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Medical Education in China.A SPECIAL meeting of the medical profession

will be held on the afternoon of Monday next,Feb. 21st, at the Royal Society of Medicine, theobject being to emphasise the developments whichhave been made in China in recent years inmedical education-developments to which medicalpractitioners from the United States and thiscountry have mainly contributed. To our readersthe information that the profession of medicineis held in the deepest esteem in China will notcome as news, for we have been able from timeto time to keep them posted in things medical,as they occur in the vast Eastern Republic.Dr. Wu LIEN TEH, physician extraordinary tothe President of China, published in our issueof May 29th, 1920, a detailed account of medicalprogress in China since the establishment ofthe Republic, and especially since the issue of aPresidential mandate in 1915 recognising Westernmedicine as the proper course of medical practicein China. The National Medical Journal of Chinahas brought the story up to date, a recent issuecontaining, in addition to a varied assortmentof quite modern medical articles, an excellentessay by Dr. PETER C. KIANG, showing the keennessand devotion of the Chinese medical student to thecalling which he has adopted.The Republic of China is in a state of transition,

so that all vocational education of a modernsort is complicated by the political situation.But the calling of medicine appears likely tobe the first to establish itself on an organisedbasis, chiefly because a greater percentage ofmedical students than of students in any otherfaculty stick to the profession of their first choice,practising it faithfully after return from universitiesor professional schools to which they may have beenattached abroad. This is a distinguishing featureof the medical student. Other students, on theirreturn to China from abroad, are prone to changethe direction of their work. Chemists and engineersgo into the public services or into the employment ofbanks, and mining engineers drift into commerce;but the Chinese medical man, educated in Europe orAmerica, on returning to his native land invariablypractises medicine. And he does this, as many of ourown medical men do, not because an easy or lucrativecareer is open to him, but because, having servedhis apprenticeship in medicine, no other metierseems worth following. The career of the Chinesegeneral practitioner among his own people isattended with two main drawbacks which makegeneral practice so often hard in this country-the life is physically a wearing one, andthe public appreciation of medical efforts iscapricious. Criticism, indeed, of the Chinesepractitioner appears to be prompt and outspoken,for if a patient’s temperature does not abate onthe mere appearance of the doctor, the reasonwhy is demanded severely. Public opiniontherefore needs to be cultivated, and educationof the public earnestly undertaken. But we

may be certain that the fact of the medicalstudents sticking persistently and faithfully totheir profession, when they return from abroad,will prove a great public argument for a betterappreciation of science. The Chinese are notori-ously good and honourable men of business, snd tothem the recognition that medical men prefer theirown calling to any other, despite its drawbacksand despite invitations to easier careers, will forma definite proof that the rewards of a life with noble

ideal are higher than those of an exclusively materialobjective, and that the calling must be a high onewhich obtains adherence on such a basis.Modern China is ripe for the development of

modern medicine. Medical learning in China haspassed the first and difficult stage, and now it isnecessary that the standards of medical educationshould be raised, and that hospital practice shouldbe more generally based upon the science ofto-day. Dr. HAROLD BALME’S work, prepared underthe auspices of the China Continuation Committee,a committee instituted to inquire into the scientificefficiency of mission hospitals in China, indicatesa general consensus of opinion in regard to thismatter. The institution of this committee, thefine housing of the China Medical Board, and theequipment of the Pekin Central Hospital and UnionMedical College alike prove this. The pioneers ofmedical science in China have to face a considerabledifficulty in laying out a medical curriculum forChinese students, for whom it is necessary tohave a bilingual system in medical nomenclature,with the attendant difficulty of securing an exactequivalent of meaning. But a good beginning isbound to have a fruitful issue.

The Sanitary Authority and

Encephalitis Lethargica.As is well known, acute encephalitis lethargies

has been a notifiable disease since Jan. lst, 1919,and the number of cases notified in the administra-tive county of London is issued weekly on theauthority of the Registrar-General and is recorded inour columns. One of the striking features in theinteresting survey of the cases notified in Manchesterduring 1920, which we publish in our present issue,is that in not a single instance has the spread ofinfection from one person to another been traced.Not one of the 138 family " contacts " of the diseasecaught the infection. Dr. W. ST. C. MCCLURE makesthe deduction that the disease is not infectious orthat the infection is widespread and most peopleare immune. He, however, " hedges " by the sug-gestion that until our knowledge becomes morecomplete we ought to presume the disease infectiousor contagious and take precautions accordingly. Thefatality of the Manchester cases is very high. The

diagnosis was confirmed in 32 cases, of which 17proved fatal. Of the remaining 15 only 2 have madea complete recovery, 7 are still ill, and 6 at periodsvarying from two to nine months after the onsetare seriously damaged. It seems probable fromthis high fatality that a considerable number ofmilder cases have been unrecognised. We believethat experience elsewhere confirms the Manchesterexperience as to the failure of the patient to spread

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infection, but that elsewhere the occurrence of alarger number of milder cases has been reported.The value of notification at present is chiefly thefacilitation of investigation, and the ManchesterPublic Health Department, through its staff ofmedical assistants, has been in a good position toundertake such inquiries.For most notifiable diseases there is a routine

procedure-isolation of the patient, removal to

hospital, and disinfection of the house. Inthe case of encephalitis lethargica, those whohave had experience do not hesitate to treat

patients in a general hospital. Nor can we seethat it is justifiable, in view of the apparentlynon-infectious nature of the disease, to exclude" contacts from school or work. Education is

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already much interfered with by diseases knownto be infectious and we ought not to add anotherdisease to the list without any evidence of its infec-

tivity and simply because it is as yet a mystery.The tendency is rather to regard a mysteriousdisease as infectious. In OsLER’s Medicine, theedition published in 1901, it is mentioned that theleading Russian medical authorities at that timebelieved scurvy to be infectious, and OSLER himselfclassified beri-beri among the specific infectious I,diseases. In these last years we understand thesetwo diseases better. There is already too great atendency on the part of the half-informed to createscares about new diseases and we must not panderto that tendency. Notification has its value nodoubt as a means of putting the medical practi.tioner on the alert when he meets with obscureailments resembling encephalitis lethargica, and ofthus facilitating the patient investigation of itscause, but it cannot be said that, in the presentstate of our knowledge, notification enables the

sanitary authority to take any practical steps forthe prevention of encephalitis lethargica.

The Prince of Wales, F.R.C.S.ON the occasion of the birth of the PRINCE OF

WALES as third in direct succession to the Crown,a partly humorous but wholly loyal suggestionwas thrown out in these columns that, havingregard to the increasing part which things medicalmust play in future Imperial administration,his Royal Highness should be a medical man.

The suggestion became a fact on Monday eveninglast, when at the Hunterian Festival Dinner hisRoyal Highness was admitted an Honorary Fellowof the Royal College of Surgeons of England. Atthe time of his birth the constitution of the Collegemade no provision for Honorary Fellows, but in1900, that being the centenary date of the recon-stitution of the College under Royal Charter, thenecessary powers were acquired, and the firstHonorary Fellow thus admitted was the late KingEDWARD VII. The present KING, while Prince ofWales, graciously accepted the same diploma, andnow the PRINCE OF WALES has followed his father’sand grandfather’s suit, being elected among a groupof six who have especially distinguished them-selves in the war. The other five are the Duke ofCONNAUGHT, Colonel-in-Chief of the Royal ArmyMedical Corps; Dr. PIERRE DuvAL and ProfessorANTOINE DEPAGE, respectively selected to repre-sent the medical work of our Allies, France andBelgium ; and Brigadier-General J. M. T. FINNEY andDr. CHARLES MAYO, respectively Chief Surgeon tothe American Army in France and Adviser to theArmy Medical Service in the United States. ThePRINCE OF WALES’s right to inclusion ’in thisdistinguished group was justified fully by SirANTHONY BowLBY at the Hunterian Festival Dinner,when he described the Prince’s work at the frontas admirable, his personality to have actedthroughout the war in all ranks as a source

of inspiration, and his tour of the Empire tohave been an unqualified success. The Presidentobviously spoke out of conviction and not out ofcourtliness, and the PRINCE OF WALES in his replytook the opportunity of paying a tribute to theservice of medicine throughout the war in wordswhich clearly had their origin in sights which hehad seen and things which he had learned. The

Iimpressive part of a dignified ceremony was thatit was the outward sign of genuine feeling.

Annotations.

THE DISPOSAL OF DOMESTIC REFUSE.

"Ne quid nimis.1’

I AN inquiry held by the Ministry of Health on

Jan. 12th at Sheffield with regard to a proposal to spend;&bgr;200,000 on a new method of disposing of the city’srefuse has more than a local interest. The problem hasits economic side and its sanitary aspect. It wasshown that the total amount of refuse collectedannually is about 130,000 tons from a population ofabout half a million. Putting aside the 20,000 tonsfrom the privy middens, an incubus which mustcontinue to be dealt with at the destructors tillthe privy middens are all converted into water-

closets, the problem consisted of dealing with thecontents of dustbins and so-called dry ashpits.Three methods were considered--viz., the reconstruc-tion and extension of the destructors, tipping, and a.

special method of sorting and screening the refuse. Itwas shown that the capital cost of reconstructing andextending the destructors would be from 6150,000 to.6200,000, while the cost of burning the refuse at thedestructors after collection would be equal to a shillingrate, or over 290,000 per annum. Tipping was ruledout largely on sanitary grounds. The tips would havehad to be at a long distance from the city, and objectionis always raised by the residents of the districts inwhich they are established. Besides the nuisance fromrats, effluvia, paper being blown about, the firing of thetips, and so forth, the cost is always run up by theheavy transport charges.The third method was the one selected. Plant of a

size capable of dealing with the refuse of a populationof 40,000 has been in use for some time, so that themethod has already had a sufficient trial to enablereliable estimates to be made as to the cost of theprocess. The plant consists of electrically drivenrevolving screens, which sort the refuse into constituentparts according to the size of the mesh of the screen.The first material sorted out is a fine dust, about 33 percent. of the whole, which passes through a in.screen. This dust has a higher manurial value in

nitrogen, phosphates, and lime than stable manure, andgood reports have been received of it from agriculturalistsand golf clubs. The second material removed is a finecinder which passes through a in. mesh, amount-ing to about 26 per cent. of the refuse. Thisfine cinder when made into briquettes, with theaddition of 812 per cent. of pitch and 2 per cent. of tar,has a high calorific value. The third material is largecinder which, owing to its specific gravity, can beseparated by a washing process from the heavier residueand has also a high calorific value. Its fuel value is 11,taking coal as 14, and it is used instead of coal forheating the corporation baths. The large cinderconstitutes about 18’5 per cent. of the whole. Theheavy material which is separated by the washeramounts to about 14 per cent. and consists of stone,shale, broken pottery, while it also contains a certainamount of unburnt coal which falls out with theheavy debris. The unburnt coal is one of thefew useful things not used, but its quantity would notjustify the cost of sorting. This heavy residue beingwashed forms a quite innocuous material for tipping,very different from the stuff at present tipped, beingmore like clean builders’ rubbish. The vegetablematter, amounting to between 3 and 4 per cent., willeither be burnt in the destructor or pulverised andadded to the dust to increase its manurial value, pro-vided a good market is found for the dust. The"tailings" or larger particles, containing tins (1 percent.), rags (0’4 per cent.), paper (3’6 per cent.), arecarried on to a revolving belt where articles ofvalue are picked off by hand. This hand sorting is

light work of a quite unobjectionable nature on sanitary

grounds and is necessary because of the varying value

of the tailings. For example, during the war a goodprice could be got for the paper; now there is