In the book there are many accounts of his interactions with the local Chinese medical physicians, whose skills he had many opportunities to observe and greatly respected, and in addition there is a brief account of his introduction to《伤寒论》, in which he compared Zhang Zhongjing's knowledge of typhoid fever to that of his teacher William Osler. I'd like to share his review of what he translated as A Treatise on Typhoid Fever by Chang Chung-ching here, and ask if anybody knows of an earlier English-language review of the text.
(Note that the event described below occurred in 1906-07)
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Madame T'ao brought her daughter over to the hospital on a special stretcher that had been improvised. "We want to put the girl in your care. All the best Chinese doctors in Changsha have prescribed for her, yet she does not get better." The mother realized how seriously ill the girl was and had decided to ask me to treat her in the hospital.
She was ill indeed. Typhoid fever, with a high temperature and delirium--a very gloomy outlook. I gave each of the others in the immediate family a shot of typhoid vaccine, then went ahead with the care of the eighteen-year-old patient, using cooling baths as Osler had taught us. I thought it was a thoroughly modern procedure. Madame T'ao asked me the next day whether I had ever heard of Dr. Chang, one of the most renowned of China's old physicians and at one time mayor of Changsha. "Your use of enemas and of cooling baths reminds me of what my father used to tell me of this celebrated physician's way of treatment. Tomorrow I will bring over, for you to see, one of the volumes of the remarkable essays this old-time physician wrote."
The following morning Madame T'ao brought over the first volume of A Treatise on Typhoid Fever, by Chang Chung-ching, published about A.D. 196. It was an astounding discovery to find such a book in Changsha. Here were accurate descriptions of the onset of the fever: chilliness and headache; loss of appetite and nosebleed; temperature rising higher each afternoon. Osler could scarcely have given a clearer picture. More important still, old Dr. Chang had written, "Never use drastic purgatives in this fever. If necessary, use enemas of pig's bile, mixed with a little vinegar, and inserted with a slender bamboo tube. If the fever is high, use cooling baths; they will be found to give strength to the patient and reduce his delirium."
Madame T'ao told me more about this historic book, written in Changsha, where our hospital was supposed to be setting the pace in scientific diagnosis and treatment. Her father, who was always reading biographies, especially of the eminent medical men of China, was particularly devoted to this celebrated physician and considered these volumes the first rational treatise on treatment ever written in China.
He thought one reason for the fame of the book was its classic style, something all Chinese literati admired, and insisted that this Treatise on Typhoid Fever was in every sense the medical equivalent of The Four Books, which formed the foundation of the Confucian classical literature. In her father's library, she said were several editions, the best being one published during the Sung Dynasty. It was in fourteen volumes and contained two hundred and ninety-seven outlines of treatment and over a hundred prescriptions.
Dr. Chang, who received his literary degree during the reign of the Emperor Ling Ti of the Han Dynasty, became interested in typhoid fever when he saw that most of the deaths in his native village over a period of ten years were from this disease. In that time the deaths numbered two-thirds of the two hundred inhabitants. One epidemic so impressed him by its severity that he gave himself over to the study of the causes and symptoms, the treatment and prevention of the disease. A Treatise on Typhoid Fever was the result.
Repeated editions of Chang's great work had been issued through the centuries, Madame T'ao told me, and with many commentaries. One of the first of these was by Dr. Wang Shu-ho, China's great authority on the pulse, who lived a century or so after Dr. Chang.
From then on, I found that every intelligent Chinese knew about this book. I soon concluded that far more people in China knew about Dr. Chang and his work on typhoid fever than did my countrymen about William Osler and other physicians who had described this fever.
During the next few days, as I cared for Madame T'ao's daughter, I felt as if I were listening to the voices of two counselors. Both of them seemed to warn me about symptoms that might appear toward the end of the second week, or a sign that might be peculiarly unfavorable. These two distinguished physicians lived seventeen hundred years apart and in opposite hemispheres; yet each observed something that put him ahead of most of his contemporaries. It was fascinating to discover how many similarities there were between the two. Both emphasized the prime importance of diagnosis; both were bedside clinicians, experienced in interpreting symptoms; both were different from their contemporaries in cautioning against excessive medication and in recommending hydrotherapy. How near together these two great leaders were, though continents and centuries apart!
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