The past and the present in medicine in Corea.--Corea has had her own physicians almost from time immemorial. She borrowed her system of medicine from her great neighbour China, to whom she looked for inspiration in every direction.
Corean doctors of the old school to-day differ comparatively little in professional outlook and practice from their remote predecessors. Surgery, to them, is still largely summed up in the use of the chim, or hot needle, which is used in very much, if not in exactly, the same way as it was used thousands of years ago. These "doctors" have a rough idea of the anatomy of the human body, and teach their pupils the proper places to insert the needle, either to obtain the desired effect, or to avoid chimming a vulnerable part. Most of our patients who come with a surgical disease--and many of the medical cases also--bear the marks of these chims, which means to say they have first been to consult their own doctor, and finding his treatment ineffective, have come on to see what we can do for them. Sometimes the visit is at the instigation of the native doctor himself, as Coreans generally, nowadays, frankly admit our superiority when any "cutting" has to be done. All the same, and especially in the country, they still firmly cherish, first, a firm belief in the superiority of their own medicines, at any rate for the Corean inside, and, secondly, a general doubt of the capacity of any Westerner to really grasp the principles on which the Corean constitution works. So it is the commonest experience, when investigating a case, to find a series of little punctate marks dotted all over a joint, or very commonly over the stomach region, the calf of the leg, or elsewhere, marking the places where the needles have been inserted. This treatment seems drastic, and sometimes, undoubtedly, does great harm; but, on the whole, less damage is done than might be expected. The needles, being very hot, are generally sterile, and sometimes undoubtedly do much good, barring the actual pain caused and the fright given to young children. Often, however, the disease for which the treatment is applied is complicated rather than relieved, though it is always a difficult matter to make them believe that this is so, so great is their belief in the time-honoured remedy.
Next to hot needles, in the native doctors' armamentarium, is the plaster, which does more harm and causes more pain than the chims. The latter are probably intended to let evil spirits out of the body, though Coreans will rarely own that this is their belief, but the plasters are surely meant to keep all the evil spirits in, as they effectively seal up all the discharges from wounds, and entirely prevent the entrance of air. Made of dough, clay, leaves, or commonly the thick Corean paper which is used for all purposes, they are applied firmly to an ulcer or wound and remain in situ indefinitely. The patient is liable to suffer abominably unless he falls into the hands of a Western doctor. Dums, again, which are a violent form of counter-irritation, are much believed in, but liable to do great harm.
In pure medicine the native doctor is a herbalist, but believes in considerably larger doses than even our allopaths permit, e.g., an adult drinks a bowl with probably about a pint of crude castor oil, a child will take half this quantity, and with other drugs they dose themselves accordingly. In their knowledge of medicinal plants they probably have something to teach us. They have long cherished the belief that we missionary doctors could do very little for them in purely medical complaints, therefore for many years it was our experience that the surgical were much fuller than the medical wards. But for the last few years, owing probably to the confidence won by our treatment of their surgical complaints, the people are coming more and more freely to us for other things, though, needless to say, after first trying their own remedies, or possibly intending to take them at the same time!
It will be seen from the above that the old system till recently still had a great hold on the Coreans, so that we rarely got even our surgical cases uncomplicated by previous treatment, and the tendency in other cases, however much they trusted the missionary doctor, was to supplement his treatment privately. In a successful case, therefore, the honours are apt to be divided, or the Corean remedy may even get all the credit; in an unsuccessful case, conversely, the Western treatment may get all the blame. The native doctors, too, have taught people that in order to get any treatment worth having they must be prepared to pay handsomely for it; consequently, Coreans do not appreciate our treatment unless we charge them highly. The Western doctor is apt to charge too little in his inexperience and in his anxiety that none shall be turned away for lack of means, little suspecting that the value of his treatment is accordingly lowered in his patient's esteem.
Keeping the above facts in mind, and remembering also that the Corean people in the latter half of last century were no better informed than their physicians, we can get a fairly good idea of the atmosphere of superstition, convention, and distrust of things new which our first doctors had to face when they came out with Bishop Corfe in 1890. At this time the country was as yet only slightly stirred by outside influences, though it was on the eve of political events with far-reaching effects. It was still the Hermit Kingdom, strenuously clinging to the old isolation and withdrawal from external influences, which nevertheless were gradually making themselves felt. Difficulties existed then of which a doctor working in the country to-day has no conception. Prejudice and dislike of the foreigner, profound distrust of his motives in leaving his own country, distrust of his treatment and skill, all acted against the missionary doctor. In Corea, as in other countries, these difficulties had all to be overcome by our pioneer doctors and hospital builders. The years spent by Dr. Landis at Chemulpo, in learning the language and customs and in winning the confidence of the people, bear fruit to-day in the esteem and confidence given to the hospital by the Coreans of the surrounding district.
With the coming of the Japanese, and the assumption by them of authority, Western medicine came into her own, in this country, to a considerable extent. To-day we find a well-equipped Government hospital in every large town; there is a Japanese doctor in every large village, and a Japanese chemist selling Western drugs and appliances, e.g., hypodermic syringe inhalers, feeding bottles, patent medicines and patent foods, instruments, etc., in every village large enough to boast a druggist's shop. The Government medical schools and hospitals send out every year into private practice a number of qualified Corean doctors and nurses. Mission hospitals are not behindhand in cither treatment or training. Besides our own hospitals, the American, Canadian, and Australian Missions have large, well-equipped hospitals in different parts of the country. These great changes in the position of Western medicine in the country can only have one result, viz., in gradually breaking down the prejudices of the people. They are now in the position of clinging to their old system, but keeping at the same time an eye open to any possible benefits to be derived from ours, and the foreign doctor if within reach generally gets called to a bad case sooner or later, though still often too late to be of any use.
Medical work under the English Church Mission.--This commenced with the arrival, with Bishop Corfe in 1890, of Dr. Wiles and Dr. Landis, both of whom did invaluable pioneer work, the former from 1890-93 in Seoul, where the first Mission Hospital of S. Matthew was built largely owing to his generosity. In Chemulpo Dr. Landis commenced work with the support of the Hospital Naval Fund, who have continued to help the Hospital of S. Luke at Chemulpo to the present day. The work in Seoul initiated by Dr. Wiles was carried on for a term of years by Dr. Baldock at the Hospital of S. Matthew for men, and by Dr. Katherine Allan at the Hospital of S. Peter for women, assisted by the Sisters of S. Peter. This work in Seoul was carried on indefatigably until 1904 when changes in the capital made it seem advisable to close down the work there, and concentrate on the development of the work at Chemulpo. Some of the American missionary societies had by this time erected good hospitals in the capital, and there was the prospect of extensive Government hospital work being launched in the near future, whereas, at the important treaty port of Chemulpo, there was no medical work except what had grown from the small beginnings made by Dr. Landis.
S. Luke's Hospital, Chemulpo.--The arrival of Dr. and Mrs. Weir to take charge of S. Luke's Hospital in 1904 when the hospital had been closed for two years for lack of a doctor marked the beginning of a new era. Both the work and the buildings had suffered much by the long break, and very necessary was the reconstruction which was bravely tackled by Dr. Weir, even while he was in the initial stage of struggling with the very difficult language. The hospital was practically reconstructed in 1904 as the foundations of the old building were unsafe. Only a few years later work had increased to such an extent that it became necessary to add a block for women patients. This was completed in 1909.
Meanwhile, the European staff had been increased by the arrival of Miss Pooley and Miss Rice, dispenser and nurse respectively. From this period the work of S. Luke's Hospital has gone steadily forward and the number of in-patients, out-patients, and of operations has greatly increased, especially during the last five or six years. The hospital has quite a place of its own in the affection and confidence of the Coreans in that neighbourhood, who look on S. Luke's as the hospital for Coreans and come to us very readily. There is rarely any difficulty in persuading' patients to stay in when necessary, and very little difficulty nowadays in getting consent for operations. We are also patronized very considerably by Chinese from the Chinese district in Chemulpo.
The hospital at present has two wards for male cases, one for female cases, and three private wards, with accommodation for forty patients in all. This number includes accommodation in a temporary ward made out of an old laundry in 1915 at a time when there was great pressure on the women's side. We had to use the laundry as a very indifferent ward for better class paying patients, but they seemed quite pleased with their accommodation. The patients all lie on beds which till recently were simply wooden planks nailed together and supported on trestles, but these are very undesirable for hygienic reasons, and we are replacing them now throughout the hospital by iron bedsteads. We do not give them sheets, as Coreans do not like them nor understand their use, so they are an unnecessary tax on the laundry; the patients lie on a mattress covered with a blanket, and wrap themselves up in one of the thick wad-quilts which are lined with coarse unbleached calico. These are not hygienic to our Western notions, but the Coreans like them far better than anything else, so we put up with them. They are a nuisance to clean as the whole thing has to be picked to pieces and made up again, and they require a disproportionate amount of storage room. But S. Luke's has always worked on the principle of, first, letting the patients be happy; secondly, of making them well; and, last of all, trying to make them clean and hygienic. For example, all Coreans smoke, so we let them smoke at all hours. The European nurse is probably distracted several times a day by the reek of the smoke or the untidiness of the beds, with cigarettes, or a long pipe, or a wadge of tobacco all over the place, but Coreans do not dream that anything is amiss, nor is the Corean nurse likely to notice it. They also love a good hot ward, and in the winter are for ever stoking up the big ward stove, till the place is unbearably and unhygienically hot, with all the windows tightly shut, until one of the staff appears and insists on them being opened.
The patients generally have two meals a day, sometimes three, the mid-day meal then being a mere snack, or the remains of the morning food. Morning and evening are the meal-times, but the actual hours of eating-are very elastic, always a difficulty to the foreign staff who wish to maintain an exact routine. In summer everyone eats very early in the morning between 7 and 8 o'clock and late in the evening, e.g., about 7 o'clock; but in the winter the people get up late, as it gets light late, and the morning food is not generally ready till after 9 o'clock. It is always a difficulty to get them to understand that the hour at which the doctor wishes to begin work is to be compared in importance with the solemnity of the morning meal. The staple food is rice, of which every patient eats a large bowl. It is astonishing to see how easily a large quantity is disposed of by quite small youngsters. With the rice our poorer patients invariably eat kimji, a kind of sauerkraut, and a little panchan or hors d'oeuvre, e.g., a little dried fish or raw turnip, etc. A Corean patient is a very sick man indeed, in his own and his friends' estimation, if he cannot get through his daily quota of rice. Invalid diet is always a difficulty, as the patients pine for rice, and there are no substitutes which in any way take its place. There is no milk to fall back on, so it is not easy to arrange a carefully graded diet for the really sick. We generally fall back on various forms of crushed rice done up in different ways, soups of various kinds, eggs, etc. The relations and friends are always pathetically anxious about the sick man if he does not want to eat, and bring in all sorts of Corean delicacies--by your leave or without--which they think may tempt him. Sometimes they act on a firm belief that certain articles of diet are indicated for certain kinds of diseases--true enough, but apt to be misdirected. On these occasions they generally find themselves speedily at loggerheads with the doctor, as, for instance, when a patient, gravely ill with acute peritonitis, was surreptitiously fed on Corean pork by his relations at night, when the night watchman was peacefully taking forty winks by the ward stove. The patient, being in extremis next day, the relations took fright and owned up.
Type of patient.--For the most part we get poor townsfolk, small farmers, boatmen, little shopkeepers, and country folk. Our Mission hospitals are very badly needed, even in spite of good Government hospitals in all the large towns, for all these classes of patients, as they have very little money and cannot afford to pay the fees asked at most of the Japanese hospitals. S. Luke's has always been a hospital for the poor, who come to us very freely and pay what they can, but recently we have had a good many of the wealthy merchant class in Chemulpo and their wives and daughters coming to us for treatment. We arc glad to have them, though at present we have-scarcely accommodation for them, but they are an influential class who are not otherwise easy to reach.
Fees.--For many years the patients paid very little; poorer people, at best, can only pay a small sum, or offer a string of eggs, i.e., ten eggs tied up in straw and worth about 2Jd. Generally a fee of 2^d. or 3d. includes the doctor's examination and a bottle of ordinary medicine; for special medicines, such as quinine, they pay a little more. The wealthier patients are expected to pay according to their means, but the difficulty in adjusting fees is that the foreigner is never really able to discern who are the poor and who are not, as appearances are often misleading. It is a safe rule to remember that what a Corean pays for he will respect, and therefore the well-to-do patient, who is charged a fee in proportion to his position, is more likely to come back again for further treatment than if he is only asked to put down the small fee that the poor man pays. This method of grading fees has worked very well since it was initiated, and it is hoped in the future, by means of it, to make the hospital considerably more self-supporting than it has been in the past.
The hospital staff.--For a good many years, as an outcome of the self-sacrificing work of Dr. and Mrs. Weir, the growing work of the hospital has really required the services of two foreign doctors, two foreign nurses, and a dispenser to tackle it adequately. This ideal has never yet been attained, as it has never yet been possible, owing to shortage of staff, to have two doctors on the staff, and also for considerable periods there has been only one nurse. The consequence is that the doctor and nurse are so fully occupied with professional work that they are unable to give to the evangelistic work all the time and attention that it requires. This is an indictment of our whole position as a Mission hospital and as foreign missionaries. But as long as the patients come to us they must be treated; we cannot even limit the numbers. The patients come such long distances that when they do arrive at our gates they have a right to be aggrieved if they cannot be seen. Evangelistic work is faithfully carried on by our Corean catechist and Biblewoman, both among the out-patients and the in-patients, but the foreign doctor and nurse, however stumbling their language may be, can appeal more easily probably than the Corean worker to most of the patients, because they realize they owe their treatment and cure to them. It is one of our hopes for the future that we may so increase the staff as to make it possible for the foreign missionaries to take a larger share in the evangelistic work of the hospital. We have since the earliest days of the work been assisted by a staff of "boys" (i.e., young Coreans of any age from fourteen to thirty who are trained by ourselves), and also by a middle-aged Corean woman on the women's side, who is very faithful, but naturally does not know very much. The "boys" work well, and are very quick in picking up information in the wards and in the outpatients' department. They become very useful assistants to the doctor and to the nurse, but up to the present they have only learned by working with us and by watching us; we believe that the time has now come to give them a fuller training as hospital assistants. We also hope immediately after the war to replace the old untrained woman, who has hitherto watched over the destinies of the women's block, by young women as probationers in training under our foreign nurses. We do not desire that the girls who may be trained in this way should necessarily become professional nurses, but would rather that, after serving us for a term of years, they should marry, make Christian homes, and spread the ideas of hygiene and nursing which they have learned from as in their own villages and homes.
The daily routine in the hospital.--The daily work in the hospital begins at 9 a.m. with prayers. These are attended by the whole Christian staff of the hospital, by the household, by such Christian patients as can walk, and by the Biblewoman and catechist. Prayers are taken in turn by one of the staff, or by the catechist, and consist of the reading of a passage of Scripture, and short prayers for the day's work and for the patients. The doctor and nurse then make the daily round of the wards, while the catechist and Biblewoman are taking service in the outpatients' department. The morning is spent in seeing out-patients, of whom there will be from fifty to sixty, and twenty to thirty of these will be new cases; the doctor examines each case, and directs the treatment which the Corean staff carries out as far as possible. The afternoon is absorbed by the in-patients, by late out-patients, and by operations. After Evensong there are sometimes more patients, accounts, problems of administration, visits to foreign patients, then dinner at 7 p.m., recreation till 8.30 p.m., and the evening round of the wards. The day is a very full one for both doctor and nurse, especially perhaps for the latter. As she has the care of all the wards and the oversight of the whole Corean staff, she requires untiring patience to cope with all the demands on her time and energies. On Sundays we do as little professional work as possible, and we always have a "preaching" service with hymn-singing, both in the men's and women's wards. The women respond more readily than the men to the Gospel teaching; they have a hard life in their own homes which perhaps makes them more accessible. It is always very interesting to watch the change in their faces as they stay with us. At first they are generally hard and uninterested, if not scornful, during the services in the wards and at morning and evening prayers; they may refuse to listen or to learn anything. But, gradually, some of them seem to open up and begin to listen eagerly, and when they are leaving will confess, with tears in their eyes, how much they have learned in hospital of things undreamed of before, and how they are dreading the return to their own homes.
Ay-in Hospital, Chin-chun.--At Chin-chun, eighty miles from Seoul and several hours' journey from the nearest railway station, the Mission is fortunate in having an excellent little hospital in charge of Dr. A. F. Laws, who did valuable pioneering' work for several years on the island of Kanghwa--a work which is gratefully remembered to the present day by the Coreans. In 1909 Dr. Laws built at Chin-chun the Ay-in Hospital, i.e., hospital of the "love of man," and has been at work there ever since. The building', an adapted Corean house, is, in many respects, well suited for hospital work in a country district. The number of patients it will accommodate is elastic, as the patients lie in Corean style on the floor, and numbers are only limited by the square feet of floor space.
Chin-chun is a good centre for medical work; it has a large market every five days, which attracts quite a crowd of men. On these days the doctor and staff have to work from early morning till evening to get through the numbers of patients who come to the hospital .for treatment. The men come in to the market with their merchandise, and bring their wives and children along with them, to "show a sickness," as they say. It is interesting1 to watch the little groups as they sit about waiting to be seen. The East is often called "the patient waiting East," but in a hospital waiting-room they do not seem much more patient than the rest of humanity. They do not understand being kept waiting for more than a few minutes, and, if you give them a chance, they will tell you that they have been waiting "since before a very long time," and that there is a baby at home which does nothing but cry, or some other equally valid excuse for being seen before anyone else. In the middle of the busiest hours, as often as not, a kama, or carrying chair, will be brought up to the hospital door, and a very sick man or woman be carried in on a man's back and dumped down on the floor of the surgery. Such patients often come considerable distances, and are very ill before getting to the point of deciding- to come to the hospital; so, on arrival, they generally require immediate attention, and often then have to be told they have come too late. Whatever the doctor's ultimatum may be a regular hubbub ensues, and the patient's relations, the hospital staff, and the patients all seem to be talking at the same time for a few minutes, while they are making up their minds, out loud. Then a decision is reached, the patient admitted, or carried off again.
There is, perhaps, more real suffering and more disease in the Chin-chun district than elsewhere. Floods are very frequent and the rice-crops are destroyed over considerable areas of country. Rice to the people is life itself, representing their worldly all, and in times of famine many of the destitute sooner or later find their way to the hospital. Even in ordinary times there is a considerable number of folk who seem to exist on the verge of starvation, and eventually find their way to us suffering from disease, the result of the mal-nutrition and hard conditions to which they have been subjected.
Medical work at Paik-chun.--Paik-chun is a fairly new Mission centre north-west of Seoul, where we have a keen band of Christians. They were very anxious to have a doctor and a Mission hospital, so in 1912 a doctor was sent up by the Bishop and a small beginning made of medical work. The Christians were largely instrumental in obtaining a suitable house, and gave time and money to put it in repair. Throughout the period during which medical work was carried on in this district they were keenly interested in its progress and success.
The buildings and equipment were of the simplest description. An ordinary, small, Corean house was adopted for hospital purposes by knocking down a few partitions, adding one here and there, putting up shelves, etc. The largest room was used as surgery, operating-room, and waiting-room, the other rooms being given up to in-patients, of whom there were about ten. Being a Corean house, it was entirely guiltless of drains or any other sanitary arrangements. In common with most Corean houses of the poorer kind, it possessed its quota of insectivorous pests in the woodwork--who were too firmly established to be in the least perturbed by such trifles as kerosene or boiling water, but continued to plague our patients in the hot weather.
In spite of these and all the other difficulties incidental to pioneering work, the little hospital was very successful, and quickly established itself with the Coreans. In the first four months of the work over 2,000 new cases were seen at the hospital and in six months nearly 400 visits were paid to patients in their own homes. The majority of the patients were heathen, and the catechist and some of the Christians did their best to teach the people the elemental facts of the faith. The work promised well for the future, and rapidly outgrew the accommodation in the little premises it was started in, but in 1913 it was closed down owing to financial shortage and lack of doctors.