Explore the full ebook collection and download it now at textbookfull.

com

Multimodal Management of Canine Osteoarthritis

Second Edition Fox

https://textbookfull.com/product/multimodal-management-of-
canine-osteoarthritis-second-edition-fox/

OR CLICK HERE

DOWLOAD EBOOK

Browse and Get More Ebook Downloads Instantly at https://textbookfull.com

Click here to visit textbookfull.com and download textbook now
 Your digital treasures (PDF, ePub, MOBI) await
Download instantly and pick your perfect format...

Read anywhere, anytime, on any device!

Multimodal Management of Canine Osteoarthritis 2nd Edition

Fox

https://textbookfull.com/product/multimodal-management-of-canine-
osteoarthritis-2nd-edition-fox/

textbookfull.com

HANDBOOK FOR CANINE PRACTITIONERS Second Edition Dr C S

Arun

https://textbookfull.com/product/handbook-for-canine-practitioners-
second-edition-dr-c-s-arun/

textbookfull.com

BSAVA Manual of Canine and Feline Fracture Repair and

Management 2nd Edition Toby Gemmill

https://textbookfull.com/product/bsava-manual-of-canine-and-feline-
fracture-repair-and-management-2nd-edition-toby-gemmill/

textbookfull.com

Canine and feline geriatric oncology : honoring the human-

animal bond Second Edition Kaplan

https://textbookfull.com/product/canine-and-feline-geriatric-oncology-
honoring-the-human-animal-bond-second-edition-kaplan/

textbookfull.com
Oxford Textbook of Osteoarthritis and Crystal Arthropathy
Arden

https://textbookfull.com/product/oxford-textbook-of-osteoarthritis-
and-crystal-arthropathy-arden/

textbookfull.com

Management of Knee Osteoarthritis in the Younger Active

Patient An Evidence Based Practical Guide for Clinicians
1st Edition David A. Parker (Eds.)
https://textbookfull.com/product/management-of-knee-osteoarthritis-in-
the-younger-active-patient-an-evidence-based-practical-guide-for-
clinicians-1st-edition-david-a-parker-eds/
textbookfull.com

All That Jazz 1st Edition Jane Fox [Fox

https://textbookfull.com/product/all-that-jazz-1st-edition-jane-fox-
fox/

textbookfull.com

See No Evil 1st Edition Ivy Fox [Fox

https://textbookfull.com/product/see-no-evil-1st-edition-ivy-fox-fox/

textbookfull.com

Catastrophic Perioperative Complications and Management A

Comprehensive Textbook Charles J. Fox

https://textbookfull.com/product/catastrophic-perioperative-
complications-and-management-a-comprehensive-textbook-charles-j-fox/

textbookfull.com
MULTIMODAL MANAGEMENT OF
CANINE OSTEOARTHRITIS
SECOND EDITION
 MULTIMODAL MANAGEMENT OF
CANINE OSTEOARTHRITIS
SECOND EDITION
STEVEN M. FOX MS, DVM, MBA, PhD
Surgical Specialist: New Zealand VMA President: Securos Surgical, A Division of
AmerisourceBurgen Independent Consultant, Clive, Iowa, USA Adjunct Professor,
College of Veterinary Medicine, University of Illinois Adjunct Professor, Massey
University, Palmerston North, New Zealand Program Chairman (2000-02), President
(2004), Veterinary Orthopedic Society

Special Section on Regenerative Medicine by

Brittany Jean Carr, DVM, CCRT & Sherman O. Canapp, DVM, MS, CCRT Diplomate
ACVS, Diplomate ACVSMR
Veterinary Orthopedic Sports Medicine Group, Annapolis Junction MD
CRC Press
Taylor & Francis Group,
6000 Broken Sound Parkway NW, Suite 300,
Boca Raton, FL 33487-2742

© 2017 by Taylor & Francis Group, LLC

CRC Press is an imprint of Taylor & Francis Group, an Informa business

No claim to original U.S. Government works

Printed on acid-free paper

Version Date: 20160502

International Standard Book Number-13: 978-1-4987-4935-0 (Hardback)

This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have
been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal
responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any
views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not
necessarily reflect the views/opinions of the publishers. The information or guidance contained in this book is intended
for use by medical, scientific or health-care professionals and is provided strictly as a supplement to the medical or
other professional’s own judgement, their knowledge of the patient’s medical history, relevant manufacturer’s
instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any
information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly
urged to consult the relevant national drug formulary and the drug companies’ and device or material manufacturers’
printed instructions, and their websites, before administering or utilizing any of the drugs, devices or materials
mentioned in this book. This book does not indicate whether a particular treatment is appropriate or suitable for a
particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her own
professional judgements, so as to advise and treat patients appropriately. The authors and publishers have also
attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright
holders if permission to publish in this form has not been obtained. If any copyright material has not been
acknowledged please write and let us know so we may rectify in any future reprint.

Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or
utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including
photocopying, microfilming, and recording, or in any information storage or retrieval system, without written
permission from the publishers.

For permission to photocopy or use material electronically from this work, please access www.copyright.com
(http://www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers,
MA 01923, 978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of
users. For organizations that have been granted a photocopy license by the CCC, a separate system of payment has
been arranged.

Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for
identification and explanation without intent to infringe.

Visit the Taylor & Francis Web site at

http://www.taylorandfrancis.com

and the CRC Press Web site at

http://www.crcpress.com
Contents

Preface

Disclaimer

Abbreviations

1 Pain and Lameness

Pain
Lameness
Diagnosis of OA
Anamnesis
Examination
The Orthopedic Examination
Diagnostic Imaging
Arthroscopy
Arthrocentesis
Quick tips
References

2 Osteoarthritis: the Disease

Definition
Joint Structures
Inflammation in OA
The ‘Pain Pathway’
Morphological Changes with OA
References
3 Multimodal Management for Canine Osteoarthritis

Quality of Evidence
Background
Medicinal Management
Nonsteroidal Anti-Inflammatory Drugs
Prostaglandin E2 Receptor EP4: Piprant Drug Class
Disease Modifying Osteoarthritic Agents
Nutraceuticals
Adjuncts
Acupuncture
Radiosynoviorthesis (radio-synovi-orthesis): a new therapeutic and diagnostic tool for
canine joint inflammation
Drug classes for multimodal use
Nonmedicinal Management
Diet
Surgical Intervention
Summary
References

4 Physical Rehabilitation in the Treatment of Osteoarthritis

Introduction
Environmental Modification
Pain Pathophysiology Related to Physical Rehabilitation
Cryotherapy
Thermotherapy
Therapeutic Exercises
Other Techniques
Multimodal Case Studies
References

5 Regenerative Medicine for Multimodal Management of Osteoarthritis

Regenerative Medicine for Osteoarthritis

Platelet-Rich Plasma
Adipose-Derived Stem Cell Therapy
Bone Marrow-Derived Stem Cell Therapy
Recommendations Following Stem Cell Therapy
Other Intra-Articular Therapies
References

index
Preface

‘Multimodal’ has become a popular term in the recent medical literature. Arguably
introduced as an acronym for ‘balanced anesthesia’, denoting induction by a multiple drug
approach, multimodal is currently recognized to identify any protocol that includes
multiple drugs, agents, adjuncts or delivery methods. Marketers have also come to embrace
the term, as they tout the virtues of administering their products as part of a given protocol.
Frequently this leads to advertising, where one is encouraged to incorporate a given product
within ‘your multimodal protocol’. Herein, at issue is actually identifying a foundation
protocol.

The Multimodal Management of Osteoarthritis described in this work delineates an

evidence-based approach for the canine patient with osteoarthritis (OA), pursuing the
objective of the best available medicine. Appreciating that surgical intervention may
initially be required, particularly for stabilizing a joint, the major focus of this work is the
‘conservative’ management of OA. A simplistic approach is taken with the overlapping of
two three-pointed triangles of management: medical and non-medical. Medical
management includes nonsteroidal anti-inflammatory drugs (NSAIDs), chondroprotectant
and adjunct agents; while the non-medical management includes weight-control/exercise,
an eicosapentaenoic acid-rich diet and physical rehabilitation. Each of these approaches has
been independently shown to be effective, and while there are no published works on their
collective synergism, the concept is intuitive and three actual case examples are
overviewed.

As we learn more about the pathophysiology of OA, we are also becoming more aware of
how to implement treatments to attack various components of these pathways. Our
challenge as veterinary health professionals is to maintain awareness of contemporary
issues in treating OA so that we can offer canine patients the care they need and deserve.

Since publication of this text’s first edition (2010), several innovations are now potentially
available for consideration in treating the OA patient. First, is introduction of a new Piprant
Class, prostaglandin receptor antagonist. This new (2013) class of drugs specifically targets
receptor subtypes for prostaglandin E2; namely EP4, which has been identified as a major
player in the pain pathway. This new class of drugs may offer the same analgesic features
as NSAIDs, but without the associated adverse effects of many NSAIDs. Second, is
availability of a new therapeutic and diagnostic tool to treat canine joint inflammation
using radiosynoviorthesis. With the novel preparation of the radionuclide tin-117m
suspended in a colloid (homogenous tin-117m colloid), comes a practical and safe
treatment option for those patients that either respond poorly or have adverse side effects
with traditional therapies. Because this treatment option is quite novel to companion animal
practice, a detailed overview is provided in this revised text edition. The author would like
to thank Drs. John Donecker and Nigel Stevenson for their inclusive contribution to insights
on this treatment. Third, is recognition of the role that stem cells and platelet rich plasma
are increasingly playing in the management of OA. The author expresses his deep
appreciation for the segment on regenerative medicine provided by Drs. Sherman Canapp
and Brittany Jean Carr (Veterinary Orthopedic Sports Medicine Group, Annapolis Junction,
MD, USA).

This textbook is intended for veterinary healthcare professionals seeking to better

understand the issues related to pain management associated with canine OA.
Disclaimer

Knowledge and information in this field are constantly changing. As new information and
experience become available, changes in treatments and therapies may become necessary.
The reader is advised to check current information regarding the procedures described in
this book, the manufacturer of each product administered to verify the recommended dose
or formula, the method and duration of administration, and any contraindications. Where a
particular pharmaceutical is not approved for use in the target species and reader’s country,
the reader accepts full responsibility for administration. It is the responsibility of the reader
to make an appropriate diagnosis, determine the dosages and the best treatments for each
individual patient, and to take all appropriate safety precautions, including informed
consent of the owner. To the fullest extent of the law, neither the Publisher nor the Authors
assume any liability for any injury and/or damage to persons or property arising out of, or
related to, any use of the material contained in this book.
Abbreviations

AA arachidonic acid
ACE angiotensin-converting enzyme
ADE adverse drug event
ADPC adipose derived cultured progenitor cells
AL-TENS acupuncture-like transcutaneous electrical nerve stimulation
ALA alpha-lipoic acid
ALT alanine aminotransferase
AMA American Medical Association
ANA antinuclear antibody
ASU avocado/soybean unsaponifiable
bFGF basic fibroblast growth factor
BAPS biomechanical ankle platform system
BMAC bone marrow aspirate concentrate
BMSC bone marrow derived stem cells
CAM complementary and alternative medicine
CCL cranial cruciate ligament
CCLT cranial cruciate ligament transection
CK creatine kinase
CNS central nervous system
CODI Cincinnati Orthopedic Disability Index
COX cyclo-oxygenase
CT computed tomography
DHA docosahexaenoic acid
DJD degenerative joint disease
DMOAA disease modifying osteoarthritic agent
DMOAD disease modifying osteoarthritic drug
ECG electrocardiography
ECGC epigallocatechin gallate (antioxidant)
EGF epidermal growth factor
EMG electromyography
EPA eicosapentaenoic acid
ES electrical stimulation
ESWT extracorporeal shock wave therapy
FCP fragmented coronoid process
FDA Food and Drug Administration
GABA γ-aminobutyric acid
GaAIA gallium-aluminum-arsenide
GaAs gallium-arsenide
GAG glycosaminoglycan
GAIT Glucosamine/chondroitin Arthritis Intervention Trial
GI gastrointestinal
GS glucosamine sulfate
HA hyaluronic acid
HFT high frequency transcutaneous electrical nerve stimulation
HRQL health-related quality of life
HTC homogenous tin-117m colloid
ICAM intercellular cell adhesion molecule 1
IFN interferon
IL interleukin
iNOS inducible nitric oxide synthase
IRAP IL-1 receptor antagonist protein
IVD intervertebral disc
keV kiloelectron volt
LE lupus erythematosus
LFT low frequency transcutaneous electrical nerve stimulation
LLLT low-level laser therapy
LOX lipoxygenase
LPS lipopolysaccharide
LR-PRP leukocyte-rich platelet rich plasma
LP-PRP leukocyte-poor platelet rich plasma
MMP matrix metalloproteinase
MRI magnetic resonance imaging
MSC mesenchymal stem cell
nAchR nicotinic acetylcholine receptor
NCCAM U.S. National Center of Complementary and Alternative Medicine
NF-kB nuclear factor kappa-light-chain-enhancer of activated B cells
NIH National Institutes of Health
NMDA N-methyl-D-aspartate
NMES neuromuscular electrical stimulation
NNT number needed to treat
NO nitric oxide
NRS numeric rating scale
NSAID nonsteroidal anti-inflammatory drug
OA osteoarthritis
OCD osteochondritis dissecans
OTC over-the-counter
PAG periaqueductal gray
PBS phosphate-buffered saline
PDGF platelet-derived growth factor
PENS percutaneous electrical nerve stimulation
PG prostaglandin
Piprants new (Y2013) drug class of prostaglandin E2 receptor antagonists
PKC protein kinase C
PLA phospholipase A
POMR problem oriented medical record
PPI proton pump inhibitor
PRGF plasma rich in growth factors
PRP platelet-rich plasma
PSGAG polysulfated glycosaminoglycan
QOL quality of life
RA rheumatoid arthritis
RBC red blood cell
RCCT randomized, controlled, patient-centered clinical trials
RNA ribonucleic acid
ROM range of motion
RSO radiosynoviorthesis
RSV radiosynovectomy
SAP serum alkaline phosphatase
SDS simple descriptive scale
SMF static magnet fields
SRI serotonin reuptake inhibitor
SVF stromal vascular fraction
TCA tricyclic antidepressant
TCM traditional Chinese medicine
TENS transcutaneous electrical nerve stimulation
TGF transforming growth factor
TIMP tissue inhibiting metalloproteinase
Tin-117m (Sn-117m) an artificially produced radionuclide of tin
TNF tumor necrosis factor
TPI total pressure index
TX thromboxane
UAP ununited anconeal process
US ultrasound
VAS visual analog scale
VCAM vascular cell adhesion molecule
VCPG viable cells per gram
VEGF vascular endothelial growth factor
VRS verbal rating scale
Chapter 1

Pain and Lameness

PAIN
Pain is the clinical sign most frequently associated with osteoarthritis (OA)1. The clinical
manifestation of this pain is lameness. When an animal presents with clinical lameness, a
determination must be made whether the animal is unable to use the limb, or is unwilling to
use the limb. Inability to use the limb may be attributable to musculoskeletal changes, such
as joint contracture or muscle atrophy. These anomalies are best addressed with physical
rehabilitation. On the other hand, unwillingness to use a limb is most often attributable to
pain. Herein, lameness is an avoidance behavior.
Ironically, articular cartilage is frequently the focus of studies regarding OA. However,
clinical treatment of the OA patient is most often focused on the alleviation of pain.
Appreciating that articular cartilage is aneural, the focus of OA pain management resides in
the periarticular structures. No pain is elicited by stimulation of cartilage, and stimulation
of normal synovial tissue rarely evokes pain2.
OA pain is the result of a complex interplay between structural change, biochemical
alterations, peripheral and central pain-processing mechanisms, and individual cognitive
processing of nociception (1.1).
The source of pain in the joint ‘organ’ is multifocal: direct stimulation of the joint
capsule and bone receptors by cytokines/ligands of inflammatory and degradative
processes, physical stimulation of the joint capsule from distension (effusion) and stretch
(laxity, subluxation, abnormal articulation), physical stimulation of subchondral bone from
abnormal loading, and (likely) physical stimulation of muscle, tendon, and ligaments.
Bony changes at the joint margins and beneath areas of damaged cartilage can be major
sources of OA pain. Subchondral bone contains unmyelinated nerve fibers, which increase
in number with OA3. Increased pressure on subchondral bone (associated with OA) results
in stimulation of these nociceptors. This is thought to contribute to the vague, but consistent
pain frequently associated with OA. In humans OA is believed to be responsible for
increased intraosseous pressure, which may contribute to chronic pain, particularly
nocturnal pain. Human OA patients report pain, even at rest, associated with raised
intraosseous pressure4.

LAMENESS
Most often lameness in pets is identified by the owner, who subsequently seeks further
consultation and advice from their veterinarian, or is identified by the veterinarian during
routine examination. Most simply, dogs (and cats) are lame because they cannot or will not
use one or more limbs in a normal fashion. Pain associated with OA is recognized to
become more persistent and intense as the disease progresses. The condition may be
asymptomatic in the early stages. With progression of the disease, discomfort may be
continuous, or exacerbated by motion and weight bearing. In the later stages of OA, pain
can become pervasive and affect nearly all activities and behaviors.

DIAGNOSIS OF OA
A proper diagnosis depends on a complete history and full assessment of the patient,
possibly including:
• A complete physical, orthopedic, and neurologic examination.
• Radiographs of affected area(s).
• Advanced imaging, such as computed tomography, magnetic resonance imaging, nuclear
scintigraphy.
• Advanced gait analysis, such as force plate (kinetic) analysis of gait and motion
(kinematic) analysis.
• Clinicopathologic examination including hematology and serum chemistries, especially
creatine kinase and electrolytes, and synovial fluid analysis.
• Electrodiagnostic testing: ultrasound, electromyography, nerve conduction velocity
measurements, evoked potential recordings with repetitive nerve stimulation.
• Muscle biopsy examination including histopathology and histochemical analysis.
• Special tests: muscle percussion, serology for pathogens (e.g. Neospora, Toxoplasma),
measurement of acetylcholine receptor antibody, immunohistochemistry, and molecular
diagnostic techniques.
1.1 The pain associated with osteoarthritis is far more complex than the 3-order neuron ‘pathway’. Many
sophisticated processes occur in the functions of transduction, transmission, modulation, and perception. PAG:
periaqueductal grey; RVM: rostral ventromedial medulla.

ANAMNESIS
The medical history, signalment, and owner’s complaint(s) comprise the process of
anamnesis. Most canine patients do not vocalize from their pain of OA, and many pet
owners do not believe their pet is in pain if it does not vocalize. Nevertheless, signs
suggesting animal discomfort include lameness, muscle atrophy, reluctance to exercise,
general malaise, lethargy, inappetence or anorexia, change in temperament, licking or
biting an affected joint, restlessness, insomnia, seeking warmth, seeking comfortable
bedding, and difficulty posturing to toilet. Supraspinal influences are known to alter the
behavior of humans with OA1, and it is reasonable to presume the same occurs in dogs.
Pet owners often recognize lameness only when there is gait asymmetry; however, dogs
with bilateral OA, such as with hip or elbow dysplasia, have a symmetrically abnormal gait
and do not favor a single limb. These patients shift weight from hind to forelimbs or vice
versa with resultant muscle atrophy of the affected limbs and increased development in
compensating limbs. Rarely are dogs nonweight bearing simply due to OA. Pet owners do
often report that their dog is stiff after resting, particularly following strenuous exercise,
but they report that the pet will ‘warm out of the stiffness’. The amount of time required to
warm out of this stiffness gradually increases with progression of the disease. Pet owners
also frequently report a shortened stride and stiff gait. This is associated with a decreased
range of motion (ROM) in the joint, often due to joint capsule fibrosis and osteophyte
formation.

EXAMINATION
For many years degenerative joint disease (DJD) (often used interchangeably with the term
OA) was considered a disease of the cartilage. DJD is most appropriately considered a
disease of the entire joint, with the influence of multiple structures including articular
cartilage. Pain is a hallmark of DJD, provoked by instability, and therefore a comprehensive
physical examination is the essential diagnostic tool.
An orthopedic examination should be part of every routine examination and should be
conducted in conjunction with a neurologic examination (when appropriate) to identify
neurologic causes for pain or lameness, such as a nerve root signature sign secondary to a
laterally herniated intervertebral disc (IVD) or brachial plexus pathology.
A consistent ‘routine’ for examining a patient is advised, and it is also recommended
that the ‘lame’ limb be examined last. A consistent examination pattern (e.g. distal limb to
proximal limb, and left side to right side or vice versa) is helpful to avoid missing a
structure during the examination, and leaving the most painful limb for last in the
examination avoids the early elicitation of pain which may render the patient noncompliant
for further examination. A thorough examination also requires the aid of an assistant who is
adequately trained to hold and restrain the animal. The assistant is also important for
identifying the animal’s painful response to examination, such as body shifts and change of
facial expression.

Animal restraint
Appropriate animal restraint by the assistant (with the patient standing on the examination
table) is with one arm over or under the patient’s trunk, while the other arm is placed under
and around the patient’s neck (1.2A). This constraint allows the assistant to quickly tighten
his/her grip to control the animal and avoid the patient from harming anyone, should it
become confrontational. In lateral recumbency the assistant should be at the animal’s
dorsum, ‘lightly leaning’ on the animal with his/ her forearms while holding the hind and
forelimbs (1.2B). One forearm should be placed on the animal’s neck, with that hand
grasping the forelimb that is closest to the table, or the ‘down limb’. The other arm is
placed over the top of the abdomen and the hand grasps the ‘down’ hindlimb. With this
restraint, the assistant can rapidly increase his/ her amount of weight on their forearms,
thereby controlling the animal’s movements. Regarding restraint, large dogs are analogous
to horses: if you control their head, you control their body.
THE ORTHOPEDIC EXAMINATION
Forelimb examination
In the growing dog, forelimb lameness differentials mostly reflect abnormal stressors on
normal bone or normal stressors on abnormal bone (excluding fractures and minor soft
tissue injuries) and include:
• Osteochondritis dissecans (OCD): shoulder.
• Luxation/subluxation shoulder: congenital.
• Avulsion: supraglenoid tubercle.
• OCD: elbow.
• Ununited anconeal process (UAP).
• Fragmented coronoid process (FCP).
• Ununited medial epicondyle.
• Elbow incongruity:
congenital.
physical injury.
• Premature closure of growth plates, such as with radius curvus.
• Retained cartilaginous core (ulna).
• Panosteitis* (a disease of diaphyseal bone).
• Hypertrophic osteodystrophy*.

In the adult dog, forelimb lameness differentials mostly reflect abnormal stressors on
normal bone or normal stressors on abnormal bone (excluding fractures and minor soft
tissue injuries) and include:
• Arthritis.
• OCD: shoulder.
• Luxation /subluxation: shoulder.
• Avulsion: supraglenoid tubercle.
• Bicipital tenosynovitis*.
• Calcification of supraspinatus tendon*.
• Contracture of infra- or supraspinatus*.
• Medial glenohumeral laxity.
• OCD: elbow.
• UAP.
• FCP.
• Ununited medial epicondyle.
• Elbow incongruity.
• Angular limb deformity.
• Hypertrophic osteopathy.
• Bone/soft tissue neoplasia*.
• Inflammatory arthritis.

1.2 Restraint for examination. Standing restraint (A) of large dogs is done with the neck cradled close to the
assistant’s chest with one arm, while the other arm controls the patient’s trunk by placement either under or over
the trunk. If the patient struggles or becomes aggressive, the assistant holds the dog as tight as possible. Lateral
restraint (B) of large dogs is done with the assistant’s forearm over the dog’s neck. If the patient struggles, more
weight is applied on the forearm.

For the purpose of examination, the forelimb can be anatomically segmented into the paw,
antebrachium, brachium, scapula, and interpositional joints. Although the entire limb
should be examined in every patient, the orthopedic examination can be focused more on
areas prone to disease and signalment of the individual patient.

1.3 Carpus flexion. The carpus should be comfortably flexed with the palmar surface nearly touching the flexor
surface of the antebrachium.

1.4 The carpus should be stressed in extension, looking for signs of discomfort/pain.

Paw
The paw should be thoroughly examined with flexion and extension of each digit, as well as
inspection of each nail and nail bed. Findings incidental to those suggesting OA might
include:
• Pad lacerations.
• Foreign bodies.
• Split nails.
• Overgrown nails.
• Nail bed tumors.
• Phalangeal luxations/fractures.

Some patients resist manipulation of the paws. Here, the assistant can be very helpful by
talking to the patient or scratching the patient to distract him/her from the examination.
Carpus
The carpus should be placed under stress in flexion, extension, valgus, and varus (1.3, 1.4,
1.5 and 1.6). The normal carpus should flex comfortably until the palmar surface of the paw
nearly touches the flexor surface of the antebrachium. Findings from the carpal
examination may include:
• Young dog ‘carpal laxity syndrome’.
• Carpal flexural deformity of young dogs.
• Degenerative joint disease.
• Hyperextension.
• Inflammatory arthritis.
• Luxation.
• Fracture (including an intra-articular fracture, possibly mistaken as OA).

1.5 Placing the carpus in valgus stress identifies integrity of the medial radial collateral ligament.

1.6 Placing a varus stress on the carpus challenges the integrity of the lateral ulnar collateral ligament.

Joint capsule distension is easily palpated and suggests joint inflammation.

Antebrachium
Periosteum of bone is a sensitive tissue, well innervated with nociceptive axons. Therefore,
examination of both the radius and ulna should focus on deep palpation for a response of
bone pain (1.7). Panosteitis is commonly revealed in this manner. Osteosarcoma is another
condition that results in pain on palpation of the metaphyseal region of bones. Although an
orthopedic examination would include assessment of the antebrachium, OA includes only
diarthrodial joints. Nevertheless, joint pain should be localized and differentiated from the
pain of long bones and soft tissues.

1.7 Digital palpation is made on the antero-medial aspect of the antebrachium, where there is minimal muscle
cover. In the normal dog the elbow joint is parallel to the carpal joint.

Physeal disturbances are relatively common in the growing dog, the severity of which
depends on the amount of growth remaining following injury until physeal closure.
Resultant aberrant growth is expressed as angular limb deformities of the carpus and/or the
elbow. In general, the plane of the elbow joint should be parallel to the plane of the carpal
joint.
Sources of lameness within the radius/ulna include:
• Hypertrophic osteopathy.
• Angular limb deformities.
• Panosteitis.
• Neoplasia.
• Hypertrophic osteodystrophy.

Elbow
The elbow is the most common forelimb joint responsible for lameness, especially in
growing dogs of predisposed breeds (i.e. large breeds, sporting dogs, and Rottweilers). The
elbow should be manipulated through a complete ROM (1.8), noting the abnormal presence
of crepitus or painful response, particularly in full extension. In a normal dog,
hyperextension of the elbow should elicit minimal to no discomfort. Valgus and varus
stress placed upon the joint are performed to assess integrity of the joint capsule and
collateral ligaments/tendons. Joint effusion accompanying disease often distends the joint,
palpable by placement of the thumb and index finger in the normally concave depression
caudal to the distal humeral epicondyles.

1.8 Examination of the elbow joint includes manipulation through a full range of motion.

Common orthopedic diseases of the elbow joint include FCP, UAP, and OCD. Palpation
of the medial joint, in the area of the medial coronoid, often elicits a painful response in
dogs suffering from any (or all) of these conditions (1.9, 1.10).
Less common findings of the elbow, aside from OA, include:
• Subluxations or luxation (can be associated with OA).
• Fractures.
• Radioulnar incongruities (can be associated with OA).
• Inflammatory arthropathies.
• Neoplasia.

1.9 Fragmented medial coronoid, ununited anconeal process, and osteochondritis are common diseases of the
elbow, constituting elbow dysplasia. Patients with any of these pathologies often resent deep digital pressure on the
medial aspect of the joint near the affected location. Further, joint capsule distension is common with any of these
conditions, and can best be identified with palpation, as with thumb placement in the figure.
Brachium
Osteosarcoma is a common tumor of the forelimb, frequently residing in the proximal
humerus (and distal radius/ulna). Deep palpation along the length of the humerus is
conducted to reveal evidence of pain and areas of inflammation or swelling. Other
abnormal conditions of the brachium (not associated with OA) include:
• Hypertrophic osteodystrophy.
• Fractures.
• Hypertrophic osteopathy.
• Panosteitis.

1.10 Osteochondritis dissecans of the elbow most commonly occurs on the distal, medial humeral condyle.

Shoulder
As with examination of all joints, the shoulder joint should be examined through a full
ROM to include flexion, extension, adduction, and abduction as well as internal and
external rotation (1.11). Of particular note is examination of the shoulder joint in extension.
The examiner should be mindful to avoid placing the forelimb into extension with his/her
hand placed caudal or distal to the elbow joint (1.12). Placing the hand behind or distal to
the elbow when forcing the shoulder into extension also forces the elbow into extension. A
resultant painful response from the patient might actually be from elbow disease rather than
shoulder disease. The examiner’s hand placed above the elbow allows the elbow to be
placed in a neutral position, and avoids this complication.
Painful conditions associated with the shoulder joint include:
• OCD (especially in young animals, which can lead to OA).
• Biceps tenosynovitis.
• Mineralization of the supraspinatus.
• Infraspinatus contracture.
• DJD (of unknown etiology).
• Articular fractures.
• Incomplete ossification of the caudal glenoid process.
• Medial shoulder instability (leading to OA).
• Luxation, either congenital or acquired (leading to OA).

Stabilization of the shoulder joint is maintained by both medial and lateral glenohumeral
ligaments, the shape of the articular surfaces (humeral head and glenoid), and
musculotendinous units of the rotator cuff: the supraspinatus, infraspinatus, teres minor,
and subscapularis. Abnormal excursion of the shoulder joint, with or without pain, suggests
involvement of several of these periarticular soft tissue structures. Medial shoulder
instability typically results in excessive shoulder abduction as well as pain at the end of
abduction.

1.11 Examination of the shoulder in flexion. The shoulder joint should also be assessed in abduction and adduction.
Note restraint of the patient with the assistant’s forearm over the patient’s neck.

1.12 Avoid placing the forelimb in extension with hand placement caudal to the elbow. This typically causes
simultaneous hyperextension of the elbow and may give a false impression that the source of discomfort is in the
shoulder joint when it may reside in the elbow joint.
Scapula
The scapula is not a common source of forelimb pain. However, atrophy of scapular
muscles is frequently associated with disuse of the forelimb as well as many neurologic
conditions. Tumors, acromion fractures, midbody fractures, and scapular luxation from the
thoracic wall are commonly seen when pain is localized to the scapular area, so deep
palpation and manipulation of the scapula should be performed when this anatomic
structure is suspect.
The biceps tendon should be palpated from its origin on the supraglenoid tubercle
through its excursion within the intertubercular groove in the proximal humerus. Biceps
tenosynovitis frequently results in the patient’s painful response to this deep palpation
(1.13). Another maneuver that may elicit pain is to flex the shoulder joint while
simultaneously extending the elbow joint. This places maximal stretch on the biceps tendon
and may exacerbate a pain response.

1.13 Examination of the shoulder joint with superimposed arthrology. A ‘drawer manipulation’ of the shoulder joint
should be part of the examination, as well as palpation of the biceps tendon (red) from its origin on the supraglenoid
tubercle of the scapula through the intertubercular groove of the humerus.

Spine
IVD disease and lumbosacral disease commonly lead to limb dysfunction. Therefore,
examination of the patient’s spine should be part of an orthopedic/neurologic examination
(1.14). Deep palpation of the paravertebral musculature with the patient in extension of the
spine often reveals peripheral neuropathies and spinal pathology. DJD of the spinal articular
facets is not uncommon in IVD disease and instability. Further, clinical presentation of
caudal spinal disease can mimic the pain associated with hip dysplasia.

Hindlimb examination
In the growing dog, hindlimb lameness differentials mostly reflect abnormal stressors on
normal bone or normal stressors on abnormal bone (excluding fractures and minor soft
tissue injuries) and include:
• Hip dysplasia.
• Avascular necrosis: femoral head (Legg–Calvé–Perthes)*.
• OCD: stifle.
• Luxating patella complex.
• Genu valgum (knock knee).
• OCD: hock.
• Avulsion of long digital extensor*.
• Panosteitis*.
• Hypertrophic osteodystrophy*.

1.14 Lumbosacral (or intervertebral disc) disease can often manifest as hip or limb disease, therefore palpation of
the spine should be included as part of an orthopedic examination.

Adult dog hindlimb lameness differentials mostly reflect abnormal stressors on normal
bone or normal stressors on abnormal bone (excluding fractures and minor soft tissue
injuries) and include:
• Arthritis.
• Hip dysplasia.
• OCD: stifle.
• Cruciate/meniscal syndrome.
• Luxating patella complex.
• Genu valgum.
• Avulsion of long digital extensor*.
• Luxation of superficial digital flexor tendon*.
• Inflammatory arthritis.
• Neoplasia*.

As with the forelimb, the hindlimb can be divided into anatomic regions: paw, tarsus,
tibia/fibula, stifle or knee, femur, hip, and pelvis. Cranial cruciate ligament compromise of
the stifle and hip dysplasia constitute two of the most common DJD conditions causing
pain/lameness in the dog.

Paw
Examination of the hind paws is similar to examination of the fore paws. Each individual
digit, including the nail and nail bed, should be assessed.

Tarsus
The tarsocrural joint accounts for ROM in flexion and extension (1.15, 1.16). Popping of
the joint, palpated during ROM assessment, may be associated with displacement of the
superficial digital flexor tendon following retinaculum tearing. This condition can lead to
hyperflexion of the tarsus and digits. Damage to the common calcaneal tendon can also lead
to tarsal hyperflexion. Assessing this tendon from its insertion on the calcaneus, proximally
to the gastrocnemius muscles should be performed with a clinical presentation of
hyperflexion.

1.15 Examination of the tibiotarsal (hock) joint in flexion. Compromise of the gastrocnemius tendon and superficial
digital flexor muscle tendon is best identified with this joint in flexion.
Exploring the Variety of Random
Documents with Different Content
The Twentieth Division of Manchurian territorials at Lanchow Camp
near Peking earned immortal glory by sending up to the National
Assembly and the throne nineteen constitutional articles which they
said had to be signed before they would war for the throne. This
was lèse majesté with a vengeance! The Guards Division was at
Peking, where it stayed, watching the hoards of bullion and sycee
more than constitutional articles! The Sixth Division was in Shansi
province. The First Division of Manchu troops, and the Second and
Fourth Divisions at times shuttlecocked along the railway between
Hankau and Peking. The Fifth Division was at Tsinan, capital of
Shangtung province.
Had China’s army not been territorial, the rebellion might never
have got into swing, because it would have been impossible to have
intrigued with a mixed Eighth Division. Again, had China’s army not
been territorial, President Yuan could have used the Third, Fourth,
Sixth and Twentieth Divisions at Peking in March, 1912, to suppress
the mutiny, whereas these divisions remained in sympathy with the
First Manchu Division and the Imperial Guards Division, and refused
to obey the constitutional head of the government at a climacteric
time. A mixed army is not easily mobilized, but when mobilized it is
more amenable to discipline, and the ignoring of local feeling in view
of the larger aims of statesmanship. England’s, Germany’s and
France’s armies are territorial. Italy’s and America’s regular armies
are not. America’s vast militia army, however, on which she mainly
depends, is, of course, territorial.
General Yin Tchang, who had much to do with organizing the
effective ten divisions of the northern army, is a graduate of Peking
University. He served five years in the Austrian infantry, and as
minister to Germany, at Emperor William’s request, he enjoyed that
unusually able and enthusiastic monarch’s private instruction in army
matters. In 1900 General Yin Tchang came in contact with the allied
forces at Tientsin, and held his retreat together well enough to elicit
much admiration. General Yin and the regent, Prince Chun, both
visited Hongkong in 1901 and there gained sympathy from us all for
the great promise which they showed in guiding the New China. Yin
Tchang’s excellent idea was to take the provincial armies away from
the viceroys, and make the new divisions answerable to the Board of
War (Ping Pu) at Peking. Prince Tsai Tse’s, the finance minister’s
plan, was to inform each governor what amount he was to send to
Peking as the province’s share in maintaining a central army. There
was considerable conflict over this issue, many southern governors
saying that they paid for two armies, one modern army which was
held in the north, of which they never received their allotted division
or brigade, and the old-style provincial troops which they had to
maintain to preserve order. General Ha Han-Chang, a Chinese by
blood, came next to Yin in drilling the new army. He is also a Pei
Yang graduate, and trained with the Japanese army. General Liang-
Pi, a Manchu, had an experience similar to that of General Ha,
before accepting command of the First Brigade. None of these men
is like Tieh-Liang and the other well-known old-style generals, strong
in classics but weak in tactics. They reversed the order. General Li
Chin Hsi at remote Yunnan City raised and drilled an excellent
division. The division at Canton went all to pieces before the
republican troops of General Wu Sum, but the Shansi divisions were
effectually held together by General Sheng Yun, a Mongol, who later
captured the Tongkwan pass, which commands the road from the
west to Peking. Many soldiers of the southern divisions, in the first
few weeks of the revolution, fired from the hip, as they were not
used to the recoil on the shoulder. They, of course, soon did better.
One of the best and most popular marksmen of the Singapore Rifle
Team which competed at Bisley in 1910 was Sergeant Tan Chow
Kim, a Cantonese Chinese.
The name of Frederick T. Ward should be linked with “Chinese”
Gordon’s in connection with Chinese military records. General Ward,
born at Salem, Massachusetts, lost his life in the service of China. He
organized and led the only great army that China ever had before
1906. His name stands linked with Gordon’s as the maker of the
“Ever Victorious Army,” the conqueror of the Taiping horde.
A modern rage for dull-colored new uniforms has struck
gorgeously gowned old China. I shall recite an amusing instance. In
the fall of 1911 a band of rebels organized in Sining, in far-western
Kansu province. They chose a boy of fifteen as their prophet leader
because he bore peculiar birthmarks. He was given the fanciful name
of Savior of the Land (Chu Shih Waang). The generals reported that
the new force should wear modern uniforms of cotton. The stores
were swamped with orders, and every bolt of foreign cotton was
immediately bought up, no matter what its design. The Imperial
Guards wear gray, and the other divisions wear blue and khaki.
Aviation was introduced in China (really Indo-China) at Saigon
on December 1, 1910, by the Holland-Frenchman, Vanderborn. He
was followed later in the year at Shanghai by the American, “Bud”
Mars. The first Chinese aviator was Fug-Yu, who was trained in
America, and who experimented at the Lanchow (east of Peking)
camp in 1911. During the revolution a number of Chinese students
took lessons in aviation in America and left for the rebel front. Had
the war continued it was the intention to destroy Peking by dynamite
dropped from air-ships. Both Sun and Yuan are to be congratulated
that this necessity was obviated by diplomacy.
China’s antiquity, vast population and warlikeness have been
brought in question by some writers. That she had a vast population
as far back as the third century before the Christian era is proved by
the army records. The Ts’in clan, operating under their celebrated
General Peh Ki, slew and beheaded in 293 B. C. 240,000 Hans; in
275 B. C. 40,000 Ngwheis; in 264 B. C. 50,000 Hans; in 260 B. C.
400,000 Chows, and in 256 B. C. 90,000 more Chows, thus
exterminating the imperial ancestral clan which instituted the
sacrifices and held the sacred tripods. Szma Tsien, the historian,
writing at 100 B. C., says the allies lost a million men in fighting this
Ts’in clan. After the Christian era the Chinese took fewer plural wives
and fought fewer wars. Twenty years ago, an emperor who raised
the despised military class to the equal of scholars, farmers and
merchants, would have been decapitated. Compare one of the
military edicts of the regent, Prince Chun, dated Peking, April, 1911:
“We are of the opinion that militarism is the first thing necessary to
the upbuilding and preservation of a nation.”
 Some of the military proverbs of the old Chinese are:
“The best general thinks of wise strategy before blind courage.”
“A mob does not make a regiment, for a trained man is as
effective as a score untrained, and much easier to save in a retreat.”
“A good general can’t blame defeat on bad soldiers, for a good
general has no poor regiments.”
“The pike only grabs the duck’s lame leg that can’t kick.”
“The battle may not be for a cycle of years, but the soldier must
awake for it every day.”
“A dog that bites the hardest shows his teeth the least.”
“A whisper can bring on a war.”
“Keep your good cannon masked, and your bad guns on brave
parade.”
“If the enemy doesn’t know your weakness, you are not weak.”
“It’s the man behind the gun more than the gun, and the man
inside the fort more than the wall.”
Chinese literature is not without its stirring war songs, which
breathe not only the pathos of the suffering of those at home, but
the sacrificing patriotism of the ranks. The following is quoted from
Confucius’ Odes, B. C. 551:

THE SOLDIER
 I climbed the barren mountain,
And my gaze swept far and wide
For the red-lit eaves of my father’s home,
And I fancied that he sighed.

I climbed the grass-clad mountain,

And my gaze swept far and wide
For the rosy light of a little room,
Where I thought my mother sighed.

I climbed the topmost summit,

And my gaze swept far and wide
For the garden roof where my brother stood,
And I fancied that he sighed.

My brother serves as a soldier

With his comrades night and day,
But my brother is filial and may return,
Though the dead lie far away.

The following far older poem was written in 800 B. C. by Li Hua

to commemorate a battle between the ancient Chinese tribe of Wei
and the Northern Mongols:

THE BATTLEFIELD
 Many men with but one heart;
Many lives to sell as one.

Foes and Nature interlock;

Sands arise; hills join the shock.

Rivers, death fills like a flood;

Red, Wei’s Great Wall too with blood.

Slaves ye shall be if ye yield;

Dead men if ye fight the field!

Fled no warrior; name on name,

Ghosts approach me, starred with fame.

With such Spartan poetry the early Chinese were able to fire the
race with militarism. The ideograph is virile and laconic in the
highest degree, just as the Anglo-Saxon of “Beowulf” is more
condensed than our later Latinized speech.
Confucius believed in revenge upon a murderous enemy of one’s
family. He replied to a question of a pupil on this matter: “Have only
your weapons for a pillow.”
Two of the promising colonels in the southern republican army
are graduates (1909 class) of the American West Point Academy.
They were admitted on the personal recommendations of President
Roosevelt. One is Colonel Wen Ying Hsing, a nephew of Wen Tsung
Yao, who is assistant minister of foreign affairs of the Nanking
Republican Assembly. Colonel Wen has seen hard service as military
adviser of the Canton Provincial Assembly. The other “West Pointer”
is Colonel Chen Ting, brother of Doctor Chen Shin Tao, minister of
finance of the Nanking Republican Assembly.
On one of my rambles through the narrow streets of Canton I
dropped into an artist’s shop on Yuck Tsze Street and selected some
treasured, delightful opal-colored paintings, full of spirit, of the old
picturesque three-masted Manchu war-junks which in the early days
one saw sometimes beating into the reaches and broads of the
flooded waters of Kwangtung province. The yellow shields,
emblazoned with ideographs, hang over the midship bulwarks of the
ship. The latticed red rudder is high above the water so that it may
drag the unwieldy keelless boat around. The great blue sweeps, with
yellow eyes, stretch from the galley-ports. The ship itself has eyes
on the bow. The overhanging cabin in the high stern is crowded with
men, stores and bronze cannon. The low red prow cuts the olive
green sea into white foam. The red triangular flags flaunt challenge
from all the masts. The great square brown matting sails spread like
clouds above the blue-gowned leadsman in the bow. Dipping under
the horizon are the fleeing black banners of the enemy, and the sea-
gulls scatter in terror. Only the serrated blue hills are brave along the
iron shores.
The first important names in connection with the building and
drilling of China’s modern navy are Captain Lang, R. N. (British), and
Captain Siebelin (U. S. N. and H. S. M.). These men prepared the
fleet for the war with Japan in 1894, which developed Admiral Ting
and Captain Teng as China’s sole naval heroes, who, however, could
do little with an inefficient war board (Ping Pu) behind them. The
captured battleships Chen Yuen and Ting Yuen are in Japan’s retired
list. They were very fine ships for their day, and resisted heavy
punishment in the battles of the Yalu and Wei Hai Wei. The navy
training schools are at Tientsin, Chifu, Nanking, Fuchau, Shanghai,
Amoy, and there will be another at Nimrod Bay, south of Ningpo.
Admiral Beresford, on his visit to China in 1898, advised with the
Chinese officials, especially Li Hung Chang, regarding navy matters,
and some cruisers were built in England, though the two best
battleships were built in Germany. Captain Bradley Osbon, an
American, served for years in developing the Chinese navy.
The Chinese cruiser Hai Chi, painted the regulation gray, and
spreading the gorgeous yellow dragon flag, took part in King George
the Fifth’s coronation festivities at Spithead in July, 1911, and in
September, 1911, she came to New York and anchored beneath
Grant’s tomb. Conspicuous friendliness on both occasions was shown
to the officers and crew as a mark of the new interest in China which
has arisen in Britain and America especially. Similar cruisers, the Hai
Chow and the Hai Yung; gunboats of the Po Pik class; and torpedo
boats of the Wu Pang class, were in constant use in China in the
ante-republican days. One day they were watching that Portugal did
not encroach at Macao; a week later shelling rebels around the great
cities which line the Yangtze River or making a dash to the Gulf of
Pechili to be ready to take on board the infant emperor. The cruiser
Fei Hung, the first Chinese warship built in America, was launched at
Camden, New Jersey, on April 24, 1912. Larger cruisers are building
in England, and when Chinese politics and finances are more settled,
it is proposed to order battleships from both Britain and America,
and form three fleets, the Northern, Yangtze Central and Southern
fleets. Shanghai can dock the smaller vessels, but British Hongkong
alone has up to this time been able to dock battleships in Chinese
waters. China has as yet no submarines. The British navy maintains
several submarine torpedo boats at Hongkong, and in that land-
locked harbor, of all others in the world, the moral effect upon an
enemy would be terrifying.
In recent years the naval policy of China has been developed by
Prince Tsai Hsu. Admiral Sah Chen Ping, who commanded the
Yangtze fleet which operated against the republicans in October,
1911, and against the pirates who attacked Yale College, at
Changsha, in 1910, has visited America, and entertained the
American round-the-world fleet at Amoy in 1908. He has a son in a
western American college. General Li Yuen Heng, one of the two
greatest republican generals, was really trained for the navy at Pei
Yang and Chifu Colleges, and in Japan. Admirals Jiu Cheng, Li Chun,
of the Canton riots of April, 1911; Tan; Ching, who entertained the
American fleet at Amoy; Commander Hsu Chen Pang, who was
educated at Hartford, America; Admirals Liu and Hai Chun; Admiral
Chin Yao Huan and Commander Wu Chung Lin, both of whom visited
New York on the cruiser Hai Chi, are all well known. Commanders
Chen, Yang and Wong represented China when the cruiser Fei Hung
was built at Camden, New Jersey, in 1912. When the republican
troops took the Shanghai arsenal it discouraged the navy, which
could not secure ammunition in time for effective work. The fleet
then went over to the red, white and blue sun flag, and later landed
a republican army in Shangtung province at Chifu to flank the
imperial left wing operating at Tsinan. The fleet also made a
demonstration against Chin Wang Tao on the gulf of Pechili, thus
forcing the imperialists to hold several divisions in the north to
protect Peking. This enabled the republicans to follow up the
Nanking victory, drive General Chang out of Nganhwei province, and
made the Whei River instead of the Yangtze River the republican
front. If America undertakes with a Pacific fleet to back up for all
time the “non-partition of China” policy, the writer is not a believer in
a Chinese navy at present, outside of possibly one dreadnought a
year when the finances are revised. Of course a strong revenue and
police fleet for the rivers should be provided. Attention should rather
be given to China’s army, so that she may be able to do her own
police work as far as Russian or other intruders are concerned.
Having no oversea colonies, she really has no use for a navy at
present, excepting that one dreadnought a year would, if necessary,
lend a little more than moral support to America’s altruistic and non-
land-grabbing policy in the Far East.
The Chinese are splendid sailors, and as is well known, they
invented the water-tight compartment in their junks, sanpans and
wupans forgotten centuries ago. I have had much intercourse with
the watermen of the southern provinces and can speak well of their
seamanship. They compose the crews of the mercantile fleets which
cross the Pacific, and have brought their ships through those awful
circular typhoons which rage for days. They have also developed
modern yacht designers like Ah King at Hongkong, and they are
quick at the tiller and boom. I have, in writing of the Chinese, given
perhaps a hundred instances of things which they do oppositely to
the Occidental manner. Here is the one hundred and first: Holding
their nostrils, they dive feet foremost, like the pearl fishermen of the
Manaar Gulf of Ceylon! When our launch screws would get tangled
with the many ropes of Blake Wharf, Hongkong, I have often seen
half of the crew merrily jump overboard with knives in their teeth,
and work under water for an extraordinary length of time; and
though some writers call the Chinese stolid and humorless, I have
always seen them highly appreciative of applause and good-natured
laughter over the unexpected incidents that arise in an Oriental day’s
work. On one occasion the writer, who was exhausted with the tide,
was saved from drowning at Junk Bay, Hongkong, by the quick-
witted efforts of a native laota (coxswain) who deftly swung his
launch within reach, and whose ready arms reached out to “chiu
ming” (save life).
The short story of China’s navy would not be complete without a
word on the naval engagements of the China-Japan War of 1894–5
over Korea, when the whole world breathlessly watched the first trial
of modern ironclads, and when the Chinese on several occasions
really showed fearlessness under hopeless conditions. At the end of
July, 1894, Chinese troops arrived at the Yalu River (which divides
Korea and Manchuria) to reinforce General Yeh and Yuan Shih Kai,
under cover of the cruiser Chi Yuen (2,300 tons, 17.5 knots), the
Kuang Yi (1,030 tons, 16 knots), etc. On July 25th this fleet was met
by the much superior Japanese fleet consisting of the Yoshino (4,100
tons, 23 knots), Akitsushima (3,150 tons, 19 knots), and Naniwa (19
knots). After a hot exchange the Chi Yuen escaped from the faster
Yoshino by superior work in the stokehold. The Kuang Yi ran
aground. Admiral Ting, the one big name in China’s navy, with a
weak squadron, daringly sailed from Pechili Gulf on September 14th
for the Yalu, landed stores, and skilfully evaded Admiral Ito’s and
Rear-Admiral Tsuboi’s squadrons. On September 17th, Admiral Ting
led the way with the Chen Yuen (7,400 tons, 15-knot German-built
battleship) and the Ting Yuen, a twin battleship, in the center, the
other vessels on the wings, to meet the Japanese fleets which were
advancing in column. Ito passed wide of the right wing of the
Chinese. At 6,000 yards the Chinese opened fire ineffectively, but the
Japanese reserved their fire until 3,000 yards’ range was reached.
The Japanese passed through to the rear, and drove off the smaller
Chinese warships. The larger Chinese vessels swung to starboard to
keep their bows toward the circling Japanese. The Japanese
armored cruiser Fuso (3,700 tons, 13 knots), built in England,
steamed in close to the Chinese line. The Hi Yei, protected Japanese
cruiser (2,250 tons, 14 knots), crossed between the Chinese
battleships Chen Yuen and Ting Yuen, and as could be expected,
both were so damaged that they had to seek the Japanese rear. The
slow Japanese Akagi, gunboat (614 tons, 13 knots), was hit by the
Chinese left wing. The second Japanese squadron now came up, and
at once attacked the Chinese front, the first Japanese squadron
having completed the circle, attacking the Chinese rear. The
Japanese then withdrew and reformed, but the Chinese were not
able to reform their line. The Chinese Yuen Wei (gunboat, 1,350
tons, 16 knots) on fire, headed for the Yalu, where she sank with the
brave Captain Teng. The Chinese Chao Yuen (gunboat, 1,350 tons,
16 knots) was accidentally rammed by the unmanageable Chinese
Chi Yuen (coast defense, 2,300 tons, 17 knots), and both sank,
leaving only the two Chinese battleships, which kept fighting and
following the Japanese as best they were able. The second Japanese
squadron sank the Chinese King Yuen (coast defense, 2,900 tons, 15
knots), while the first Japanese squadron circled around the two
Chinese battleships, which could not be maneuvered to advantage.
The Chinese Ting Yuen cleverly planted a shell into the Japanese
Matsushima (coast defense, 4,277 tons, 16 knots, French built). At
5:30 P. M., after seven and one-half hours’ fighting, the Japanese
withdrew for repairs, although they had three armored coast
defense, 4,200-ton, 16-knot ships in good condition, two armored
and six protected cruisers, all of which answered their helms.
On October 18th, the Chinese battleship Chen Yuen struck at
Wei Hai Wei and was seriously injured. On February 5, 1895, at 2
A. M., by a bold move, the first of its kind in naval war, the Japanese
torpedo boats raced for an entrance to narrow Wei Hai Wei harbor.
Eight boats got in under the high-pointed guns of the fort and fired
eleven torpedoes. One torpedo from boat “9” struck the Chinese
battleship Ting Yuen, which steamed for shallow water, where the
Chinese blew her up (this is the battleship which the Japanese later
raised and used against the Russians in 1904). The Japanese lost
torpedo boats “9” and “22”.
On the morning of February 6th, five more Japanese torpedo
boats headed for the harbor, and four entered, torpedoing the
Chinese Lai Yuen (coast defense, 2,900 tons, 15 knots) German
built; the Wei Yuen (corvette, 1,300) and tender Pan Fah. The
Chinese torpedo fleet attempted to escape from the western
entrance, but were captured or destroyed by the first Japanese
squadron. The Japanese towed mortar platforms near the western
entrance, and pounded the remaining Chinese battleship Chen Yuen,
which sank, as her deck was not armored (later raised by Japanese
and used against the Russians in 1904). On February 17th, Admiral
Ito steamed in, and China’s one fighting naval hero, Admiral Ting,
brave but unfortunate, committed suicide. The Japanese secured as
prizes the Kang Chi, third-class cruiser (1,030 tons, 16 knots), built
at Shanghai; the Ping Yuen (coast defense, 2,600 tons, 10 knots),
built at Shanghai, and the Kuang Ping (third-class cruiser, 1,030
tons, 16 knots), built at Shanghai. The battle showed the world that
a large, fast mosquito fleet, with longer-range guns, can whip even a
few bulldog battleships, if the maneuvering of the latter is crippled
by lucky shots early in the engagement. In other words, a fleet of
faster unarmored cruisers, converted Lusitanias, for instance, whose
full gun and engine power is effectively maintained, by choosing and
keeping their favored range, could in the open sea finally whip
poorly handled units of slower battleships.
On one other occasion the crew of a Chinese warship quitted
themselves like men. That was when the gunboat Chen Wei alone
engaged the whole French fleet of armor-clads at Foochow, August
23, 1884. I quote the report of an independent eye-witness,
Commissioner Carrall of Sir Robert Hart’s Imperial Customs Service:
“Exposed to the broadsides of the Villars and the D’Estaing, and
riddled by a terrific discharge from the heavy guns of the
Triomphante, the little Chen Wei fought to the last. In flames fore
and aft, drifting helplessly down the stream and sinking, she plied
her guns again and again, till one of the French torpedo boats, the
Volta, dashing in through the smoke, completed the work of
destruction with a well-placed torpedo.”
The successful rush of an unsupported republican torpedo boat
at Hankau on November 19, 1911, past the whole line of blazing
imperial shore batteries, in broad daylight, is considered by the
foreigners of Hankau as dangerous and courageous a piece of work
as the recent revolution exhibited.
 XVIII

MODERN EDUCATION IN CHINA

There are twelve modern universities available for the education

of the four hundred millions of people in China, located respectively
at Hongkong, Shanghai, Nanking, Changsha, Wei Hsien (Shangtung
province), Tientsin, Suchow, Tai Yuan, Peking, Hangchow, Wuchang
and Canton. One of these is British, nine Mission, one Chinese, and
one American Collegiate.
Hongkong University counts among its former law students Wu
Ting Fang, foreign minister of the Nanking republicans; among its
medical students Doctor Sun Yat Sen, president of the Nanking
republican government; and Kang Yu Wei, the original reformer of
China, who inspired the imperial reform edicts of 1898. The
university is a growth of Queen’s College, Anglican (London Mission),
and other foundations. Part of the land was given by a generous
Parsee, Mr. Mody, and part of the endowment by Sir Paul Chater,
both residents of the colony. One gift of $1,000 came from Chang
Ming Chi, at the time viceroy of Canton (Kwangtung province). The
Hongkong and Cantonese Chinese are generous contributors. The
colonial government and other private founders intend to put the
university on a broad basis worthy of the great colony, and equipped
for the vast opportunity offered to influence China in the ways of
permanent progress. The Cantonese are, and have always been,
leaders of republicanism and modernity, and most of their advanced
students will avail of the superior advantages offered by the new
Hongkong University. There are nearly half a million Chinese in the
crown colony itself. Chinese pupils of the London Mission Girls’
School on Bonham Road, Hongkong, have recently won high honors
in the art examinations of the Royal Drawing Society, London.
The splendidly housed and equipped St John’s University at
Shanghai is American Episcopal. The tourist should take a rickshaw
out to Jessfield suburb, five miles from the River Bund, and see its
modern buildings, with adapted Chinese roofs. Its leading spirit has
for years been a New Yorker by birth, Doctor Francis Pott, son of the
noted publisher. Its theological school is, of course, Episcopalian.
Most important is its famous medical school, headed by Doctors
Boone, Lincoln, Jefferys, Tucker, Myers, and Fullerton, whom all
Central China loves. Chinese doctors, such as Tyau, Waung and Koo,
assist. The school of arts is equally famous and brilliant, though
perhaps not so imperative. I hope the day will soon come when this
model university will have a larger science school, not of mediocre
equipment, but endowed by some American at least half as richly as
a standard American college would be endowed in science. The
library, museum, dormitories and teachers’ school all need
endowments. The university has a full-fledged modern athletic
department, and it is thrilling to see the Chinese boys “play up, play
up, and play the game” of American football, baseball, etc. The
football team has mowed down the Municipal Police team on many
occasions. Track teams and rowing teams from St. John’s are yet
going to make China famous at Olympics and Henleys. Military drill is
exceedingly popular, and many of the four hundred boys, who
represent every province, jumped into the front rank in winning
China’s republican revolution, though St. John’s has not yet taught
politics. It should and will perhaps add a strong branch in political
economy. The debating society is popular, as one could expect in the
New China, and the dramatic society is successful, for the Chinese
are born actors. The students also have a modern orchestra. The
university is not a “griffin”, for it dates back to 1879. Five large
buildings stand on the twenty acres of campus.
 The Chinese pay in fees $20,000 a year, which is the record for
“self help” in China. The college does a work free that it should not
be compelled to do, and that is to instruct the families of
missionaries. Soon schools for this purpose will be opened at
Shanghai, Kowkiang (Kuling mount), and elsewhere in the Far East.
Even the poor of foreign families are instructed free at St. John’s
whose bowels of compassion so move for the whole East that verily
she would exhaust herself in her altruistic zeal. One hundred dollars
a year keeps a medical, science, art, political, pedagogical or
theological student at St. John’s. St. John’s asks what added
American tourists and others will take a “share”, as they call it a
Jessfield. The answer is that thousands will. Six hundred dollars
keeps one of the best students in America a year to finish. St. John’s
asks who will thus enable America to teach the leaders of China, and
forever sit closest to their hearts, as they rule the widest political
and economical opportunity on earth. America and England should
remember that if good does not sit on the bench in the New China,
evil will. Japan coerced China out of that immense 1895 indemnity.
She should morally pay part of it back, and part should go to the
famous St. John’s University of Shanghai, where America has stood
so long as a lighthouse amidst the dark waters of remote places.
The University of Nanking (New York State charter) is a union
work of the American Methodists, the American Presbyterians, and
the Disciples of Christ. Its strategic situation at the cultured capital
of the imperial Mings, the high-water mark of the Taiping rebellion,
and the capital of southern republicanism, is at once apparent. The
leaders of the University took a dramatic part in bringing about the
bloodless surrender of Nanking to the victorious republicans, who
might have avenged the imperialist Chang’s atrocities. Doctor A. J.
Bowen is president, and the following noted educational and medical
leaders assist: J. E. Williams, J. W. Drummond, E. C. Lobenstine,
Doctor Garritt, Alexander Paul, Frank Garrett, C. S. Settlemyer,
Doctor E. Osgood, the noted Doctor J. C. Ferguson, Doctor Henke,
Mr. Martin, Mr. Millward, Mr. Bailie, Doctor R. Beebe, and W. F.
Wilson. This university does its immense work with only $44,000 a
year, because every one works for a pittance, the salary of the
president being only $1,500 in a land where life for the foreigner is
expensive. That is to say, the president of the University of Nanking
altruistically accepts in salary less than would the shorthand writer in
the railway office at Nanking, both of whom come from America; the
one a cultured gentleman of power, the other probably only a
machine mind. The five hundred Chinese students themselves
contribute the remarkably large sum of $13,000 a year in fees. The
departments include science, arts, theology, pedagogy, athletics, and
practically the all-important medical department, because the East
China Medical Association (dean, Doctor Shields) works in
connection with the University. Nanking will always be a political,
naval, military, scientific and cultured center, and therefore the
university will have a great influence in teaching the coming leaders
of the New China.
There is nothing narrow-minded about the college, for it teaches
the Chinese language, literature and philosophy. The extensive
grounds cover in the aggregate forty-three acres. There are several
dormitories, chapels, residences for staff, and a Y. M. C. A. The best
building is the large science hall. The university, surely run
economically, needs larger funds for an endowment from America,
because it has not the heart to turn away many promising but poor
students who must be accommodated practically free. Thirty dollars
boards a worthy student for a year, and the college is always glad to
hear from those who will support scholarships, increase the buildings
and equipment, or add to the library and endowment. Athletes of
the university are making their mark, and may extend their triumphs
to the Olympic games. Football and track athletics are popular. There
is a library, museum, students’ magazine, press, and of course a
debating society. The college band, the largest in China, numbers
seventy pieces. The boys showed their mettle in benevolent activities
when they contributed five hundred dollars for the famine and flood
victims, and besides volunteered for work in the stricken districts of
Nganhwei province. Model farm colonies in the distressed sections
have been undertaken by the university. The university now makes a
special appeal for a larger library and reading room building, or
institute, to throw open to the great metropolis, and in Chinese
fashion, they propose to have a self-supporting tea-room which will
be a college club and city institute; a people’s institute in other
words. This would be a very popular move in a city which politically
will remain either as the first or second city in China. The Chinese
themselves prefer it for the capital; the foreigners in North China are
using their influence to have Peking retained as the national capital.
While hot Nanking is not so healthy as Peking, the writer believes
that the foreigners should bow to the wish of the Chinese, and have
Nanking named as capital. The higher classes of Chinese are timid
as yet of the religious hall, but they are enthusiastic attendants at
lecture halls, libraries and clubs. Nanking University intelligently
proposes to miss no opportunity.
Yale University (Missionary Society) has its collegiate school and
splendid medical school and hospital at Changsha, the capital of
conservative inland Hunan province, the former center of “Darkest
China.” The staff, in addition to the Chinese members, are Dean
Brownell, W. J. Hail, D. H. Leavens, K. S. Latourette, Doctor E. H.
Hume, Nurse Nina Gage, and the wives of the staff. All the men are
from Yale University, New Haven. As might be expected, wherever a
Yale man goes, there is to be found the manly athletic temperament,
and Yale at Changsha has its champion football team which is
repeating the Camp round-the-end runs, the Heffelfinger plunges,
etc.! Yale in China agrees with the Nanking plan of including Chinese
in the curriculum. While Yale College mainly supports the work, help
for the hospital has come from such churches as the Broadway
Tabernacle, of New York, and private donors. Chinese physicians,
fully equipped from a western standpoint, like Doctors Yen and Hou,
assist. This is the intelligent educational, medical and mission plan
throughout all China: “Help the Chinese to help themselves.” Yale
College took a leading part in curing opium habitués, and in this
astonishing reform in China Yale has been prominent. That the
Chinese are not parsimonious or unappreciative is proved by the
following facts. Among many others, the governor of Hunan province
sent his check for seven hundred dollars, covering his own and the
subscriptions of the officials under him, though he felt free to
criticize foreign intervention in financial and railway matters in his
province. The governor of Chekiang province subscribed one
hundred dollars, Ex-grand Councilor Chu gave one hundred dollars,
Colonel Niu gave two hundred dollars.
The University of Pennsylvania has a similarly popular medical
department at Canton, and Harvard University plans shortly to have
a medical branch at Shanghai. Their choice of effort is perfect in
wisdom.

Copyright, American Episcopal Church, Foreign Board, N. Y.

The splendid military company of St. John’s University, Shanghai.

 Copyright, American Presbyterian Church, Foreign Board, N. Y.

Shangtung University, at Wei, leading Presbyterian University.

Located in Confucius’ province, and influential in the new intellectual
China.
 Copyright, American Episcopal Church, Foreign Board, N. Y.

The largest foreign University in China, St. John’s American

Episcopal, at Shanghai. Very influential in the New China.

The Shangtung Union University, now located at Wei, will

probably be moved to Tsinan, the capital of the province in which
Confucius and Mencius were born. It is a union of the American
Presbyterian and the British Baptists, and later the Anglicans, the
American Baptists, Congregationalists and Methodists will join. The
total endowment of this effective university is only $35,000. There
are five hundred students. There are collegiate, science,
pedagogical, medical, Chinese, athletic and women’s departments.
There is an attractive, towered, large main building, science hall,
dormitories, museum and a unique observatory. The chief members
of the faculty are the well-known Messrs. Bergen, Hayes, Bruce,
Burt, Luce and Whitcher, and the college is able to draw upon the
many foreign notables at Peking and Tientsin for popular lectures.
China urgently needed advanced education. The individual missions,
brilliant in parts, were in general endowed so poorly that they could
not furnish it. Therefore they united all over China, and better
results are being obtained in specialization by this intelligent
method, which has established an example for the western world to
follow. Subscriptions should as usual be sent to the mission favored
by one’s early training or allegiance, and when they reach China they
are applied in some needy department of the union work. In union,
there is no lapping over or duplication, and the result is efficiency.
When any member of the union lags, a united appeal is addressed to
the home board. The high aim of this extensive University of
Shangtung is to have an income of $150,000 a year. In all these
universities the preparatory and pedagogical departments are not
neglected. The need is urged of a large assembly hall, library,
science hall, dormitories, scientific equipment, Y. M. C. A., etc., at
Tsinan for this university, which stands where four great roads of
influence meet and its opportunity is therefore inspiring. China,
Britain, Germany and Japan come together closely in Shangtung
province, and the university’s sphere is so wide a one that the
present constricted income is insufficient. The students contribute
nearly $2,000 in fees, though many students must necessarily be
taught free. Shangtung University has always stood high for its
special work in translating and printing important books into
Mandarin Chinese. It is interesting that the students have developed
choral work perhaps more than most of the colleges. China has
neglected music in the recent centuries, but St. John’s, Nanking and
Shangtung Universities are teaching it to her again.
The Pei Yang University, of Tientsin, is the leading engineering
and technical institute of China. Its teachers are Americans, British
and Germans. English is taught. It aims to be the Stevens Institute,
or Boston Tech. of China. The Chinese board has been sometimes
obstructive, depending on the intelligence of the directors. However,
the school does wonderful and will do better work when affairs
become settled in China. Its hope, as in every other institute, is in its
graduates even more than in its professors, and certainly more than
its native directors of the old type! It will soon have the fine German
technical schools of Tsingtau to emulate. The Pei Yang University has
sent out many notable graduates who have at once advanced to
leadership in China. One is now vice-president of China.
The Shansi University at Tai Yuan, the provincial capital, was
established in 1901 by the English Baptists with “Boxer” indemnity
funds restored to China at the request of Doctor Timothy Richard,
the promoter of the Red Cross in China, and president of the
university for ten years. It is English and Chinese in personnel, and
has passed through bloody waters in the many disturbances which
have surged around it.
Peking University is also a union in educational work of the
American Congregationalists, American Presbyterians and London
Mission, and in medical work, of the Methodists and Anglicans in
addition. This is decidedly the leading medical college in China, and
includes a women’s medical college, nurses’ training school, hospital
and dispensaries. World famous names in connection with the
university are Doctor W. A. P. Martin, Doctor J. W. Lowrie, Doctor
Smith, Doctor Wherry, Doctor Fenn, Doctor Leonard, Doctor Hall,
Doctor Mackey, Doctor Young, and Doctor Lewis. The medical school
led in the heroic efforts to stamp out the virulent pneumonic plague
in Manchuria in 1911.
At beautiful Hangchow, the “bore city,” the American
Presbyterians are erecting a full college equipment on a lovely site
outside the city wall, on a hill near the water. The students run the
grounds, gardens, roads, etc., on a “self-help” plan. The famous
mission press, which is doing wonderful work in translating and
publishing, is retained, however, at cultured Soochow for the
present. At Soochow the American Methodists have established a
large university. It has a prominent clock tower, an unusual feature,
which is highly appreciated by the modernized Chinese.
At Wuchang, where the republican revolution broke out in
October, 1911, the American Episcopals have Boone University, and
Oxford and Cambridge will establish here the extensive university on
which Lord Salisbury’s son, Lord Cecil, after his visit to China, wrote
a charming book in 1910. At Canton is the Canton Christian College.
These are the leading universities. The Chinese themselves
intended to establish government universities, high and preparatory
schools, at all the twenty-one provincial capitals, but to date only
those at Peking, Paoting, Tsinan, Tai Yuen, Nanking, Shanghai,
Chingtu, Yunnan, Tientsin, Hangchow, Fuchau and Canton have
been established, and they have drawn mainly on the mission
universities and foreign-trained students for professors. The new
education was naturally organized by the government first in the
metropolitan province of Pechili. It included a university at Tientsin,
a provincial college at Paoting, seventeen industrial schools, three
high, forty-nine elementary normal, two medical, three foreign
language, eight commercial, five agricultural, thirty middle, one
hundred and seventy-four upper, one hundred and one mixed, eight
thousand six hundred primary, one hundred and thirty-one girls’
schools and one hundred and seventy-four night schools in the
industrial cities. Is this not an inspiringly comprehensive program?
Both the Board of Education and Yuan Shih Kai deserve credit for
largely taking the suggestions of the foreigners at Peking and
Tientsin in establishing in Pechili province this system of modern
education, which stands as a model for the other twenty provinces
and territories. Many modern buildings have been erected, but
where sufficient money was not available, the fine old temples and
barracks have been impressed, and the surprised sad gods
overthrown. In many cases the gentry and guilds have donated
buildings. The government finds its greatest difficulty in securing
teachers, and they are exhausting the supply that the mission
universities are able to certificate. This new proof of the friendliness
of missions had much to do with the disinclination of the republicans
and imperialists to take the lives of foreigners during the recent
revolution. In preparing pupils to go abroad for further training, the
government has maintained at Peking a special school. At Chingtu,
the capital of Szechuen province, the provincial government
established railway, medical, normal, mining, engineering,
agricultural, foreign language and military schools, and owing to its
success Szechuen led in the agitation for provincialism versus
nationalization in railway and other matters, and this really opened
the revolution in September, 1911, a month before the outbreak in
Hupeh province. The students in the universities at the provincial
capitals are clothed and boarded at government expense, the
student signing for three years and promising to answer a draft for
government service.
Japan has lost her grip to a degree, and America particularly and
Britain have taken her place in educating China. The Chinese
complain of the “enormous” cost of a foreign teacher, but have him
or her they will! The American educational advance has been
astonishingly brilliant. What America is doing for Chinese education
can be judged by the statement that the American Presbyterian
Church alone has three hundred and fifty-nine institutions of learning
in China, and I believe the Methodist denomination has even more,
for that church leads in world missions, as is well known. America
does not pay for all of this, for no race surpasses the Chinese in
generosity and “self-help.” The Hackett Presbyterian Women’s
Medical College of Canton, under the charge of the celebrated
Doctor Mary Fulton, aims “to supply each city with two modern
physicians.” What a brave contract! Charities and orphanages are the
special field of the Roman church; there is no work that can equal
theirs in China in this regard. The Protestants and Chinese prefer to
train the more advanced mind. The American Presbyterians have a
beautiful high school at Fati, Canton; an academy at Ningpo, a high
school at the south gate of Shanghai, and an academy at Peking.
The list is too long to enumerate. The annual reports of the various
Foreign Mission Boards make illuminating reading and give the
names of the heroic educational pioneers. The brilliant work of the
presses, like those at Shanghai, Peking, Wei Hsien (Shangtung) and
Soochow, the ten thousand little rills of income, the contributions of
the broad-minded Chinese officials and students, are all surprising.
How much they are doing with so little money! How much they
could do for American and British educational influence in China with
only a little more money! It is “up to” the American and British
business man, if he decides to be both kind and “wise in his
generation.”
The women of America and Britain are doing their share,
especially in hospitals and nurses’ and girls’ schools. The American
Presbyterian women have at Canton and elsewhere model
institutions, similar to many throughout the crowded land, which
land is going to heal itself, with foreign help, of all its diseases:
bodily, mental, economical and international. I have known several
people of late who have inherited legacies, and happening to read a
China book, they were curious to see what a little money, that came
so easily, altruistically “invested” there, would do. They have erected
a few hospitals and schools, and their joy has not ceased when they
saw the wonderful results in the able hands to which the
philanthropy was committed. The impetus they thus gave to the
progress of the world was greater than the same amount would
have caused anywhere else.
For the girls and women of China, St. Hilda’s School, at
Wuchang, where the revolution broke out on October 10, 1911, does
a great work under the auspices of the American Episcopal women
of Philadelphia, a few of whom bought land outside the east gate of
that old capital, where the famous Chang Chih Tung was for many
years viceroy. The girls’ college sprang up under the watchful eye of
Bishop Roots, who has made a noble name among the Chinese. The
opportunity of this school is to be yet the Barnard College or the
Girton College of China, and of the need of it, by women for women,
all this volume could not say enough. No land is sure of its
progressive condition until the women are freed, educated and
progressive. The enjoyment of continued progress by the men is not
certain until the girls and women are swinging alongside of them on
the great road of life at the same pace, and with equal opportunity.
There can not be real companionship between inferior and superior;
women and men must be equal. Therefore the eyes of all China and
America and Britain are on such institutions as St. Hilda’s. It, too, is
run on the share principle, fifty dollars per girl per year, to put a
modern woman as a lighthouse in China to advance the world cause
of womanhood.
The Yangtze valley, in particular, is the sphere of America’s
influence, and where the high tide of rebellion swept, America’s
educational influence will now follow, since fate has launched her
there in the colleges mentioned, and others not mentioned for want
of space. Lord Cecil plans to have the vast English foundation of
Oxford and Cambridge Colleges at Wuchang (see his enthusiastic
book), and if America has its equal at the other end of the brimming
Yangtze at Shanghai, honors will be equal. Germany is not going to
neglect the opportunity, as she has plans for Nanking and Hankau.
Much luck to her. Contentia in bona! America and England have won
a vast advantage, however, over Germany and France, in that China,
on recommendation of the Board of Education, has adopted English
as the official language for the study of science, geography, travel
and international politics in all Chinese universities, technical colleges
and high schools. This victory was brought about through the
influence of the Chinese students who had studied in Britain and
America, and a comparison of the technical and educational books
issued by the different countries, the report being that the English
language had three to one in its favor. When the nations wish to
study about China or any foreign country, they have to take up or
translate books written in English, for the American and Briton are
the most curious concerning the world’s countries and naturally the
authorities on comparative ethnology and international economics.
The Y. M. C. A. has come to China, and at Tientsin maintains a
school as an adjunct pf the religious, literary and athletic work.
Industrial schools have been opened, and they will do a vast work in
recovering China’s lost arts and extending her commerce. There is a
government industrial school at Peking for the production of the
famous and almost lost cloisonné, rugs, furniture, etc. The patterns
for rugs are memorized. At Tientsin the pattern is hung over the
worker’s head. The schoolboys of old China were most familiar with
the first two lines of the Trimetrical Classic: “Man in the beginning
was essentially holy.” In Mandarin this is pronounced: “Jin chi tsu,
Welcome to our website – the ideal destination for book lovers and
knowledge seekers. With a mission to inspire endlessly, we offer a
vast collection of books, ranging from classic literary works to
specialized publications, self-development books, and children's
literature. Each book is a new journey of discovery, expanding
knowledge and enriching the soul of the reade

Our website is not just a platform for buying books, but a bridge
connecting readers to the timeless values of culture and wisdom. With
an elegant, user-friendly interface and an intelligent search system,
we are committed to providing a quick and convenient shopping
experience. Additionally, our special promotions and home delivery
services ensure that you save time and fully enjoy the joy of reading.

Let us accompany you on the journey of exploring knowledge and

personal growth!

textbookfull.com