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leniency, the interests of the whole nation should be imperilled. Thus only can the will of Her late Majesty in intrusting this high responsibility be respected and the nation's aspirations fulfilled.
November 20, 1908.
It is due to the enlightened and far-seeing policy of Their late Majesties the August Empress Dowager and the Emperor that at this period, when a double calamity has befallen the nation, tranquillity reigns alike in the capital and the provinces, and that our relations with all the Treaty Powers are of the most cordial nature. Recently, however, certain evil-disposed persons have been endeavouring to excite disaffection among the ignorant populace, and lawless characters living in foreign countries have been conspiring to disturb the peace of the country. Unless stringent measures of repression are taken, there is reason to fear that the peaceful administration of the Empire will be endangered. We therefore order the Board of the Interior, the Head Office of Gendarmeric, the Governor of Peking, and the Governors-General and Governors of the provinces to instruct their subordinates, both civil and military, to increase the detective staff, offer rewards, and search for and arrest such evil-doers with the utmost thoroughness. If any ringleaders are arrested they should, when found guilty, be executed on the spot, and officers distinguishing themselves in carrying out these measures are to be recommended for rewards.
Inclosure 2 in No. 1.
Medical Note on the Deaths of the Emperor Kuang Hsü and the Empress Dowager.
THE Emperor.-Since birth he had never been of robust constitution. There seems little doubt that he suffered from hypospadias, a congenital condition in which It is a surgical fact that there is absence of some part of the floor of the urethra.
in almost all these cases there is some degree of arrested development of the testicles The local irritation caused by this and scrotum, with loss of ability to procreate.
hypospadias is capable of setting up spermatorrhoea, or rather a false spermatorrhoea, in which there is a discharge of a seminal-like fluid, destitute of spermatozoa. The presence of this complaint would serve to keep him in a more or less debilitated condition—a lack of virility-all his life. The heavy duties of Court life, from which there was never any respite, with Grand Council meetings beginning at 4 A.M., and all the worries of his peculiar position, would appear to bave brought him into a condition of neurasthenia. From time to time he suffered from attacks of insomnia. The never-ending press of work in an individual in whom the capacity for work was limited and the general history of the case were causes such as give rise to nourusthenia, The doctors who attended him know well enough the symptoms of phthisis, as it is so common a disease among Chinese, but they have never said he suffered from this. Nor had his face the puffy appearance of one suffering from kidney disease, and he did not show any of the other manifestations of tuberculosis, such as intestinal or bone disease, as far as can be gathered from the clinical symptoms he was said to have shown. The progressive weakness of neurasthenia was accompanied, as is the case in its latter stages, by cardiac. weakness and general loss of tone of the circulatory, intestinal, and sexual systems from which he respectively suffered in the last stages of his illness: (1) swelling of the lower The "vicious limbs, (2) pronounced constipation, (3) pronounced spermatorrhoea. circle thus established, by which the weaker his constitution became the more these symptoms were aggravated and vice versa, gives a quite reasonable explanation of how he came by his death,
2. The Empress Dowager. At the recent audience when Sir John Jordan introduced Adiniral Lambton it was remarked by those of us who were present that, while Her Majesty was looking well, she had aged in appearance, and for some time previous to that there were reports that she had not been in good health. At the beginning of October she suffered from an attack of weakness, and the Chinese said she had caught cold ("chao liang"). There was a good deal of influenza in Peking about that time, from which a great many Chinese suffered, and it is quite possible she had that, as there were no definite symptoms that they could put a name to beyond general body weakness. On her birthday, by all accounts, she ate more than usual and took
some fruit which was over-ripe. By next day she was suffering from dysenteric symptoms, and the acute diarrhoea with loss of blood very soon brought her into a debilitated state. Dysentery in elderly people is always much more dangerous than in earlier life. A Chinese doctor (Surgeon-Lieutenant-Colonel in the Lu Chün and in touch with other official doctors) told me that for four days she passed motions of "strips of black blood"-evidently pieces of her intestinal mucous coat mixed with blood. This blackness points to the irritation being high up in the bowels-probably an acute gastritis. In any case it seems certain she never really rallied from this attack and felt herself getting steadily weaker. While in this state she sent Prince Ching to see about her tomb, and during his absence, on hearing of the Emperor's grave condition, her anxiety became acute and no doubt made her worse. A few hours after Prince Ching's return the Emperor died-about 8 p.m. to the unsettled state of the succession, coupled with the absence of any proper This in itself, having regard treatment, sedative or otherwise, must have strained her to the utmost. She held a Grand Council meeting at 2 A.M., after a long and anxious day, and later on in the early morning when they returned to again consult with her she could only waive them aside, saying she was too weak to speak. She died next afternoon, her dysenteric symptoms persisting to the end.
On reviewing the circumstances of these deaths with a view to rumours which have been bruited abroad as to foul play (poisoning), while, in the Emperor's case, there is no evidence of it, the sudden appearance of acute intestinal disease in the Empress Dowager might be said to be suspicious. But I do not think so for the following
reasons :-
Poisons all fall into the three main classes of-
(1.) Corrosives;
(2.) Neurotics; and
(3.) Irritants.
Unless there was a widespread collusion to hide the truth, she had none of the symptoms of the two former classes. Those of corrosives are marked and unmistakable, and neurotics are equally excluded-there was no sudden death as by prussic acid, nor coma as by a narcotic nor sudden rapid suffocating sensations as by strychnine, &c. She might have been given an irritant poison; in the absence of all opportunity for analysis it would be difficult to say definitely, but from her symptoms it is improbable that such was the case. There is no mention of her having had nausea, violent vomiting, or great pain, and her illness did not steadily increase in severity till collapse and death occurred. As far as can be gathered, though the treatment may have left much to wish for, and if properly carried out might have tided her over this attack, her death was a natural one, iny diagnosis being dysentery accentuated by over-fatigue in a senile constitution.
G. DOUGLAS GRAY, M.D.
Peking, November 19, 1908.
(Signed)
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