A SHORT HISTORICAL REVIEW OF THEDEVELOPMENT OF SURGERY IN CHINA

B*F. I. TSEUNG, M.B., B.S. (H.K.)., J.P.

The oldest classic of Chinese medicine"Internal Classic" (Nei Ching (*)$), supposedto be written by Huang Ti recorded thatHuang Ti invented the nine needles for acu-puncture and wrote a treatise on medicine andsurgery. The Internal Classic dealt with Ana-tomy and Physiology in a very crude mannerand also dealt with the theory of disease, pulseindications, health conservation, principles oftreatment and acupuncture, etc.

According to Historical Recordsthe first Chinese surgeon during 2698-2598 B.C.was Yu Fu (jjIfWt)- It was recorded that hecut open the skin, dissected the muscles, sever-ed the blood vessels, tied the tendons, washedthe stomach and cleansed the intestines. Thisdescription revealed that abdominal surgery waspractised in China as early as this period.

Another famous surgeon who lived about255 B.C. was Pien Ch'iao also named Ch'inYueh-jen ( ^ X-^^^A ). It is said that heobtained his medical knowledge from ChangSang-chun (-jt^i^) who gave him a book anda package of herbs and asked him to take theherbs for a period of one month. He follow-ed his directions and eventually was able to seethrough the human body revealing all the dis-eases of the internal organs. This seemed tobe an anticipation of the modern X rays.

In Lieh Tzu Tang Wen Pien (#!]-? ftJ&), the following passage is of interest:

Kung Hu of Lu and Ch'i Ying of Chaofell ill and both asked Pien Ch'iao for treat-ment. Pien Ch'iao addressed Kung Hu:

"Your will is strong, but your animus weak,hence you are strong in one respect but weakin another. The will of Ch'i Ying is weak buthis animus is strong, hence he is weak inthought and dangerous in his designs. If yourhearts were exchanged there would be an equili-brium and the result would be good. He gavethe two persons narcotic wine to drink whichmade them insensible for three days. He cuttheir chests open, removed the hearts, exchang-ed them and put them in again. The twopersons made an eventual recovery.

About four hundred years later, i.e 190A.D China produced the best known surgeonever recorded in history by the name of HuaTo (JJif'S). His fame rests mainly on hisdiscovery of the use of anaesthetics and hisoutstanding skill of surgical technique. Accor-ding to the Annals of the Later Han Dynasty,he gave a patient an effervescent powder in winewhich produced numbness and insensibility.He opened the abdomen or back, as the casemight be, washed, cut, or removed the diseasedportion. He then sutured the parts togetherand applied a salve to the wound which healedup in four or five days, completely returningto normal within a month. In his biographythere was an account of a case of splenectomyperformed by him under anaesthetics. One mansuffered from sharp cutting pains in the abdo-men. Within ten days the whiskers and eye-brows dropped out. Hua To diagnosed thecase as gangrene of the spleen and advised thepatient to have an operation. After giving thepatient a dose of medicine, he put him in arecumbent position and opened his abdomen.The spleen was found to be half gangrenous.

180 THE BULLETIN OF THE HONG KONG CHINESE MEDICAL ASSOCIATION

This was excised, the wound smeared with anointment, and another dose of medicine wasgiven. The patient made a complete recoveryafter one hundred days.

In the Wei and Han Annals, Chronicles ofthe Three Kingdoms, were described all sorts ofoperations performed by Hua To ranging fromvenesection and acupuncture to laparotomy,splenectomy. excision of intestines and liver.Sometimes he operated without an anaestheticas in the case of Kuan Kung, a famous generalof the Three Kingdoms whom he operated onfor necrosis of arm as the result of a poisonedarrow. Another story was that Tsao Tsao,King of Wei was suffering from persistent head-ache. Being his personal physician, Hua Towas summoned to treat him. He offered toopen the skull of Tsao Tsao but his offer wasdeclined. The king suspected him that hewanted to murder him and thereupon put himin prison where he died. Just before his death,he gave his manuscripts to the warder, whohowever, dared not accept them. So he burntall his papers leaving behind only the descrip-tion of the art of castration which is still prac-tised by the Chinese on cocks and boars.

The death of Hua To unfortunately marksthe end of Chinese surgery, for since then his-tory does not record any further use of theeffervescent powder for anaesthetics nor anyattempt for major operations by Chinesesurgeons.

It should be noted that in China surgeonswere classified on an inferior plane thanphysicians and only lower grade doctors wereput in charge of the surgical department ofGovernment in the old days.

The first and most important treatise ongynaecology is the Fu Jen Ta Ch'uan LiangFang ( $?A^^-JJt^ ) by Chen Tzu-ming ofthe Sung dynasty in which menstruation, concep-tion, pre-natal care, hygiene during pregnancy,

preparations for delivery, difficult labour, thepuerperium and various diseases of womenwere described.

The first reliable source on ophthalmologywas the Tzu Wu Ching ( JJ"Jf-#3L) or "the Im-portance of Needling" published in the Handynasty in 250 B.C. The Yen K3 Ta Ch'uan(a.>ft*-) or "Most Complete Eye Book"was written, at the end of Ming dynasty, 1628A.D in which it is noteworthy to mention theprocedure for excision of pterygium and thegolden needle for removing cataract, which aremost probably the only surgical methods whichhave been used for treating eye diseases up tothe present time.

In 1821 A.D. in Yen Ke Liu Yao (or "The Six Essential Features of Eye

Diseases'' by Chen Hou-hsi, the method ofclamping the lids with the aid of forceps madeof bamboo in cases of entropion is discussed.

The decline of Chinese surgery is mainlydue to two reasons: (1) the Confuciandoctrine which holds the body to be sacredand not to be mutilated in any way and (2)the degradation of the medical profession whichis classified amongst the four artisans, theothers being fortune-telling, astrology and phy-siognomy.

Whatever remains of Chinese surgery nowsince the last thousand years is acupuncture,bone-setting, incision of abscesses, removal oftumours, perineal lithotomy and a very crudeform of entropion operation.

The introduction of Western medicine inthe 19th century at first met with tremendousdifficulties in overcoming the Chinese prejudicesand the Chinese then only looked to surgeryas a very last resort.

It is interesting to record that the firstoperation for bladder stone was performed by

A SHORT HISORICAL REVIEW OF THE DEVELOPMENT OF SURGERY IN CHINA 181Dr. Parkes in 1844 who in 1846 published abook on "Surgical Practice amongst the Chin-ese." In 1847 ether anaesthesia was firstadopted in Canton followed by chloroformnarcosis a year later. In 1857 Hobson pub-lished a book 'First Lines of the Practice ofSurgery." It was in 1874 that the first femalestone operation was performed in Canton anda year later the first ovariotomy was attempted.In 1876 operations were performed under anti-septic precautions in Shanghai and about ayear later the Lister's method was perfected.

The establishment of missionary medicalschools and hospitals and Government institu-tions and the training of Chinese doctorsduring the last decade or two have considerablychanged the attitude of the Chinese peopletowards operations and in recent years more andmore Chinese doctors gradually took up surgeryas their post-graduate specialty. Certainly themajority of the Chinese. people have more con-fidence in surgery now than hithertofore andthere is a great future in the advancement ofsurgery in China.

ELECTROMEDICAL. SURGICAL EQUIPMENTMADE BY

THE BIRTCHER CORPORATION, U.S.A.

ELECTRO-SURGICAL UNIT(hyfrecator)

FOR DESICCATION. FULOURAT1ON. COAGULATION.

ULTRASONIC UNITFOR TREATMENT Of

RHEUMATIC DISEASES. ARTHRITIS. SCIATICA.BRONCHO- ASTHMA. VARICOSE ULCER ANDCONTUSIONS.

MODEL 300, ELECTRO CAROI06PAPHTWO SPEED DIRECT WRITING EKG EQUIPMENT

SPOT QUARTZ LAMPFOR INTKNSI: LOCALISED RADIATION.

Sole Distributors: ' . 'GIBB LIVINGSTON 6- CO., LTD.

KNCl lNEERINXi DB'T.2nd Boo. I'. I- 1). l'.W,p Hung Kuiig. Tel. .10326