Correspondence
The University Medical School of Canton
To the Editor:—The University Medical School of Canton has been a name for six years, and now that it has become a reality it seems only right that our friends in the medical profession should know something about it. The school is under the management of the Board of Directors of the Christian Association of the University of Pennsylvania, and is affiliated with the Canton Christian College, being located on adjoining property. The purpose of the school is threefold:
- To transform and mold the character of Chinese youth by leading them to a knowledge of Jesus Christ.
- To give in the English or Chinese language a course in western medicine modeled after that of the best schools in America.
- To cooperate with the Christian Association of the University of Pennsylvania in its work with the undergraduate body in Philadelphia.
Until the present year the University Medical School has had no buildings of its own, but has rented from the Christian College. The permanent hospital is now, however, being built. It is of brick and reenforced concrete, and for good workmanship and solidity in construction it cannot be excelled by any building in all China. Only the first section is now being erected, at a cost of $16,000, to be finished Sept. 1, 1911. It is estimated that the entire building will be 500 feet in length and will cost not less than $100,000.
The hospital is to be equipped according to the latest ideas of modern hospital construction.
In February, 1910, several students of the Canton Christian College asked us to start a class in medicine. This we finally agreed to do, and at the present time there are five students who have completed one and one-half years' study. During this time they have covered osteology, histology, physical diagnosis and an elementary course in physics. They are still studying anatomy, physiology, therapeutics, etc.
There are now four physicians in charge of the medical school—three American and one Chinese—all graduates of the University of Pennsylvania. In addition to these, there is a secretary and a trained nurse and a number of Chinese helpers.
During the past winter plans have been made for widening the scope of the school by inviting the missions represented in Canton to contribute the services of at least four physicians, thus making it a union school. There has been hearty endorsement of this plan, and it is now hoped that by next March this union school will be started with instruction given in the Chinese language. The plan is to have classes admitted every year to be taught in Chinese, and to admit classes taught in English when sufficient students apply.
The opportunity for original research in a tropical city like Canton is unlimited. The school aims, also, to give opportunities in this direction. The first postgraduate course was held this year when Dr. H. S. Houghton of Wuhu, at the invitation of the school, gave a most instructive course in parasitology and examination of the blood. Thirteen physicians, representing nine different missions, were in attendance—some coming from a distance of 300 miles. The course was held daily for two weeks in February, during the Chinese New Year season, classes beginning at 9:30 a.m. and lasting until 4 p.m. with one and one-half hours' intermission at noon.
Next year it is planned to hold another course, taking up ophthalmology and some other subjects.
As we look back to the beginnings of our great medical schools in the United States, we recall that they owe their origin to physicians trained in Europe who devoted their lives to developing the art of medicine in the American colonies. Can we, who have reaped what they have sowed, do better than follow their example, and help the men in this great land of China to realize their ideals of establishing schools of medicine modeled after the institutions of Europe and America?
Queries and Minor Notes
Anonymous Communications will not be noticed. Every letter must contain the writer's name and address, but these will be omitted, on request.
Generalized Vaccinia
To the Editor:—I wish to report a case of generalized vaccinia occurring in a series of eighty-two vaccinations. The patient, T. D., aged 10 years, height 4 feet 81⁄2 inches, pulse 96, respiration 24, temperature 99.9 F., skin dry and harsh, no vaccination scar, although he had been previously vaccinated, presented the symptoms of incipient tuberculosis in the right apex of the lung. He was vaccinated April 24, 1911, at the same time the physical examination was made. About a week later, he states, his arm began to itch and pain him and he scratched it. Following this the arm became swollen from the elbow to the axilla and a few days later vesicles formed which changed later to pustules; these dried up, forming thick brown crusts. The eruption, although discrete, was very profuse over the extremities and back, the chest on its anterior surface having only a few scattered spots. The face also escaped with only three or four points of eruption. About the site of vaccination the pustules were confluent, nearly half of the anterior surface of the arm being occupied by a large, dry crust. The last examination was made June 10, 1911, and the crusts had nearly all fallen off at that time. The question which occurred to me was, Why should one child in eighty-two have a generalized eruption and the others escape? Was it due to the tuberculous condition, to the vaccine or to some personal idiosyncrasy?
Answer.—Assuming that the eruption in the case described was that of a generalized vaccinia, an assumption that is not entirely conclusive from the portrayal of the symptoms, the following could be stated: The fact that the child scratched the site of vaccination might readily account for the swollen condition of the arm and for the development of secondary vaccine vesicles in the immediate neighborhood of the primary insertion. Such a complication is by no means rare. The generalized outbreak might have been a true generalized vaccinia of hematogenous origin, or the child might have scratched various parts of the body and produced a generalized vaccinia by auto-inoculation. In true generalized vaccinia, the eruption usually appears from the fourth to the tenth day after vaccination, but most often from the sixth to the ninth day. Spontaneous generalized vaccinia is an extremely rare condition, and many cases reported us such have doubtless been auto-inoculative cases.
As to the intimate cause of true generalized vaccinia, we know but little. It is possible that it might be due to an abnormal susceptibility to the vaccine infection. There is no evidence at hand to suggest that tuberculosis would in any way predispose to generalized vaccinia, unless it be that the skin of the tuberculous is more sensitive to toxins in general, as Sorgo recently suggested (The Journal, July 8, 1911, page 173).
The Practice of Ophthalmology
To the Editor:—Please inform me what books contain adequate information from the standpoint of the ophthalmologist for the acquiring of the necessary knowledge to be able to examine eyes and correct errors of refraction satisfactorily. How far is it necessary to carry the mathematical work in optics? Are analytic geometry and calculus absolutely necessary to a practical understanding of physical optics as applied to ophthalmology? Why can't an optometrist refract correctly?R. F.
Answer.—There are many works on the market whose contents properly digested, would enable one to make a thorough examination of the eye, including its refraction. First of all the uninstructed student should study one of the shorter and simpler manuals, like May's "Diseases of the Eye," or Wood and Woodruff's "Commoner Diseases of the Eye," following it by a larger text-book such as that of deSchweinitz, Weeks or Duane's translation of Fuchs, For all practical purposes only a knowledge of the fundamental principles of physiologic optics is necessary for the practice of ophthalmology but an acquaintance with the geometry and algebra involved in a study of works like Landolt and Donders on the refraction and accommodation of the eye are highly desirable. If the capacity to do the mechanical work of determining human refraction were all that is demanded in "fitting glasses" almost anybody might learn how to do it in a comparatively short time but, as a matter of fact, this result is a minor consideration in the practice of ophthalmology. What the public generally asks for is relief from certain ocular symptoms thought to come from needed glasses, but inasmuch as any or all of these may, partly or wholly, arise, not from abnormal refraction but from disease of the eye itself, from the nose, brain, frontal sinus and other organs, and since only a well-trained physician has the ability to determine which of these organs is at fault, it must readily be seen that the optometrist (who has had no medical training) could not possibly be
