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Poisoning & Drug Overdose 7th Edition Kent R. Olson (Ed.)

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64 views41 pages

Poisoning & Drug Overdose 7th Edition Kent R. Olson (Ed.)

The document provides information on various eBooks available for download, including titles related to poisoning, drug overdose, and veterinary drug compounding. It outlines the structure of the 'Poisoning & Drug Overdose' 7th Edition, detailing sections on evaluation and treatment, specific poisons, therapeutic drugs, and environmental toxicology. Additionally, it emphasizes the importance of confirming medical information with reliable sources due to the evolving nature of medical science.

Uploaded by

urataprobyfg
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Available Formats
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Comprehensive Evaluation and Treatment: Provides a step-wise

Emergency
Treatment
approach to the evaluation and treatment of coma, seizures, shock,
and other common complications of poisoning and to the proper use of
gastric decontamination and dialysis procedures.

Common Poisons
Specific Poisons and Drugs: Diagnosis and Treatment: Alphabeti-

& Drugs
cal listing of specific drugs and poisons, including the pathophysiology,
toxic dose and level, clinical presentation, diagnosis, and specific treat-
ment associated with each substance.

Antidotes & Drug


Therapeutic Drugs and Antidotes: Descriptions of therapeutic drugs

Therapy
and antidotes discussed in the two preceding sections, including their
pharmacology, indications, adverse effects, drug interactions, recom-
mended dosage, and formulations.

Environmental and Occupational Toxicology: Approach to hazard-


Chemicals
Industrial

ous materials incidents; evaluation of occupational exposures; and the


toxic effects, physical properties, and workplace exposure limits for
over 500 common industrial chemicals.

Index: Includes generic drug and chemical names and numerous


brand name drugs and commercial products.
Index

MCGH396-FM_i-xiv.indd 1 09/10/17 11:27 AM


This page intentionally left blank

MCGH396-FM_i-xiv.indd 2 09/10/17 11:27 AM


seventh edition

POISONING
& DRUG
OVERDOSE
Edited by
Kent R. Olson, MD, FACEP, FACMT, FAACT
Clinical Professor of Medicine and Pharmacy,
University of California, San Francisco;
Co-Medical Director, California Poison Control System,
San Francisco Division (retired)
Associate Editors

Ilene B. Anderson, PharmD Richard F. Clark, MD, FACEP


Clinical Professor of Pharmacy, University Professor of Medicine,
of California, San Francisco; University of California, San Diego;
Senior Toxicology Management Specialist, Director, Division of Medical Toxicology
California Poison Control System, and Medical Director,
San Francisco Division California Poison Control System,
San Diego Division

Neal L. Benowitz, MD Thomas E. Kearney, PharmD, ABAT


Professor of Medicine Professor of Clinical Pharmacy, and
and Chief, Division of Clinical Pharmacology Associate Dean for Academic Affairs
and Toxicology, University of California, San Francisco;
University of California, San Francisco; Clinical Consultant
Associate Medical Director, California Poison Control System,
California Poison Control System, San Francisco Division
San Francisco Division

Paul D. Blanc, MD, MSPH Susan Y. Kim-Katz, PharmD


Professor of Medicine and Chief, Division of Clinical Professor of Pharmacy,
Occupational and Environmental Medicine, University of California, San Francisco;
University of California, San Francisco Senior Toxicology Management Specialist,
California Poison Control System,
San Francisco Division

Alan H. B. Wu, PhD


Professor of Laboratory Medicine,
University of California, San Francisco;
Chief, Clinical Chemistry Laboratory
San Francisco General Hospital

New York Chicago San Francisco Lisbon London Madrid Mexico City
Milan New Delhi San Juan Seoul Singapore Sydney Toronto

MCGH396-FM_i-xiv.indd 3 09/10/17 11:27 AM


Copyright © 2018 by McGraw-Hill Education. All rights reserved. Except as permitted under the
United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in
any form or by any means, or stored in a database or retrieval system, without the prior written permis-
sion of the publisher.

ISBN: 978-0-07-183980-8
MHID: 0-07-183980-1

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Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowl-
edge, changes in treatment and drug therapy are required. The authors and the publisher of this work
have checked with sources believed to be reliable in their efforts to provide information that is com-
plete and generally in accord with the standards accepted at the time of publication. However, in view
of the possibility of human error or changes in medical sciences, neither the authors nor the publisher
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Contents

Authors ..................................................................................................................... vi
Preface ..................................................................................................................... xii

Section I. Comprehensive Evaluation and Treatment............................................ 1


This section provides a step-wise approach to the evaluation and treatment of coma,
seizures, shock, and other common complications of poisoning and to the proper use
of gastric decontamination and dialysis procedures.

Section II. Specific Poisons and Drugs: Diagnosis and Treatment.................... 73


Organized alphabetically, this section lists specific drugs and poisons, as well as the
pathophysiology, toxic dose and level, clinical presentation, diagnosis, and specific
treatment associated with each substance.

Section III. Therapeutic Drugs and Antidotes..................................................... 498


This section provides descriptions of therapeutic drugs and antidotes discussed in
Sections I and II, including their pharmacology, indications, adverse effects, drug inter-
actions, recommended dosage, and formulations.

Section IV. Environmental and Occupational Toxicology.................................. 636


This section describes the approach to hazardous materials incidents; the evaluation
of occupational exposures; and the toxic effects, physical properties, and workplace
exposure limits for over 500 common industrial chemicals.

Index....................................................................................................................... 783
The index includes generic drug and chemical names.

MCGH396-FM_i-xiv.indd 5 09/10/17 11:27 AM


Authors

Suad Abdullah Saif Al Abri, MD, ABEM, OBEM


Medical Toxicology Fellow, California Poison Control System, San Francisco Division,
University of California, San Francisco; Consultant Emergency Physician and Medical
Toxicologist, Emergency Department, Sultan Qaboos University Hospital, Muscat, Oman

Timothy E. Albertson, MD, MPH, PhD


Professor of Medicine, Medical Pharmacology and Toxicology, University of California
Medical Center, Davis; Medical Director, California Poison Control System, Sacramento
Division

Ilene B. Anderson, PharmD


Clinical Professor of Pharmacy, University of California, San Francisco; Senior
Toxicology Management Specialist, California Poison Control System, San Francisco
Division

Gilberto Araya-Rodriguez, Licenciado en Farmacia (Costa Rica)


Volunteer, California Poison Control System, San Francisco Division, San Francisco,
California

Ann Arens, MD
Medical Toxicology Fellow, Department of Medicine, University of California,
San Francisco, California; Medical Toxicologist, Minnesota Poison Control System;
Assistant Professor, Department of Emergency Medicine, University of Minnesota

Patil Armenian, MD
Associate Professor, Assistant Research Director, Department of Emergency
Medicine, University of California, San Francisco-Fresno

John R. Balmes, MD
Professor of Medicine, University of California, San Francisco; Division of Environmental
Health Sciences, School of Public Health, University of California, Berkeley

Neal L. Benowitz, MD
Professor of Medicine and Chief, Division of Clinical Pharmacology, Medicine and
Bioengineering & Therapeutic Sciences, Zuckerberg San Francisco General Hospital/
University of California, San Francisco

Kathleen Birnbaum, PharmD


Toxicology Management Specialist, California Poison Control System, San Diego Division

Paul D. Blanc, MD, MSPH


Professor of Medicine, Division of Occupational and Environmental Medicine, University of
California, San Francisco and the Veteran Affairs Medical Center, San Francisco

Stephen C. Born, MD, MPH


Clinical Professor Emeritus, Division of Occupational and Environmental Medicine,
University of California, San Francisco

F. Lee Cantrell, PharmD


Managing Director, California Poison Control System, San Diego Division; Professor of
Clinical Pharmacy, University of California, San Francisco; Clinical Professor of Pharmacy
and Medicine, University of California, San Diego

James Chenoweth, MD, MAS


Assistant Professor, Director of Toxicology Research, Department of Emergency Medicine,
University of California, Davis

Richard F. Clark, MD
Medical Director, San Diego Division, California Poison Control System;
Director, Division of Medical Toxicology, University of California, San Diego Medical Center

vi

MCGH396-FM_i-xiv.indd 6 09/10/17 11:27 AM


AUTHORS vii

Michael A. Darracq, MD, MPH


Associate Professor of Clinical Emergency Medicine, University of California,
San Francisco-Fresno

G. Patrick Daubert, MD, FACEP


Division of Emergency Medicine, Kaiser Permanente, South Sacramento Medical Center,
Sacramento, California

Timur S. Durrani, MD, MPH, MBA


Medical Director, Occupational Health Services, Zuckerberg San Francisco General
Hospital; Assistant Medical Director, San Francisco Division, California Poison Control
System; Principal Investigator, UCSF Pediatric Environmental Health Specialty Unit;
Assistant Clinical Professor of Medicine, University of California San Francisco

Jo Ellen Dyer, PharmD


Clinical Professor of Pharmacy, University of California, San Francisco; Senior Toxicology
Management Specialist, California Poison Control System, San Francisco Division

Gary W. Everson, PharmD


Toxicology Management Specialist, California Poison Control System, Fresno/Madera
Division

Jeffrey Fay, PharmD


Assistant Clinical Professor of Pharmacy, University of California, San Francisco;
Toxicology Management Specialist, California Poison Control System, Fresno/Madera
Division

Jonathan B. Ford, MD
Assistant Professor, Emergency Medicine, University of California, Davis

Thomas J. Ferguson, MD, PhD


Associate Clinical Professor, Departments of Internal Medicine and Public Health,
University of California, Davis

Frederick Fung, MD, MS


Clinical Professor of Occupational Medicine, University of California, Irvine; Medical
Director, Occupational Medicine Department and Toxicology Services, Sharp Rees-Stealy
Medical Group, San Diego, California

Fabian Garza, PharmD


Assistant Clinical Professor of Pharmacy, University of California, San Francisco;
Toxicology Management Specialist, California Poison Control System, Fresno/Madera
Division

Curtis Geier, PharmD


Emergency Medicine Clinical Pharmacist, Zuckerberg San Francisco General Hospital,
San Francisco, California, Assistant Clinical Professor of Pharmacy, University of
California, San Francisco

Richard J. Geller, MD, MPH


Associate Clinical Professor of Emergency Medicine, University of California, San
Francisco; Medical and Managing Director, California Poison Control System, Fresno/
Madera Division

Nasim Ghafouri, PharmD


Toxicology Management Specialist, California Poison Control System,
San Diego Division

Joyce Go, PharmD


Emergency Medicine Clinical Pharmacist, Department of Pharmacy, Zuckerberg San
Francisco General Hospital and Trauma Center, San Francisco, California

MCGH396-FM_i-xiv.indd 7 09/10/17 11:27 AM


viii AUTHORS

Joanne M. Goralka, PharmD


Department of Clinical Pharmacy, University of California, San Francisco; Toxicology
Management Specialist, California Poison Control System, Sacramento Division

Hallam Gugelmann, MD, MPH


Attending Physician in Emergency Medicine, CPMC St. Luke’s Hospital; Assistant Medical
Director, California Poison Control System, San Francisco Division

Sandra A. Hayashi, PharmD


Assistant Clinical Professor, University of California, San Francisco; Toxicology
Management Specialist, California Poison Control System, San Francisco Division

Patricia Hess Hiatt, BS


Operations Manager (retired), San Francisco Division, California Poison Control System

Raymond Y. Ho, PharmD


Managing Director, California Poison Control System, San Francisco Division

Leslie M. Israel, DO, MPH


Medical Director, Occupational Health Services, Los Angeles Department of Water and
Power, Los Angeles, California

Sam Jackson, MD, MBA


Chief Medical Officer, Alkahest, Inc., San Carlos, California

Thomas E. Kearney, PharmD, DABAT


Professor of Clinical Pharmacy and Associate Dean for Academic Affairs, University of
California, San Francisco; Clinical Consultant, California Poison Control System,
San Francisco Division

Paul Khasigian, PharmD


Toxicology Management Specialist, California Poison Control System, Fresno/Madera
Division

Susan Kim-Katz, PharmD


Professor of Clinical Pharmacy, University of California, San Francisco; Senior Toxicology
Management Specialist, California Poison Control System, San Francisco Division

Richard Ko, PharmD, PhD


Pharmaceutical Consultant, Herbal Synergy, Pinole, California

Michael J. Kosnett, MD, MPH, FACMT


Associate Clinical Professor, Division of Clinical Pharmacology & Toxicology, Department
of Medicine, University of Colorado School of Medicine Denver, Colorado

Allyson Kreshak, MD, FACMT, FACEP


Assistant Clinical Professor, Department of Emergency Medicine, University of California
San Diego

Chi-Leung Lai, PharmD


Assistant Clinical Professor of Pharmacy, University of California, San Francisco; Assistant
Clinical Professor of Medicine, University of California, Davis; Toxicology Management
Specialist, California Poison Control System, Sacramento Division

Darren H. Lew, PharmD


Toxicology Management Specialist, California Poison Control System, Fresno/Madera
Division

Justin C. Lewis, PharmD, DABAT


Managing Director, California Poison Control System, Sacramento Division

MCGH396-FM_i-xiv.indd 8 09/10/17 11:27 AM


AUTHORS ix

Kai Li, MD
Medical Toxicology Fellow, Department of Emergency Medicine, University of California,
San Francisco

Derrick Lung, MD, MPH


Assistant Clinical Professor, Division of Clinical Pharmacology and Toxicology,
Department of Medicine, University of California, San Francisco

Binh T. Ly, MD, FACMT, FACEP


Professor and Vice Chair (Education), Department of Emergency Medicine (Medical
Toxicology), University of California, San Diego

Conan MacDougall, PharmD, MAS


Professor of Clinical Pharmacy, University of California San Francisco

Tanya M. Mamantov, MD, MPH


Medical Toxicology Attending Physician, Zuckerberg San Francisco General Hospital and
California Poison Control System, San Francisco Division

Beth H. Manning, PharmD


Assistant Clinical Professor of Pharmacy, University of California, San Francisco;
Toxicology Management Specialist, California Poison Control System, San Francisco
Division

Kathryn H. Meier, PharmD


Assistant Clinical Professor of Pharmacy, University of California, San Francisco;
Toxicology Management Specialist, California Poison Control System, San Francisco
Division

Alicia B. Minns, MD
Assistant Clinical Professor of Emergency Medicine, Department of Emergency Medicine,
University of California, San Diego

Eileen Morentz
Poison Information Provider, California Poison Control System, San Francisco Division

Stephen W. Munday, MD, MPH, MS


Chair, Department of Occupational Medicine, Sharp Rees Stealy Medical Group, San
Diego; California Poison Control System, San Diego Division

Sean Patrick Nordt, MD, PharmD, DABAT, FAACT, FAAEM, FACMT


Associate Professor of Clinical Emergency Medicine, Keck School of Medicine, University
of Southern California

Charles W. O’Connell, MD
Clinical Professor of Emergency Medicine, Division of Medical Toxicology, University of
California, San Diego

Steven R. Offerman, MD
Assistant Professor, Department of Emergency Medicine, University of California, Davis;
Division of Emergency Medicine, Kaiser Permanente, South Sacramento Medical Center,
Sacramento, California

Kent R. Olson, MD, FACEP, FACMT, FAACT


Clinical Professor of Medicine and Pharmacy, University of California, San Francisco;
Co-Medical Director, California Poison Control System, San Francisco Division, San
Francisco (retired)

Michael A. O’Malley, MD, MPH


Associate Clinical Professor, Public Health Sciences, University of California, Davis

MCGH396-FM_i-xiv.indd 9 09/10/17 11:27 AM


x AUTHORS

Annamariam Pajouhi, PharmD


Assistant Clinical Professor of Pharmacy, University of California, San Francisco;
Toxicology Management Specialist, California Poison Control System, Sacramento
Division

Mariam Qozi, PharmD


Toxicology Management Specialist, California Poison Control System,
San Diego Division

Joshua B. Radke
Medical Toxicology Fellow, Department of Emergency Medicine, University of California,
Davis

Cyrus Rangan, MD
Assistant Medical Director, California Poison Control System; Director, Toxics
Epidemiology Program, Los Angeles County Department of Health Services; Attending
Staff, Children’s Hospital, Los Angeles, California

Daniel J. Repplinger, MD
Assistant Clinical Professor, Department of Emergency Medicine, University of California,
San Francisco; Zuckerberg San Francisco General Hospital, San Francisco, California

Freda M. Rowley, PharmD


Assistant Clinical Professor of Pharmacy, University of California, San Francisco;
Toxicology Management Specialist, California Poison Control System, San Francisco
Division

Thomas R. Sands, PharmD


Assistant Clinical Professor of Pharmacy, University of California, San Francisco;
Associate Clinical Professor, School of Medicine, University of California, Davis;
Toxicology Management Specialist, California Poison Control System, Sacramento
Division (retired)

Aaron Schneir, MD
Professor of Emergency Medicine, Division of Medical Toxicology, Department of
Emergency Medicine, University of California, San Diego

Jay Schrader, CPhT


Poison Information Provider, California Poison Control System, San Francisco Division

Dennis Shusterman, MD, MPH


Professor of Clinical Medicine, Emeritus, Division of Occupational and Environmental
Medicine, University of California, San Francisco

Craig Smollin, MD
Medical Director, California Poison Control System, San Francisco Division; Associate
Professor of Emergency Medicine, University of California, San Francisco

Jeffrey R. Suchard, MD
Professor of Clinical Emergency Medicine and Pharmacology, Department of Emergency
Medicine, University of California, Irvine

Mark E. Sutter, MD
Associate Professor of Emergency Medicine, University of California, Davis

R. Steven Tharratt, MD, MPVM


Clinical Professor of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine,
University of California, Davis

Ben T. Tsutaoka, PharmD


Assistant Clinical Professor of Pharmacy, University of California, San Francisco;
Toxicology Management Specialist, California Poison Control System, San Francisco
Division

MCGH396-FM_i-xiv.indd 10 09/10/17 11:27 AM


AUTHORS xi

Janna H. Villano, MD
Clinical Faculty, Emergency Medicine, University of California, San Diego

Kathy Vo, MD
Medical Toxicology Fellow, California Poison Control System, San Francisco Division,
University of California, San Francisco; Assistant Clinical Professor of Emergency
Medicine, University of California, San Francisco

Rais Vohra, MD
Assistant Professor of Emergency Medicine, University of California,
San Francisco-Fresno

Michael J. Walsh, PharmD


Assistant Clinical Professor of Pharmacy, University of California, San Francisco;
Toxicology Management Specialist, California Poison Control System, Sacramento
Division

R. David West, PharmD


Toxicology Management Specialist, California Poison Control System, Fresno/Madera
Division

Michael Young, DO, FACEP, FACMT


Associate Director, Division of Toxicology, Kaiser Permanente, San Diego, California

MCGH396-FM_i-xiv.indd 11 09/10/17 11:27 AM


Preface

Poisoning & Drug Overdose provides practical advice for the diagnosis and man-
agement of poisoning and drug overdose and concise information about common
industrial chemicals.
The manual is divided into four sections and an index, each identified by a black tab
in the right margin. Section I leads the reader through initial emergency management,
including treatment of coma, hypotension, and other common complications; physical
and laboratory diagnosis; and methods of decontamination and enhanced elimination
of poisons. Section II provides detailed information for approximately 150 common
drugs and poisons. Section III describes the use and side effects of approximately 60
antidotes and therapeutic drugs. Section IV describes the medical management of
chemical spills and occupational chemical exposures and includes a table of over 500
chemicals. The Index is comprehensive and extensively cross-referenced.
The manual is designed to allow the reader to move quickly from section to section,
obtaining the needed information from each. For example, in managing a patient with
isoniazid intoxication, the reader will find specific information about isoniazid toxicity
in Section II, practical advice for gut decontamination and management of complica-
tions such as seizures in Section I, and detailed information about dosing and side
effects for the antidote pyridoxine in Section III.

ACKNOWLEDGMENTS
The success of the first and second editions of this manual would not have been pos-
sible without the combined efforts of the staff, faculty, and fellows of the San Francisco
Bay Area Regional Poison Control Center, to whom I am deeply indebted. From its
inception, this book has been a project by and for our poison center; as a result, all
royalties from its sale have gone to our center’s operating fund and not to any indi-
vidual editor or author.
In January 1997, four independent poison control centers joined their talents to
become the California Poison Control System, administered by the University of
California, San Francisco. With the third, fourth, fifth, and sixth editions, the manual
became a project of our statewide system, bringing in new authors and editors.
On behalf of the authors and editors of the seventh edition, my sincere thanks go
to all those who contributed to one or more of the first six editions:

Timothy E. Albertson, MD, PhD Stephen Born, MD


Judith A. Alsop, PharmD Christopher R. Brown, MD
Ilene Brewer Anderson, PharmD Randall G. Browning, MD, MPH
Patil Armenian, MD James F. Buchanan, PharmD
Margaret Atterbury, MD Alan Buchwald, MD
Georgeanne M. Backman Cindy Burkhardt, PharmD
John Balmes, MD Chris Camillieri, DO
Shireen Banerji, PharmD F. Lee Cantrell, PharmD
James David Barry, MD Terry Carlson, PharmD
Charles E. Becker, MD Shaun D. Carstairs, MD
Neal L. Benowitz, MD Gregory Cham, MD
Bruce Bernard, MD Chulathida Chomchai, MD
David P. Betten, MD Summon Chomchai, MD
Kathleen Birnbaum, PharmD Richard F. Clark, MD
Paul D. Blanc, MD, MSPH Matthew D. Cook, MD

xii

MCGH396-FM_i-xiv.indd 12 09/10/17 11:27 AM


PREFACE xiii

G. Patrick Daubert, MD Anthony S. Manoguerra, PharmD


Delia Dempsey, MD Kathy Marquardt, PharmD
Charlene Doss Michael J. Matteucci, MD
Chris Dutra, MD Timothy D. McCarthy, PharmD
Jo Ellen Dyer, PharmD Howard E. McKinney, PharmD
Brent R. Ekins, PharmD Kathryn H. Meier, PharmD
Andrew Erdman, MD Michael A. Miller, MD
Gary Everson, PharmD Alicia Minns, MD
Jeffrey Fay, PharmD S. Todd Mitchell, MD
Thomas J. Ferguson, MD, PhD Eileen Morentz
Donna E. Foliart, MD, MPH Walter H. Mullen, PharmD
Frederick Fung, MD Stephen W. Munday, MD, MPH, MS
Mark J. Galbo, MS Nancy G. Murphy, MD
Fabian Garza, PharmD Frank J. Mycroft, PhD, MPH
Richard J. Geller, MD, MPH Joshua Nogar, MD
Robert L. Goldberg, MD Sean Patrick Nordt, MD, PharmD
Joanna Goralka, PharmD Steve Offerman, MD
Colin S. Goto, MD Kent R. Olson, MD
Gail M. Gullickson, MD Michael O’Malley, MD, MPH
Christine A. Haller, MD Gary Joseph Ordog, MD
Jennifer Hannum, MD John D. Osterloh, MD
Sandra Hayashi, PharmD Kelly P. Owen, MD
Patricia H. Hiatt, BS Gary Pasternak, MD
Raymond Ho, PharmD Manish Patel, MD
B. Zane Horowitz, MD Paul D. Pearigen, MD
Yao-min Hung, MD Cyrus Rangan, MD
David L. Irons, PharmD Brett A. Roth, MD
Leslie M. Israel, DO, MPH Freda M. Rowley, PharmD
Sam Jackson, MD, MBA Thomas R. Sands, PharmD
Thanjira Jiranankatan, MD Aaron Schnier, MD
Gerald Joe, PharmD Jay Schrader, CPhT
Jeffrey R. Jones, MPH, CIH Kerry Schwarz, PharmD
Paul A. Khasigian, PharmD Dennis J. Shusterman, MD, MPH
Thomas E. Kearney, PharmD Craig Smollin, MD
Kathryn H. Keller, PharmD Karl A. Sporer, MD
Michael T. Kelley, MD Jeffrey R. Suchard, MD
Susan Y. Kim-Katz, PharmD Mark E. Sutter, MD
Lada Kokan, MD Winnie W. Tai, PharmD
Michael J. Kosnett, MD David A. Tanen, MD
Allyson Kreshak, MD S. Alan Tani, PharmD
Amy Kunihiro, MD John H. Tegzes, VMD
Grant D. Lackey, PharmD R. Steven Tharratt, MD
Chi-Leung Lai, PharmD Josef G. Thundiyil, MD, MPH
Rita Lam, PharmD Christian Tomaszewski, MD
Shelly Lam, PharmD Ben T. Tsutaoka, PharmD
John P. Lamb, PharmD Mary Tweig, MD
Belle L. Lee, PharmD Rais Vohra, MD
Darrem Lew, PharmD Peter H. Wald, MD, MPH
Diane Liu, MD, MPH Michael J. Walsh, PharmD
Jon Lorett, PharmD Jonathan Wasserberger, MD
Derrick Lung, MD, MPH Janet S. Weiss, MD
Binh T. Ly, MD R. David West, PharmD
Richard Lynton, MD Timothy J. Wiegand, MD
Tatiana M. Mamantov, MD Saralyn R. Williams, MD
Beth H. Manning, PharmD Joyce Wong, PharmD

MCGH396-FM_i-xiv.indd 13 09/10/17 11:27 AM


xiv PREFACE

Olga F. Woo, PharmD Evan T. Wythe, MD


Alan H. B. Wu, PhD Peter Yip, MD
Lisa Wu, MD Shoshana Zevin, MD

We are also grateful for the numerous comments and suggestions received from col-
leagues, students, and the editorial staff at McGraw-Hill, which helped us to improve
the manual with each edition.

Kent R. Olson, MD
San Francisco, California
September 2017

MCGH396-FM_i-xiv.indd 14 09/10/17 11:27 AM


Another Random Document on
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for the information of our representatives aforesaid.

"In the first place there arose in the provinces of Chih Li


and Shantung a kind of rebellious subjects who had been in the
habit of practicing boxing and fencing in their respective
villages, and at the same time clothing their doings with
spiritualistic and strange rites. The local authorities failed
to take due notice of them at the time. Accordingly the
infection spread with astonishing rapidity. Within the space
of a month it seemed to make its appearance everywhere, and
finally even reached the capital itself. Everyone looked upon
the movement as supernatural and strange, and many joined it.
Then there were lawless and treacherous persons who sounded
the cry of 'Down with Christianity!' About the middle of the
fifth moon these persons began to create disturbances without
warning. Churches were burned and converts were killed. The
whole city was in a ferment. A situation was created which
could not be brought under control. At first the foreign
Powers requested that foreign troops be allowed to enter the
capital for the protection of the legations. The imperial
government, having in view the comparative urgency of the
occasion, granted the request as an extraordinary mark of
courtesy beyond the requirements of international intercourse.
Over five hundred foreign troops were sent to Pekin. This
shows clearly how much care China exercised in the maintenance
of friendly relations with other countries.

"The legations at the capital never had much to do with the


people. But from the time foreign troops entered the city the
guards did not devote themselves exclusively to the protection
of their respective legations. They sometimes fired their guns
on top of the city walls and sometimes patrolled the streets
everywhere. There were repeated reports of persons being hit
by stray bullets. Moreover they strolled about the city
without restraint, and even attempted to enter the Tung Hua
gate (the eastern gate of the palace grounds). They only
desisted when admittance was positively forbidden. On this
account, both the soldiers and the people were provoked to
resentment, and voiced their indignation with one accord.
Lawless persons then took advantage of the situation to do
mischief, and became bolder than ever in burning and killing
Christian converts. The Powers thereupon attempted to
reinforce the foreign troops in Pekin, but the reinforcements
encountered resistance and defeat at the hands of the
insurgents on the way and have not yet been able to proceed.
The insurgents of the two provinces of Chih Li and Shantung
had by this time effected a complete union and could not be
separated. The imperial government was by no means reluctant
to issue orders for the entire suppression of this insurgent
element. But as the trouble was so near at hand there was a
great fear that due protection might not be assured to the
legations if the anarchists should be driven to extremities,
thus bringing on a national calamity. There also was a fear
that uprisings might occur in the provinces of Chih Li and
Shantung at the same time, with the result that both foreign
missionaries and Chinese converts in the two provinces might
fall victims to popular fury. It was therefore absolutely
necessary to consider the matter from every point of view.

"As a measure of precaution it was finally decided to request


the foreign ministers to retire temporarily to Tien-Tsin for
safety. It was while the discussion of this proposition was in
progress that the German minister, Baron Von Ketteler, was
assassinated by a riotous mob one morning while on his way to
the Tsung-Li-Yamen. On the previous day the German minister
had written a letter appointing a time for calling at the
Tsung-Li-Yamen. But the Yamen, fearing he might be molested on
the way, did not consent to the appointment as suggested by
the minister. Since this occurrence the anarchists assumed a
more bold and threatening attitude, and consequently 'it was
not deemed wise to carry out the project of sending the
diplomatic corps to Tien-Tsin under an escort. However, orders
were issued to the troops detailed for the protection of the
legations to keep stricter watch and take greater precaution
against any emergency.

"To our surprise, on the 20th of the fifth moon (June 16th),
foreign (naval?) officers at Taku called upon Lo Jung Kwang,
the general commanding, and demanded his surrender of the
forts, notifying him that failing to receive compliance they
would at two o'clock the next day take steps to seize the
forts by force. Lo Jung Kwang, being bound by the duties of
his office to hold the forts, how could he yield to the
demand? On the day named they actually first fired upon the
forts, which responded, and kept up fighting all day and then
surrendered. Thus the conflict of forces began, but certainly
the initiative did not come from our side. Even supposing that
China were not conscious of her true condition, how could she
take such a step as to engage in war with all the Powers
simultaneously? and how could she, relying upon the support of
anarchistic populace, go into war with the Powers?

{115}

"Our position in this matter ought to be clearly understood by


all the Powers. The above is a statement of the wrongs we have
suffered, and how China was driven to the unfortunate position
from which she could not escape. Our several ministers will make
known accurately and in detail the contents of this decree and
the policy of China to the ministers of foreign affairs in
their respective countries, and assure them that military
authorities are still strictly enjoined to afford protection
to the legations as hitherto to the utmost of their power. As
for the anarchists they will be as severely dealt with as
circumstances permit. The several ministers will continue in
the discharge of the duties of their office as hitherto
without hesitation or doubt. This telegraphic decree to be
transmitted for their information. Respect this."

CHINA: A. D. 1900 (June-July).


Failure of attempt to entrust Japan with the rescuing of
the Legations at Peking.

A British Blue Book, issued on the 18th of February, 1901,


contains correspondence that took place between the Powers
late in June and early in July, looking to an arrangement for
the immediate sending of a large force from Japan to the
rescue of the beleaguered Legations in Peking. As summarized
in the "London Times," this correspondence showed that "the
necessity of asking the help of the only Power that was near
enough to intervene promptly was strongly pressed by Lord
Salisbury on the other Powers in the beginning of July. M.
Delcassé fell in entirely with the scheme and insisted on the
need of putting aside all jealousies or afterthoughts which
might hinder unity of action on the spot. The Russian
Government, however, seems to have misunderstood Lord
Salisbury's meaning and to have conceived him to wish Japan to
settle the Chinese crisis by herself and with a view to her
own interests, a misunderstanding which it required a whole
series of despatches to clear up completely. The Japanese
Government itself showed the most commendable readiness to
act, and on July 11 Mr. Whitehead telegraphed from Tokio, in
reply to an appeal from Lord Salisbury to the Japanese
Government, that 'in consequence of the friendly assurances'
given by Lord Salisbury the Japanese Government had decided to
send one or two more divisions to China. To this Lord
Salisbury replied on July 13 that her Majesty's Government
were willing to assist the Japanese Government up to
£1,000,000 if they at once mobilized and despatched an
additional 20,000 men to Peking. But the latter, in the
absence of any definite scheme of operations on the part of
the Powers, showed an unwillingness to accede to this
proposal, which thus fell through."

CHINA: A. D. 1900 (June-August).


The siege of the Foreign Legations at Peking.
The story of two dreadful months as told by one of the besieged.
The most detailed and altogether best account of the dreadful
experience which the foreigners besieged in the quarter of the
Legations at Peking underwent, from the first week in June
until the 14th day of August, when a rescuing army forced its
way into the city, is that furnished to the "London Times" by
its Peking correspondent, who was one of the besieged. His
narrative, forwarded immediately upon the opening of
communication with the outer world, was published in "The
Times" of October 13 and 15. With some abridgment it is given
here under permission from the Manager of "The Times."

"Missionaries in Peking began collecting together into the


larger mission compounds for common protection. Many ladies
went for safety into the British Legation. Railway
communication was now severed and the telegraph communication
threatened. Our isolation was being completed. In the country
disaffection spread to the districts to the east of Peking,
and the position of the American missionaries at Tung-chau
became one of great danger. It was decided to abandon their
great missionary establishments, and with the native
Christians that could follow them to come into Peking. They
asked for an escort, but Mr. Conger felt himself compelled to
decline one, on the ground that he did not venture to send the
small body of men that he could spare from the Legation
through so dangerous a district. Protection must be looked for
from the Chinese Government. What soldiers could not be sent
to do one fearless American missionary succeeded in doing.
Late in the evening of June 7 the Rev. W. S. Ament, of the
Board Mission, left Peking in a cart, and with 20 other carts
journeyed 14 miles to Tung-chau through a country palpitating
with excitement. It was an act of courage and devotion that
seemed to us who knew the country a deed of heroism. His
arrival was most opportune. He brought safely back with him to
Peking the whole missionary body then in Tung-chau—five men,
including the author of 'Chinese Characteristics,' 11 ladies,
and seven children, together with their Christian servants. …
"More troops were sent for to reinforce the Legation guards in
Peking, but they were sent for too late. Already many miles of
the railway had been torn up, and it was hopeless to expect an
early restoration of communication. … The Empress-Dowager and
the Emperor, who had been for some time past at the Summer
Palace, returned to Peking, entering the city at the same hour
by different gates. Large escorts of cavalry and infantry
accompanied them; Manchu bannermen in large numbers were
posted on the walls. It was noticeable that the body-guard of
the Empress was provided by the renegade Mahomedan rabble of
Tung-fuh-siang, who had long been a menace to foreigners in
the province. The return of the Court was expected to have a
tranquillizing effect upon the populace. But this was not the
case. Students were attacked when riding in the country; our
race-course, grand stand, and stables were burnt by 'Boxers'
armed with knives; Europeans could not venture along the
streets outside the foreign quarter without being insulted.
People were saying everywhere, 'The foreigners are to be
ended.' Streets were being patrolled by cavalry, but there was
every fear that the patrols were in league with the 'Boxers,'
who were marching through the streets bearing banners
inscribed 'Fu Ching Mieh Yang.' 'Protect Pure (the Dynasty),
exterminate the foreigner.'

"The London Mission and the Society for the Propagation of the
Gospel handed over their buildings to the Chinese authorities,
holding them responsible for their safe keeping, and all
missionaries and their families went to the British Legation.
The American Board Mission likewise delivered over their
valuable property to the Government and fell back upon the
great Methodist Episcopalian Mission near the Hata Mên Gate,
beyond the foreign quarter. Tung-chau missionaries and their
families and several hundred Christian converts were already
gathered there. Steps were at once taken to fortify the
compound. Under the direction of Mr. F. D. Gamewell deep
trenches were cut, earthworks thrown up, and barbed-wire
entanglements laid down.
{116}
Watch was kept and sentries posted, provisions laid in, and
all preparations made to withstand a siege. Twenty marines and
a captain from the American Legation were sent as a guard, and
some spare rifles were obtained from the British Legation.
Converts were armed with pikes and knives, and a determined
effort was to be made in case of attack. The mission was,
however, absolutely at the mercy of any force holding the high
city wall and Hata Mên Gate. Without the power of reply the
small garrison could have been shot down from the wall, which
is little more than a stone's throw from the nearest point of
the compound. Shell-fire such as was subsequently used against
the Legations would have smashed the buildings into fragments.
All the Maritime Customs staff and their families living in
the East City, a mile or more beyond the foreign quarter, the
professors and teachers of the Tung-wen-Kuan, Dr. Dudgeon, Mr.
Pethick, the secretary of Li Hung Chang, and others, were
forced to abandon their homes and come in for protection.
Preparations for defence went on at all the Legations, for it
was now inevitable that we should have to fight. A 'conseil de
guerre' was held, attended by all the military officers, and a
plan of defence determined. The palace and grounds of Prince
Su, opposite the British Legation, were to be held for the
Christian refugees, and an area was to be defended some half a
mile long by half a mile broad, bounded by the Austrian and
Italian Legations to the east, the street running over the
north bridge of the canal to the north, the British, Russian,
and American Legations to the west, while the southern
boundary was to be the street running at the foot of the great
City Wall from the American Legation on the west, past the
German Legation on the east, to the lane running from the Wall
north past the French Legation, the buildings of the
Inspectorate General of Customs, and the Austrian Legation.
All women and children and non-combatants were to come into
the British Legation. Each position was to be held as long as
possible, and the final stand was to be made at the British
Legation. No question of surrender could ever be entertained,
for surrender meant massacre.

"On the 10th it was announced that reinforcements were on the


way and that they were coming with the approval of the Viceroy
and of the Chinese Government, an approval more readily
accorded since it was known to the Viceroy that the troops
could not come by train. More than one of the Ministers was so
confident that they were coming that carts were sent to await
their arrival at Machia-pu, the terminal railway station at
Peking. … Then Government gave its first public official
recognition of the 'Boxers' by announcing that the notorious
chief of the 'Boxers,' Prince Tuan, had been appointed
President of the Tsung-li-Yamên. Prince Ching was superseded
but was not removed from the Yamên. One harmless old Chinese,
Liao Shou-hêng was sent into retirement while four rabidly
anti-foreign Manchus entirely ignorant of all foreign affairs
were appointed members. The last hope of any wisdom springing
from the Yamên disappeared with the supersession of Prince
Ching by the anti-foreign barbarian who, more than any other
man in China, was responsible for the outbreak. The following
morning most of the Europeans rode to Machia-pu to await the
arrival of the foreign troops. They waited, but no troops
came, and then rode back past the jeering faces of hordes of
Chinese soldiers. Our security was not increased by this
fiasco.

"Soldiers sent to guard the summer residences of the British


Legation in the Western Hills left their posts during the
night. The buildings had been officially placed under the
protection of the Imperial Government. In the pre-arranged
absence of the soldiers the buildings were attacked by
'Boxers' and entirely burnt to the ground; the soldiers
witnessed if they did not assist in the burning. But worse
events were to happen that day. In the afternoon news passed
through Peking that Mr. Sugiyama, the Chancellor of the
Japanese Legation, had been murdered by soldiers. He had been
sent by his Minister a second time to Machia-pu to await the
arrival of the troops. Passing unarmed and alone in his cart
beyond the Yung-ting Mên, the outer gate on the way to the
station, he was seized by the soldiers of Tung-fuh-siang,
dragged from his cart, and done to death in the presence of a
crowd of Chinese who witnessed his struggles with unpitying
interest and unconcealed satisfaction. …

"On the 12th a deputation, consisting of Chi Hsiu, a member of


the Grand Council and newly appointed to the Yamên, Hsu
Ching-chêng, the ex-Minister, the 'Boxer' leader Chao
Shu-chiao, and another Manchu, called upon the British
Minister. Chi Hsiu made a long address, his theme being the
enduring nature of the friendship between China and England
and the duty which China has always recognized as a sacred
obligation to protect the members of the Legations who were
her guests and the strangers within her walls. Chi Hsiu
assured the Minister that the movement was at an end, that all
was now tranquil, and that there was no more reason to fear.
Yet the very next day Baron von Ketteler himself captured a
'Boxer' from amid the crowd in Legation-street. He carried the
consecrated headpiece, and was armed with a sword. Round his
waist he had a belt containing a talisman of yellow paper
smeared with mystic red symbols by which he was rendered
'impermeable to foreign bullets.' And in the afternoon the
'Boxers' came down in force from the north of the city and the
burning of foreign buildings began. The cry arose that the
'Boxers' were coming. Every man ran to his post, a cordon was
established round the foreign quarter and no one was allowed
to pass. Guards were on watch at all the Legations, but their
numbers, spread over so many posts, were very inadequate, and
they were still further reduced by the guards detached for
duty at the Pei-tang Cathedral, where, three miles distant
within the Imperial City, were gathered in the one great
compound Mgr. Favier, the Bishop, his coadjutor, Mgr. Jarlin,
the missionaries and lay brothers, the sisters of charity, and
a vast concourse of Christian refugees, estimated at 2,000,
who had fled from the massacre in the country. A guard of five
Austrians was sent to the Belgian Legation. The Austrians with
their machine gun commanded the Customs-street leading to the
north: the Italians with a one pounder commanded the
Legation-street to the east. The British with their
Nordenfeldt swept the Canal-street to the north and the
North-bridge, the Russians were on the South-bridge, while the
Americans with their Colt machine gun had command of
Legation-street to the west as far as the court facing the
Imperial Palace. The Russians, having no gun, dropped their
heavy ammunition down the well.

{117}

"As darkness came on the most awful cries were heard in the
city, most demoniacal and unforgettable, the cries of the
'Boxers,' 'Sha kweitze'—'Kill the devils'—mingled with the
shrieks of the victims and the groans of the dying. For
'Boxers' were sweeping through the city massacring the native
Christians and burning them alive in their homes. The first
building to be burned was the chapel of the Methodist Mission
in the Hata Mên-street. Then flames sprang up in many quarters
of the city. Amid the most deafening uproar the Tung-tang, or
East Cathedral, shot flames into the sky. The old Greek Church
in the north-east of the city, the London Mission buildings,
the handsome pile of the American Board Mission, and the
entire foreign buildings belonging to the Imperial Maritime
Customs in the East City burned throughout the night. It was
an appalling sight. Late in the night a large party of
'Boxers' bearing torches were seen moving down Customs-street
towards the Austrian Legation. The machine gun mounted was in
waiting for them. They were allowed to come within 150 yards
in the open street near the great cross road, and then the
order was given and the gun rained forth death. It was a
grateful sound. The torches disappeared. They had come within
a restricted space, and none, we thought, could have escaped.
Eagerly we went forth to count the dead, expecting to find
them in heaps. But there was not one dead. The gun had been
aimed very wide of the mark. Two hundred yards north of the
'Boxers' there is a place where 30 ft. above the level road
the telegraph wires crossed to the station. Next morning they
were found to have been cut by the Austrian fire. The only
persons who suffered injury were possible wayfarers two miles
up the street. There can be little doubt that this fiasco
helped to confirm the Boxers in a belief in their
invulnerability.

"The Tung-tang, or East Cathedral, having been burned, it, was


clear that the Nan-tang, the South Cathedral, was in danger.
Père Garrigues, the aged priest of the Tung-tang, had refused
to leave his post and had perished in the flames. But the
fathers and sisters at the Nan-tang might yet be saved. Their
lives were in great peril; it was necessary to act quickly. A
party of French gentlemen, led by M. Fliche of the French
Legation and accompanied by M. and Mme. Chamot, rode out at
night, and early the following morning safely escorted to the
hotel every member of the mission—Père d' Addosio and his two
colleagues, a French brother, five sisters of charity, and
some twenty native nuns of the Order of Josephine. They were
rescued just in time. Scarcely had they reached a place of
safety when the splendid edifice they had forsaken was in
flames. … It continued burning all day, the region round it,
the chief Catholic centre of Peking, being also burnt. Acres
of houses were destroyed and the Christians in thousands put
to the sword. …

"On the 15th rescue parties were sent out by the American and
Russian Legations in the morning, and by the British and
German Legations in the afternoon, to save if possible native
Christians from the burning ruins around the Nan-tang. Awful
sights were witnessed. Women and children hacked to pieces,
men trussed like fowls, with noses and ears cut off and eyes
gouged out. Chinese Christians accompanied the reliefs and ran
about in the labyrinth of network of streets that formed the
quarter, calling upon the Christians to come out from their
hiding-places. All through the night the massacre had
continued, and 'Boxers' were even now shot redhanded at their
bloody work. But their work was still incomplete, and many
hundreds of women and children had escaped. They came out of
their hiding-places crossing themselves and pleading for
mercy. It was a most pitiful sight. Thousands of soldiers on
the wall witnessed the rescue; they had with callous hearts
witnessed the massacre without ever raising a hand to save.
During the awful nights of the 13th and 14th Duke Lan, the
brother of Prince Tuan, and Chao Shu-Chiao, of the
Tsung-li-Yamên, had followed round in their carts to gloat
over the spectacle. Yet the Chinese Government were afterwards
to describe this massacre done under official supervision
under the very walls of the Imperial Palace as the handiwork
of local banditti. More than 1,200 of the poor refugees were
escorted by the 'foreign devils' to a place of safety. Many
were wounded, many were burnt beyond recognition. All had
suffered the loss of every thing they possessed in the world.
They were given quarters in the palace grounds of Prince Su,
opposite the British Legation. Among them was the aged mother
and the nephew of Ching Chang, recently Minister to France,
and now Chinese Commissioner to the Paris Exhibition. The
nephew was cruelly burnt; nearly every other member of the
family was murdered. A Catholic family of much distinction—a
family Catholic for seven generations—was thus almost
exterminated and its property laid in ashes. It was announced
this day that only 'Boxers' might enter the Imperial City. The
Government was rushing headlong to its ruin.

"On June 16 a party of twenty British, ten Americans, and five


Japanese, with some Volunteers, and accompanied by
Lieutenant-Colonel Shiba, the Japanese military attache,
patrolled the East City, visiting the ruins in the hopes that
some Christians might yet be in hiding. But to our calls
everywhere no reply was given. Refugees, however, from the
East City had managed to escape miraculously and find their
way, many of them wounded, to the foreign Legations, seeking
that protection and humanity that was denied them by their own
people. As the patrol was passing a Taoist temple on the way,
a noted 'Boxer' meeting place, cries were heard within. The
temple was forcibly entered. Native Christians were found
there, their hands tied behind their backs, awaiting execution
and torture. Some had already been put to death, and their
bodies were still warm and bleeding. All were shockingly
mutilated. Their fiendish murderers were at their incantations
burning incense before their gods, offering Christians in
sacrifice to their angered deities. They shut themselves
within the temple, but their defence availed them nothing.
Everyone of them, 46 in all, was in 'Boxer' uniform armed with
sword and lance. Retribution was swift; every man was shot to
death without mercy. In the afternoon a fire broke out in the
foreign drug store in the native city outside the great gate
of the Chien Mên.
{118}
It was the work of 'Boxers,' done while the soldiers were
looking on. In order to burn the foreign drug store and do the
foreigners a few pounds worth of damage, they did not hesitate
to jeopardize by fire property worth millions of pounds, and that
is what happened. Adjoining buildings took fire, the flames
spread to the booksellers' street, and the most interesting
street in China, filled with priceless scrolls, manuscripts,
and printed books, was gutted from end to end. Fire licked up
house after house, and soon the conflagration was the most
disastrous ever known in China, reducing to ashes the richest
part of Peking, the pearl and jewel shops, the silk and fur,
the satin and embroidery stores, the great curio shops, the
gold and silver shops, the melting houses, and nearly all that
was of the highest value in the metropolis. Irreparable was
the damage done. …

"During the night the Americans, fearing an attack from the


street at the back of their Legation, kept the street clear
till daybreak. During one of the volleys four of the
Tsung-li-Yamên Ministers called upon the American Minister.
They were blandly assuring him that all was now quiet, that
there was no need for further alarm, that great was the
tenderness of the Throne for men from afar, when a rattle of
musketry was heard which rendered them speechless with fear.
They hurriedly went away. Assurances of the Throne's
tenderness did not deceive us. Our barricades were everywhere
strengthened and defences systematically planned, for rumour
was quick to reach us that the relief forces had been driven
back to Tien-tsin, and this did not add to the security of our
position. Inside the Imperial City wall, within one hundred
yards of the British picket on the north bridge a large
Chinese camp was formed. Peking was in a state of panic, all
the streets near the foreign quarters were empty, and people
were fleeing from the city. There was a run on the banks, and
the Ssu-ta-hêng, the four great banks, the leading banks of
Peking, closed their doors, and paper money was not in
circulation. The Palace of Prince Su was occupied by the
refugees, and its defence, the most important of all and a
vital one to the British Legation, was entrusted to Colonel
Shiba and Japanese marines and volunteers.

"The crisis was approaching. On the morning of June 19 Mr.


Cordes, the Chinese Secretary of the German Legation, was at
the Yamên, when the secretaries told him that the allied
fleets had taken the Ta-ku forts on June 17. This was
remembered when at 4.30 in the afternoon an ultimatum was sent
to the foreign Ministers. It was a bolt from the blue. They
were to leave Peking within 24 hours. 'A despatch,' they
wrote, 'has arrived from the Viceroy Yu Lu, forwarding a note
which he has received from the doyen of the Consular body in
Tien-tsin, the French Comte du Chaylard, to say that, unless
foreign troops are at once permitted to land at Tien-tsin, the
allied fleets will bombard the Ta-ku forts. As this is
equivalent to a declaration of war, the Tsung-li-Yamên
herewith notify the foreign Ministers that they must leave
Peking within 24 hours, otherwise protection cannot be
guaranteed to them. They will be given safe conduct and
transport.' It was quite in accordance with Chinese custom
that a despatch saying that the seizure of the Ta-ku forts had
been threatened should be sent after the seizure had been
effected. What is distasteful to them to say they avoid
saying. A meeting of the diplomatic body was at once held. It
was decided to accept the ultimatum. They had been given their
passports by the Chinese Government; what other course was
open to them? … Word was passed round that preparation had to
be made to leave Peking the following day. Mr. Conger, the
American Minister, asked for 100 carts; and his Legation spent
most of the night making preparations. No packing was done at
the British Legation, for it was there considered
inconceivable that China should insist upon sending the
Ministers their passports. Only two days before, in the
'Peking Gazette' of June 17, it had been officially announced
that the road to Tien-tsin was unsafe. … When the decision of
the Diplomatic Body became known in Peking the most profound
indignation was everywhere expressed at so unworthy a decision
and the most profound astonishment that such a course of
action should have received the support of M. Pichon, the
French Minister 'Protecteur des Missions Catholiques en
Chine,' and of so humane a man as Mr. Conger, the American
Minister; for to leave Peking meant the immediate abandonment
to massacre of the thousands of native Christians who had
trusted the foreigner and believed in his good faith.

"Early on the morning of the 20th a meeting of the Diplomatic


Body was held at the French Legation. No reply had been
received from the Tsung-li-Yamên to the request for an
audience, and the proposition that all the Ministers should go
to the Yamên found no seconder. Had it been carried out, there
would have occurred one of the most appalling massacres on
record. Two chairs later left for the Yamên. In the first was
the German Minister, Baron van Ketteler, who had this
advantage over the other Ministers, that he spoke Chinese
fluently. In the second was the Chinese Secretary of the
German Legation, Mr. Cordes. News travels quickly in Peking.
Not many minutes later my boy burst into my office—'Any man
speakee have makee kill German Minister!' It was true. The
German Minister had been assassinated by an Imperial officer.
The Secretary had been grievously wounded, but, running for
his life, shot at by a hundred rifles, had escaped as if by a
miracle. A patrol of 15 men under Count Soden, the commander,
went out to recover the body. Fired on by Chinese soldiers
from every side, they were forced to retire. … There was no
more question about leaving for Tien-tsin. Later in the day
the Yamên, evidently indifferent to the gravity of the
position created by the Government, sent an impudent despatch
to the German Legation to the effect that two Germans had been
proceeding in chairs along the Hata Mên-street, and at the
mouth of the street leading to the Tsung-li-Yamên one of them
had fired upon the crowd. The Chinese had retaliated and he
had been killed. They wished to know his name. No reply was
sent, for it was felt to be a mockery. Only too well the Yamên
knew whom they had murdered. Weeks passed before the body was
recovered, and it was not until July 18 that any official
reference was made to the murder. In the course of the morning
a despatch was sent to the Diplomatic Body in reply to the
answer they had sent to the ultimatum of yesterday.
{119}
The country, it said, between Peking and Tien-tsin was overrun
with brigands, and it would not be safe for the Ministers to go
there. They should therefore remain in Peking. It is difficult
to write with calmness of the treachery with which the Chinese
were now acting. Four p. m. was the hour given in the ultimatum
for the Ministers to vacate their Legations, but the ultimatum
had been rescinded, and the Ministers invited to remain in
Peking. Thus it was hoped that they would be lulled into a
false security. Chinese soldiers were secretly stationed under
cover at every vantage point commanding the outposts. At 4 p.
m. precisely to the minute, by preconcerted signal, they
opened fire upon the Austrian and French outposts. A French
marine fell shot dead through the forehead. An Austrian was
wounded. The siege had begun.
"At this time (June 20), at the opening of the siege, the
total strength of the combined Legation guards consisted of 18
officers and 389 men, distributed as follows:

"American.
Three officers, Captain Myers in command, Captain Hall,
Surgeon Lippett, and 53 marines from the Newark.

"Austrian.
Five officers, Captain Thomann, the Commander of the Zenta,
Flag-Lieutenant von Winterhalder, Lieutenant Kollar,
two mid-shipmen, and 30 marines from the Zenta.

"British.
Three officers, Captain B. M. Strouts in command,
Captain Halliday, Captain Wray, and 79 men R. M. L. I.
-30 from H. M. S. Orlando and 49 from Wei-hai-wei.

"French.
Two officers, Captain Darcy and Midshipman Herbert, and
45 marines from the D'Entrecasteaux and Descartes.

"German.
Lieutenant Graf Soden and 51 marines of the
3rd Battalion Kiao-chau.

"Italian.
Lieutenant Paolini and 28 blue-jackets from the Elba.

"Japanese.
Lieutenant Hara and 24 marines from the Atago.

"Russian.
Two officers, Lieutenant Baron von Rahden and Lieutenant
von Dehn, and 79 men—72 marines from the Sissoi Veliki and
Navarin and seven Legation Cossacks.
"Total,
18 officers and 389 men.

"In addition the French sent Lieutenant Henry and 30 men to


guard the Pei-tang Cathedral, and the Italians detached one
officer, Lieutenant Cavalieri, and 11 men for the same humane
mission. To this insignificant force of 18 officers and 389
men of eight nationalities the entire foreign quarter had to
trust for its defence. Fortunately several visitors or
residents had received military training, and they at once
went on the active list and rendered invaluable service. … A
volunteer force numbering altogether 75 men, of whom 31 were
Japanese, was enrolled and armed with all available rifles.
They added greatly to the strength of the garrison, taking
watch and watch like the Regulars, fighting behind the
barricades, and never shrinking from any duty imposed upon
them. There was also an irregular force of 50 gentlemen of
many nationalities, who did garrison guard duty in the British
Legation and were most useful. They were known, from the
gentleman who enrolled them, as 'Thornhill's Roughs,' and they
bore themselves as the legitimate successors on foot of
Roosevelt's Roughriders. Armed with a variety of weapons, from
an elephant rifle to the 'fusil de chasse' with a picture of
the Grand Prix, to all of which carving knives had been lashed
as bayonets, they were known as the 'Carving Knife Brigade.' …
Such were the effective forces. They were provided with four
guns, an Italian one-pounder with 120 rounds, an American Colt
with 25,000 rounds, an Austrian machine gun, and a British
five-barrel Nordenfelt, pattern 1887. Rifle ammunition was
very scanty. The Japanese had only 100 rounds apiece, the
Russians 145, and the Italians 120, while the best provided of
the other guards had only 300 rounds per man, none too many
for a siege the duration of which could not be foreseen.

"Punctually, then, at 4 o'clock Chinese soldiers began firing


upon us whom they had requested to remain in peace at Peking.
And immediately after the Austrian Legation was abandoned. No
sufficient reason has been given for its abandonment, which
was done so precipitately that not an article was saved. It
was left to the mercy of the Chinese, and the guard retired to
the corner of Customs-lane, leading west to the Prince's
Palace. This involved the sacrifice of Sir Robert Hart's and
all the Customs buildings, and hastened the advance of the
Chinese westward. As previously arranged, the American mission
buildings had been abandoned in the morning, for they were
quite untenable. All the missionaries, their wives, and
families crossed over to the British Legation. Converts to the
number of several hundreds joined the other refugees. The
captain and 20 American marines returned to the American
Legation. By an error of judgment on the part of the captain
the mission was finally left in a panic. Almost nothing was
saved, and nearly all the stores accumulated for a siege were
lost. The British Legation was now thronged. Rarely has a more
cosmopolitan gathering been gathered together within the limits
of one compound. All the women and children were there, all
the missionaries, American, British, French, and Russian, all
the Customs staff, the French, Belgian, Russian, American,
Spanish, Japanese, and Italian Ministers, and their families,
the entire unofficial foreign community of Peking, with the
exception of M. Chamot, who remained in his hotel throughout,
though it was in the hottest corner of the besieged area. …
French volunteers bravely stood by their own Legation, and the
Austrian Charge d'Affaires and Mme. von Rosthorn remained there
as long as there was a room habitable. Mr. Squiers, the first
Secretary of the American Legation, with Mr. Cheshire, the
Chinese Secretary, and Mr. Pethiek, the well-known private
secretary of Li Hung Chang, stayed by the United States
Legation, and the staff of the German Legation also kept
stanchly to their posts. … At the British Legation
fortification began in real earnest, the refugees working like
coolies. Sand-bags were made by the thousand, and posts
mounted round the Legation. A way was knocked through the
houses to the Russian Legation, so that the Americans, if they
had to fall back, could pass through to the British Legation.
During the day every Legation was exposed to a continuous fire
from surrounding house-tops, and in the case of the British
Legation from the cover in the Imperial Carriage Park. Chinese
put flames to the abandoned buildings, and the Belgian
Legation, the Austrian Legation, the Methodist Mission, and
some private houses were burned.

{120}

"June 22 opened disastrously. The evening before, Captain


Thomann, the Austrian commander, announced that as the senior
officer he had taken command in Peking. This morning, hearing
from an irresponsible American that the American Legation was
abandoned, he, without taking steps to verify the information,
ordered the abandonment of all the Legations cast of
Canal-street, the detachments to fall back upon the British
Legation. There had been no casualties to speak of, none of
the Legations had been attacked, and every commander who
received the order to retreat regarded the action as madness.
Peremptory orders were sent to the Japanese to abandon the
Prince's Palace or Fu (as I shall henceforth call it), and
they retired to their Legation. In the British Legation
nothing was known of the order when, to the amazement of all,
the Italians, Austrians, and French came running down
Legation-street, followed a little later by the Japanese, and
subsequently by the Germans, who recalled their post on the
wall and marched without a shot being fired at them down under
the wall to Canal-street. Americans and Russians, learning
that all east of Canal-street had been abandoned, saw
themselves cut off, though their communications had not even
been menaced, and retreated precipitately into the British
Legation. It was a veritable stampede—a panic that might have
been fraught with the gravest disaster. Prompt action was
taken. Captain Thomann was relieved of his command, and Sir
Claude MacDonald, at the urgent instance of the French and
Russian Ministers, subsequently confirmed by all their
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