The League's Health Service and China
WHEN I first read the news that China was applying to the Health Committee of the League of Nations for help in putting her sanitary house in order, I admit that I thought of mandarins baiting a hook for unwary idealists. Geneva is full of enthusiasts of both sexes who want to regenerate or reform something or somebody—usually several thousand miles away, I imagined that the real object of the Chinese Government might be fiscal rather than medical ; but I was quite wrong. What China asks the League to do is to employ the facilities provided by an international organization for the solution of those aspects of her health problems which are themselves international, or at any rate part of the common cause of humanity.
In the proposals of the. Chinese Government to the Health Committee of the League (Health, 1980, III 8 Feb. 12, and in League publications) it is obvious that the desire of the Republic is chiefly that facts shall be ascertained, . statistics compiled, and suggestions made as to the reorganization of the Chinese Ministry of Health, rather than that there should be any direct intervention on . the part of Western doctors. As Dr.
Madsen, the President of the Health Committee, has said recently : " The machinery of the League—technical organizations, Secretariat, etc.—are equally at the dis- posal of all the States Members, and League officials are the servants of every Government." The Chinese require technical assistance in modernizing their country ; very wisely they have enlisted the services of the League to make available to them the technical experience that has accumulated at Geneva during a decade of inquiry into, and collation of, health reports from all over the world.
The following are the points on which the League Health Organization has been asked to collaborate :- (a) Reorganization of the present Quarantine Ser- vice ; and consideration of the steps to be taken to build .up an efficient Port Health Administration to command the confidence of the Health Services of the nations trading with China. The Health Committee has sent Dr.
Park (a League official) to China for this purpose, and he will complete the survey of quarantine conditions which has already been begun, and will report at an early date with detailed proposals. Meanwhile, the Chinese Ministry of Health is to participate in the forthcoming study-tour of Port Health officers arranged by the Health Organiza- tion of the League, and will send two or three officers to be trained abroad by the League for responsible posts in the reorganized Quarantine Service.
(b) The posting of a League technical officer in China, to advise on the organization and development of a Central Field Health Station which is to serve as the nucleus of a National Field Health Service. This officer will shortly be chosen and sent to China. Through the Health Organization, facilities will also be provided for the training abroad of officers selected for important posts in the Field Station. - (c) Technical assistance in planning the first big modern National -Hospital for undergraduate instruction and post-graduate training. Similar help will be given as regards a big Provincial Hospital in Chekiang, and facilities will be provided for the senior administrators of both these hospitals to study abroad. - (d) The prosperous and progressive province of Chekiang will be the first in which modern preventive medicine and health administration will be applied ; it the Health Organization of the League' is asked to send various officials to prepare a scheme for a modern health service.
(e) The reform of medical teaching in China, the cam- paign against malaria, and the training of sanitary engineers, are further subjects on which it is expected that the Chinese Government will desire to consult the Health experts of the League.
(f) A problem of urgent importance, not only to China but to all the world, is the control of smallpox and cholera in Shanghai. The Chinese Ministry of Health has already invited the health authorities of two foreign settlements in Shanghai to co-operate ; it has now asked for the collaboration of the Far Eastern Bureau of the League Health Organization.
This summary demonstrates the manner in which the Republic proposes to attack the gigantic task of building up a modern Health Service in China, and how practical are the lines on. which it proposes to approach the problem. It may be added that the Government has put aside $1,000,000 (Mexican) to implement these proposals, and has already made available £20,000 of this sum in order that there should be no delay in the interchange of doctors and technical experts. In the province of Che- kiang, already alluded to, it is the intention of the Pro- vincial Government to build and equip, as soon as possible, a four hundred-bed hospital in Hangehow, and to use this hospital for teaching purposes, making it a centre of public health work and medical relief. It is also intended to build a sanatorium and a leper hospital to replace those at present in use, and to establish a training school for midwives. When this has been done, and each of the seventy-two districts of Chekiang have been provided with two properly trained midwives, it will be possible to prohibit the old-style gynaecological practice which causes so much needless suffering.
The report also provides some illuminating comment on the relative freedom from plague of Shanghai, which is due, apparently, to the rarity of the rat-flea which carries this disease. Statistics have been obtained of the average number of fleas for two kinds of rats rattus rattus having an average of 2.78 and rattus decu- masus an, average of 8.48 on their persons. Smallpox and cholera, however, are apparently endemic in Shanghai, and the former is virulent, twenty deaths having occurred from sixty-two cases among the foreign population. Energetic measures, such as isolation of cases, treat- ment of water supplies, and laboratory investigations, are being taken to control cholera.
In a country of such stupendous size, and so torn by faction, it is naturally impossible that any far-reaching medical reform such as now contemplated should be accomplished in a period of months, or even in a few years. Much time must pass before the measures that have been initiated, and the students now being trained will have succeeded in stamping out the terrible epidemics to which China is still subject. Meanwhile, it is gratifying to observe what has already been done by the Health Organization of the League of Nations, not only in the collection of data for future use, but in an active collabo- ration with the • Republic as regards the training of personnel. This is the first time that a great non-European State has realized that membership of the League affords it facilities in the solution of its problems of reorganiza- tion and reconstruction. • The progress of modern China in her efforts to bring greater health and happiness to her teeming population will be watched with interest.
F. YEATS-BROWN.
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