Angharad Fletcher
Hong Kong, China

In his 1895 government report on the recent outbreak of bubonic plague, Dr Philip Bernard Chenery Ayres, last Colonial Surgeon of Hong Kong, berated the Tung Wah Hospital for its dangerous and insanitary conditions. Ayres listed the many “medical and surgical atrocities” he had witnessed within the walls of this “menace to the health of the community”. He was also careful to state that his objections were “based entirely upon professional grounds” rather than any cultural objections he might have to the therapeutic practices embraced by the Chinese community.¹

Such outrage at the function of an institution that countless European physicians and civic officials would try, and fail, to comprehend was nothing new. Already in 1885 Dr C. J. Wharry, Superintendent of the Government Civil Hospital, wrote of the Tung Wah that, “…the Establishment is an anachronism, and it is difficult to understand how, in a British Colony, a hospital can continue to exist in which the physicians and surgeons know nothing of anatomy, physiology, chemistry, surgery, medicine and midwifery…all the regular Hospital work of the Colony falls upon the Civil Hospital.”²

Yet Wharry’s own institution, the Government Civil Hospital, had been established in 1849 primarily for the use of Europeans, namely government officials, members of the police force and prisoners at the city jail.  If the indigenous Chinese population required treatment, they would need to be appropriately affiliated, and standards of care and accommodation differed greatly between those offered to private paying patients and those encountered by the destitute. Furthermore, the admittance cost of $1 made the Government Civil Hospital an unrealistic option for most Chinese workers.

By the mid-nineteenth century, Hong Kong already had about half a dozen hospitals. These included the Alice Memorial Hospital, founded in 1887 as a charitable endeavour by both European and Chinese philanthropists, designed to meet the previously neglected requirements of the colony’s vast labouring majority by offering them affordable western medical care; and the Lock Hospital, created in 1858 specifically for treating venereal disease. Despite John Carroll’s correct assertion that Hong Kong was a multi-ethnic society comprising Chinese, Europeans, Americans, Armenians, Indians, Portuguese from Macau, Jews from Bombay and Eurasians,  the city was still overwhelmingly Chinese.³ As Hong Kong was a free port and never intended as a settled society, government provision of healthcare facilities was fragmented and focused mainly on the needs of the European minority. Not only could  the vast majority of the populace not afford the prohibitively expensive healthcare options, many inhabitants were also deeply suspicious of western medical care.

When historians including Frank Welsh affirm that in the nineteenth century and by the time plague arrived in Hong Kong, Chinese medicine was “still half a millennium behind the times” they are disregarding the existence of centuries old deeply ingrained and highly systematic holistic approach to healthcare.⁴ Such customs were constantly reinforced by a steady stream of economic migrants from China, making any form of cultural paradigm shift unlikely. Practitioners of traditional Chinese medicine believed that illness resulted from an internal imbalance that must be rectified in order for individual vigour to be restored. To achieve this goal, a person might visit a professional herbalist, acupuncturist, dispensary, wise woman or other form of healthcare specialist. Furthermore, many Chinese people considered practices that were routinely enacted at western hospitals to be barbarous defilements of the body, including amputation or post mortem examinations, which would have ramifications in both this and the next life. Most forms of surgery were shunned for similar reasons, and the fact that antiseptic technique was also rudimentary further reinforced Chinese scepticism. With limited pharmacological resources, many treatments seemed more frightening than the illnesses they aimed to eliminate. Bubonic plague, for example, was frequently treated at the Government Civil Hospital, and aboard the quarantine ship Hygeia, with the medicinal application of brandy and by packing the patient in ice, with predictably patchy results.

As a result the Tung Wah Hospital, established in 1869 and officially opened on Po Yan Street in the Tai Ping Shan district on 14th February 1887, was created to offer Chinese medical care to the Chinese community, and therefore meet a demand originating from a vast sector of a society that considered existing hospital care conceptually irrelevant. However, the hospital fulfilled many other purposes, for example caring for the destitute, repatriating Chinese remains as well as kidnapped labourers and women, running the colony’s first asylum, and generally managing Chinese affairs in areas where the colonial government had proved deficient. More than a medical institution, the Tung Wah provided a wide range of political and social functions including representing the Chinese population and communicating between the government and the indigenous populace, supporting education, arbitrating disputes, creating links between the Chinese overseas and those at home and undertaking a range of charitable works. If a sociocultural vacuum existed between the needs of the Chinese populace and the provisions of the colonial government, then the Tung Wah was often where those needs were met. Its very origins lay in the outrage created by such a vacuum.

The Kwong Fook I-ts’z (common ancestral hall) had existed since 1851 as a place to store ancestral tablets for prayer. However, as the Chinese believed that to have a person die in one’s home constituted an unacceptable befoulment, the I-tz also contained coffins awaiting shipment back to home villages, and sick patients awaiting death. Despite the existence in China of institutions designed to provide relief for chronic ailments, the notion of a hospital as a specialised place of cure and relief for the dying was anathema to many local people. As it catered to those of limited means, the I-ts’z had always been overcrowded and its sanitary condition deplorable, particularly as it served natives as well as the vast number of Cantonese immigrants who came from the Mainland to find work. The colonial government ordered the closure of the I-ts’z in1869 after testimony regarding its deplorable hygienic condition by Acting Registrar General Alfred Lister created a public scandal, the ramifications of which stretched all the way to Westminster. Lister’s observations and misinterpretation of the conventional role of the I-ts’z meant that the colonial government’s policy of non-intervention in Chinese affairs was no longer feasible. After arguing that the original purposed of the I-ts’z as a temple had been violated, Governor Richard MacDonnell was forced to authorise the construction of a hospital funded by influential Chinese businessmen and other members of the local elite, run on Chinese medical principles yet subject to Government control.

Once opened, the hospital could handle between 80 and 100 patients in wards strictly segregated by gender. Lower wards were designed for those who required free medical care, and upper wards, which enjoyed better ventilation, for paying patients. Aside from an apothecary, dispensary and mortuary, the hospital also had a large area for preparing Chinese medicine. This task was undertaken by specially trained staff, each making individual prescriptions in a patient’s own earthenware vessels to avoid contamination.

While positive aspects about the hospital were noted on occasion, for example in helping vaccinate the local population against smallpox, the colonial officials adopted a critical stance, based on the disproportionate high death rates at the hospital.⁵ This failed to acknowledge the building’s social function as a place for the moribund of limited means to die, and refuse to recognise the training and skill of Chinese practitioners who used methods that remained unenlightened in the eyes of most Europeans.

In 1896, after an outbreak of bubonic plague, the colonial government extended official administration and forced medical reforms at the hospital. Dr Chung Boon-chor was appointed in 1897 as the resident western doctor and Dr Thomson, superintendent of the Alice Memorial and Nethersole Hospital, was asked to undertake twice-daily supervisory visits. With the introduction of these western medical influences the Tung Wah became the first institution in Hong Kong to offer both western and Chinese medicine. It also provided an economic alternative to the Government Civil Hospital and was the only medical establishment in the colony that did not perform post mortems. In her masterful study of the subject, Elizabeth Sinn stated that the development of the Tung Wah was “so closely tied to the story of Hong Kong itself” and today the Tung Wah Group of Hospital is the oldest, largest, and perhaps most influential charitable body in Hong Kong.⁶

Notes

1. Dr James Lowson, The Hongkong Government Gazette, 13th April 1895, p.368.
2. Dr C. J. Wharry, “Report from the Superintendent of the Civil Hospital”, included in “The Cononial Surgeon’s Report for 1885”, 10th May 1886, p.301.
3. John M. Carroll. A Concise History of Hong Kong (Hong Kong: Hong Kong University Press, 2007), p.36.
4. Frank Welsh. A History of Hong Kong (London: Harper Collins Publishers, 1993), p.302.
5. The annual reports of the Colonial Surgeon from the first decades of the hospital existence are replete with such examples.
6. Elizabeth Sinn. Power and Charity: The Early History of the Tung Wah Hospital, Hong Kong (Hong Kong: Oxford University Press, 1989) p.1