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When I first came across this statement by a medical missionary to China, Harold Balme, I wondered if it could possibly be true. 1 I had not expected that the "modern" hospital would have arisen in China but, in the West, the modern hospital has a long and continuous history, beginning with institutions where medicine was not necessarily paramount. Could it be that nowhere in China's history were the sick cared for in institutions? I discovered the view Balme expressed-that the hospital, as a concomitant element of Western medicine, was introduced into China by Protestant missionaries in the 19th century-was commonly held.2 The implication is that the transfer was one-way, complete, and into virgin soil. Were this so, one would expect a number of consequences to be evident in the historical record. If the introduction had been a straightforward transfer from the West, then one might suppose that hospitals the Chinese subsequently established would be closely modeled on the Western example. When I subsequently found a reproduction of a rough sketch-plan and brief description of a hospital established by the Chinese government in 1906 I realized that this might not have happened. The hospital in question, the Minzhengbu yiyuan ~lI& tml2SJJG, bore little resemblance physically to hospitals in the Protestant missionaries' home countries. Although I did not find plans of any other government hospitals, it seems that this one is representative. Firstly, according to a member of the medical staff of the Methodist Episcopal Mission (MEM) hospital at Beijing, John Mullowney (who described this hospital for the benefit of his missionary colleagues in 1912), the Minzhengbu (or Ministry of Civil Affairs) operated hospitals in several of China's largest cities and,

although they may "differ a little, in a general way they are practically laid out on the same plan.,,3 And secondly, Ronald Knapp, an expert in vernacular Chinese architecture, finds the plan to be what he "would have expected. It looks like the general plan of complexes all over China in the 19th and 20th century, even to the present.,,4 It would seem that the plan and design were indigenous to China. (see Plate 1)

One of the most striking features of the layout was the style of patient accommodation-I was reminded of a plan I had seen of a Roman infirmary excavated at Inchtuthil in Perthshire, Scotland. This Roman building, in the form of an open courtyard surrounded on all sides by a double row of individual cubicles separated by a corridor, was apparently typical of a valetudinarium (hospital for soldiers) in a legionary fortress. 5 Rather than in communal wards, as one might have expected if it had been based on an American or British model, Chinese patients in the Minzhengbu hospital lived in small, one or two-bed, rooms arranged around a central courtyard. I imagined that this hospital might have looked like a present-day small hospital, with which I was familiar, in the grounds of the Wai Yuan ~HJt (Foreign Languages Institute) in Xian 1ffi3i: (Shaanxi), the layout of which shares features with this early-twentieth-century institution. (see Plate 2)

Plate 1. Plan of the Mingzhenbu Yiyuan, Beijing, 1912 Source: John J. Mullowney, "Modern Hospitals for Chinese by Chinese." CM] 26, no.1 (1912): opp.36