AFTER MORE THAN 25 YEARS of planning and fundraising, American medical missionaries opened the first mental hospital in China in 1898. In 19th century China, the mentally ill were usually confined by their families in a dark room of the house, essentially neglected.1 If left to wander in the streets, they were often mocked and laughed at, and sometimes stoned. If they did anything wrong, they could be arrested and thrown into prison. Because the mentally ill were largely invisible, some missionaries argued that mental illness was not as prevalent in China as in Europe or the United States. John G. Kerr, MD (1824–1901), an American Presbyterian medical missionary, disagreed—and he worked long and hard to change the treatment of the mentally ill. Kerr had trained at Jefferson Medical College in Philadelphia and went to Canton, China (now Guangzhou), in 1854. For more than 40 years, he ran the Ophthalmic Hospital in Canton, which treated almost one million patients.2 He also trained 150 Chinese medical students, including Sun Yat-Sen, who would become the first president of the Chinese republic. Kerr translated 34 volumes of Materia Medica into Chinese and published many of his own articles and treatises. In 1887, he became the first president of the Medical Missionary Association of China. As president, Kerr presented his plan for a mental asylum to the Medical Missionary Association. He was strongly supported by Professor Edward P. Thwing of the American Presbyterian Mission, who read a paper at the Shanghai Medical Convention in 1890 on “Western methods with insane Chinese.”3 In it, Thwing noted that he and Kerr had visited a number of wealthy citizens of Hong Kong and Canton and appealed to them for funds to open a mental hospital to bring relief to their suffering kinsmen; these citizens had listened politely but declined to do anything. But Thwing was not deterred; the demands of humanity required a mental hospital—whether or not the Chinese themselves wanted one. “We ask, not what they want, but what they need,” he wrote. “The heathen do not ask for bibles and missionaries, but they need them all the same.”3(p399) The same logic applied: the Chinese did not want, but needed, a mental hospital. The Medical Missionary Association agreed, in 1890, to support the proposal, despite doubts and objections from some of its members. In 1891, Kerr bought three acres of land in Canton, at his own expense, and started a dispensary. In 1894, he received unexpected help from a former medical missionary who gave him the money to erect a building on the site. By 1897, the hospital, with 24 rooms, was ready; in February 1898, the first patient was admitted.4 Kerr said that most of the patients were brought to him in chains; his descriptions suggest that, at that time, the insane were often treated as harshly as lepers. The first patient admitted had been chained for three years to a stone in such a way that he had been unable to take a single step and had lost the power of walking.5 The second patient, a woman, was found with a chain around her neck, the end of which was fastened to the floor behind her. John G. Kerr Refuge for the Insane, Canton, China Source. Courtesy of the National Library of Medicine. When he opened his Refuge for the Insane, Kerr declared some new principles: first, insane patients were ill and should not be blamed for their actions; second, they were in a hospital, not a prison; and third, they must be treated as human beings, not as animals. He pledged to conduct a course of treatment based on persuasion rather than force, on freedom rather than restraint, and on a healthy outdoor life with a maximum of rest, warm baths, and kindness. He also wanted to provide patients with gainful employment wherever possible. The directors of the Canton refuge worked closely with local Chinese officials and local police, who did not know how to handle insane people and were glad to refer them in large numbers to the refuge.6 Chinese officials paid the refuge an annual allowance for taking care of the patients. Local families also brought in patients, and some were sent from Hong Kong by the British authorities. The hospital was eventually expanded to 500 beds, and it operated with considerable success until it finally closed in 1937.
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Sep 8, 2024
Sarah Luke 
Open Access