neurological diseases in late 19th century taiwan ... · abstract-western medicine was introduced...

221

Acta Neurologica Taiwanica Vol 14 No 4 December 2005

From the Department of Neurology, Chang Gung MemorialHospital, Linkou Medical Center, Taoyuan, Taiwan.Received October 5, 2005.Revised and Accepted November 10, 2005.

Reprint requests and corresponding to: Nai-Shin Chu, MD.Department of Neurology, Chang Gung Memorial Hospital,No. 199, Tung-Hwa N. Road, Taipei 10591, Taiwan.E-mail: [email protected]

Neurological Diseases in Late 19th Century Taiwan--Medical Reports of the Chinese Imperial Maritime Customs

Nai-Shin Chu

Abstract- Western medicine was introduced to Taiwan in 1865 when Dr. James L. Maxwell, a missionarydoctor of the English Presbyterian Church, established a hospital in nowadays Tainan. The period of themissionary medicine lasted for over 30 years until Japanese took over. During this period, however, officialrecords of diseases in Taiwan that were based on Western medicine were scanty or not available.

Fortunately, port surgeons stationing respectively in Tamsui and Kelung in the north and in Takow andTaiwan-fu in the south reported semi-annually diseases seen in the ports, foreign communities and mission-ary hospitals that they volunteered to work. The diseases reported by port surgeons were either cases orsummary of cases with classification and statistics. Their medical reports covered from 1871 to 1900.

The data show that neurological diseases and/or disorders in the late 19th century Taiwan were uncom-mon, comprising only 2-3% of total diseases. The data further show that common neurological diseaseswere leprosy, opium smoking, syphilitic dementia (GPI), paralysis, hysteria, neuralgia, epilepsy, mania, sci-atica, meningitis and ataxia. Stroke was uncommon while Parkinson’s disease and Alzheimer’s disease werenot mentioned, indicating that neurological diseases related to old age and neurodegeneration were not yet athreat to health. Similarly, headache, insomnia, anxiety and depression, hallmark of functional disorders ofthe modern society, were also not mentioned, suggesting that these disorders were indeed rare or did notcause sufficient concern for patients to seek help from doctors of Western medicine.

Key Words: Neurological diseases, Diseases of Taiwan, Medical history of Taiwan, Chinese ImperialMaritime Customs, Medical missionary

History 221

222


2005 9 7 2005 10 12

5 E-mail: [email protected]

1871

2-3%

Acta Neurol Taiwan 2005;14:222-233

(1)

1.

2.

17

223


3.

1865

James Laidlaw Maxwell

The Takow

Chinese Hospital

The Mansion Memorial Hospital of the

English Presbyterian Church in Tainan

Changhua Christian

Hospital

Mackay Hospital (2-4)

4.

(2,3,5)

5.

(4)

(6,7)

port surgeon medical officer of the cus-

toms service 6

Robert Hart 1863

inspector general 50

1861-1911(8,9)

1868 Customs

Gazette

Medical Reports

3 9

1871 (10) 1872 (11) 1878

(12)

1910 1904

9-12

10

Patrick

Manson

filariasis 1877

9 Further observations on Filaria

Sanguinis Hominis 35 mono-

graph(11)

224


1863 William

Maxwell(13,14) Anping

1865 William Pickering(13,14) 1898 Pickering Pioneering in

Formosa Recollections of Adventures among

Mandarins, Wreckers, and Head-hunting Savages (15)

.

. 1872 3 David Manson

225


Tamsui Kelung

Takow Taiwan-fu

Taiwan-fu

Anping(13,14)

1871-1873 Dr. David Manson

1873-1881 Dr. Thomas Rennie

1881-1901 Dr. Wykeham W. Myers

1874-1884 Dr. B.S. Ringer

1884-1886 Dr. C.H. Johansen

1886-1893 Dr. Alexander Rennie

David Manson

1871

The Takow Chinese

Hospital

(16,17) 1873

The David Manson

Memorial Hospital

David Manson

Memorial Hospital Medical School(17)

1916

Dr. Ringer

Rev. George Leslie Mackay

clinic

1880

Mackay Hospital

Tamsui Mission Hospital

Captain Mackay

. 1873 3 5 David MansonPatrick Manson

226


(4,17)

1879

(1,17)

(18)

Distoma Ringeri Paragonimus Wester-

mani

5

1866-1871(19)

Browne (4,17)

(4,17)

natives

1

2

3

. (A) B.S. Ringer (B) T. Rennie 1875

A

B

227


neu-

rological diseases 1

neuropsychiatric disor-

ders 2

3

4

the remaining cases of no special interest

5

2

diseases of the

nervous system hysteria

epilepsy neuralgia sci-

atica paralysis apoplexy

mania local dis-

ease

tertiary syphilis

leprosy enthetic disease

hysteria, mania

neuropsychi-

atric diseases opium

smoking

otitis

2-3%

1871 1900

leprosy, opium smoking, GPI, paralysis, hysteria,

neuralgia, epilepsy, mania, sciatica, meningitis, ataxia

paralysis ataxia

1

2

3

4

paralysis

. 1871 9 David Manson

228


locomotor ataxia

GPI

hysteria mania

Charcot hysteria(20)

hysteria

sciatica

Epilepsy

. David Manson 1873 3 leprosy, hysteria, epilepsy, sciatica,paralysis 1.57%

229


. David Manson 1872 9 5

(A) zymotic dis-ease (B) constitution-al disease (C) localdisease (D) develop-mental disease (E) lesions from violence

C-I2.7%

230


James L. Maxwell

James L. Maxwell, Jr

1901 Tainan Mission

Hospital 20 (4,16,17) 1923

China Medical Missionary Association

1910

Jefferys

The Diseases of China, including Formosa and Korea(21) 1929 2 Jefferys

(22)

The Diseases of China(22) 6

diseases of the nervous system and insanity

neuropsy-

chiatric disease 4

5

beri-beri

diseases of the brain

summary

leprosy Leprosy

is a common disease over a large part of China and also

in Korea and Formosa. In Formosa we estimate

the incidence among the Chinese at 1 in 450.

leprosy, epilepsy, hysteria, GPI,

mania opium smoking

rabies, beri-beri, facial paralysis, cerebrovascular

disease, hypochondria, suicide, dementia praecox

schizophrenia

Table 2. Common neurological diseases in late 19th century andearly 20th century China(22)

1. Infection

Rabies

2. Deficiency disease

Beri-beri

3. Nerves

a. Peripheral neuropathy

Infection-leprosy

Deficiency-beri-beri

Toxic form-lead, mercury

b. Facial paralysis

c. Vagus neuritis-beri-beri

4. Brain

a. Intracerebral hemorrhage

b. Thrombosis of cerebral arteries

c. Functional diseases

Epilepsy

Hysteria

Neurasthenia and hypochondria

5. Insanity-manic-depressive insanity, dementia praecox,

general paralysis of the insane (GPI)

6. Suicide

7. Opium habit

Table 1. Neurological diseases in late 19th century Taiwan

Disease No of cases

1. Leprosy 58

2. Opium smoking 34

3. General paralysis of the insane (GPI) 28

4. Paralysis 27

5. Hysteria 21

6. Neuralgia 18

7. Epilepsy 9

8. Mania 4

9. Sciatica 3

10. Meningitis 3

11. Locomotor ataxia 3

12. Concussion of the brain 2

13. Chronic hydrocephalus 2

14. Apoplexy 2

15. Facial paralysis 1

16. Tetanus 1

17. Cerebral malaria mentioned only

18. Sun stroke mentioned only

231


1901

The Diseases of China(22)

1. Beri-beri

It is quite common in Formosa.

2. Rabies

Owing to the large number of half wild and

often quite uncared for dogs in most villages, rabies

is comparatively common throughout the country.

3. Facial paralysis seventh nerve

Facial paralysis is very common and impresses

us as being more so than in the west. The causes

appear to be the same except that possibly syphilitic

lesions of the nerve are more frequent.

4. Cerebral haemorrhage

Cerebral haemorrhage is very common, and at

an earlier age we believe than in other lands. It is

especially frequent in the wealthy merchant class.

Here everything favours its occurrence- a strenuous

life almost without exercise and with excessive con-

sumption of food leading to considerable obesity.

5. Thrombosis of cerebral arteries

Thrombosis of cerebral arteries leading to hemi-

plegia is surprisingly frequent in comparatively

young people, and is doubtless largely due to untreat-

ed or inadequately treated syphilis.

6. Functional diseases

Functional diseases of the nervous system, espe-

cially epilepsy, are very common in China.......

Hysteria is expected to be common in a land with a

long history such as China has.......Neurasthenics and

hypochondriacs are also very common.

7. Suicide

Suicide is extremely common, and for the most

trivial causes, next to quarrels debt being the com-

monest.

1. Tetanus

Customs Gazette, No 13,

1872

tetanus

Among the “accidents” was the case of a man

whose hand had been crushed in a sugar mill three

weeks before admission to hospital. The hand was in

a most filthy conditions. The jaws were firmly

clenched. Amputation was performed in the middle

of the forearm. Opisthotonus and spasm of the inter-

costal muscles coming on. The patient died 14 days

after operation

2. Delirium tremens

Medical Reports and

Customs Gazette, 31st March, 1876

Among the foreign community there was one

death from traumatic delirium. The subject had

resided about fourteen years in warm climates, and

had long been addicted to alcoholic excesses. After a

period of free drinking alcoholism set in, and while in

this state, by a fall, simple oblique fracture of the

right thigh bone was produced. Almost immediately

232


after the accident delirium commenced, and in ten

days terminated fatally by coma.

3. Status epilepticus

Medical Reports,

30th September 1878. Statutes epilepticus

CNS infection

A pale, delicate boy nearly four years old was

seized one morning with a sudden convulsion which

continued for a short time, leaving the patient perfect-

ly insensible. Breathing soon became difficult from

the collection of mucus in the throat. This condition

lasted for 2 hours, when another fit, not so violent as

the former, occurred. The dyspnaea now increased

rapidly and the child expired quietly 3 hours from the

commencement of the first attack, never having

recovered consciousness sufficient to answer ques-

tions, though he seemed once or twice to try to cough

when loudly told to do so.

The child had complained of feeling feverish the

morning before the attack. ......The next morning he

was in a state of high fever and complained of pain in

the head. The temperature in the axilla was 106.6˚,

and the pulse between 140˚ and 150˚. During the

attack the head was cooled with wet clothes, and dur-

ing the second fit the body was placed in hot water,

the head and neck being still kept cool; the bowels

were opened twice involuntarily. After the bath the

convulsive movements ceased, but the patient though

quieter seemed more exhausted and died shortly

afterwards. There was no postmortem.

4. Temporal herniation

Medical Reports,

30th September, 1890. Death from fracture

of the skull

C.A., aged 26, Norwegian sailor. At 3 A.M. on

13th March 1888 arrived by rapid boat from Kelung,

where he had been injured on the previous day. It

appears that during a scuffle he had fallen down the

hold of a ship alighting on his head among iron rails.

At 9 A.M. patient almost unconscious, pupils equal

and abnormally sensitive to light. Is very restless;

when touched he commences to push with his hands

and to kick off the bedclothes, then tosses to and fro

and keeps aimlessly feeling his genital organs a

most persistent symptom. On the scalp, over the right

occipital region, is a contused wound 2 inches long,

running from the vertex backwards. Pressure here

causes intense pain. Fracture of the skull suspected,

but not ascertained.

14th March- Patient drowsy, but easily roused,

when great restlessness is manifested- tearing the

bedclothes and throwing his arms about.

15th Match- Can reply to simple questions.

Complaining of pain in the head and left side of body.

Ideas confused.

6 P.M.- Has relapsed into unconsciousness.

Breathing slow and stertorous. Pulse irregular. Eyes

insensible to light; right pupil dilated. Loss of power

in left arm and leg.

16th March- Temperature 101˚. Quite uncon-

scious. Right pupil much dilated. When stimulated

moves right arm feebly.

6 P.M.- Complete paralysis of limbs. Laboured

breathing.

Died at 11 P.M.

Postmortem examinatim- A linear fissure runs

transversely across the superior angle of the occipital

bone. Much effused blood found between the dura

mater and the temporal bone, especially over the

petrous portion. The whole right side of the brain on

its outer and under aspect is bruised. Left side of

brain apparently healthy.

4 2

233


19

leprosy, opium smoking, tertiary syphilis (GPI),

paralysis, hysteria, neuralgia, epilepsy, mania, sciatica,

meningitis, ataxia

19

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