"THE HEALTH SERVICE AND THE STANDARD OF SURGERY IN THE PEOPLE'S REPUBLIC OF CHINA"

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP80T00246A021200250001-8
• Release Decision: RIPPUB
• Original Classification: C
• Document Page Count: 29
• Document Creation Date: December 23, 2016
• Document Release Date: July 18, 2013
• Sequence Number: 1
• Publication Date: April 16, 1963
• Content Type: MISC

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INFORrMATiON REPORT IN
CENTRAL INTELLIGENCE
REPORT
This material contains information affecting the National Defense of the Unit States wit in the meaning of the spionage Laws, Title
18, U.S.C. Sea. 793 and 794, the transmission or revelation of which in any manner to an unauthorized person is prohibited by law.
50X1-HUM
COUNTRY China
SUBJECT "The Health Service and. the
Standard of Surgery in the
People's Republic of China"
DATE OF
INFO.
PLACE &
DATE ACQ.
REPORT
DATE DISTR.
NO. PAGES 1
REFERENCES
16-April 1963
50X1-HUM
50X1-HUM
THIS is UNEVALUATED INFORMATION
English translations of three reports, each
entitled, "The Health Service and the Standard of Surgery in the People's
Republic of China." These were prepared in 1961 by Dr A K Schmauss of
the Surgical Clinic and Polyclinic of Greifsvald, East Germany, for
publication in the Zeitschrift fuer arztliche Fortbildung.
The first report (5 pages) has the following sub-headings: 0
a) The Central Hospital for Children of the City of Peking p. 1
b) The Fu4Wai Hospital for Thoracic Diseases p. 2
c) The Hospital for Women of the City of Peking P. 3
d) The Tumor Hospital P? 3
e) New Medical School in Wuhan (Hangkau) p. 4
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The second report (8 pages) has the following sub-headings:
a) The doctrine of the traditional Chinese medicine on the
viscera and on the function of the inner organs p. 1
b) The doctrine of the causes of Illness p. 2
c) The doctrine of the "effective points" and of the
"conducting pathways" P. 3
The principle Yang-Yin
P. 3
e. The doctrine of consecutive furtherance and impediment
among the five elements "Wu Xing" p. 4
f) The conception of diseases of the traditional medicine and
the methods of diagnostics p. 4
The third report (14 pages) has the following sub-headingd1
Abdominal Surgery
13- 3
Diseases of Liver and Gall Ducts
P. 5
Thoracic Surgery
P. 7
Carcinoma of the Esophagus
p. 8
Cardiac Surgery.
P- 9
Urology
. Traumatic Surgery .
1:" 9
p. 10
5
Pediatric Surgery
P. 12,,
5
4
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The Health Service and tAe.Otanclard Opurgery in the Peoples' Republic
?
?
?t ? China.
?
By.
*A. X. 3ohmiu24.
?
?
50X1-HUM
In our first paper wehave reported, that during the 10 years sinoe,the
'liberation of Cigna a great nuiber of modein and :well equipped general
and specialized hospitals have been founded, in connection with ?the
etlargement.or foundation of medical schools or in connection with the
Public Health Service. Weare *going to report about several of the..
hOspitals, some of which we have *senas visiting physicians, and the.other'
ones, which we know frOm short.9alls.only,.appeared to be Of general
interest due to their equiplent and task. ?
a) The Central Hospital for Children of the City of Peking.
In 1955, the City of Peking bUilt,t.iarge.hospital for .childred with 65o bode
which is situated near Vharold west. gate at the Chang-An-Street, the main
east-west link of the capital. Pig. 1 shows a wing of the complex;
This hospital has independent large departments with 150-16o beds epch, .
for internal diseases of ah4ldr4isio pediatric surgery and infectious diseases..
There are.also.saaller departments for ophthalmology, otolaryngology,
diseases of the mouth and .a department for traditional medicine with 75
beds. At the latter, physicians of thOwestern 'medicine" cooperate
with traditional doctors. There issue a ward for immature newborns.
The floors of this hospital have 50 beds as an average. The rooms, wit)
2-8 beds, have glass walls. The nurse, sittin g in the center of the floor,
can watch all rooms. Next to the nurses station are 4 small rooms
for severely i11 or reCovering children.
This childrens' hospitel.has a large outpatient department with
all specialties, which is open 24 hours a day. Every day, 12oo - 1600
children are examined or treated.
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Jausu.a.utaus: pauzwAmsj cliwa 114.114 watoaidoosloatocrerv" Aasm,mvu'avai.a
( including :those of traditional medicine) and 20
chiefs of the department! and of the subspecialties. 400nurses and
'technicians are employed for patient care and research work.
In addition to the treatment of patients, the hdspital is responsible
for several tasks given by the Public Health Service. It has to take
care bf the training of pediatricians .and pediatric surgeons. In pediatric
? 4 years are requested, 1 year .:ii general medicine and 3 years in the
specialty itself; the.treining of pediatric surgeons takes 5 yeire.
Thor &malt/vs.& number pediatricians faom,North China for some
additional' training. They stay. between '6 and 12 months.
The hospital operates a school of nursing for the special
,training of mums for infantsand children. -;
Another task is the supervision and guidance of all pediatric
departments and.out-patient departments of the capital, and of newborn
and youth welfare.. The impioval in the mortality of newborn babies from
117 per.thqusand in 1949 to 35 per thoutand'in 1959 is partly a success
of this institution. . .
The hosptial also has to sttOi certain 'problems in the central
research. plan It does-research.work.on epidemic meningitis', measles.
-viral*pneumonitisc on the complications of poliomyelitis, toxic d'eenteria
and on the indications and risulti of. therapeutic .methods of the.traditio-
nal medicine in .some.dieeases Of childhood. According to the present
experiences, there is a-believe,. that some of the methods of the traditiona
medicine-are of value in thitreatment of dyspepsia, bronchill asthma,-
'enuresii, rheumatic diseases,- doif-muteness, meningitist.enoaPhalitis:
. .
and pylorospasm.
b) The Pu-ifai -Hospital for Thoracic diseases.
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?
A hospital for thoracic diseases was given to the Academy of Science in
1958. It is situated in the torAkFest of Peking. Pig. 5 shows a pari of
- the hospital. It his 450 bed, with departments for tuberculosis of the
' lungs, for unspecific thoracic *diseases, for cardiology, where all
progedures of modern cardiac surgery are performed. More about it later.
The department owns a machine for extracorporeal circulation, which was
constructed in China. It has been used during the past year with success
in open heart surgery. The department for thoracic surgery has special
? experiences in the, surgical treatment of carcinoma of the esophagus.
. A more extensive report will follow later. -
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his hospital has also an exoelliant etkri and anuinmant_ Page 3
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?.
. ? L-.% r'' ?
,
? 0) The Hospital for Women of the City of Peking.
-
$.
.Near the northern wall of7the old C.forbiddep city" , a-new hog pita].
for women with 250 beds was opened in June 1959. 75 beds are available
for gynecological and. 175for obstetrical cases. ..The out-patient
department is visited by 35o.r400patients daily. Every month, about
5oo'children are. delier.d and 2oo medium and,maior operations are
performed. This hoipital has 8 iirconditioned .delivery rooms, where
only one woman delivers at a time.. The staff consists of 52 doctor's,
116 nurses and 50 .nurses gide. The hospital has to take care of the .
specialty training in Ob-Gyn and of advanced courses for specialist,?
and the .training of midwivee. ?
All meibers of the staff have office.hours for pregnant, women,.
ind proPhylactic examinations for Ca of the cervix in factories and
peoples' communes. The cancer examinations are done on all women over
35. The ca of the cervix has a Very high. incidence.in.North China.
They follow research work on problems of t'cpterlAee oirrero.,?ti.
'he weight and lengAirof babies at time.of.delivery in Peking, the
value of 'methods of the.traditional medicine for complications during '.
pregnancy and birth. Questions of " painless delivery" are studied. by a r
special team in cooperation with doctors of the tradtitnal medicine.
(1) The Tulor 'Hospital.
?????
In March 1958, * recently constructed hosiitalvith outpatient'
department.: for the treatmontof-cancer was given to the Academy of
. . ?
? Medical Sciences. It is situated in the east Of Peking, near the new
embassies. It has 4 departments: Surgery, gynecology, radiology and
'chemotherapy, with 2oo:.beds. UP to the present,. 3000 in,- and 130 coo'.
outpatients have been tAted. .
In addition to the .most modern equipment for radiotherapy, ,the hospita
owns an iiitOpo laboratory and two CObaltmachines, very modern laboratorioi
inclUding one for cytology. .The hospital plays an important part in the.
examination of all women over 35 years for carcinoam ofthe cervix,
which was done in cooperation with all hospitals for women in Peking and
by many senior skidents of medicine. A:paper On the tumor problem
Will give a report of the results of these examinations. At this hospital,
following malignant tumors were found to be themost frequent: .
1. cartinoma of the cervinThr:.:carcinoma of the breast, 3. carcinoma -
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. .
. in addition to these siicill'hospitils,a number of other large hospita:
- for the treatment of 7 millions Anhabitanis have been built during
the past yearb. The hospitals hve usually 5oo- 800 beds and all specialties
but one specialty is given. MOre.importance. In the north of Peking is
'a center for traumatology With'3oo beds, the other departments: ?
? .general Surgery, internal medicine and giiecology consist of. only 50
beds.. At.the Tung4en-Hospttal1the ENT.ie the largest with 15O beds.
But. not Only in Peking,.but in all other big cities like .., ?
. Sinking, ShInghai, Hantshow, Wuhan-and Nanning, we saw new University
and general hospitals, which 'eqUal those in Peking. :
Os"' Wieihralk&APPRW/i'visiting physicians At the new medical
. :school in-.W.uhan,(?Hangkau) for a longer, period of time.. In 1951, the
construction of .-(the ttoorptictl: inStitittes, the hospitals buildings
. and,theaiirintquartA:v Tor teaching staff and students was started .on the
. site Of.a former derby field. Ts already finished buildings .occupied an
area of 15C 000 equare asters. At the.tiie of:our visit, the brick work
. *.of a new hospital for children and a large library building were
? finished...and:thex are now.probably.in fUll-operation.
the teaching staff of 'the former' 50X1.-HUM
.Tung-Chi-yniversity has been appointed to this medical ichool, so that
all professors and lecturers speek-fluently *German. Their special
.-object is the study of the Grecian medical literature. In the libary
of the university, one can find -nearly all modern German hand- and .
textbooks, monographiei'end the most important medical journals.
? Some figures relating.to'this medical school: 1951 the "'umber of
students was 450, 196o therehave.been'32oo students, 35 % of whom are 1
women. . From the old Tung-Chi in Shanghai 798 students graduated betweeni
19o7'and.1949, 19 in a..Year; 'from the new Tung-Chi, 5oo.physians ibecieved
.their-degreel in , ?
'
The toachinustaff:OonSists.nOirlxr:51 professors, 103 lecturers and
261 asSistants.. 37.71 were lifoiMMM.- During the vacations, a part of the staff
works at the hospital of the piolpinceaupei, one of the largest and most
populated parts of China, to teach new knowledge and methods of their-spe-
cialties. In the'language* our'chinese friends it is called " to
'take the science to the. baiir. This was the reason that .I could not meet on
of the leading traumatic surgeon's of China, Prof. Tzu Tung Bat, who is ?
translating &Shiers " Technique of Fracture Treatment " into the Chinese.
He gave a-course for specialiste_in a hospital; 3oolcm from Whhan, ?
without any railway or riverboat connections.
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the A,noie pf their parents and the grades of the students.
? ,.. In the, past years, .a collogewas founded in connection with the
untiereity, adcording to.Our " Yorkers. and Pamirs' Faculty". During
:his time at the medical aohool, every' WUhad.student has to. spend two ?
months doing.,manual labor, ? the prepeaical students work on a farm,
? the -senior students Eery? in the ...Hygiene Bewegung". ( -50X1-HUMi
there are quite-go:few-new-notions-in the official language of.
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copmunistic countries, which have never been used in German or other
languages. This." Hygiene 'kiwi:guar:seems to be a. government inspired
aria directed trial to teaph the Chinese peasants the basic principles of .
hygiene and health care, and perhaps also to give them some medical care.):
The government researdh plan has several special objects for the
medical thool:. Problems of prophylaxis splatroatment of schistomosiasis.
and their complications, ( The Tingtse valley had a very high incidence.
ofIschistomoilasisliefore the liberation), frequency of tumors in the
province Hupei, and occupational hygiene and diseases. ( Wilhan is one Of
the ". 3 stovess of China, the other ones are Nanking and Thhunking). - ?
Old chines. medicine is also studied in liUhan. Both clinical institutes .
have 3oo beds together for the cooperation of European and old ehintse
doctors.
Specially the lst institute of the University, which was enlarged
and modernised from an old, poorly equipped missionary hospital with 200
beds in the center of the town to a present 5oo beds with many new
spacious buildings, does research work in traditional medicine. One
department studies the methods of fracture treatment of the Chinese doctors,
another department; the one of the"5.connections" (1tiitraditional and
european medicine,'24 red and.speoialist, 3..physician and nurse, ?
4.-Jfork and. recreation, 5.1ffs'prophylaxis and treatment) studios the .
.00mplex 'treatment ( combination of ,methods of both modern and traditional
'medicine) of certain diseases, and they are convinced thatie.g. some infocti
tious diseases, gallbladder and kidney stones and .lymph node tulierculosis
with fistulas can bi cured by conxervative measures in a relattyely short
time.
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4. 114-4U.L. ruLuv.
k
.._ on. 2
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The Public Health Service and the Standard of Surgery
in the Peoples' Republic China.
by
:B.A. Schmga.
?
4
.In the former reports we have pointed out that today in China.
the. teaching. institutions and the largd hospitals " of western
? medicine" are studying the "traditional chinese medicine".
? This way of treatment is based oft the -experiences of several thousand
'years; which has been developed 'until the beginning of the last
century. At that time the:development stopped, probably due to '
political ciroumstances, just at .a time, when the European medicine
advanced fast under the influence of the sciences. This is the reason
that the old chinese medicine has no scientific basis. It is
based on a mystic-philosophic.aoctrine., developed during a. praxis
thousands ofyears long, which is difficult to be understood by us
Europeans.
One of the oldest logic books of the tradtional chinese medicine
is the Huang-Di-Nei-Ting, Which is supposed to. be written in the
' 8th century B.C. The text of this book ie.-thought to have its origin
at the timi?of the goliernmeht of. the Ban prince Huang-Di (2698-2599 IBC)
It cohtains articles .on hygiene, the anatomy of the human body and the
functions of described organs, and on the method of *treatment
of different.diseades. The basic thoughts of this book arefollowed ,
through the whole medical.literatuve of later centuries, e.g. in the
Shan-Han-Za.Ding-lan_( Systmmatics of internal.diseasee). by
Zhang-Zhong-Jing (142-21o), in thellai-Tai-Mi-Yao by Wang-Tao, published
around 752 (.B.S7mary of the former medical literature) and in the
books by Li Shi Zhen, 16th century, and Yang Shi Zhou, 17th century.
We are going to give a summary of the theories, which are most important
for the understanding. of the traditional chinese medicine.
a,) The doctrine of the traditional chinese medicine on the
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. According to reportsicadaveritif-executedicrintlinals-.balt:-been
opened repestedly'in presence. of doctors, painters and officials of
the emperors during:the past 2opo years, and studies of the
anatomy and exact repottgand sietches of the findings have been made
? Nevertheless, the theories.on the human antomy are not quite correct.
There are to groups of organs known:tthe solid organs "Zang",
which are supposed to have a.stoiing function, and 2. the hollow
organs "Fu", which have the function of digestion, resorption, transport
and excretion.
. The.former oompridi the ,hiiit With the pericard, the liver, spleen,
lungs, and kidneys, to the. second group belong gallbladder, stomach,
large.and small bowel-, bladder and: the Organ "San Jiao = 3 parts
of the body cavity". According, to the doctrines of the traditional medic-
ine, the organs nhang" are in a relation " inner-outee with the
organs "Fu". For instance liver-gallbladder, kidney-bladder,
incomprehendible for us e.g. spleen-stomach, where the spleen is
supposed to store the nutriments.
With this organ system "Zhang-Fu" are associated all sensory
organs, the body tissues and the emotions. Liver-gallbladder, tendons
and ligaments and the emotion anger belong e.g. together.
b) The dbctrihe.of the cauSes of illness. -
In the traditional medicine, the human being is seen in close
relation with his surroundings and the social circumstances. This
has its expression in the doctrine of the causes of illness. It
knows"external causes': these are metereologic phenomena like' !wind,
coldness, heat, humidity and dryness" which come at the wrong time
or in excess. They banAead to.fire in the organism. An "external
factor of illness" is the damaging factor Yi Li", which can be
found in the nature. It can lead to epidemics together with unfavoUiable
metereologic circumstances and a poor public hygiene.
The 7 emotions:a10y, anger, sadness, fear, longing; sorrow and
oppression are in excess the ."internal causes of-illness?.
In addition to the internal' and external causes, there are still
"other causes of illness"; to which belong irregular way of living,
false nutrition, increased sexuality and bites of poisonous animals,.
as well as accidents and injuties.
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1.....,.... ???,... ,1,44,... ,00/1044,64...4A/V414.q5 1
[ .. . ? 'pathways". .
Very important for'seveial.schools.of.the Chinese medicine is the
'doctrine of the "effective.points"*.and,theconducting pathways"
( in the German-French literature mostly called "meridian", but the
Chinese word Mai-is 'translated best by. "conducting Pathways")..
It means, that pathologic pr.ocelises.in.the can be influenced by
'some-manipulations from exactly located points on the body surface.
, The doctrine of such "effectitob point's" is according to newer studies
several thousand years old, and instruments(needles) from the
Chinese bronze.agehave been found, which serve tiles purpose.
These'points are not always2in the Areas of'Head's.zones, most of the
points, according to the Chineie-medicine the most effective ones,
are situated on. the distal parts of the extremities. Later, when
a large number of points '.were known, they have beensummarized in
" donducting pathways"). These also run on the surface of the body, but,
according to the Chinese doctors; are connected by "deep physicians"
with the interna#rgans Zhang-Fu. The doctrine of the Chinese
healing art says, that in these conducting pathways the vitality
"Chi" circulates. If one organ, belonging to a certain conducting
pathway, diseases, a disturbance of the circulation of the "Chi"
originates.Vice versa, a Prevention of the Circulation of the Chi
in the c.p. leads to a pathologic disturbance in the corresponding
organ. The circulation of the Chi can be normalized by certain
manipulatians-and by.this way the basis for-the-improvement of patho-
logic processes can be created. The traditional medicine knows
1; couples of c.p., which are in direct relation to the internal
drgans, 2 single.main.conducting pathways and 6 extraordinary ones.
) The principle Yang-Yin.
An important role plays the doctrine of Yang and Yin in the traditional
medicine. It has been.taken over from the primitive-materialistic
natural philosophy, developed by the school of the philosophist
Zou-Yi around 5000 years ago. This means, roughly explained, that.
in all matter and. in all appearances of nature and life,. Yang and
Yin are Present and, affect each other. Yang and Yin-are in continuous
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possible without the other. In nature is e.g. light= Yang, darkness =
.Yin; fire = Yang, water = Yin; warm = Yang, cold =. Yin.- '
All parts and organa of the-human body are relatedtto these two
'principles: The upper parts of the body are'Yang',..the loer ones are
Yin, at the extrtp41es the outsides are Yang, the insides are Yin.'
The hollow organs/are Yang, the stbrage-organsj2hang are Yin.
Yang and Yin is present in each part of the living organism.
'If they are in balance, all physiologit processes are tormal'and the
'organism is healthy..If one principle prevails, the other declines and;
diseases appear.
e) The doctrine of:consecutive furtherance and impedement
kmong.n the 5 ellats "Wu Xing". .
Very important in the traditional Chinese medicine is the doctrine
of the consecutive furtherance.lead'impedement among:n the 5 elements:
Wood, tiie,goiltmetal.and water. The"element"is a philosophic notion,
to which certain organs, natural phenomena and vital phenomena are relate
liver, gallbladder, tendons, ligaments, eyes, anger, birth, wind belong
e.g. to the "element wood";. heart, small intestines, vessels, tongue,
joy.,.growth.belong to "fire". .
The elementssaliance each other in the 'above named sequence; in
the sequence.wood'iwater-fire-cetaiwood-. goes the suppression.
*f) The conception of diseases of the.traditional.medicine and the
methods of diagnostics.
? The traditional medicine does notLhave
in the sense of the European medicine, i.e.
like gastric ulcer, but only syndroms; the 8
1. Yang and Yin, to which the other syndroms
2. Biao and Id(= outer and inner).
3. Chan and Cho (= fever-coldness).
4. Sue and Chi (= lack and. abundance).
The main syndromes can occur together,
Yin + abundance, etc.
a conception of disease
it has no organ diagnosis
main syndromes are:
are subordinated.
e.g. inner fever + Yang-lack;
The 4.main methods of examination of the Chinese medicine consist
in: ?
1. Looking at the patient,
Anorinly ftrA'amAllino
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3. Asking the. patient, .
, 4. Touching and judging the pulse.
? :Under .."looking at the patient!. they understand a thorough
.inspection of the face,.posture, watching of the'psychic
and:firet.of all an eiact.examination of the 'angtie.
The "hearing refers only to those symptoms one can recognise'
without physical.eiaMination (auscultation, percussion) like '
coughing, rattlil..borborygmi etc. The smelling consists in judgment
of the odor of the body and the excrements.
? Thegroatest iMpOrtance has the judgment of the pulse, which is
eych forearm at 3. different points. The Chinese physician's
?know differences between .8 .kinds of pulsations, and it was surprising
fop us,:thit.several treditional dootors, whom we asked to palpate the
pulse, came indepedent]y to the same conclusion.
At least, .we want to mention the Chinese pharmacology, which has
been tho0oUghly studied bi.U.Shi Men in the 16th century. His books
were translated intO.nearly,all European languages during the 17th
and 18th century. They are still the basic textbooks for the
training of the: pharmacist in the traditional medicine. The traditional '
medicine has A great number of drugs. In addition to probably very
1tubiOu4rugs,like.pulverized etag antlers as roborants, or flour ?
.olit of tiger bones for the treatment of rheumatic diseases, they have .?
many certainly effective dr1.10 which could be used after an exact testiint
in the iharm.iceutici'orthe ."western medicine". It may be mentioned,
that the Chineee doctors have treated:the?Sr/gni of hypertension,:.
which prertnaireforCcersrixu:ies, withsrauwolfia drugs, and that their
. ?
. ? pharmacology knows 4 different kinds of rauwolfia,plents.
.? The tradition4mmdicins:As to a .cortain degree specialised.
Som. physicians do:thoir.main work iorihe pharmacotherapeutics of..
internal diseeiei. ?
AMOngii 'thi "surgeons." ere Specialists for the treatmept of '
fractures.and luxatiOns.. Thiiii.?trinciples of treatmenteftee,.
: which have been.propagated,by u:c'a s- C.hamponniere
during the last century in?Europe:no immobilisation of adjacent
. ?
?
joints, early motions 6d early use. Drugs, favorable to the healing
of fractures, are important .in addition to the Chinese massage.
: The second. large realm for surgeons is the"proctology". ?
Hemorrhoids, anal'fissureit and fistulas are their domain. ?
The-anal fistulas ars. treated exclusively by ligation with a thread'
a method which ahs been . described in !iron firnt by Hi nnniraes
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The results are excellent, and One hardly sees agiggffimgc, as we couia uee
in Peking, Nanking, and Shanghai.
Mucgsurgical work has not-been done by the"surgeons" oftraditiona
? I
medicine during the last centuries. The, maximal operations were the
castrations of young men, which were employed as eunuchs at the
imperoes court and'An the palacec'of the four main princes. This
operation was.reserved for thp surgeons to the court. It is the theme
of -a famous picture in the emperor's palace. It shows young eunuphs
after the castration, who make an extremely miserable impression, so
that one can aupposet!that the.operagon was not entirely ..painlesa.
.This underdevelopment of th surgery is difficult to explain,. .
as it was probably verl ilourishin!in the first centuries. A.D. The
school of the. surgeon Hua Tuo.his perf.armed intraabdominal
operatiOnland was able to do bowel reeectiontand anastomoses at that
time.. According to the chinese-medicine,. Hua Tuo was the first one
to use narcotics for the rolls& of pain.
?
. Other specialties in the traditilmal medicine are "pediatrics",
gynecology' ( but not obstetrics) and the specialties for diseases
of the eyes and nose and throat. .
. An important part of the traditional medicine is the acupuncture,
which ii used ohly by specialists. .Its theoretical basis is the
above outlined doctrine of the effective points and conducting ip
pat4ways. The principle of treatment is the introduction of thin
steel needle into the "effective points" of. the present " syndromes".
'For several"syndroMes", specially cold syndromes, cones of
pulverised leaves of Artimesis vulgaris are burned on these points until
the patient has the sensation of warmth.
This doctrine is also the bqsis for the Chinese massage doctors,
who are also considered specialists of the traditional medicine.
Another specialty of the traditional medicine is the"chi Gung",
a method of 'treatment,. which combines the complete relaxation of the bod!
with gymnastics, which are developed from old defense gymnastics.
(Tai Di Juan). The exercises for relaxation recall much the autogenic
training. ?They believe .to gat good results with this method in the
treatment of vegetative disturbances.
This traditional medicine has found an variable judgment during the
past decades. After the intruding Of the scientific medicine, it was
more and more refused officially and during the Kuo Min Tang,4
?
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complete suppression was planned. .1; was aiways sponsorea oy Tne
?..?
communistic party. Mao Tse Tung has suggested a cooperatA.on
?
of traditional and western medioini on the meeting in Yennan in 1944,
where the outline we's set on questions of culture, education and
? related fields.. .
According to the report by.pr, 0-Yong-Jing, secretary of State
in the Ministery of Public:Health, there are about 5oo poo doctors
.practicing in China, one on every 1400 inhabitants, According to the
? motto: "The European medicine is good', the Chinese traditional
medicine is.good, but the cooperation of 'both is better" , the .
traditional doctors have' been sponliored' systematically after the.
victory of the leberation army and are now part of the Public Health
Service.
? The training of the traditional physicianswas done before exclusiv.
? ly by an apprenticeship:'An.academy in Peking and institutes for
-traditional medicine 3.4 2o province capitals have been founded
during' the past years. They have to train doctors and pharmacists
of the traditional medicine within 6 years, to take care of the
advanced training of the.traditipnal.doctors and, in special
courses lasting from 1 to 2 1/2 years, to give an introduction
into the theory and praxis' of traditional medicine to physicians
? of the western medicine. ?
The teaching staff,of these academies consists of representatives
of western medicine as well as Of the traditional medicine. The
academy in Peking has 29 professorships, 15 of which are for traditional.
medicine, 14 for the European one. The chairs for traditional
medioine have the following distribution at the academy of Peking:
? 4 chairs for the. history of the traditional medicine and ite .
main literature, the others: Chinese prescription, diagnostics,
theories of famous schools of medicine, internal medicine, surgery,
pediatrics, gynecology, acupuncture, eye And throat diseases, massage,
_
old medical languages. .
At all medical schools,.chairs and own institutes for traditional
medicine have been erected and the students have lessons on the
theories and praxis of the old Chinese art of healing in their '
premedical. and medical curriculum.
Alltogether, in China are available 10 000 beds only for the
traditional medicine, and 5000 students attend the academies and
institutes for tiaditional.medioine.. In addition, the old way of
training by an apprenticeship with well known traditional doctors is
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Parte 8
continued. 80.000 of such.apprentices are registered with the
Ministery for Public Health There is no.final state board examination,
the teacher is fully responsible for his students.
The special courses for physicians of western medicine have been
attended by 2000 persons during the last years, including many university
teachers. They have to direct the research in combindd methods of.
traditional. andwestern medicine.
The goal. of the Ministery'fbr Public Health of thePeoples'
Repubac China, which sponsors the old Chinese healing art, is a
critical evaluation of their methods and praxis, the application of
the:valuable means.of this healing art, which rests mostly on
. .
experiences; in order to get an synthesis between traditional and
modern medicine.
The traditional medicine with its 25o 000 cadres is irreplacible
for the huge tasks of the health service in China and many of
the successes of the past 10 years are dile to the work of these doctors.
Many leading physicians and research workers, which received
their training in Europe or USA, have us frequently reassured, that ?
they expect the western medicihe to get many valuable ideas
for basic research and therapy from the traditional Chinese medicine.
Several of their drugs are known by us-tdd,"e.g. the "Ging-Senn
root, which was propakited much by tAe pharmaceutic industry and
sold for a high price as a,roborance. During the last years appeared
in the medical literature, in the. press, in radtfieRSAltiany reports,
praysing the acupuncture, one of the most importantrinethod+f the
Chinese medicine, which has been known in Europe since the 18th century
(Ten Rhyne and Kaempfer met it in East Asia and introduced it in
Europe) as. an ideal'methedmf treatment fro the most differing diseases.
We have seen'undoubtedly results.o.fsthis.method in China, while we
worked there, But ami we' suggest the outmost reservation in the judgment
of its value, regarding,the results of the placeiro therapy.
? . .
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FOR C 'II. ::%L.
The Public Health Service and the standard of sur.gerv in the
Peoples' Republic China.
by
SchmauB.
? During our long stay as. visiting, physicians at ?the hospitals
in Peking and Wuhan, and during short visits.to.surgical departments
in Peking,. Nanking, panghak. and Hatshow, we had the opportunity. to
learn something about the standard and the present problems of
surgery in China, from discussions with leading surgeons of the
Peoples' Republic China, like Wu' Ying Kai, president of the Chinese
Society of Surgery, Shen Ke Fe, Director of the 1st Medical Faculty
in Shanghai, and .Tjiu Fa Dsu, president of the Surgical Society of.
the Province Hupeil
? . We mentioned in our report on. the traditional medicine, that
surgery has been a specialty for renturies..The first known textbooks
on surgical diseases and their treatment date back to the Chan dynasty
(1134-770 B.C..),.as 'well as the first specialists for surgery.
We mentioned also the golden age of surgery of the Chinese healing
art during the Han period, especially under Hua Tuo, who introduced
the narcosis with the drug Na Pu Tang, and performed bowel resections wil
.anastbmosis.
The history of the surgery of the "western medicin4lin China is you./
'3.
It begins around the'end of the last centUry, and was performed by
foreign physicians in the first third of this century, who worked
,in teaching institutions or in missionary hospitals. 'Operations like
gastric resections, operations on the gall ducts, nephrectomies etc.
have been performed only in.a few hospitals in the largest cities
before the victory of the revolution. In the 10 yap since.the
liberation, surgery did a "great legp forward" too/the work and
performance equal those in westeuropean hospitals throughout.
numerous new hospitals har50X1-HUM
founded during the last years, witI4iuite modern operating wings,
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consisting of 5-8 airconditionect-optina rooms for about 250-
? ?
,
-35o bed's: In all new hoipitals, highest importance was placed on a.
complete asepsis in .the operating wing, which could be entered by
doctor, aids and patient only through a lock:naftxx and after
changing all clothes. .
glk
? Surprising for us was the far advanced specialisation of surgery
in China at teaching and research institutions and at the large city
'hospitals. Each university hospital has independent departments
for anesthesiology, general surgery, traumatology, orthopedics,
urology, thoracicfsurgery, cardiovascular surgery, pediatric surgery,
'plastic surgery end.neurosurgery. This specialisation began after
the liberation and was considered necessary and sponsored by the older
generation of surgeons. ?
The second surprise was the sponsoring of the surgical assistents
We have seen relatively young residents performing resections for
Cancer of the esophagus, portocaval anastomoses, and heart surgery,
frequently with the assistance of their teachers, who consider it
their. main responsibility ,:not_to operate everything themselves, but
to train efficient, technically .gifted astistantt -in every respect.
As we learned later, this has not always been so. In China too,
many older colleagues believed a few yes ago, that only thel themsblveE
could performthe most,difficUlt operations. In the year 195/54,
the teachers and the rising generation had discussions, after which
the former realized, their :opinion was false and obstructive to the
development -of surgery. .We didn't see a military hierarchy and the
absolute authority of the chief in China, as it is suppotedly in some
Getman hospitals. We have frequently seen, how the youngest residents
said their opinion freely, and discussions were never closed with
the words ? The chief is always right"..
? The anesthesiology is completely independent. Modern machines for
endotracheal anesth&sia are available at all hospitals; they are
being tionstructed in good quality in China now. Many hospitals have
good experiences With operations in hypotherMla and hypertension. -
They believe, that the body temperature should not be lowered under
.28 degree and they consider alFatkoerature between 29 and 31 degree
best. Systolic blood pressure7malues between 80 and 90 mm Hg are
considered to be without danger even for long operations during
controlled hypotension. In addition to open heart surgery, hypothermia
is used much for the critically ill patient. Some anesthesia
dprtmrt h f on -c
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*
..P
surface), severe toxid dysenteri), and'septicemigrand.toxemia.
Local anesthesia, epidural and lumbar anesthesia are performed.
*frequently at many hospitals.. In Peking, we-have Seen radical
.-breast operations done in prolonged-peridural, anesthesia. Shieh Yung,
-the head of the anesthopia department Of the university of Peking .
told us, that he.prefitra it to the endotracheal and inhalation '
anesthesia during surgery for breatt cancer, for years. '
Abdominal surgery.
48.
1 .
1
The surgical treatment of the chronic gastric and duodenal ulcer
and of its complications' has the first place in the abdominal surgery.
'Tsui-Chih-Yi and colleagues reported recently on the present stand of
ulcer surgery, revi4wing 65 recent Chinese papers. The uncomplicated
chronic ulcer is treated now by a 2/3 resection, gastroenterostomy
and vagotomy are generally not used. Most, frequently a Billroth II
is. performed, and it is. much discussed, whether a total or partial
anastomosis, or a retro-.or antecolic 100p. should be done. In recent -
timeg more people are preferring the resection according to Billrottri
for gastric ulcers. .
In presence Of duodenal ulcers, which are difficult to resect,
? periorm
it is warned to/the exclusion operation And the Nissen procedure
is preferred.- After the exclusion operation "(Bancroft-Plenki
Chien had two fatal hemorrhages funm the.not.:resected ulcer among
nine-patients. (-We have had equal inf.ayoralfip experiences in Vietnam
with this operation.) If a good closure of the duodenal Stump is
-impossible, a catheter duodenostomy is performed; as we have recommended
in Vietnam.
The mortality is. low, considering the difficult circumstances.
It was 2.14 % of 1682 resections, including emergency operations for
.perforation and hemorrhage; excluding the emergency operations, it was
-between 0.47 and 1.8 %, about the results of leading European and
Amedican hospitals.
. The late results of the resection for ulcers ar according to
the reports of follow-Up examinations ery good ' About 90 % of the
patients were without complaints and were able to work in their old
job, about 84 % had.gained leight or did not lose 4eight.
In presence of /2i Perforition, .a primary resection is pre-irerred
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with-suction according to Gordon-Taylor. The latter is considered only
then to'be permitted, when the condition of.the patient is so poor,
that. even the simple closure is too dangerous or if the patient or his
relatives refuse surgery. Follow-up examinations of 390 patients with
simple closure of a perforated ulCer showed, that 43.08 %had symptoms'
again, while Of 295 patients with: primary resections,. only 2.38 % . ?
had complaints. ( 7 Patients.) The mortality Of the primaty resection is
low, Tsui had 538 resection with 14 po3toperative deaths . 2.6 %.
In presence of hemorrhnge due to an ulcer, surgical invention is
, more and more preferred to conservative treatment. The emergency
. X-ray examination ( on the value-of'.Which we have reported together with
Co from V.ietnam) is preferred to the esopfiagoscopy and to the time
consuming liver function tests, in order to_make.the diagnosis
'bleeding ulcer and td'exciudit'Other qauses of GI bleeding, especially
esophageal,varices.
Treatment of the shock and blood transfusions are performed in:
cooperation with the internist, and an-.immediate resection is indicated
in all patients .over 45 years, in younger patient 6 with several
hemorrhages during a short 'period of time,in patients where the
:bleeding does not 'stop shortly Atter blood transfusions, in all patients
with pyloric stenosis, and finally .in patients with a lOnglyistory.of
ulcers.The.mortality'after'resecion for bleeding ulcers was 8.75 %
of 240 cases, and is lowex(than the mortality after conservative treatment.
Postoperative complication% which need special consideration,
are bleeding from the line of anastomoois. The careful ligature of all
submucosal vessels is considered necessary for their prevention. The
.insuffiency of the duodenal stump wgs quite frequent in the first
years afer the liberation, when thegeneral condition of the patients was
' poor. 35.= 1-.47 %.stump insuffiencies occure4m 2094. resections...
.Immediate relaparatomy-with drainage and suction in the postoperative
? period, a careful fluid:an+leCtrolyte therapy, in severe cases a jejunal
.fistula for aliitaentation are recommended.
The jejunal ulcer is very rare after the typical resection, as weli3
seen in Vietnam too. Elute characteristic dumping syndrom after
? resections occurs occasionally.
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Diseases of Liver and Gall ducts.
CholeIithiasis and choledocholithiasis are frequent in China,
like in Vietnam, a primary occurrance of the stones in gall ducts,
even in the intrahepatic ducts,is not rare.' The cause is. frequently
a former choledochal 'ascariasis. Wang from the hospital in Tsingtao
has examined the removed gallstones of 84 patients. He found in the
stones of 11 patients with isolated.ggllblaxider stones only in one. stone
.fragments- of of ascaris as an nucleus, while he could show in the
:Stonea.from 51 patients from 73. with choledocholithiasis eggs or
-
fragments of ascatis'as nuCleus.
? 2he choledocho-duodenostomy is generally not used during
operation on the common duct, and drainage according to Kehr or. Voelker
Is preferred.
? We have described the choledochal ascariasis as an entity in
our:report from Vietnam. liike,weillaysaisaolEeiftg
terti'inness
the Chinese surgeons consideredInKil recently an immediate operatfo74
with choledochotomy and extraction of the invaded worms.Now the
conservative treatment is preferred: Oxygen insufflation into the
duodenum, drugs of the traditional medicine,and use of the acupuncture..
Wang in Tsingtao.has had good experiences and points to the special.
advantage of the rare occurance of cholangitis after this treatmen
The director of the .surgical department of the Childrens' .Hospital
. in Peking reports now-that from more than 300 children admitted with
a .choledochal ascariasis, more than 99 % have been cured by the above
outlined treatment.
Portal hypertension is not rare in China., it is especially frequent
in thelang7Tse valley and in the southern provinces of the country;
caused:.by the'schistttlasis. Shunt operations have been performed during
the past years' with a low mortality and satisfactory results.
According to a statistic of the Academy of Medical Sciences, the morta-
lity is 4.8 %,.of 650.-splenorenal and portocavil shunts.
? Special' experiences in the field of surgical treatment of portal
hypertension has the SUrgical. University Hospital in Wuhan, where we
could stay for.,a longer. period Of time: as visiting physicians. The
'portocaval shunt is performed there, according to the proposal by Tjiu,
by a aide t?ide anastomosis with transplantation bdtwedm.Toetal ahd
caval:veins of .a piece from the splenic vein, with less postoperative
complications thakiafter the end to sidle anastomsois. ?Since 1958. the ;! ?
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hoS"pital had no mortality in more than 100 shunts.
? . According to a statistic.of the largerpathologic iistitutes of
'China, the hepatoma is the most.frequent.cause of death due to cancer.
In recent-time,-several 'hospitals have studied thoroughly the problems
of extensive liver *resections for hepatoma. The P.O. mortality waS
17.3 % of 75 liver resections, performed during the past two years
at nine hospitals. "epatic coma and pottoperative liver insuffiency was
the main cause of death. 'The late resiillts of tbe resection are still
rather discouraging, nearly all patients died within one year due to
recurrency.. 4 .
Another indication for partial livertysection are the primary.
.intrahepatic cholelithiasis and large liver abscesses, which are
located in one lobe.
Acute inflammatory diseases of the pancreas are not to rare.
The conservative treatment of acute pancreatitis, introduced by Katsch,
Nordmann and others, is generally used in China. In the last time,
more and more the opinion is expressed to perform early, surgical
interventions, if the conservative treatment doe not show improvement
soon. They consider in such cases a laparatomy indicated with suction
of the exdudate, drainage. Of. the right upper abdomen to dorsolateral
and the revision of the common dUct.
The treatment of appendicitis plays an important role in the emer-
gency. surgery. Old reports, according to which the appendicits is-suppo-
sed to .be very rare in Qhina, are disproved by the experiences of the
medical centers. The acute appendicitis is 1,,eing treated more and more..410a.
conservatively with-methods of the traditional Chinese medicine, even
by the surgeons at the teaching institutions of the "western medicine"
in complete surgical surroundings. The immediate results are
good, but the recurrency.within.w4,bhie.the first year is around 15 % ?
and for this reason alone the operation aTpears us to be better.
Invagination, ascariasis, and volvulus in addition to
incarcerated hernias.are-ftequent causes of acute mechanical intestinal ,
obstructions. Of. 7355 cases, collected by the academy, 18.4 % were _
'caused by'an invagination,. 10.2 % by an volvulus and 5.1 % by ascariasis.
The Congenital anomalies of the ano-rectal region with 3.6 % Of the
cases With mechanical
obstruction( = 271 .patients) are apparently
more-frequent as in our country. The percentage of cases with obstruction
due:to tumors is with f0117()*(agyt?r--.?
Malignant tumors of the colOn and rectum seem to be rarer. in China
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diotribution of malignagt tumors. Interesting are the studies by ?
'Wu.Tsai Tung on the relation between schistalasis and carcinoma ?
of the colon. He found of 1138 cases of carcinoma of the colon
129 (= 10.8 %) combined with.a schistoitioNiasis. ?The mean age of
? Patients with combined Ca of 'the colon was 37.59 years, and 44..04 in
patients with carcinoma of.the colon, without schistaAdasis. The
relation men: women was in the former group 40,, in the latter 2:1.
The cancer in-the first group occuredat the Same location as the ?
schistomosiasip.Signifant diiferences,have.been found morphologically
and it. is probable, that the combined occurrence is not incidentally.,
but that in the first group the carcinoma developed on the chronic in-
flammation caused by the.schiStdiaohdasis.
The proctologic diseases.: hemorrhoids and anal fistulas, are a
domain of the -traditional medicine, the methods of which are used
nowadays also 'by' the surgeons of the"Western medicine l for these illnessE
The traditional drug Ku Ji San is used for the treatment of hemorrhoids,
and it is either powdered on prolapsing.hemorrhoids or in form Of ?
thin sticks introduced into the hemorrhoidal nodules. Within a few.
days, a dry gangrene results and the nodule sloughs off.
For the treatment of anal fistulas, the ligatuft method is very use4
ful. If several openings occur, operation and ligature-method are
per?
formed together.
t.
*ThorEicic Surgery. ?
. Thefost important problem of thoracic surgery is the treatment of
pulmonary tuberculosist.which-has drawn' much. attention during the
last years. Considering the especially' severe cases,.the-operative
moitality is low for pneumonectomiee, lobectomies, an#egmental resec-
? tions for tuberculosis at the large centers or thoracic surtry.
The Fu-Wai-Hospital in Peking performed such operations between 1956
and 1958 with a mortality, of 0.77 % and the hospital of the firit
,Faculty rof Medicine in Shanghai reported 1174 pulmbry resections dug
to tuberculosis with a mortality of .2;f segmenl4resections
"?have a mortality of CO %.
The surgical treatment of bronchiectasis has-with 1.4 % lbw postopera-
tive mortality aAerApUln,;ii.resacttbns.
The bronchial carcinoma seems to be rare in China. Only a hilt. .
cases have been observed in the q.arge cities, especially in Shanghai.
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Carcinoma of the. esophagus.
In the provinces of Northchiria, the carcinoma of the esophagus
is the commonest of all malignant tumors. Several of our colleagues
have a large experience in the surgery oarcinoma of the esophagus
and can show results, which are better than those of leading American
surgeons. According to the report of the Chinese Academy of medical
Sciences, 3531 patients With a-carcinoma of the esophagus have be,,n
admitted to hospitals in 12 cities in North China,_on 2785, a thoracoto-
my.was performed) in 1650 of which a primary resection:' was possible,
so that the resection was performed in 39..7 %. The average mortality .
during the past .10 years was..10 % of 1562 resections of the esophagus.
.The hospital of Professor Wu Ying kai in Peking has especially large
experiences in the treatment of the carcinoma of the esophagus. At his
hospital, the postoperative. mortality could be lowered to less than 3-%
in more than 300 resections, during the last 1.1/2 years, due to an
refinement in surgical techiques and the improvement of pre- and post
operativ+reatment. At his.hTgpital, a preoperative irradiation
.with the cobalt machine is performed now generally, the patients receive
3006 r. 41 7 days, and not later than 8 days after the end of the
.irradiation? the operation. is performed. The technique for carcinoma'
in the middle and lower third of .the esophagus is the intrathoracic remov
k4e
val of the esophagus, followed by an esophagagastrostomy high in apex
of the pleura. the operation through an leftsided thoracotomy is preferret
The chances for survival of the patients operated at this hospital
are remarkable. They are or all resected. cases:
1 year = 79.1%
2 years =34.8 %
3 years =-24.2%
For patients without metastes.es ip,regione.1 ductsithe time survival
y
1 year =292.3 %
2 years .= 55.6 %
3 years = 51.8 %
These figures prove, that our sometimes shown -pessimistic judgment of
the chances dor cure of a/ cancer of the esophagus are not justified.
w
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Cardiac Surgery_..
According to 'a report by Wu. Ying Kai, the first mitral
commipsurotomy was performed in China in 1954; today, the operation
.is performed in 60 departments for dardiac surgery. At the end of
1959,.a report on 2735 operations on rriitral stenosis was given..The
surgical mortality was 2.1 %. The late results of 755 cases were
satisfactory with 84 %.
Open heart surgery in a bloodless tield with hypothermia have been
performed since 1957 in Peking, Shanghai and 13 other heart centers in
province universites..In 239 cases the total mortality was 8.03 %;
98 of which have been pulmonic stenosis ( mortality 2.5 %). 89
atrial septum defects(5.62 %), 31 ventricular septum defect3(12.93 %).
In 1956, several medical centers in China started experimental.
studies on extracciporeal circulation. Since the end of 1958 both
" cardiac centers in Peking and Shanghai operate with a heart-lung
machine built in Shanghai. Both hospitals had experiences with 40 ?
cases with this apparatus at our visit in July 1960, and they had per-
formed mostly .operations because of ventricular Septum defect and the
tetralogy of Fallot, and the mortality was around 15 %.
Vabculgr surgery was also expanded during the last years. In
Shanghai. transplantations of prostheses have been performed, made in
China from plastics and from silk with a special preparation.
Urology.
, The tubercUlosis of the GU tract seems to be relatively frequent
in China. Chinese urologists observed,,that a complication not to
rarely 'found with .a unilaterS14.menal'tuberculosis was a contreateral
hydronephrosis.. The urologists.of the Uospital of the Academy of
"edical Sciences.in Peking.found in 1334 patients with a unilateral
renal tuberculosis 214 = 16 % with a contre.ateral hydronephrosis,
caused by stenosis of-the-ostium of the'bladder
or by a bladder contraclion.
?
Stone formation in the kine and the urinary tractis frequent.
Interesting differences between the occurance in .the upper and lower
, urinary tracts hayesbeen found,in relation with different regions
of China and different ways of nutrition and live. In Shanghai,
a port, the relation of stones in upper and lower urinary tract stones.
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In, Paling, Wahan, Sian and ifa.ntshow, in towns situated in the interior
. on large plains the relation was 1.05 lin 1188 casen, while in
the mountainous regions, e.g. the proyince Shantung the incidence of
s.tones in the lower tracts, especially bladder stones, have been
strikingly frequent. The reftption for Shantung was 1:45.9..
? In Central and South China, complications of filiariosis occur in ti
the urinary organs, edema of scrotum and penis and elephantiasis,
? hydroceles and above all the chyluria in about 10 to 30 %. of all
infected patients. Gpod.results in the lattchave been seen after
exposute of the kidney with severance of all lymph ducts.
.The uretero-sigmoidostomy is performed by the Chinese urologidts
for. destruction of the bladder by an carcinoma or chromic inflammatory
processes 50X1-HUM
? In Sharighai, an artificj.al.kidney has been-lieveloped in
cooperation of the medical institutes and the industry, which has been
used with succes in mqny-hospitals on uremic patients. It is now
an export article on the list of 'the chinese industry.
Traumatic Surgery.
The further development of traumatic surgery finds much interest,
there are lectures andexaminationsat.the medical schools. Large
independent departments for traumatic surgery have been foundadin all
large cities and indUstrial centers durin&the.last years.
The treatment of fractures follows the rules. of BOhler at the a
large centers for traumatic slirgery, only a few hospitals- mostly under
.rci4444As
the directions of former sTamornie of the Aurora University in Shanghai-
prefer a mainly operative treatment of fraCtures of the long bones .
with bane's plates etc. Only in recent times the methods of fracture trea
ment of the traditional medicine are being checked at large ceREg
for traumatic surgery-. At several hospitals they believe, that drugs
used by the Chinese doctors can accelerate the healing ?fractures.
The results of experiments on anihals a4liteseem to show, that some of
these drugs favor callus formation. At the 1st Surgical Hospital
in Wuhan, which does, research work on these drugs,we saw some patiants
with fractures of the long bones, which have been consolidated in a.
surprisingly short time. One man, 55 years old, with an oblique
fracture of the upper third of the femur, was healed and could bear
wileight after 4 weeks. Wather these drugs favor callus formation actually
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are available. '
The"chinese massage" used now as .a part of fracture treatment,
is certainly not as da4gerouS as the Ci-roition OPicicotAireetGio44 #1441?sola.
which is still used by some of our surgeons in spite of all intensive
well founded warnings. It consists mainly in alight pressure
on well definlled points of the extremity noit injured. The points
nre selected according to the doctrine of the effective points and
conductive pathway; 50X1-HUM
. Fractures of the neck of the femur seem to be very rare in China.
We made the same observation in Vietnam. The fixation of the fracture
of the femoral nedk is therefor not introduced yet. The 1st
Medical School in Shanghai reported on 77 surgical fixations by
intramedullary nail for medial. fractures of the femoral-ne6k.
The ,early intratrochanteric osteotomy , which we used at the Charite
-with good results, is recommended for pseudarthrosis in the femoral
neck. Cases, which are admitted aboUt after 4 weeks, with frac-
tures of the medial neck, are according to many surgeons best treated
by intrattchanteric osteotomy.
Injuries to the. semilunar cartilages are frequent in areas
with mining industries, and it is surprising, that the external semi-
lunar cartilage is more frequently lacerated then the internal one.
The method of Matti was preferrad for the treatment of pseudarthro-
sis, if there was no bone defect or only a small one, in cases with
larger defects, the method of Phemister was used.
- The large teaching instItikons in Shanghai, Peking, Tsientin
are equipped with bone banks, but most Of the surgeons we .4 Ra preferred
the autoplastic grafts to the conservated ones. Lyophilized grafts
are available in Peking since two years.
? Remarkable progresses have been made in the treatment of patients
With extensive burns dUring the last years. Well documented reports
49,4
are available from .Peking, Shanghai and Wuhan, alRult the saving of
patients with 2nd and 3rd degree burns of over 80 % of the body surface.
The large traumatologic centers are equipped with own departments for
patients with burns. We could visit such special units in Peking .and.
Wuhan.. These department are separated completely from the other
hodpitil, can be entered only by a lock and some of them have already
an airconditioning, so that an asepsis was guaranteed. The open wound
4?nt -PnIn 1^^^1 4-IrwrA^4me.1...4. ,r44, 4.1,^n^
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-ACC0(12.I1a 1.-411U CAIMI-1ruuctsV.LA.oc? w.LuziJJ LiAs
'biAecondary is markedly less than after closed treatment. Highest
importance has the careful nursing care. Special teams of physicians,
nurses and techlicians are trained for all severely injured patients,
who have to. take care only of such patienta-all around the clock.
1 ? 1 0,
Pediatirc surgery..
Pediatric surgery is an independent specialty at all teaching
institutes.. According tothe'statistics of the. Ministiry for public
.health, the moitality after operations on children decregsed definitely,
atter special ceAters for pediatric surgery have been-founded. The
Mortality ofir acute diseases of theabdOmenC. was e.g. 1956-5.6 %,
1958, after the hospital for children has been founded in Petting,
it was only" 2.4 %. .The number, of pationtsis.relatively high at this
hospital. In 1958, 202 patients4ith intestinal, obstruction due to
ascariasis; 229 with a choledochal ascariasis, 178 with invaginations,,
.220 patients with an acute appendIcitis have been treated at the
hospital for pediatric surgery in Peking. Malformations'of the
? intestinal tract have been obServed strikingly frequent. Chen ( Peking)
told Us,. that he treated intestinal and.164 anal and rectal atresias
-in the last years. An snalysis-byft An Chuan shows, that from 1322
:Children. with a boWelobstruction, 296 had congenital atresias.
High is also the .number of invaginations with 558.patients = 42.2 %
of all cases. In all early cases, a trial of desingagination by barium
enema is made, and the author has seen results with this method
in over 50.% of these patients.
. .In Peking, a great number Of progressing'necroses'of the skin
were observed.in infants. The disgaseleccured only in babies delivered
in hospitals. The mortality of this disease was high during the first
years, (1956 = 16.6 %); but it couldbe lowered to 6.7 % in 1958
by extensive early incisions, and a treatment with plasma infusions
had high vitamin dosages.
We noticed during our Wit in the hospital in Peking, that no -
inpatient with ?a hernia was tAated. We learned, that hernias
are operated in the outpatient department and discharged home immediatel:
Finally a word on the problem of thromboembolism. Thrombosis
and embolism are extremely rare in China. We have talked to many
surgeons who have never seen a postoperative pulmonary embolism, and
the pathologist Lin Chen Kong, who worked before with Roessle,
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? --inPeking. We also saw 'never an embolism during our work ih Vietnam. '
At that time we belWed it to be due to the underwtrition, which most
of Our patients suffered from. But in China, the nutrition has been suff-
icient for mny years; We discussed this problem thoroughly with a
colleague in Wuhan; who who.was working before at the. Paulun Hospital
in Shanghai. The, had never, seen an pulmonary embolism at that hoppital,
rthidh was frequented by the well to do classes. These observations.
.make it probable,,that'the extremelY'rare.inCidince of thrombosis and
? embolism in East iSii,deiendton the'constituton.
. /t'was interestinifOr'uS,.that many hospitals did not dress the.
? wounds.postoperativeli, and, that the patients even after manor
.operations like resections of the esophagus have been transferred to
? the ward without dressings.....The.percentage of infections is according
`to the experiences of these surgeons lower than in the wounds with dress-
ings.. The pains are less too, as the patients are not bothered by the
dressings.
. Recent studies on the sensitivity, of bactprias.to the, different
antibiotics show, that also in %-;hina, where the antibiotics are
available'on a larger scale only since 1951, 'the percentage of resistant
organisms is increasingly constantly. 70-90 % of all staphylococci'are
resistant to penicillin:
In our former. reports we hive tried to give i small survey on the
develOpment of surgery and itS stand in modern China. We restricted our-
selves to the main specialties-of. our discipline. But also the
the smaller subspecialties of surgery have been developed., which did
not exist before the victory of the revolution. All teachintinstitutions
have centers for neurosurgery, which can report on good results of the
treatment of brain injuries and brain 'and medullary tumors. A list of
1448 intracranial tumors shows, that the procentual distribution of the
different tumors, equals nearly the frequency found in western Europe
.and in anglo- american countries. ( Glioma 30.6 %,
meningioma 20.6 %,.tumors'of the hypophysis 10,4 %, acusticus neurinoma
9 craniopharyngioma.7.1 % angioma and vascular abnomalies 4.6 %,.
tuberculoma .3.7 %, cholesteatoma 2.3 %). An important field of neuro-
surgery is the treatment of intracranial and intraspinal diseases
? caused by parasites, above'all the Paragonimiasis and the cerebral
cysticercosis.
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?
Plastic and reconstructive surgery also can report on. very good
reoults in the treatment of severe mutjlations by war injuries and of
elephantiasis of the lower extremiti6s and the penis due to filiariosis.
Address of the author:
Oberarzt bt. med. habil. A. 1K: SchmauB.
Chirurgische Universitatsklnik der Charitg
Bertin N. 4 .
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