Chapter 2: The Medical Door

Peter Parker and the Fusion of Healing and Empire

The Lancet

On November 4, 1835, in a rented building on Hog Lane in the foreign quarter of Canton, a thirty-one-year-old American physician named Peter Parker¹ opened the doors of a hospital. It was the first Western hospital in China. Parker had no staff beyond a few Chinese assistants, no endowment, and no assurance that anyone would come. The building itself belonged to Wu Bingjian² (伍秉鑑, Wǔ Bǐngjiàn)—known to the foreigners as Howqua—the wealthiest of the cohong merchants. Howqua waived the annual rent of five hundred dollars—the most powerful Chinese merchant in Canton sheltering the foreign doctor’s enterprise before it had treated a single patient.

Parker waited for his patients. They came.

On the first day, a small number. Within weeks, dozens. Within months, the hospital was overwhelmed. During its first three months of operation, Parker treated 1,061 patients, of whom 1,020 suffered from diseases of the eye—cataracts, glaucoma, entropion³, the accumulated blindness of a population with no access to surgical intervention. By the end of the first year, nearly three thousand had passed through the wards. Over the next two decades, the number would exceed fifty thousand.

Parker had arrived in Canton the previous year, in October 1834, sent by the American Board of Commissioners for Foreign Missions—the first medical missionary dispatched to China by any Protestant body. That winter, while waiting for a building and a license to practice, he bent over Morrison’s grammar and dictionary, working through the tonal system by the same methods Morrison himself had used two decades earlier: locked doors, whispered repetitions, Chinese assistants whose lives were at risk for helping him. The instruments that had made his mission possible were barely a generation old. He had received his Presbyterian ordination one month before sailing—barely time for the ink to dry on one calling before the other claimed him. The logic of the medical mission was that healing was not an end in itself but an entering wedge. A patient whose sight had been restored by a Christian doctor might be disposed to listen when that doctor spoke of a different kind of light.

The phrase that would later attach itself to Parker’s enterprise was not his own but captured his method precisely: he was “opening China at the point of a lancet”.⁴

The Surgeon’s Table

The procedure took less than a minute. Parker steadied the patient’s head, drew back the eyelid, and inserted a fine needle into the margin of the cornea. With a single precise motion he depressed the clouded lens—pushed it down and out of the visual axis—and withdrew the instrument. The patient blinked. Light entered where there had been none. This was “couching,” the oldest cataract operation known to surgery, and Parker performed it with a confidence that startled even the physicians who came to observe. In a single afternoon he could operate on eight patients. The results were not always lasting, and the risks were real—infection, hemorrhage, the lens drifting back into the field of vision—but to a patient who had lived in years of darkness and now could see, the distinction between a perfect cure and a partial one was academic. What mattered was the light.

The fame of the healer went before him. Word spread through Canton and beyond—carried by patients who returned to their villages with sight restored, by merchants who heard the stories, by the servants and compradors who moved between the Chinese and foreign worlds. Patients began arriving from distant provinces, traveling for days or weeks to see the 洋醫⁵ (yángyī)—the “ocean doctor”—on Hog Lane. The waiting rooms filled with people of every social station: street beggars with untreated infections, wealthy merchants with ailments their own physicians could not cure, women who came despite the social prohibitions against contact with foreign men, children carried in by desperate parents. Parker treated them all without charge. Medicine was, in Parker’s own phrase, “the handmaid of religious truth”.⁶

The institution was funded in significant part by donations from foreign merchants in Canton—many of them opium traders whose generosity toward the Canton Hospital⁷ existed in uneasy proximity to the trade that was destroying Chinese lives elsewhere in the city. Some missionaries noted it, uneasily. Most chose not to dwell on it. The hospital needed funds; the merchants had funds; the transaction was completed without too much scrutiny of its moral architecture.

Parker recorded his cases not only in clinical logs but in oil paint. Beginning in 1836, he commissioned the Cantonese painter Lam Qua⁸ to produce portraits of patients before and after treatment. Lam Qua was not an obscure craftsman but one of the most acclaimed portraitists on the South China coast, who was trained in the Western style by the English painter George Chinnery⁹. Lam Qua initially painted the hospital portraits without charge—a contribution to the enterprise, perhaps, or a recognition that the subject matter was extraordinary. Over the next nearly two decades he produced more than a hundred paintings, many depicting patients with massive tumors, severe deformities, or disfiguring growths that Parker would attempt to remove surgically—the suffering rendered with the same academic precision Lam Qua brought to a merchant’s portrait, the patient’s gaze meeting the viewer’s as steadily as any Canton grandee’s. Eighty-six of them survive in the collections of Yale’s Cushing/Whitney Medical Library.

Parker sent copies and descriptions of the portraits to the United States, where they were displayed at meetings of medical societies and—inevitably—at missionary fundraising events. The tumors of Canton became arguments for the collection plate. Suffering, made visible, became a case for donations. Look at what these people endure. Look at what your money can heal. Plates filled.

In February 1838, the growing reputation of Parker’s work led to the founding of the Medical Missionary Society in China—the world’s first organization dedicated to medical missions. Dr. Thomas Richardson Colledge¹⁰ served as president; Parker as vice president. The Society’s stated objective was to encourage physicians to “come and practice gratuitously among the Chinese”, but its deeper significance was structural. What had been one man’s improvisation now had letterhead, officers, and an annual report.

The Paradox of Conversion

Each morning before the consultations began, the patients assembled in the hospital chapel—some on benches, some squatting against the walls, some still bandaged from the previous day’s operations. An interpreter read a passage of scripture. Parker or an assistant offered a short prayer. A few patients bowed their heads. Most waited for the medicine to begin. When the consultations were over, when the cataracts had been couched and the tumors excised and the prescriptions written, the patients expressed their thanks, gathered their belongings, and returned to their villages and their ancestral practices.

Parker baptized relatively few of them. The hospital healed tens of thousands; the chapel converted almost none. Some showed genuine interest in the foreign doctor’s God. A few accepted baptism. But the mass awakening that the medical missions model implicitly promised—the idea that healed bodies would naturally lead to saved souls—did not materialize.

Yet the patients were not indifferent. When Parker restored sight to Yë Maouchang¹¹, a youth who had been blind for ten years, the boy’s uncle—Chang Kwôkin of Lingkang, whom Parker described as “a literary gentleman”—remained at the hospital through the recovery. On leaving, he presented two calligraphic scrolls, each four feet long, inscribed with a poem in large characters down the center. The prose dedication read: “Dr. Parker, of the flowery-flag nation, sailed over the ocean, and came to Canton, with healing medicines. All men feel gratitude towards him. My nephew, Yë Maoushang, had been blind ten years. With a metallic instrument, he opened his eyes, and gradually restored vision. Therefore I have prepared these scrolls to record his deed.” The verse rendered the surgery in a different key:

The clouds and vapors rolling off,

Quickly appear the sun and moon.—

His art’s true badge, the knife, he grasped,

And therewith op’d the way to sacred light.

The light in the uncle’s poem was not the light of the gospel but the light of sun and moon—clouds lifting, the natural world restored. Parker noted the translation as “interesting as a specimen of Chinese taste and customs”. He did not record a baptism.

Some converts’ profession of faith appeared motivated less by spiritual conviction than by the material benefits that association with a mission could provide—food, medicine, education, legal protection under the treaty system. The term that circulated in missionary literature was blunt: “rice Christians”. The accusation was not always fair. Many Chinese converts were entirely sincere, and the missionaries who raised the concern were often the first to insist on rigorous doctrinal preparation before baptism. Robert Morrison had required years of instruction before accepting his first converts; his printer and ordained minister Liang Fa distributed evangelical tracts—by his own account tens of thousands of them—outside the examination halls of Guangdong.

But sincerity could produce consequences no mission board had anticipated. Whether Hong Xiuquan’s Taiping catastrophe belonged in the rice-Christian ledger, or in a different one altogether, was not a question the mission boards in Boston were equipped to answer. What it demonstrated was that Chinese Christianity, once seeded, would grow in soils and directions the missionaries could neither predict nor control.

The suspicion about rice Christians lingered all the same, and it pointed to a structural problem in the medical missions model. When the entering wedge was a material benefit—the restoration of sight, the removal of a tumor, the cure of a fever—how could one distinguish between a convert who had found God and a patient who had found a doctor? Chinese observers, who understood the logic precisely, had their own phrase: 吃教 (chī jiào), “eating the religion”—the convert acknowledged, the motive suspect.

Parker’s own days made the contradiction visible. Morning to evening he operated—eight cataracts in an afternoon, tumors that required hours—and when the last patient left, the chapel stood empty. The patients trusted the surgeon’s knife, not necessarily the surgeon’s theology. If he spent all his time in the operating room, he was a physician, not an evangelist. If he subordinated medicine to preaching, he lost the very patients whom the hospital was designed to attract.

The ABCFM resolved the tension for him—by cutting the knot. In June 1845, Parker learned that the Board had terminated his missionary support. Rufus Anderson, the Board’s foreign secretary, had written that if Parker insisted on prioritizing medicine over evangelism, he must find other sources of income. Anderson’s logic was unimpeachable within the framework that had sent Parker to China: the Board existed to save souls, not to restore sight. Parker, with a family to feed and a hospital to sustain, applied for and received an appointment as Secretary and Chinese Interpreter to the United States Legation—a salaried government position that would let him continue both his practice and his household. The physician who could not be made into an evangelist became, by financial necessity, a diplomat.

The Opium Wars and the Missionary Position

At the shore near Humen (虎門, Hǔmén) in June 1839—four years after the hospital opened its doors—five hundred Chinese workers labored for twenty-three days to destroy more than twenty thousand chests of confiscated opium. They mixed the drug with lime and salt in stone-lined trenches near the shore and flushed it, batch by batch, into the sea—over a thousand tons of narcotic dissolved into the tide.

Lin Zexu¹² had ordered it. He had arrived in Canton three months earlier as Imperial Commissioner with a mandate to end the opium trade, and he had set about it with methodical incorruptibility. He arrested more than 1,700 Chinese opium dealers, confiscated over 70,000 opium pipes, and demanded that the foreign merchants surrender their stocks. When they resisted, he blockaded the foreign factories, trapping merchants and missionaries alike in their quarters for weeks—until the chests were surrendered and the destruction at Humen began.

Lin composed an open letter to Queen Victoria—almost certainly never delivered, later reprinted in the Times—that asked a question the missionaries, had they been honest with themselves, might have asked too:

Suppose men of another country carried opium into England and lured your people to buy and consume it—would your esteemed sovereign not deeply abhor and utterly prohibit it? We have heard your ruler is benevolent at heart, and would not inflict upon others what he himself does not desire.¹³

The British response was not a letter but a fleet. The First Opium War ended with the Treaty of Nanjing, which imposed an indemnity of twenty-one million silver dollars on the defeated Qing. Parker’s hospital had been forced to close during the hostilities. When it reopened, it reopened in a different world—one in which the treaty system offered missionaries new protections, new access, and a new moral problem.

The missionaries had not caused the Opium War. Most of them—Parker included—opposed the opium trade publicly and sincerely. But they benefited enormously from its consequences. The treaties that the war produced opened the doors through which missionaries would walk for the next century. The protections that missionaries enjoyed—the right to reside in the treaty ports, the right to build churches and hospitals—were provisions of a system built on military victory over opium. The missionary’s Bible and the opium trader’s chest arrived on the same ships, docked in the same ports, and were protected by the same treaties. Lin Zexu, exiled to Xinjiang for his trouble, had not needed a missionary to explain the arrangement to him.

From Healer to Commissioner

In the summer of 1844, in a temple near Macao draped for the occasion, Parker took his seat beside Caleb Cushing at the negotiating table. Cushing, the Massachusetts congressman who had been dispatched to secure America’s first treaty with China, could not read the documents before him, could not address the officials seated across the table, could not assess whether the Chinese text matched the English draft or subtly diverged from it. Parker could. He had learned both Cantonese and the literary Chinese necessary for official correspondence—two registers as different as spoken English from legal Latin—and as he translated the clauses one by one, he looked across the table and recognized the faces. They were his acquaintances. Some had been his patients. Their parents also. The medical work that had failed to produce converts had produced something the Board had not anticipated: a network of personal relationships that reached into the Qing bureaucracy. The entering wedge had opened a door, but not the one the missionaries expected.

It was Parker and Bridgman who urged the insertion of Article 17, a single sentence among dozens of articles governing tariffs, consular rights, and dispute resolution, guaranteeing Americans the right to build churches and hospitals in the treaty ports. For the first time, the legal relationship between the United States and China included a formal guarantee of missionary access—written into the treaty by the missionaries who served as translators. Parker’s diplomatic career did not end at Wanghia. It escalated.

In 1855, President Franklin Pierce appointed Parker as United States Commissioner to China—the highest-ranking American diplomat in the country, and the first missionary to hold the position. The appointment was the culmination of the missionary-to-diplomat conduit that Morrison had initiated and that Williams and Bridgman had extended. Here was a man who had come to China to heal the blind and preach the Gospel, now representing the United States government in its relations with the Qing court.

The lancet was behind him now. Parker arrived in his new role with the conviction, reinforced by two decades of frustrated experience, that the Qing government was obstructionist, deceitful, and incapable of reform without external pressure. When the emperor refused to receive him in Beijing or to renegotiate the Treaty of Wanghia, Parker’s frustration curdled into something harder. He proposed to the British and French that they form a triple alliance and mount a joint naval expedition to compel Chinese compliance. When this was rejected, he went further. In a dispatch to the State Department dated February 12, 1857, Parker urged the United States to seize and permanently occupy Formosa—present-day Taiwan—in the interests, as he framed it, of “humanity, civilization, navigation and commerce”. The subject of Formosa, he wrote, “is becoming one of great interest to a number of our enterprising fellow citizens”. He noted that half the island lay beyond effective Manchu control, in the hands of Aboriginal peoples who might be brought under the order of “a civilized power”. He went so far, without authorization, as to instruct the local American naval commander to send a ship to Fengshan (鳳山, Fèngshān) in the south of the island, hoist the flag, and take possession. The vocabulary had not changed—humanity, civilization, commerce—but the instrument had. The missionary doctor who had, two decades earlier, entered China at the point of a lancet was now proposing to complete his career at the point of a cannon.

The proposal was rejected. President James Buchanan, who had replaced Pierce, recalled Parker after nineteen months in the post. The logic that carried him from lancet to cannon was not madness but consistency: China’s resistance to Western engagement was irrational; the missionary’s intentions were self-evidently benevolent; force was justified when persuasion failed. Parker was the first to follow the logic to its imperial conclusion. He would not be the last. What he lacked was a theology capacious enough to contain what he had become. That theology was already being written, in a Congregationalist minister’s study.

The Hospital Outlives the Man

The hospital did not follow Parker to Washington. It remained on Hog Lane, in other hands, for another half-century.

The patient was strapped into position. John Glasgow Kerr¹⁴ made a perineal incision, extracted the stone with forceps, and closed the wound—the entire procedure completed in minutes to minimize shock. This was lithotomy, cutting for bladder stone, a condition endemic in southern China, and Kerr performed it with a frequency that no Western surgeon could match. By the end of his tenure he was reputed to have operated on more cases of stone in the bladder than any living surgeon. He had assumed charge of the hospital in 1855 and never left. Forty-seven years, one building, one city, one calling. By 1871 more than twelve of his former students were practicing independently in country towns across Guangdong, referring the surgical cases they could not handle back to Canton—the hospital reproducing itself through the hands it had trained. In 1879 the medical school became the first in China to admit women. On three acres at Fangcun (芳村, Fāngcūn) that he purchased with his own money, Kerr opened the John G. Kerr Refuge¹⁵ for the Insane—the first modern psychiatric institution in China. The first patient admitted had been chained to a stone for three years and had lost the power of walking.

Training at Canton was apprenticeship, not a degree: students lived in the compound, walked rounds with Kerr and his senior Chinese assistants, and—once their hands were trusted—operated under his eye. The hospital’s medical school, established in 1866 and attached to the wards, was the first Western medical school in China.

Among the students, in the autumn of 1886, was a nineteen-year-old from Xiangshan (香山, Xiāngshān) county named Sun Yat-sen¹⁶. He had been baptized in Hong Kong two years earlier by the American Board missionary Charles Hager¹⁷, who is said to have recommended him to Kerr’s school. Sun later described medicine as “the kindly aunt who would bring me out on to the high road of politics”—the scalpel was camouflage from the start. Now he sat in a missionary hospital classroom studying Western anatomy and surgery under a sixty-two-year-old Ohio Presbyterian who had spent three decades cutting for stone on the Pearl River. Beside him sat Zheng Shiliang¹⁸, a Hakka Christian from Guishan (歸善, Guīshàn) county who would, within two years, become head of the local Triad society. Sun later wrote of his friendship at Canton with Zheng Shiliang, who “had a very large circle of acquaintances amongst widely-travelled people who knew China well”. The medical school that had been built to heal bodies and save souls was producing revolutionaries.

After a year Sun transferred to the newly opened Hong Kong College of Medicine for Chinese, drawn, he wrote, by “the thought that there I should have a wider field for my revolutionary propaganda”¹⁹. By the mid-1890s he had put medicine aside for the project that would, in October 1911, topple the Qing dynasty. The hospital had trained him; the revolution claimed him.

By Kerr’s death in 1901, Parker’s model had multiplied along the coast—Lockhart²⁰ in Shanghai, McCartee²¹ in Ningbo, successors in Fuzhou, Amoy, and Tianjin. The hospital itself passed to Lingnan University in 1930 and has continued to operate under a succession of names, most recently as the Sun Yat-sen Memorial Hospital of Sun Yat-sen University—a direct descendant of the rented building on Hog Lane.²²

The Treaty System Expands

Parker’s recall did not slow the expansion of missionary rights in China. The mechanism for that expansion was not individual diplomacy but the treaty system—and the system’s next great revision came in 1858, at Tianjin, in the wake of another war.

The Second Opium War (1856–1860) had been triggered by a tangle of grievances, among them the boarding of the British-registered ship Arrow by Qing officials in Canton and—significantly—the execution of a French Catholic missionary, Auguste Chapdelaine²³, by local authorities in Guangxi province. France seized on Chapdelaine’s death as a pretext to join Britain in the war, citing the need to protect missionaries and French commercial interests. The missionary cause and the imperial cause were, once again, fused in a single act of war. A dead priest became a casus belli.

The Treaties of Tianjin²⁴, signed in June 1858, marked a qualitative leap beyond Wanghia. Where the 1844 treaty had confined foreign residence to five coastal ports, the Tianjin treaties opened the Chinese interior. Foreigners—merchants, consular officials, and crucially, missionaries—now had the legal right to travel anywhere in the empire, provided they carried a valid passport. The barrier that had contained Morrison in Canton and Parker on Hog Lane was, by the stroke of a pen, abolished.

For missionaries, the decisive provision was Article 29 of the Sino-American treaty, known as the Toleration Article. Samuel Wells Williams, serving as interpreter for the American delegation, drafted the religious toleration language himself—by his own account inserting it during the negotiations as Parker and Bridgman had inserted Article 17 at Wanghia fourteen years earlier. The pattern was now fixed: in both of America’s China treaties, the translator’s pen had written protections for the translator’s faith. Article 29 guaranteed Christians—both foreign missionaries and Chinese converts—the right to practice their religion without interference anywhere in the empire.

The Tianjin treaties also extended the principle of extraterritoriality²⁵—the doctrine that foreign nationals in China were subject to the laws of their own countries, not to Chinese law. A missionary who settled in a district uninvited, offended local customs, or provoked the hostility of officials had recourse to his consul, who could invoke treaty rights on his behalf. The Chinese magistrate, however senior, had no jurisdiction. The foreigner stood in his courtyard but outside his law.

The Contradiction

The missionaries who entered the Chinese interior after 1858 were, in the main, people of genuine conviction and often of considerable personal courage. Many sacrificed their health and some their lives. But they did so under the protection of treaties that China had signed under duress—after military defeats in two Opium Wars, with foreign warships anchored in its rivers and foreign troops occupying its forts. The doctor’s lancet and the admiral’s cannon were provisions of the same treaty system. Parker’s career had made the fusion literal: the same man who healed the blind had negotiated the first treaty, and the same legal architecture that guaranteed religious freedom also legalized the opium trade that Lin Zexu had given his career to stop.

The work was good; therefore the system that enabled it must be acceptable. The patients were grateful; therefore the treaties were just.

The unequal treaties were not formally abolished until January 11, 1943—when the United States and Great Britain, needing China as a wartime ally against Japan, finally relinquished the privileges they had held for nearly a century. By then, missionaries had carried the Bible and the treaty system’s protections into every province—under rights that China had never freely granted.

Peter Parker, who had started with a lancet and ended with a proposal to seize Taiwan, was the extreme case. The system he helped to build was not. The Bible had arrived, as Chinese nationalists would put it, in the shadow of the gunboat. The medical door that Parker opened took a century—and a world war—to close. The shadow did not close with it.

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1. Peter Parker (1804–1888), born in Framingham, Massachusetts. Yale College 1831; Yale Divinity School January 1834; Yale Medical School March 1834; ordained Presbyterian minister in Philadelphia in May 1834. He sailed from New York on June 4 aboard the Morrison and reached Canton on October 26. See Chan, Liu & Tsai, “The First Western-Style Hospital in China”, Arch Ophthalmol 129, no. 6 (2011): 791–797, doi:10.1001/archophthalmol.2011.120.

2. Howqua II (1769–1843) of the Thirteen Factories, head of the Ewo (怡和, Yíhé) hong and leader of the cohong merchants’ guild. His wealth was estimated at twenty-six million Mexican silver dollars in 1834, making him the richest man in the world at the time.

3. A condition in which the eyelid turns inward so that the lashes abrade the cornea. Left untreated, it produces chronic pain, scarring, and, over time, blindness. It is surgically correctable in minutes.

4. The earliest known attribution is David W. Stevenson, M.D., of the Canadian Mission: “Dr. Peter Parker, who went out in 1835, almost opened China to the Gospel at the point of his lancet”, quoted in W. H. Withrow, China and its People (1894), p. 230. The phrase became the title of the centennial history of Canton Hospital: Cadbury and Jones, At the Point of a Lancet (1935).

5. The common Canton-period term for foreign physicians. The later categorical distinction between 中醫 (zhōngyī, Chinese medicine) and 西醫 (xīyī, Western medicine) did not crystallize until the 1860s–1870s. Before the foreign doctors arrived, Chinese medicine was simply 醫 — it required no qualifier. The prefix 中 arose only when a competing system forced the distinction.

6. The phrase summarizes Parker’s strategic conception of medical missions, paraphrased from his quarterly reports and circulated in secondary scholarship rather than appearing as a single verbatim sentence. The parallel ABCFM Board instruction was that medical work be acceptable only as it could be made “handmaids to the gospel”.

7. Originally called the Ophthalmic Hospital at Canton. After Parker’s departure, John Glasgow Kerr reopened the hospital on a new site in 1859 as the Canton Pok Tsai Hospital (博濟醫院, Bójì Yīyuàn, “Universal Helpfulness”).

8. 關喬昌 (Guān Qiáochāng, 1801–1860), the most prominent Chinese painter working in the Western oil tradition in the 1830s and 1840s. His studio on New China Street in Canton produced portraits for the foreign merchant community as well as the medical paintings commissioned by Parker.

9. George Chinnery (1774–1852), trained at the Royal Academy Schools in London, settled in Macao in 1825 after twenty-three years in India. He was the only Western painter resident in South China in the first half of the nineteenth century. Contemporaries credited him with training Lam Qua, though Chinnery himself denied the connection.

10. Thomas Richardson Colledge (1796–1879; some sources give 1797), a surgeon of the British East India Company who opened an ophthalmic infirmary in Macao in 1827—the earliest Western medical facility in China for Chinese patients. He served as president of the Medical Missionary Society from its founding until his death.

11. Case No. 4370 in Parker’s Seventh Quarterly Report of the Ophthalmic Hospital at Canton (1838). The patient had lost his right eye entirely and had a staphyloma on the left. After surgery the cornea cleared and admitted light. The uncle’s scrolls and poem are reproduced in Parker’s report; the English translation is Parker’s own. The romanizations “Yë Maouchang” and “Chang Kwôkin” follow Parker’s orthography.

12. 林則徐 (Lín Zéxú, 1785–1850), a Fujian native who held the jinshi degree (進士, jìnshì) and had risen through the imperial bureaucracy as governor-general of Hunan and Hubei before the Daoguang Emperor appointed him Imperial Commissioner with extraordinary powers to suppress the opium trade. After the Opium War he was exiled to Xinjiang; rehabilitated, he died at Puning in Guangdong on November 22, 1850, while traveling to Guangxi to help suppress the Taiping Rebellion.

13. The document is titled 擬諭英吉利國王檄 (Nǐ yù Yīngjílì guówáng xí, “Draft Edict to the King of England”), drafted on August 3, 1839. The original text: “設使別國有人販鴉片至英國，誘人買食，當亦貴國王所深惡而痛絕之也。向聞貴國王存心仁厚，自不肯以己所不欲者施之於人。” The closing phrase invokes the Confucian Golden Rule in diplomatic language addressed to a foreign sovereign. The British Foreign Office refused to receive the letter.

14. John Glasgow Kerr (1824–1901), born Dunkinsville, Ohio. Graduated Jefferson Medical College 1847; arrived in Canton 1854, assumed charge of the Canton Hospital 1855, retired 1899. He died in Canton two years later, having treated roughly 780,000 patients from over four thousand villages, performed some 48,000 operations, and translated thirty-four volumes of Western medical texts into Chinese.

15. The first psychiatric hospital in China. The Refuge operated until 1937; its successor is the Affiliated Brain Hospital of Guangzhou Medical University.

16. Sun has many names during his revolutionary career. His official name was 孫文 (Sūn Wén). His Japanese name 中山樵 (Nakayama Kikori) gave rise to 孫中山 (Sūn Zhōngshān), the form most common in modern Chinese references. The Cantonese reading of his art name 逸仙 (Yìxiān) produced “Sun Yat-sen”, the form by which he is known in English.

17. Charles Robert Hager (1851–1917), Swiss-born, raised in Wisconsin, trained at Oberlin and Pacific Theological Seminary in Oakland. He arrived in Hong Kong in 1883 to found the ABCFM’s Hong Kong Mission (later renamed the South China Mission); Sun was one of its first converts, baptized on May 4, 1884.

18. 鄭士良 (Zhèng Shìliáng, 1863–1901), a baptized Christian and fellow medical student of Sun Yat-sen at the Canton Hospital. After leaving the school he joined the Sanhe Hui (三合會, Sānhé Huì, the Triad Society) and led the Huizhou Uprising of 1900 with twenty thousand men.

19. Sun Yat-sen (1918), Memoirs of a Chinese Revolutionary, p. 186.

20. William Lockhart (1811–1896), English surgeon trained at Guy’s Hospital, London, and sent to China by the London Missionary Society in 1838. He worked first in Macao and Hong Kong, opened Shanghai’s first Western hospital in 1844 near the Big East Gate (later 仁濟醫館, Rénjì Yīguǎn, “Benevolent Aid Medical House”), and in 1861 founded the first Protestant medical mission in Beijing. His memoir The Medical Missionary in China: A Narrative of Twenty Years’ Experience (1861) became a standard guide for the generation of medical missionaries that followed. Shanghai’s Renji Hospital, now under Shanghai Jiao Tong University, traces a direct line back to Lockhart.

21. Divie Bethune McCartee (1820–1900), American Presbyterian missionary and physician. He arrived in Ningbo in 1844 and spent over three decades in China and Japan, serving also as a foreign professor at the Imperial University of Tokyo in 1872. His Ningbo dispensary was among the earliest Protestant medical missions outside Canton.

22. The Canton Hospital was renamed several times after 1930. It is now formally the Second Affiliated Hospital of Sun Yat-sen University, though the memorial name is the one in common use.

23. Auguste Chapdelaine (1814–1856), a priest of the Paris Foreign Missions Society, entered Guangxi illegally in 1854 and was arrested, caged, tortured to death, and beheaded post-mortem by the local magistrate on February 29, 1856. He was canonized by Pope John Paul II in 2000.

24. The Treaties of Tianjin (天津條約, Tiānjīn Tiáoyuē) were a set of agreements signed between the Qing dynasty and several Western powers—Britain, France, the United States, and Russia—following China’s defeat in the Second Opium War. They significantly expanded foreign privileges in China beyond those granted in the earlier treaties of Nanjing (1842) and Wanghia (1844).

25. A standard feature of the “unequal treaties” that Western powers imposed on China and other Asian states in the nineteenth century, with antecedents in the European “capitulations” regime imposed on the Ottoman Empire from the sixteenth century. In China the doctrine was first formalized in the Treaty of the Bogue (1843), supplementing Nanjing; the United States and Britain did not formally relinquish their extraterritorial privileges until 1943.