Expectations and Expertise: Early British Responses to Chinese Medicine

Lay G. Tradescant , “Minutes of the First Annual Meeting of the Medical Missionary Society in China”, in The First and Second Reports of the Medical Missionary Society in China: With minutes of proceedings, hospital reports, &c. (Macao, 1841), 9.

Marshall P. J. , “Britain and China in the late eighteenth century”, in Bickers Robert A. (ed.), Ritual and diplomacy: The Macartney Mission to China, 1792–1794 (London, 1993).

See Adas Michael , Machines as the measure of men: Science, technology, and ideologies of Western dominance (Ithaca, 1989), 21–69; Spence Jonathan , The search for modern China (New York, 1990), 132–6. As David Arnold suggests [in Colonizing the body: State medicine and epidemic disease in 19th-century India (Berkeley, 1993), 43–58], India presents a variation upon this theme of enthusiasm, followed by exploration (intellectual, cultural and physical), followed by devaluation. The subcontinent's fall from grace occurred in two stages, interrupted by the brief Orientalist rediscovery of Indian science and mathematics in the late eighteenth and early nineteenth centuries.

Assessing the accuracy of the claims themselves is properly the province of historians of Chinese medicine and will not be addressed here; readers curious about this point may wish to consult the compendious work of Paul Unschuld, Nathan Sivin, Joseph Needham and colleagues, and other sinologists.

For a compelling analysis of the mission as an exercise in natural history, see chap. 4 of Hevia James , Cherishing men from afar: Qing guest ritual and the Macartney Embassy of 1793 (London, 1995), 84–115.

Barrow John , Travels in China, containing descriptions, observations, and comparisons, made and collected in the course of a short residence at the imperial palace of Yuen-Min-Yuen, and on a subsequent journey through the country from Pekin to Canton. In which it is attempted to appreciate the rank that this extraordinary empire may be considered to hold in the scale of civilized nations (London, 1804), 3.

Ibid., 3. Barrow (1764–1848) was Comptroller to the Embassy, a post he gained through the patronage of Sir George Staunton. He subsequently became Second Secretary to the Navy, and was crucial in shaping its policies of exploration in Africa and the Arctic, as well as Government responses to China.

Cranmer-Byng J. L. , An embassy to China: Lord Macartney's journal, 1793–1794 (London, 1962), 3–58. For another lucid account of this period with a somewhat different perspective, see Spence , op. cit. (ref. 3) especially chaps. 6 and 7; Mungello D. E. , Curious land: Jesuit accommodation and the origins of sinology (Honolulu, 1989).

Staunton George Sir , An authentic account of an embassy from the King of Great Britain to the Emperor of China … taken chiefly from the papers of His Excellency the Earl of Macartney … and of other gentlemen in the several departments of the embassy (London, 1797), i, 41.

Staunton , op. cit. (ref. 9), ii, 60–61.

Traditional Chinese diagnosis did (and does) not rely solely on the pulse; like their European counterparts, Chinese physicians were meant to employ all five senses — Including listening to their patients — In diagnosis. The pulse did have particular importance in prognosis. Two recent and intriguing essays exploring this subject are Kuriyama Shigehisa , “Visual knowledge in classical Chinese medicine”, and Bray Francesca , “A deathly disorder: Understanding women's health in late imperial China”, in Bates Don (ed.), Knowledge and the scholarly medical traditions (Cambridge, 1995), 205–34 and 235–50 respectively. Both note that Chinese medicine in this period is known predominantly through the scholarly writings, and hence is itself the medicine of the élite.

Staunton , op. cit. (ref. 9), 61–62.

Barrow , op. cit. (ref. 6), iii, 345–6.

For a detailed description of the British clinical encounter of the day, see Porter Dorothy Porter Roy , Patient's progress: Doctors and doctoring in eighteenth-century England (Stanford, Calif., 1989), especially Part II.

Staunton , op. cit. (ref. 9), 62 (my emphasis).

Barrow , op. cit. (ref. 6), iii, 346.

For more on the creation of cultured bodies, see Jordanova Ludmilla , Sexual visions: Images of gender in science and medicine between the 18th and 20th centuries (Madison, 1989); Gallagher Catherine Laqueur Thomas (eds), The making of the modern body: Sexuality and society in the nineteenth century (Berkeley, 1987); Laqueur Thomas , Making sex: Body and gender from the Greeks to Freud (Cambridge, Mass., 1990).

Anne Digby documents a medical community dominated by the (affluent) patient. See Digby Anne , Making a medical living: Doctors and patients in the English market for medicine, 1720–1911 (Cambridge, 1994). Also consider W. Bynum F. , “Health, disease and medical care”, in Porter Roy Rousseau George (eds), The ferment of knowledge (Cambridge, 1980), esp. pp. 212–13; and Porter Porter , op. cit. (ref. 14), Part I. Bray , op. cit. (ref. 11), 237–9, notes that the medical attendants of the élite in China, as in Europe, were necessarily (and for the same reasons — Lower social status and financial dependence) listeners and negotiators, whatever their occasional claims to the contrary.

See Porter Porter , op. cit. (ref. 14), Part II, 5; Bynum , op. cit. (ref. 18), 213; and for more detailed accounts, including discussion of the changes in this patient-centred practice, Reiser Stanley Joel , Medicine and the reign of technology (Cambridge, 1978), chap. 1.

It was (and is) actually somewhat unusual for a traditional Chinese practitioner to rely exclusively on the pulses, and especially not also to examine the tongue. However, it was certainly the ideal of Chinese physic to be free from the patient self-reporting, to derive diagnostic information entirely from the body, more or less unmediated. In a medical culture where mind and body were resolutely considered as one entity, the subjective experience of the patient would theoretically be legible from the body's state.

The western understanding of the pulse exemplified by Barrow and Staunton was constructed over the course of the eighteenth century; at the beginning of the century, responses to Chinese pulse diagnosis were considerably different. See Section 3.1. In Chinese anatomy, qi flows through channels linking related organs; the multiple pulse of Chinese medicine is taken from different points on the arm where such channels pass close to the surface of the body. Thus the Chinese pulse carries complex information about an interrelated system.

Barrow , op. cit. (ref. 6), iii, 345–6.

DuHalde J. B. , A description of the Empire of China and Chinese-Tartary, together with the Kingdoms of Korea and Tibet: Containing the geography and history (natural as well as civil) of those countries. Enrich'd with general and particular maps, and adorned with a great number of cuts. From the French of P. J. B. Du Halde, Jesuit: With notes geographical, historical, and critical: And other improvements, particularly in the maps, by the translator (London, 1738–41), 124.

Ibid., 184.

Ibid., 183.

James R. , A medicinal dictionary; including physic, surgery, anatomy, chymistry, and botany, in all their branches relative to medicine … and an introductory preface, tracing the progress of physic, and explaining the theories which have principally prevail'd in all the ages of the world (London, 1743), p. viii (my emphasis).

See Porter Porter , op. cit. (ref. 14), 160–1; Rosenberg Charles , “The therapeutic revolution: Medicine, meaning, and social change in 19th century America”, in Leavitt Judith Walzer Numbers Ronald L. (eds), Sickness and health in America: Readings in the history of medicine and public health, 2nd edn (Madison, 1985), 39–52; Jewson Nicholas , “The disappearance of the sick-man from medical cosmology, 1770–1870”, Sociology, x (1976), 225–44.

James R. , A medicinal dictionary (ref. 26), p. viii.

Ibid.

See Barfoot Michael , “Brunonianism under the bed: An alternative to university medicine in Edinburgh in the 1780s”, Medical history, Supplement no. 8 (1988), 22–45. As well as being medically radical, Brunonianism was associated with social and political radicalism. It is worth noting that Gillan's expressed ideas on fever, his enthusiasm for bleeding, and in particular his criticism (echoed by Staunton) of a Chinese healer who prescribed stimulants to a British sufferer, are anti-Brunonian.

Lawrence C. J. , “Cullen, Brown, and the poverty of essentialism”, Medical history, Supplement no. 8 (1988), 1–21. Indeed, Lawrence points out that both Brown and Cullen portrayed themselves as “supporter[s] of the view that progress in medicine was to be achieved by employing fundamental philosophical principles in order to arrive at a general explanation graced by causal simplicity” (p. 7). Thus, the absence of system would have condemned Chinese medicine in either case. For further discussions of Edinburgh, the Scottish Enlightenment, and the conflicting roles of Cullen and Brunonianism, see Bynum W. F. Porter R. (eds), Brunonianism in Britain and Europe (Medical history, Supplement no. 8 (1988)); Jacyna L. S. , Philosophic Whigs: Medicine, science and citizenship in Edinburgh, 1789–1848 (London, 1994); Lawrence C. J. , “Ornate physicians and learned artisans: Edinburgh medical men, 1726–1776”, in Bynum Porter (eds), William Hunter and the eighteenth-century medical world (Cambridge, 1985), 153–76.

Staunton , op. cit. (ref. 9), iii, 55.

Gillan Hugh , “Mr. Gillan's observations on the state of medicine, surgery, and chemistry in China”, in Cranmer-Byng , op. cit. (ref. 8), 279–90, p. 281.

Staunton , op. cit. (ref. 9), iii, 55–57.

See Gillan , op. cit. (ref. 33), 281.

Ibid., 281 (my emphasis).

Ibid., 282. Given the extraordinary precision with which the appropriate points for feeling the various pulses were located in Chinese medical theory, one wonders if this did more harm than good — The site of an alleged doctor fumbling around on the arms of a very influential patient may have destroyed any chance that remained of Western medicine being taken seriously at the Chinese court after the frequent illnesses of the Ambassadorial party.

Ibid., 280–1.

See below, Section 3.1, and Floyer John Sir , The physician's pulse-watch; or, an Essay to explain the old art of feeling the pulse, and to improve it by the help of a pulse-watch. … To which is added, an extract out of Andrew Cleyer, concerning the Chinese art of feeling the pulse (London, 1701).

Gillan , op. cit. (ref. 33), 280. Cranmer-Byng adds to this the gloss that DuHalde translated the Mo ching, written around the tenth century A.D., and published this translation in 1735, with his Description [op. cit. (ref. 23)].

Ibid., 282.

Staunton , op. cit. (ref. 9), iii, 57–58.

The Chinese physicians were of course diagnosing a disease of disordered qi. For the purposes of this article, qi can be defined as ‘universal vital force’; in traditional Chinese medicine, qi was understood to be composed of two elements, yin and yang, which circulated throughout the body, the former with the blood and the latter in a second, more ethereal, system of channels. However, it is clear from their respective texts that both Staunton and Gillan chose to interpret qi as referring to a gas in the modern sense rather than in the older sense of spiritus. This interpretation seems to have been based primarily on the treatment proposed by the Chinese: Acupuncture — Which Gillan and Staunton both presented as an attempt to create a physical outlet for a physical substance — “opening passages for its escape, directly though the parts affected”.

Staunton , op. cit. (ref. 9), iii, 378–9.

Rosenberg , op. cit. (ref. 27), 39–52, p. 39. '.

Floyer , op. cit. (ref. 39), 2.

Stephen Leslie Lee Sidney (eds), The dictionary of national biography, from earliest times to 1900 (Oxford, 1949–50), vii, 346–9.

Floyer , op. cit. (ref. 39), 2.

Ibid., title page.

Ibid., 229.

Ibid., 230–1.

Ibid., 232.

Ibid., “Preface”, 2.

Ibid., “Preface”, 3.

Ibid., 336.

Ibid., 355.

Ibid., 368.

Ibid., 247.

For more on the shared roots of Chinese and western medicine, see Kuriyama Shigehisa , “Interpreting the history of bloodletting”, The journal of the history of medicine and allied sciences, 1 (1995), 11–46.

Gillan , op. cit. (ref. 33), 283–4.

Ibid., 284.

Ibid., 279.

Ibid., 283.

For details on this contest and its origins, see Porter Porter , op. cit. (ref. 14); Peterson M. Jeanne , The medical profession in mid-Victorian London (Berkeley, 1978); Jacyna , Philosophic Whigs (ref. 31), especially his chapter on pathology.

Gillan , op. cit. (ref. 33), 279.

See Unschuld Paul , Medicine in China: A history of ideas (Berkeley, 1985), as to the extent and visibility of this culture; for comparisons, see also the reports of the French Jesuits in DuHalde Fr Jean-Baptiste (ed.), Lettres édifiantes et curieuses écrits des missions étrangères (Paris, 1702–76). An English translation appeared by 1742, and a second edition of this translation came out in 1761.

Gillan , op. cit. (ref. 33), 284.

Staunton , op. cit. (ref. 9), iii, 92–93.

Gillan , op. cit. (ref. 33), 283. There is no good way to verify that Ho-Shen indeed spoke these words; however, if Gillan was determined to show his procedures in the most positive light, he certainly could have attributed to Ho-Shen a less ambiguous turn of phrase.

Staunton , op. cit. (ref. 9), iii, 60–61 (my emphasis).

Incidentally, he was roundly criticized for his presumption in publishing an account; it was considered inappropriate for one of his low status to have views on China, and particularly to criticize his employer's handling of the political and diplomatic issues involved.

Anderson Aeneas , A narrative of the British embassy to China, in the years 1792, 1793, and 1794; with accounts of the customs and manners of the Chinese; and a description of the country, towns, cities, &c., 2nd edn (Dublin, 1796), 275.

Staunton , op. cit. (ref. 9), iii, 92–93.

Ibid., 274–5.

Chinese metallurgists actually did produce a silvery alloy at this time which was slower to tarnish than silver. It is possible that Eades may have heard of this metal, called pe-tung by the Chinese and white copper or patkong by the Europeans, through the reports of Catholic missionaries; alternatively, he may have seen specimens of the metal which had come to England in trade. For a somewhat more detailed contemporary description of this alloy, see Gillan , op. cit. (ref. 33), 292–3 and fn. 149.

Warner John Harley , “The idea of Southern medical distinctiveness: Medical knowledge and practice in the Old South”, in Leavitt Numbers (eds), op. cit. (ref. 27), 53–70. This essay focuses on the arguments for Southern distinctiveness; however, Warner amply describes some of the medical beliefs that underpinned that argument and the deliberate and explicit creation of distinct medical cultures in rural and urban, northern and southern, European and American contexts.

Savitt Todd , “Black health on the plantation: Masters, slaves, and physicians”, in ibid., 313–30.

Peterson , The medical profession (ref. 64); Walkowitz Judith , Prostitution and Victorian society: Women, class, and the State (Cambridge, 1980). See also Engelstein Laura , “Morality and the wooden spoon: Russian doctors view syphilis, social class, and sexual behavior, 1895–1905”, in Gallagher Laqueur (eds), op. cit. (ref. 17), 169–208, where the effects of context on the interpretation of disease entities is discussed.

Rosenberg Charles , “Social class and medical care in 19th century America: The rise and fall of the dispensary”, in Leavitt Numbers (eds), op. cit. (ref. 27), 273–86, for a case study of the role of economics in creating distinct medical modalities.

This encounter also sheds some light on Jewson's hypothesis that consensual diagnosis and treatment formed the foundations of Enlightenment medicine. Anderson's acceptance of the Chinese mode of diagnosis, in which he read the patient's body, rather than calling upon the patient's own account, and subsequently prescribed for him without entering into any dialogue, lends some weight to Porter's suggestion that consensus-medicine was the province of the relatively élite consumer, and that doctor–patient relationship took other forms when the patient bore other status. See Jewson , op. cit. (ref. 27), and Jewson Nicholas , “Medical knowledge and the patronage system in 18th century England”, Sociology, viii (1974), 369–85; Porter Roy , “Laymen, doctors, and medical knowledge in the eighteenth-century: The evidence of the Gentleman's Magazine”, in Porter Roy (ed.), Patients and practitioners: Lay perceptions in pre-industrial society (Cambridge, 1985), 283–314.

Dr Dinwiddie, quoted in Proudfoot William Jardine , Biographical memoir of James Dinwiddie, … embracing some account of his travels in China and residence in India (Liverpool, 1868), 87.

See Spence , op. cit. (ref. 3); Spence Jonathan , Memory palace of Matteo Ricci (New York, 1984); Unschuld , op. cit. (ref. 66); Mungello , op. cit. (ref. 8).

Adas , op. cit. (ref. 3). See particularly his Introduction and first chapter, and pp. 231–4, 248–52, on the relationship with China.

See Proudfoot , op. cit. (ref. 81), 47 and his rebuttal of Barrow's tale of “the Emperor's Favourite Draughtsman”.

Barrow , op. cit. (ref. 6), 306–7. It seems very likely that Barrow borrowed this insight from DuHalde , op. cit. (ref. 23), ii, 124.

Barrow , op. cit. (ref. 6), 354. It is, of course, suggestive that the passage specifies an “Edinburgh Surgeon”. Clearly, the distinction between the Scottish medical mode and its more traditional equivalents was evident by the close of the eighteenth century.

Staunton , op. cit. (ref. 9), 379–80.

Ibid., 380.

Proudfoot , op. cit. (ref. 81), 53.

Ibid., 53 (italics in the original).

Ibid., 46. The Chinese reaction to these gifts, and the implications which that reaction held for subsequent events in Anglo-Chinese relations, have been discussed at length by Spence , op. cit. (ref. 3); and mentioned in Bickers , op. cit. (ref. 2) and Hevia , op. cit. (ref. 5).

Proudfoot , op. cit. (ref. 79), 47–48. In the end, despite his fascination with China's grand engineering projects, and small technical innovations — For Dinwiddie prepared notes on everything from the canal network to their remarkable skill at cutting glass — The Chinese reaction to Western science led Dinwiddie to despair of China: “The extreme jealousy, added to the extreme ignorance of the Chinese, will prevent our visiting the manufactures, &c. Nothing but conquest by some polished nation will ever render this a great people. The prejudices are invincible. Ask them whether the contrivers and makers of such curious and elegant machinery must not be men of understanding, and superior persons. They answer — ‘These are curious things, but what are their use? Do the Europeans understand the art of Government as equally polished?’”.

Cranmer-Byng J. L. Levere Trevor , “A case study in cultural collision: Scientific apparatus in the Macartney Embassy to China, 1793”, Annals of science, xxxviii (1981), 503–25.

Anderson , op. cit. (ref. 72), 177.

Cranmer-Byng , op. cit. (ref. 8), 96.

Anderson , op. cit. (ref. 72), 133.