping, have machine guns turn on them—is not one that is easily forgotten. It was repeated several times during the day in our sight.
Our hospital is actually
on the island of Kulangsu, 1/4 mile
across the water from Amoy. Kulangsu
is an International Settlement, about 1 mile long by 1/2 mile wide, and
has a normal population of 35,000. To this, in the next three days, were
added 80,000 refugees from Amoy. This condition
naturally brought with it problems of housing, feeding, health, and sanitation
which were tremendous. Time forbids telling of this. Our hospital staff
with volunteers did 60,000 vaccinations and a same number of inoculations
for Cholera, during a little more than a month. During the next two years,
I gave a large part of my time to this problem. Deaths from starvation,
malnutrition, and sickness mounted to the thousands. I have seen enough
of war. It is a pitiful sight to see innocent babies die like flies. I
do not preach war and hate. I report facts. We need not expect from the
Japanese the same consideration for civilians and enemy prisoners that
we expect to give ourselves.
Page 10
There will be many real atrocities to report and many reports will be
manufactured for propoganda purposes. If all this inspires us with a spirit
of retaliation so that we bring ourselves down to their level, then the
civilization and culture and religion of which we boast will have become
an empty shell and we will be defeated even more surely than if we lose
the war of arms.
I left Amoy the latter part of October and
arrived in Whittier the day before Thanksgiving. Since then the war between
Japan and America has begun. Some fifty of my American, British and Dutch
friends have been interned and our hospital has presumably been commandeered.
It is fortunate that there are things that are more enduring than buildings
and therefore we are not without hope for the future—nor has the past
been in vain.
materials.
All text and photos will remain your property, and photos will be imprinted
to prevent unauthorized use.
E-mail: amoybill@gmail.com
Snail Mail: Dr. William Brown
Box 1288 Xiamen University, Xiamen, Fujian
PRC 361005
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