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tions of the Kuomintang and their allies, the Kuominchun. Both of these Parties have received financial support from Russia and employ Russian Red advisers, but it is always questionable what the Chinese give the foreigners in exchange for this sort of assistance. The Russians in their struggles to "come back" in Asia following their eclipse as a result of the World War have looked over the Chinese landscape and picked on the Kuomintang and Kuominchun as friendly comrades. The Japanese have done exactly the same thing with Chang Tso-lin, and the British have done likewise with Wu Pei-fu and Sun Chuan-fang, and, to be entirely fair, certain American religious interests have allied, or at least once did ally, themselves with the "Christian" General, Feng Yu-hsiang. However, this alliance has cooled considerably since Feng went to Moscow.'

It now turns out, if we are to believe a Peking Leader correspondent from Canton, that Dr. Sun Yat-sen, whom the Chinese regard as their George Washington, realized before his death that he had erred in accepting Bolshevist Russia's aid. 'He had asked for men, for advisers, for experts in various lines. He asked America and England first. On every hand but one he met with refusal. Only Russia responded.' Discovering too late that the advisers he received from Moscow were not interested in China's welfare, but in world revolution, he turned again to America, and in the spring of 1923 had a secret interview with our Minister, Dr. Jacob Gould Sherman, in which he requested the latter 'to have Washington sound out England, France, Italy, Germany, and the lesser Powers, to see if they would consent to take upon themselves a joint intervention for a period of years.' If they consented, Sun Yat-sen proposed to issue a proclamation inviting them in. His scheme, which

included joint military occupation by the Powers of all the provincial capitals, proposed that a corps of expert American and European organizers and engineers should spend five years in putting New China's Government on its feet, modernizing the departments and setting up efficient provincial administrations. Washington is said to have entered sympathetically into the scheme, but no agreement could be reached, largely because of the bitter and then fairly recent experience which some of the Powers had had at joint intervention in Siberia.'

Latin

America

We print elsewhere an exhaustive discussion of the Church conflict in Mexico, and the other side of the argument raised by our quasi-official protest against Mexico's alleged intervention in Nicaragua and by the State Department's recognition of Adolfo Díaz as the President of the latter country. We have a bad press abroad in our relations with our sister republic. The Nation and Athenæum believes that Mr. Kellogg 'yielded to the steady pressure of the oil and mining interests' in his last note to Mexico, but believes that our 'ultracautious President will continue to make use of every available means to escape from the danger of aggressive action, with the support of the vast majority of the American. people.' The Outlook refuses to be diverted from the scent, however, by a mere red herring like the Mexican land and oil laws. 'Actually the real trouble is the American imperial impulse, which is reaching out further and further into the West Indies and Central America.' It believes the average American citizen, who, 'in spite of a certain certain personal aggressiveness, is, generally speaking, rather pacific in temperament,' will take a deal of persuasion before he will fight Mexico. "The propaganda of the intervention

ists, however, is continuous and insistent, and has behind it powerful interests. The bogy of Mexican Bolshevism has been one of the cleverest moves in the efforts to compel the Government to take a "strong line" with Mexico. Nowhere in the world are people so frightened of Bolshevism as in the United States. . . . It seems only a question of time when real trouble will break out.' An amendment to the Mexican Constitution has been authorized by Congress, and will in all likelihood be ratified by the requisite two thirds of the states, permitting the reëlection of a president for a second - though not for a second consecutive-term. This clears the way for the return of General Obregón to power upon the expiration of President Calles's term and for Calles to resume the office later.

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It is too early to report the South American reaction to the proposal that Chile cede Tacna-Arica to Bolivia. The latter republic has lost more than half of its original territories since it set

up housekeeping for itself in 1825. Within its reduced boundaries, however, it has made rapid progress during the last twenty years, multiplying its revenues more than sixfold, its exports nearly sevenfold, and quadrupling its mineral output. Within the same period it has nearly quadrupled its railway mileage and has doubled its school registration. Chile has had a cabinet overturn, caused apparently by the perennial struggle between Parliament and the army. We infer from the outcome of the latest flare-up that the sword has proved mightier than the tongue. Brazil's industrial crisis, which is attributed to the deflationary policy of the Bank of Brazil, was aggravated by the fact that the Government suppressed for a time all news from the southern uprising; and the milreis fell to the lowest point since the improvement which began in August 1925. Subsequent reports that the insurrection had been suppressed without difficulty by the State authorities have restored business confidence.

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AN ENGLISH SURGEON IN AMERICA1

A PRIVATE LETTER

[THE following account of a professional visit to some of the leading medical centres of America was written by a distinguished English surgeon to a scientific friend in Tokyo. It was written as a private letter without thought of publication, and is to be read as such. Nevertheless the description which the writer gives is so vivid and to the point that it will interest many readers.]

I HAD a wonderful three weeks at the Rockefeller Institute in New York. The surgery in general in that city did not particularly impress me. The one outstanding experience was a wonderful blood transfusion done by Unger. I find that New York surgeons have no great reputation in America. But it was all so different at the Rockefeller. I lunched with Alexis Carrel and spent a morning with him. He has now given up blood-vessel surgery, for the time, and spends all his time with tissue culture. He showed me his famous piece of fibroblastic tissue that has been growing for fourteen years. It says a lot for the organization of his department that the medium has been changed every twenty-four hours for that period and never once been forgotten. How different it would have been in Egypt, where occasionally autoclaves and sterilizers and incubators go out and burn up, at will, and where every culture dies on a Friday! Carrel measures the growth of his tissues by the shadow

1 From the Japan Advertiser (Tokyo American daily), November 9

thrown by a beam of light upon a measured scale.

Carrel's operative theatre is all black; so are the gowns of his assistants and himself. In fact, all is black, with the exception of his operation area. He can get his fine needles made only in England. It takes a month of effort before his theatre sister can thread these needles; the filament of silk is pushed through the eye of the needle obliquely along the shank. The operating theatre for animals is as perfectly equipped as any I've seen for human beings.

The animal house is the cleanest I've ever seen in any research institute. The dogs are bathed daily. There is no difficulty with distemper, or, apparently, with pneumonia or tubercle in the higher apes. I could have lunched off the floor.

The simple equality of all at luncheon impressed me very much. The most junior laboratory assistant sits alongside the most senior and distinguished chief. I saw Noguchi and Rouse wandering in the luncheon room, unable to get a seat. All have the same food, which was bad, and badly cooked. But there was no fault to find with the mental food. I almost used the much abused word 'democratic' when I saw the absolute equality of all.

I liked Carrel, a simple soul with much character. In the summers he returns to his family, who live on a small island off the coast of Brittany, and there he fishes, farms, and does the quiet thinking impossible amid the noise of New York.

I spent an afternoon with Noguchi. He is a tiger for work, and, in one way, impressed me more than any of them. He showed me the spirillum of yellow fever alive in culture and the similar spirillum in the sap of the plant milkweed. He may be coming to Egypt this winter to study trachoma, leishmaniasis, and kala azar. He has his research workers all over the world. He determines the cause of obscure South American diseases in his laboratory in New York. Blood and other specimens are sent to him by collectors, and he does his work in the quiet atmosphere of his laboratory.

I had very long talks with J. B. Murphy, who upset Gye's work the other day, and with Rouse, who showed me the famous Plymouth Rock fowls. Such awfully nice and simple native Americans. They give much credit to clinicians, and say that in our hands lies the future of cancer research very largely; and they instance the clinical observation that cancer never develops in lead workers. They are convinced cancer is parasitic or microbic. They are so generous to Gye and Barnard.

Simon Flexner was delightful to me. I found a great rapprochement between American and British research workers and the people in general. No longer are the Americans going to Vienna or Berlin or the Pasteur Institute for postgraduate instructions. They largely go to Great Britain instead, and Rouse, in particular, and others are planning to spend their sabbatical years in London and Cambridge. The Rockefeller allows one sabbatical year in seven, and frequent long holidays abroad.

While in New York I had a day with Van Buren, a surgeon at the Presbyterian Hospital who has the public spirit to act as Dean of the Medical Faculty at Columbia University. We discussed curricula at length. The outstanding difference between our idea of

medical education and theirs is that a student at Columbia — and this is the model of all American schools - has only three months' medical and three months' surgical dressing in the wards. For six months each student attends special departments-Eye, Ear, Nose, Throat, and Skin. There is a feeling, not only at Columbia, but also at the University of California, that this is a mistake, and that the general grounding in the principles of clinical medicine and surgery are sacrificed to the special departments. There is a contraction also in the time spent on anatomy and physiology. The examiners of the Federal Medical Boards who examine English graduates wishing to practise in America are much impressed with the groundwork of knowledge in the essentials of medicine. Unfortunately, the individual professors in the American schools of medicine have little voice in the medical curriculum this being laid down by the American Medical Association.

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It appears to me - and this is in keeping with what I learned in Germany two years ago when I went to Munich and Berlin - that the spirit of research and the initiative in chemical and scientific progress have left Germany, where they so largely lived, and have come to America and come to stay. I look upon this as the greatest loss that Germany has sustained by the war; once this is lost it may be regained only with difficulty. They told me at Bier's clinic in Berlin that German research workers spent their efforts in mournfully contemplating the evil plight of Germany and their misery and in drowning their sorrows in dilute beer for so long after the war that when they woke to the realities of life they found they had lost the initiative.

In America they believe the future is with us and with them. They hold that the twentieth century is largely to be

theirs, as the nineteenth belonged to us. And I feel there is no doubt about it.

Three other matters impressed me very greatly in America - the curse of motor cars and telephones, the number of American business men of fifty who die suddenly on the golf links from heart failure, and the extreme beauty of the modern skyscrapers and concrete road bridges. The tall buildings now simulate Italian campaniles or Gothic cathedral towers. If these beautiful thirty-story buildings were in Florence or in Rome the whole world would come to see them. The delicate, graceful, spidery concrete bridges for the motor trunk roads are beautiful in the

extreme.

I spent a most interesting and instructive week in Victoria, British Columbia, at the Canadian Medical Association meeting. Six hundred doctors were there, and there were some really good things to hear, and some utter rubbish. They are doing good work in Toronto and Montreal to-day, and they are founding a Research Institute in Canada on the model of the Rockefeller. I renewed all my ancient friendships, and found the most remarkable work on the thyroid had been done by a man I knew, ill-educated and old, and in my day more of a retired farmer than a doctor.

But he was an observing farmer, and he found a mountain valley, called the Pemberton Meadows, in which all the white farmers develop goitre, and also all the animals. The pigs lose their hair when they develop goitre, and the young calves are born with enormous goitres. But the natives, the Siwash Indians, who live entirely off salmon and seaweed, never develop it! All human and animal inhabitants lose their goitres when iodine is added to their food. The iodine content of these snow-water glacial streams is not the sole cause; for some valleys with no

iodine in the water are free from goitre, and others where the iodine content is high are infested with thyroid enlargements. All observers agree that thyroid adenomata treated with iodine become toxic, and that there are more operations for toxic goitre than ever before. So the iodine treatment has to be carried out with great care in many pastoral communities. The results are so contradictory to what I found, in many essentials. The North American Indians, both the horse Indians of the plains and the wood Indians of the eastern forests, as well as the Mongolian Siwash Indians of the Pacific Coast, suffer terribly from trachoma; but they never develop goitre. The Indians, however, who are educated in modern colleges and fed on white American food do so in direct relation with the development of thyroid enlargement and disturbance of function among the white Americans in their communities.

I was impressed by the neurology at the University of California. I was present at a consultation of two of the leading neurologists on an obscure cerebral case, a doubtful cerebral tumor. The examination, including the introduction of air into the lateral ventricles and X-rays, was quite up to the National Hospital standard at Queen's Square, London.

The school-children of America are now all tested for susceptibility to diphtheria (the Schick test) and to scarlet fever (the Dick test), and if not naturally immune are inoculated. These two diseases are now, we hope, abolished for the young generation. And at last, in a salt-free diet, they have discovered a corrective for the toxæmias of pregnancy.

I am going to see the Mayos in Rochester, Minnesota, and I may stay there some weeks. This is the great surgical departmental store of North

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