(Ebook) Get Through MRCGP: Clinical Skills

Assessment 2E by Bruno Rushforth, Val Wass, Valerie

Wass, Adam Firth ISBN 9781444168242, 9781482220148,
144416824X, 1482220148 download pdf

https://ebooknice.com/product/get-through-mrcgp-clinical-skills-
assessment-2e-4767258

Visit ebooknice.com today to download the complete set of

ebook or textbook
 We believe these products will be a great fit for you. Click
the link to download now, or visit ebooknice.com
to discover even more!

(Ebook) Biota Grow 2C gather 2C cook by Loucas, Jason; Viles,

James ISBN 9781459699816, 9781743365571, 9781925268492,
1459699815, 1743365578, 1925268497

https://ebooknice.com/product/biota-grow-2c-gather-2c-cook-6661374

(Ebook) Matematik 5000+ Kurs 2c Lärobok by Lena Alfredsson, Hans

Heikne, Sanna Bodemyr ISBN 9789127456600, 9127456609

https://ebooknice.com/product/matematik-5000-kurs-2c-larobok-23848312

(Ebook) SAT II Success MATH 1C and 2C 2002 (Peterson's SAT II

Success) by Peterson's ISBN 9780768906677, 0768906679

https://ebooknice.com/product/sat-ii-success-math-1c-and-2c-2002-peterson-
s-sat-ii-success-1722018

(Ebook) Master SAT II Math 1c and 2c 4th ed (Arco Master the SAT
Subject Test: Math Levels 1 & 2) by Arco ISBN 9780768923049,
0768923042

https://ebooknice.com/product/master-sat-ii-math-1c-and-2c-4th-ed-arco-
master-the-sat-subject-test-math-levels-1-2-2326094
(Ebook) Cambridge IGCSE and O Level History Workbook 2C - Depth
Study: the United States, 1919-41 2nd Edition by Benjamin
Harrison ISBN 9781398375147, 9781398375048, 1398375144,
1398375047
https://ebooknice.com/product/cambridge-igcse-and-o-level-history-
workbook-2c-depth-study-the-united-states-1919-41-2nd-edition-53538044

(Ebook) Clinical Endocrine Oncology by Ian D. Hay, John A. H.

Wass ISBN 9781405145848, 1405145846

https://ebooknice.com/product/clinical-endocrine-oncology-1397502

(Ebook) Clinical Endocrine Oncology, Second Edition by Ian D.

Hay, John A. H. Wass ISBN 9781405145848, 9781444300222,
1405145846, 1444300229

https://ebooknice.com/product/clinical-endocrine-oncology-second-
edition-4301672

(Ebook) The MRCGP Clinical Skills Assessment (CSA) Workbook by

Monal Wadhera (Author); Rajeev Gulati (Author) ISBN
9780429188831, 9781138447783, 9781846192692, 9781910227770,
9781910227787, 0429188838, 1138447781, 1846192692, 1910227773
https://ebooknice.com/product/the-mrcgp-clinical-skills-assessment-csa-
workbook-12051660

(Ebook) Oxford Handbook of Endocrinology and Diabetes by John

Wass, Katharine Owen ISBN 9780199644438, 0199644438

https://ebooknice.com/product/oxford-handbook-of-endocrinology-and-
diabetes-5893538
 get
through
MRCGP
Clinical Skills Assessment

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 1 11/09/12 1:59 PM

 get
through
MRCGP
Clinical Skills Assessment

Second edition

Bruno Rushforth MA(Cantab) MBChB MA MRCGP DRCOG DFSRH

PG Cert Primary Care Ed
GP and Clinical Research Fellow in Primary Care
University of Leeds

Adam Firth BSc MBChB DTM&H DipPalMed MRES MRCGP

NIHR Academic Clinical Fellow in General Practice
The University of Manchester

Val Wass BSc FRCGP FRCP MHPE PhD

Professor of Medical Education and Head of Keele School of Medicine

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 3 11/09/12 1:59 PM

 CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742

© 2012 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

Version Date: 20130524

International Standard Book Number-13: 978-1-4822-2014-8 (eBook - PDF)

This book contains information obtained from authentic and highly regarded sources. While all reason-
able 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 publish-
ers 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 drug companies’ printed instructions, and their websites, before administering any of the drugs recom-
mended 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 publish-
ers 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, trans-
mitted, 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

© 2012 by Taylor & Francis Group, LLC

 1
Foreword by Jacky Hayden
Foreword by John Howard
Contents
vii
viii
Acknowledgements x
Preparing for the Clinical Skills Assessment: the ‘why’, ‘what’, ‘when’
and ‘how’ xi

Station 1 2

Station 2 12

Station 3 22

Station 4 32

Station 5 42

Station 6 52

Station 7 62

Station 8 72

Station 9 82

Station 10 92

Station 11 102

Station 12 110

Station 13 118

Station 14 128

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 5 11/09/12 1:59 PM

 Station 15 138
Contents

Station 16 146

Station 17 156

Station 18 166

Station 19 176

Station 20 184

Station 21 192

Station 22 202

Station 23 212

Station 24 222

Station 25 230

Station 26 238

Station 27 248

Station 28 258

Station 29 268

Station 30 276

Station 31 286

Station 32 296

Appendix 1 304
Appendix 2 306
Index 309

vi

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 6 11/09/12 1:59 PM

 1 Foreword
When I read the first edition of this book I was impressed by the way that the
authors had helped young doctors, studying to become general practitioners,
understand the complexity of the consultation whilst preparing for the Clinical
Skills Assessment of the MRCGP examination. The second edition builds on
the delightful approach of the successful first edition with new scenarios and
explanations of how to approach clinical situations in general practice and how to
think holistically about patient care in first contact situations.
The book begins with an explanation of the MRCGP CSA and makes suggestions as
to how best to prepare for it, throughout the year and in the days and hours before the
assessment. This is followed by thirty two sections, each of which is intended to represent
a station in the CSA. The scenarios cover a range of common situations encountered in
general practice and offer a complete revision guide with advice on current best practice.
The authors encourage the learner to think about different settings and how
they would approach the presenting problem; readers are encouraged to consider
what might lie behind the presenting problem and how they might use their
interpersonal skills effectively. They are also encouraged to think beyond the
clinical example, reflecting on how, by changing one piece of information, a doctor
might take a different approach to similar presenting symptoms. The book could
be used for individual study or revision, but has been written in a way that also
encourages peer learning and reflection and would be particularly useful as a basis
for group study or for trainers to use with a range of learners in their practice,
helping each to understand complex clinical management.
This edition continues to give insight into the thought processes of our
examiners and it encourages a holistic approach to study rather than a ‘box-ticking’
approach or rote learning. It approaches the CSA positively and encourages trainees
to think about the domains that need to be assessed (and demonstrated) to assure
the public of fitness for completion of training. This edition raises the concept of
‘red flags’ and the importance or recognising less common but very significant
pointers of serious conditions. I particularly liked another new concept: practising a
one-minute explanation of issues encountered in the section. A simple but effective
concept and one that could be used alone, video-recorded or in group learning.
I am certain that the second edition will be as popular as the first; helping
trainers, their registrars and foundation trainees understand and explain the
complexities of patient care in general practice.
Jacky Hayden
Dean of Postgraduate Medical Studies
North Western Deanery and University of Manchester
vii

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 7 11/09/12 1:59 PM

 1 Foreword
This edition is also aimed at Family Doctors [as General Practitioners are more
commonly known outside of the UK] who are preparing to undertake and pass the
MRCGP [INT] examination for the country, or region of the world, where they
work.
We know that, in spite of the wide variety of contexts in which Family Doctors
work worldwide, differing because of the health systems, culture, epidemiology,
language, history and geography, that at least two thirds of what we do is
recognisably similar, while a third is locally specific. These similarities and
differences are acknowledged in the differing curricula for the locally devised
MRCGP [INT] examination sites in the Middle East, South Asia, South East Asia
Pacific, North Africa and Europe.
In the West the ethos of patient-centred consulting has only become widely
established for the past thirty years, with the international evidence for this collated
in the last twenty years and then actively promoted by the World Organisation
of Family Doctors [WONCA] and World Health Organisation [WHO]. The
Royal College of General Practitioners successfully introduced this ethos into the
UK curriculum firstly by means of establishing a video assessment of consulting
skills into the MRCGP examination, which effected tremendous behavioural and
cultural changes in GPs as well as more systematic analysis of the doctor–patient
interaction.
Assessment can therefore drive the learning and the teaching. In a similar
fashion, international pioneers of Family Medicine have developed local curricula
and examinations to assess these, which the Royal College have successfully
accredited with the MRCGP [INT], having similar academic rigour to the UK
orientated MRCGP. These curricula have also recognised the evidence base for
the emphasis on patient centred consulting and this is reflected in the various
communication and clinical skills assessments that the differing MRCGP [INT]
examination sites use, increasingly in the locally used language.
As this book emphasises, unless this ethos and the communication skills that
underpin this are introduced into your own everyday work, merely rehearsing the
learnt phrases for the examination will not be enough for you to succeed in passing
the clinical skills examination for the MRCGP [INT]. The examiners can see
where this ethos has been integrated into a candidate’s own practice by the fluency,
familiarity and personal approach in their interaction with the simulated patients
of the examination.
This book suggests opportunities for you to think imaginatively how the
scenarios may be applied to your own country, health system and culture.
Furthermore, it encourages you to break down the defensive professional

viii

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 8 11/09/12 1:59 PM

 boundaries that we have, by suggesting that you identify and work with like minded

Foreword
colleagues, using the scenarios to rehearse what may initially feel are unfamiliar
attitudes and language.
Feedback from very many successful MRCGP [INT] candidates has
demonstrated how much integrating this approach has improved their own
patient care and professional development, which their patients, community and
professional colleagues will also recognise.

John V Howard FRCGP FRCP

Medical Director, MRCGP [INT] Programme

Royal College of General Practitioners

ix

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 9 11/09/12 1:59 PM

 1 ACKNOWLEDGEMENTS
We would like to thank the following individuals for giving helpful feedback on
earlier drafts of scenarios that we have subsequently updated from the first edition:
Amy Evans, Rafik Taijbee, Wendy Brown, Nicola Cooper, Nat Wright, Jacki Barson,
Linda Cusick, John Hamlin and Amy Grundy. Constructive comments on the new
scenarios and updates for the second edition were kindly provided by Michael
Bennett and Amy Evans. We are particularly indebted to the MRCGP[INT] South
Asia team for the insight they have provided into the needs of candidates sitting
International assessments.
The editorial team at Hodder Education has been supportive throughout and we
are particularly grateful to Hannah Applin, Sarah Penny and Stephen Clausard for
guiding us through the process of producing the second edition.
We thank the individuals and publishing bodies that gave permission for us to
reproduce extracts from their work. All are credited in the text.
Finally, we are very grateful to Arja Kajermo for her observant and witty
illustrations.

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 10 11/09/12 1:59 PM

 1
Preparing for the Clinical
Skills Assessment: the ‘why’,
‘what’, ‘when’ and ‘how’
This introduction outlines the Clinical Skills Assessment (CSA) and offers a strategy
for revision. We consider ‘why’ there needs to be a skills test, and discuss ‘what’ it
involves and ‘when’ to apply to take it. Advice on ‘how’ to use this book to prepare
for the CSA is then given. For this second edition we have expanded the focus.
The book has found an increasing market with readers beyond the UK preparing
for Membership of the Royal College of General Practitioners [International]
(MRCGP[INT]) clinical skills assessments. We offer advice on preparation for
candidates who have qualified abroad and are less familiar with the UK setting and
for those preparing for International examinations, which use simulated patients.

Why a clinical skills assessment?

Formal examinations have come under increasing scrutiny now that it is
acknowledged that assessment on performance in the workplace – i.e. what a
doctor actually does – is the gold standard to aim for. The MRCGP UK is no
exception. There is now considerable emphasis on the e-portfolio of workplace-
based assessment tasks that need to be completed throughout GP specialty training,
supported by discussion and formative review with your trainer.
So why have an examination as well? The reasons are perhaps self-evident. We
cannot yet be assured that assessments of performance are robust. The range of
cases covered using the workplace-based tools will vary widely across different
placements. The challenge of the tasks will differ, as will the quality of judgements
made by assessors. From the patient’s perspective, the e-portfolio alone cannot
assure a licensing body that the training curriculum has been covered. Yet
candidates in the past have not always felt that their trainer has been fair. This can
be difficult in the one-to-one supervision offered by general practice. Inevitably,
examinations must stay. If approached in the right way, they offer a positive
opportunity to consolidate the skills learned through consistent practice during
training and through regular contact with patients.
We cannot emphasize too strongly the importance of applying to take the CSA
only when you feel secure that you have developed the necessary skills through
everyday contact with patients in the cultural context of the country in which
you practise. Assessment is changing. There is an increasing understanding that
the methods selected to assess trainees must complement each other. The results
need to be compared and integrated to ensure that a full and accurate perspective
of the candidate’s ability and level of performance is obtained. It is important
to recognize this when studying for the CSA. Do not approach it in isolation
as separate from the Applied Knowledge Test (AKT) or from your e-portfolio.

xi

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 11 11/09/12 1:59 PM

 The applied evidence-based knowledge tested in the AKT is essential to your
Preparing for the Clinical Skills Assessment

performance in the CSA to demonstrate, for example, that you can use guidelines
to reach appropriate management decisions.
Formative assessments for the e-portfolio and/or group sessions with peers
working towards the formal accreditation should be planned to inform your
preparation. Identical patient-centred, evidence-based, shared management
structures underpin all components of the MRCGP assessments. Workplace-based
assessment and/or peer observation present ideal opportunities to get feedback on
areas you are concerned about. Harness the thinking behind the MRCGP to your
advantage.

View the CSA as part of an assessment package. Do not study for it in isolation.

Tips for preparation for the CSA

●● Ensure that you actively practise in the context in which the CSA is set. It is
important to understand cultural values even in a simulated setting.
●● Integrate preparation with your e-portfolio or keep a reflective diary of your
daily work.
●● Log your consultations. Identify gaps for revision against the curriculum.
●● Video your consultations from early on and discuss these regularly with your
trainer and/or peers.
●● Harness formative assessments with your trainer to develop your CSA skills.
●● Prepare carefully for case-based discussions using the suggested framework.
●● Use COT (Consultation Observation Tool) and DOPS (Direct Observation of
Procedural Skills) assessments to get feedback on all the listed clinical skills.
●● Reflect at the end of every surgery. Identify areas for improvement.
●● Make notes on consultations to use for revision and practise with colleagues.
●● If you have not trained with simulated patients, use role-play with your
supervisor and peers repeatedly to practise.
●● Write your own scenarios for role-play based on actual consultations and the
expanded tasks we have developed for this second edition.

What is the CSA?

The CSA assesses a ‘demonstration’ of how you work when consulting in the
surgery. You are invited to show the examiners how you would manage a range of
simulated consultation scenarios in real life. If you prepare inadequately there is the
danger of artificial rather than authentic performance. You should not rely on short
preparation courses. The patient-centred skills required of clinical skills assessments
cannot be learned this way.
In the past you may have revised for undergraduate Objective Structured
Clinical Examinations (OSCEs) by memorizing checklists for the skills under
test, grooming these on preparation courses or using books such as this one. Your
rehearsed behaviours may not have related to your usual practice. Indeed, it has
been argued that clinical tests can make ‘monkeys of men’, producing ‘tick list’
performances which score highly but are not at all reflective of actual practice.
This can lead to faked behaviours and artificial performance. Preparation for this

xii

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 12 11/09/12 1:59 PM

 examination must be strategic and practice based to avoid this pitfall. Relying

Preparing for the Clinical Skills Assessment

on preparation courses is not enough and misleading. The skills you require are
embedded in your actual practice and can be learned only through face-to-face
contact with real patients.
So why does the MRCGP use an OSCE-type format? Do not be misled. This is
a postgraduate examination and different. Clinical skills tests of general practice
have been designed to test an integrated approach to the consultation based on
real-life experiences. There is no checklist to perform against or expectation of
perfect performance. Your approach should mirror that of daily practice, i.e.
patient-centred consultations resulting in safe and appropriate shared management
decisions. The assessment is designed to be as authentic as possible. We deliberately
offer full, detailed scenarios that reflect the complexity of everyday encounters. The
challenge is to work with the scenarios and practise reaching shared management
decisions within the timed framework of the CSA. There is no ideal model answer.

Prepare in everyday practice: aim for authentic not artificial performance.

Familiarity with a wide range of common presenting problems is essential

across patients of different age, gender, ethnicity and social class. It is important
to understand the cultural context of UK practice. Herein lies a significant
difficulty for doctors trained abroad. Health beliefs, cultural understanding and the
National Health Service (NHS) structure itself are imperceptibly bound into the
consultation. This is why, in contrast to other UK Royal Colleges, the RCGP does
not export the UK examination to other countries. Candidates from abroad found
the old UK MRCGP difficult to pass as they were unfamiliar with the UK context.
General practice consultations depend on the local population mix, which in some
practices may not reflect the full breadth of experience required by the CSA. We
recommend that you discuss this with your trainer and ensure that you acquire the
necessary familiarity with UK patients before you sit the CSA.
Arrange to observe peers in other practices and, if necessary, ensure you consult
in a range of settings. The scenarios in this book have been written to reflect
the breadth of contexts you might meet in the CSA. Tasks have been introduced
to enable you to explore more widely the various ways a patient might present
and offer different permutations for practise. For those sitting International
examinations we suggest ways to modify the scenarios to address the local context
of their work.

The set-up
The UK CSA consists of 13 standardized simulated consultations that test
your ability to integrate consultation and clinical skills or consult with other
professionals within the primary care team at an appropriate level of challenge.
Each consultation is 10 minutes with a 2-minute break in between. The
examination is structured to allow you to feel you are sitting in a surgery with the
simulated patient entering (accompanied by the examiner) to consult with you.
Focus on the patient and ignore the examiner.

xiii

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 13 11/09/12 1:59 PM

 Preparing for the Clinical Skills Assessment

Observe your surroundings carefully on arrival: note the available equipment.

To embrace the full context of primary care the stations may include a telephone
consultation and/or home visit. In the 2-minute break between patients you may be
taken to a telephone which rings at the start of the station, allowing you to consult
with the simulated patient who is placed out of sight accompanied by the examiner.
Alternatively, you may be taken into a room ‘mocked up’ as the patient’s house. At
the end of this station you return to your consultation room.
Dress as you would for formal professional practice, ensuring you respect the
simulators as though they were real patients. At the same time be aware that the
examiners expect your appearance to be compatible with your professional role and
will be assessing your non-verbal as well as your verbal behaviour. We recommend
that you read the advice offered by the RCGP on dress code.

Recommended equipment for your doctor’s bag

You will be asked to bring a doctor’s bag of basic equipment with you. Below is a
summary of what this should include. Remember to take it with you if you move
stations for a home visit consultation.
British National Formulary (BNF)
Stethoscope
Ophthalmoscope
Auroscope
Thermometer
Patella hammer
Peak flow meter and disposable mouth pieces (N.B. These must be European
Union standard)
Tape measure
The BNF cannot be annotated and you are not allowed to take any other equipment
into the consultation room. Any additional items that might be required will be
provided at the assessment centre. When you arrive, you will be asked to transfer
your equipment to a clear plastic wallet before the exam begins.

The consultation process

There will be a set of basic notes for each consultation in a folder on the desk to
read in the break between consultations.

Read the patient information carefully, trying to formulate what is being tested.

A buzzer will sound to mark the beginning and end of each station. After the
first buzzer, the patient will knock on the door or just enter, accompanied by an
examiner. There are clocks in all rooms to help you judge the time. The
consultation ends as soon as the second buzzer sounds – you cannot score any
additional marks after this point. The simulated patient has been trained against a
written script and the content can be covered in the allocated time. The tricky part
is deciding whether a physical examination and/or clinical procedure

xiv

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 14 11/09/12 1:59 PM

 (e.g. peak flow) are required. The examiner may guide you, but do not rely on this.

Preparing for the Clinical Skills Assessment

This is the only point in the process where they may interact. If you feel an intimate
examination is indicated, you can suggest this, although it should not be attempted
unless a model is provided. If you say that you would like to examine the patient,
there are three possibilities:
●● The patient may simply give you a card with the examination findings.
●● The examiner may intervene and state, for example, ‘Assume the chest is clear’.
●● You will be required to carry out the appropriate examination and given any
findings at the end.
The patient may simply give you a card with the examination findings. The examiner
may intervene and state, for example, ‘Assume the chest is clear’. You will be required to
carry out the appropriate examination and given any findings at the end.
This emphasizes the importance of the workplace-based assessments, e.g. COTs,
in developing appropriate focused examinations through being observed and
receiving feedback. Remember to gain consent for any examination and to explain
the procedure to the patient.

Practise focused physical examinations using the workplace-based tools.

The marking system

The examiner silently makes an overall judgement in three performance domains of
your ability:
Domain 1: Interpersonal skills. Integrate eliciting the patient’s agenda and
understanding of the problem with the specific information needed to make a
diagnosis and shared decisions. Scenarios are designed to assess your ability to
handle a range of patient emotions, display ethical practice and demonstrate respect
for equality and diversity.
Domain 2: Data gathering, technical and assessment skills. Elicit the
appropriate information needed to make a clinical judgement on the patient’s
presenting problem, decide whether a physical examination is required and
undertake this, supplementing it with other clinical procedures where appropriate.
Domain 3: Clinical management skills. Recognize and manage common
presenting complaints in general practice. These include undifferentiated problems,
multiple complaints and issues that require a holistic approach to promote healthy
living. You are expected to demonstrate a flexible, evidence-based and structured
approach to decision making with patients.
An overall mark for each station is then given: clear pass, pass, fail or clear fail.
Examiners are trained and have guidelines to standardize marking. However, they
are making ‘global’ rather than ‘checklist’ judgements. They are assessing your
overall, integrated approach to the consultation, not ticking off a list of observed
behaviours. The more experience you have gained in the surgery with your trainer,
the more expert and natural your performance will be. Familiarity with a wide
range of common presenting problems is essential across patients of different age,
gender, ethnicity and social class. Only practice in the workplace will achieve this.
We cannot emphasize enough the intentions of this marking system.

xv

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 15 11/09/12 1:59 PM

 When should you take the CSA?
Preparing for the Clinical Skills Assessment

This is a matter for you and your trainer but it should take place in ST3 at a point
when you have both a sound knowledge base and a fluent, culturally appropriate,
patient-centred consultation style. You must be able to apply guidelines using
evidence-based practice and have sound diagnostic and consultation skills.
Exploring the patient’s agenda fully and formulating a shared patient plan must
emerge naturally within your consultation. This requires experience and training
using video feedback with your trainer and peers. You need to be well grounded in
practice. The examination may feel like ‘the surgery from hell’, but you should have
the experience to feel ‘this is like being at work’. You should also have mastered the
knowledge base needed for general practice.

How does this book support you in preparing for

the CSA?
This second edition of the book offers 32 stations, each with notes. We have
designed a revision strategy to build a framework for your preparation. This aims
to help you transfer skills from everyday practice into the simulated context of
the examination. The notes after each scenario offer ideal approaches that cannot
necessarily be covered fully in 10 minutes. We have aimed to paint a full picture.
Remember, the examiners are not looking for perfect consultations but a sound,
integrated, well-informed and patient-centred approach. Failing to cover all three
domains and reach a shared management outcome with the patient is one of the
most common reasons for failing. We have structured the scenarios to encourage
you to address the areas where candidates commonly have difficulty. The following
table summarizes the behaviours the examiners are looking for and how this book
supports you in achieving these.

Positive behaviours the examiners are looking for How to use this book to achieve this
Approaches logically and sequentially: no non- Practise permutations of the scenarios and tasks
sequential after thoughts within the CSA time frame
Uses open questions to identify the patient’s Make notes of your expectations before and after
agendas you read the scenarios
Uses open to closed questions to gather data and The scenarios illustrate what simulated patients will
reach a diagnosis deliver freely or not
Addresses the patient’s health beliefs and Opportunities to adapt to international practice
preferences
Listens actively to pick up cues fluently Emphasizes need to learn this through real-life
practice
Explains in language a patient can understand Practise the 1-minute explanations and invent your
own
Competent physical examination and use of Scenarios identify which examinations are
instruments appropriate in the CSA setting
Achieves an appropriate differential diagnosis Content illustrates and gives essential knowledge
for common problems

(continued)

xvi

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 16 11/09/12 1:59 PM

 (continued)

Preparing for the Clinical Skills Assessment

Positive behaviours the examiners are looking for How to use this book to achieve this
Achieves a management plan based on the current All scenarios have updated information on current
evidence base evidence-based practice
Applies current NHS practice and governance to NHS context emphasized throughout with
management suggestions extended for non-UK candidates
Makes patients aware of management options and Scenarios contain opportunities to do this with
risks information to assess risk
Addresses health promotion issues wherever Opportunities to do this are embedded in the wide
relevant range of scenarios
Concludes with follow-up and safety-netting Use the scenarios to ensure you can achieve this
arrangements within 9–10 minutes
Manages the time to reach a shared management The detailed scenarios enable different approaches
decision and permutations

After reading the notes, re-run the scenarios, aiming to cover all three domains
within 9 minutes at a ‘realistic’ but not ‘perfect’ level. We must stress the importance
of reaching a shared management conclusion within the time allocated. Aim to do
this well within the 9 minutes. This we feel allows for the anxiety that might delay
you a little in the real examination. We have added tasks to enable you to explore
different patient agendas and, for MRCGP[INT] candidates, to adapt to your own
cultural family medicine context. We are also aware that examiners are looking for
clear, effective explanations to patients to underpin shared management decisions.
We have added suggestions for specific areas where you might like to practise giving
‘lay’ explanations in the constricted time frame you will experience in the CSA. Ask
colleagues to observe and check that you use language a patient will understand. In
addition to the cases in this book, try writing your own scenarios based on patients
you see in surgery. Check the knowledge on which management decisions should
be based and then offer them to colleagues for practice. The CSA is written from
everyday examples and you will find you can do this just as well.
We strongly recommend that you prepare with a group of peers. Candidates
trained in non-UK medical schools may not be familiar with role-play. If this is the
case, ensure that you practise in a group that includes UK-trained peers who are
familiar with learning through role-play and can help you adapt to this as a learning
method. Try to gain experience of working with professional role-players as well.
Opportunities may arise during your vocational training day-release sessions. If
not, discuss the need with your trainer and ensure that you gain some experience in
doing this.
We have structured the scenarios in the book to illustrate how the role-player’s
script can influence the consultation. They are trained to deliver information
with open questioning followed by specific questioning. Keeping the simulated
consultation ‘open’ at the start is therefore essential to gain as much information
as possible before you ask more specific questions (see below, Step 3). This, of
course, reflects real life and the importance of eliciting the patient’s agenda in your
day-to-day work in the surgery. However, role-play does feel different alongside
the time pressures of the CSA consultation and we recommend that you become

xvii

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 17 11/09/12 1:59 PM

 familiar with this practice, which is now used extensively in UK medical schools for
Preparing for the Clinical Skills Assessment

communication skills training.

Step 1: Build a revision framework from the two test grids (see
Appendices 1 and 2)
The scope of the curriculum is large. It is important that you revisit this regularly
on the RCGP website (www.rcgp.org.uk). We have designed grids to illustrate.
The skills being tested are devised from the marking criteria:

Category of skill

Gender Age Skills in Ongoing Clinical Health Diversity and Dealing with
mix mix diagnosis management practical promotion ethical issues patients’
skills skills emotions

The contexts of common presentations that will be covered based on the

curriculum.

Key for test grids: contexts covered based on the curriculum

Cardiovascular problems (CVD)

Digestive problems (GI)
Ear, nose and throat, and facial problems (ENT)
Eye problems (Eye)
Metabolic problems (Endo)
Neurological problems (Neuro)
Respiratory problems (Resp)
Rheumatology, musculoskeletal and trauma (Rheum)
Skin problems (Derm)
Genetics in primary care (Gene)
Care of acutely ill people (Acute)
Care of children and young people (Paed)
Care of older adults (Geri)
Women’s health (F)
Men’s health (M)
Sexual health (Sex)
Care of people with cancer and palliative care (Pall)
Care of people with mental health problems (Psy)
Drug and alcohol problems (Drug use)
Healthy people: promoting health and preventing disease (H Pro)
Care of people with learning disabilities (Learn dis)

We suggest that you build a portfolio of consultations in your practice using these
grids to identify the gaps in presentation and management that you need to cover
before sitting the CSA.

xviii

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 18 11/09/12 1:59 PM

 Preparing for the Clinical Skills Assessment
Develop a grid to plot your consultations; identify gaps for revision.

Step 2: Build a framework to formulate what the simulated

consultation is testing
On first reading the station instructions to candidates, we encourage you to jot
down, in the space provided, your initial thoughts on what is being tested before
you read on. Commit yourself to doing this in anticipation of doing this in the CSA
itself.
The full simulated patient scenario is then included to illustrate the importance
of eliciting a comprehensive patient narrative to fully assess the purpose of the
station. If you do not do this, key areas may be missed.

Practise eliciting full patient narratives to ensure that you don’t miss hidden agendas.

Step 3: Work with the simulated patient

The simulated patient script has an additional purpose. Just as in real life a patient
presents with a narrative (and we have encouraged you to record the ones you
encounter in practice), so does the simulated patient. In the CSA these scenarios
have been scripted to give the information needed to formulate diagnoses and
management plans in the areas being tested. The simulated patient is not going
to play ‘cat and mouse’ as patients sometimes unwittingly do. The information
you require is in front of you, waiting to be elicited. Ask open questions and the
simulated patient can respond only as scripted. Responses to direct closed questions
are also highlighted to illustrate the integration of data gathering into the interview.
We use the scenario to highlight that it is crucial to listen sensitively in the initial
phases of the consultation. Look for non-verbal cues as well. For example, in one
station offered in this book, the patient has a packet of cigarettes in his breast
pocket.

The simulated patient has a script to deliver: use open questions initially to elicit this.
Keep up to date with management guidelines: identify and ‘plug’ knowledge gaps.

Step 4: Identify the full range of outcomes the examiner is

looking for
After reading the patient’s script, pause again and review what you now think
the station is assessing. Again, there is space provided for you to make notes. We
strongly recommend that you do this. You should be able to formulate the issues the
examiner is looking for under the headings: interpersonal skills, data gathering and
clinical management. Then move on. The discussion section gives our expectations,
which you can compare with your notes and discuss with colleagues. Remember,
you are aiming for sensible yet fluent coverage, not necessarily the ideal fully
comprehensive scenario set out in the book.

xix

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 19 11/09/12 1:59 PM

 Preparing for the Clinical Skills Assessment

Aim in the 10 minutes to formulate a sensible, fluent outcome: it will not be perfect.

Step 5: Your knowledge base

It is important to keep reviewing and updating your reading. It is a mistake to view
skills as distinct from knowledge. It is of paramount importance to patients that
the information given and management decisions made are grounded in up-to-
date, evidence-based practice. We have outlined how each station links with the
preparation you require for the AKT. The information is detailed. We acknowledge
that you cannot necessarily cover it all in 10 minutes. The aim is to illustrate how
everyday practice can structure reading and revision for the CSA.

Use the book to develop your own scenarios for group revision.

Step 6: Write your own stations

We have aimed to offer a framework for doing this and ideas for further revision.
Scenarios can be adapted to work with colleagues or alternative ones written.

Step 7: Finally
Why have so many stations if the marking schedule is a generic one? Herein lies a
basic principle of assessment that has an important practical message. Doctors are
not consistent in their practice. We are all good in some contexts and not so good in
others. Inevitably, however well prepared, you will perform better on some stations
than others. It is crucial that you can handle this. If you feel that you have done
badly on a consultation, avoid using the 2-minute break to reflect on this. Keep
thinking forwards and focus immediately on the instructions for the next station,
where you may well perform brilliantly.
We wish you well. Good luck.

Think forwards in the CSA, not backwards: some stations will be better than others.

Summary

Study the Regularly review the curriculum. Keep up to date and evidence based. Make a grid to
curriculum identify revision needs
Understand Develop well-integrated clinical competencies. Do not work from checklists. Get
the skills feedback through direct observation or using video. Harness workplace-based
assessments
Practise the The more experience the better, across a range of common presentations and a diversity
skills of patients
Work with your Revise together. Develop scenarios from everyday practice. Observe, role-play, give
peers feedback. It can be fun!
Use the CSA Use the breaks to think forwards, keep your eyes open, listen effectively and keep to the
format patient-centred, shared-management structure throughout
Remain Develop the right mentality.You will undoubtedly ‘flunk’ some stations. Learn to move
confident confidently on to the next

xx

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 20 11/09/12 1:59 PM

 Station 1

Information given to candidates

Wendy Morrison is a 30-year-old mother-of-two who works as an administrator and rarely
sees her doctor. You note that her records show one episode of depression 6 years ago,
which resolved without the need for medication or referral.
She saw one of the other GPs in the practice last week complaining of feeling tired all the
time. Physical examination was normal and urine dip-stick was negative.
The results of her blood tests taken last week are:

Haemoglobin 12.8 g/L (12.0–15.0) Thyroid- 2.12 mIU/L (0.35–5.5)

(Hb) stimulating
hormone
(TSH)
White 7.5 x 109/L (4.0–11.0) T4 18 pmol/L
cell count (8–22)
(WCC)
Platelets 258 x 109/L (150–400)
Na 138 mmol/L (135–145) Glucose 5.0 mmol/L (4.0–6.0)
K 4.2 mmol/L (3.5–5.0)
Urea 4.2 mmol/L (3.0–6.5)
Creatinine 82 µmol/L (60–125)

As you open the consultation the patient begins to cry and says that she feels so low she
‘just can’t go on’.
●● What do you think this station is testing?
●● Make notes or discuss your thoughts with a colleague before you read on.

© 2012 by Taylor & Francis Group, LLC

Book Interior Layout.indb 2 11/09/12 1:59 PM

Other documents randomly have
different content
 LECTURE VII.
THE ASIAN RACE.

Contents.—Physical geography of Asia. Physical traits of the

Race. Its branches.

I. The Sinitic Branch. Sub-divisions. 1. The Chinese. Origin and

early migrations. Psychical elements. Arts. Religions.
Philosophers. Late migrations. 2. The Thibetan Group.
Character. Physical traits. Tribes. 3. The Indo-Chinese Group.
Members. Character and culture.

II. The Sibiric Branch. Synonyms. Location. Physical appearance.

1. The Tungusic Group. Members. Location. Character. 2.
Mongolic Group. Migrations. 3. The Tartaric Group. History.
Language. Customs. 4. The Finnic Group. Origin and
migrations. Physical traits. Boundaries of the Siberic Peoples.
The “Turanian” theories. 5. The Arctic Group. Members.
Location. Physical traits. 6. The Japanese Group. Members.
Location. History. Culture. The Koreans.

If you observe the relief of the continent of Asia, you will note that
from the lofty plateau of Pamir, called by the orientals “The Roof of
the World,” two tremendous mountain chains diverge, the one to the
northeast, finally reaching the sea of Ochotsk, the other to the
southeast, meeting the southern ocean on the west of the bay of
Bengal. The region between them is one of high and arid table
lands, intersected by mountain ranges, and giving birth to streams
which flow in circuitous courses to the eastern sea. Along the coast
the land sinks to alluvial plains, and north of this triangle, the
endless forests, steppes, and “tundras” of Siberia and Turkestan
continue to the Arctic sea.

The region thus described is the continent of Asia in the proper

geological and zoölogical sense; the valleys of the Oxus, of
Mesopotamia, and the land to the west of them, properly belong to
Europe, and in fact, are included by naturalists in that continent,
under the name “Eurasia.”131

Asia proper is thus divided into two contrasted geographical areas,

that of the table-lands and mountains on the south, and that of the
plains on the north. These features have been decisive in directing
the migrations of its inhabitants, and to some extent in modifying
their traits. The vast majority, however, are distinctly recognizable
members of one race, which has been variously termed the Asiatic,
the Mongolian, or the Yellow race.

Physical Traits of the Asian Race.—As the last mentioned adjective

intimates, the prevailing color is yellowish, tending in different
regions toward a brown or white, but never reaching the clear white
of the western European. The hair is straight, coarse and black,
abundant on the head, scanty on the face, almost absent on the
body. The stature is medium or undersized, the legs thin, and the
muscular power inferior to that of the Eurafrican race. The skull has
a tendency to the globular form (meso- or brachycephalic), the face
is round, the cheek bones prominent, the nose flat at the bridge and
depressed at the extremity, the eyes are small and black, and the
lids do not open fully at the inner angle, giving the peculiar
appearance known as the oblique or Mongolian eye. This last trait is
not uncommon in the children of Europeans, but it is generally
outgrown. It is in the adult an arrest of muscular development,
although in some instances it seems related to the bony
confirmation of the orbit.132
 Ethnic Chart of Eurasia and Asia.

Subdivisions.—These are the general traits of the Asian race,

recurring more or less prominently wherever its members of pure
descent are found. It is divisible, however, into two branches,
corresponding roughly with the two geographical divisions of the
continent to which I have alluded. The first of these branches I call
the Sinitic, from the old Greek form of the word China, the other the
Sibiric, an adjective from the proper orthography of the name Siberia
(Sibiria). These branches are contrasted not only in geographical
location, but quite as much so in language. The Sinitic peoples speak
isolating, tonic, monosyllabic languages, while the tongues of the
Sibiric population are polysyllabic and agglutinative.

I. The Sinitic Branch.

This branch includes the people of the Chinese empire and Farther
India. They are separable into three groups:—

1. The Chinese proper;

2. The Thibetans; and

3. The Indo-Chinese of Siam, Anam, Burmah, and Cochin China.

The languages of all these have peculiar features and such affinities
that they all point to one ancestral stock.

1. The Chinese.

The population of China as we know it at present is the result of a

fusion of a number of tribes of connected lineage. Those who claim
the purest blood relate that somewhere about five thousand years
ago their ancestors came from the vicinity of the Kuen-lun
mountains, east of the Plateau of Pamir, and following the head
waters of the Hoang-ho and Yang-tse-Kiang entered the
northwestern province of China, Shen-si. Here they found a savage
people, the Lolo and the Miaotse, whom they subjected or drove
out, and pursuing the river valleys, reached the fertile lowlands
along the coast. Their authentic annals begin about 2350 B. C. Even
then they had attained a respectable stage of civilization, being a
stable population, devoted to agriculture, acquainted with bronze,
possessing domestic animals, and constructors of cities. The hoariest
traditions speak of the cultivation of the “six field fruits,” which were
three kinds of millet, barley, rice, and beans. The sorghum, wheat,
and oats now common in parts of China are of comparatively recent
introduction.

It is interesting to inquire whether these ancient arts possessed by

the Chinese were self-developed, or were borrowed in part from the
Eurafrican peoples of Iran or Mesopotamia. The former opinion is
that defended by Peschel and some other ethnographers. They claim
that the culture of the Chinese was developed independently in the
secluded and fertile valleys of their great rivers, and owed nothing to
the evolution of other civilizations until commerce and travel brought
them together within historic times. The individual character of
Chinese ancient culture speaks strongly for this view; certainly the
Chinese system of writing is one based entirely on their range and
method of thought; their domestic animals are of varieties formerly
unknown in western Asia; and the growth of many undoubted local
industries, silk for instance, for which they were celebrated in the
days of the prophet Ezekiel, prove an ancient capacity for self-
development not inferior to the Eurafrican race.

On the other hand, their astronomical system, which was in use

2300 B. C., is practically identical with that of the Arabs and Indo-
Aryans, and points for its origin to the Chaldees of Babylonia. In
later days, that is, since the beginning of our era, undoubtedly much
that has been looked upon as the outcrop of Chinese culture is due
to the Indo-Aryans. My own conclusion is that in all important
elements the ancient Chinese civilization was a home product, a
spontaneous growth of an intellectually gifted people, but one
whose capacity of development was limited, and that later
generations were satisfied to borrow and appropriate from the
nations with whom commerce brought them into contact.

This insufficiency of development is the weak point of Chinese

character, and is strikingly illustrated by the little use they made of
important discoveries. They were acquainted as early as 121 A. D.
with the power of the magnet to point to the north; but the needle
was never used in navigation, but only as a toy. They manufactured
powder long before the Europeans, but only to put it in fire-crackers.
They invented printing with movable type in the eleventh century,
but never adopted it in their printing offices. They have
domesticated cattle for thousands of years, but do not milk the cows
nor make butter. Paper money has been in circulation for centuries,
but the scales and weight still decide the value of gold and silver,
coins of these precious metals being unknown. Their technical skill in
the arts is astonishing, but the inspiration of the beautiful is wholly
absent.

These historic facts disclose the psychical elements of Chinese

character. Its fundamental traits are sobriety, industry, common
sense, practicality. The Chinaman regards solely what is visibly
useful, materially beneficial. His arts and sciences, his poems and
dramas, his religions and philosophies, all revolve around the needs
and pleasures of his daily life. Such terms as altruism, the ideal, the
universal, have for him no sort of meaning, and an explanation of
them he would look upon as we do on the emptiest subtleties of the
schoolmen—a chimera bombinans in vacuo. Such an action as the
martyr dying to atone for the sins of others he could understand
only as the action of a deranged mind.

Their mental character is well shown in their religions. Originally, the

Chinese combined a simple worship of the powers of nature with
that of the spirits of their ancestors. The principal deity was Tien,
the Heaven or Sky, in union with whom was the Earth, and from this
union all nature proceeded. This natural and sexual dualism
extended through all things. The affairs of life are governed by
countless demons and spirits, whose tempers should be propitiated
by offerings and prayers. Days and seasons are auspicious or the
reverse, and most of the rites at present in use are divinatory rather
than devotional.

The Buddhist religion was introduced into China about two centuries
before Christ, and was officially recognized as a state cult by the
Emperor Ming-ti in the year 65 A. D. Its spirit is, however, quite
different from the Buddhism of Ceylon, as it has degenerated into a
polytheism, a worship of the Bodhisattvas, or saints who have
reached the highest stage of perfection, and might enter Nirvana,
but do not, out of compassion for men. In general, it may be said
that the philosophical and moral principles taught in the Buddhistic
classics are not known and would not be admitted as representing
their faith by Chinese Buddhists.133

The teachings of the celebrated philosopher, Confucius (Con-fu-tse),

which are a substitute for religion among the most intelligent
Chinese, are in reality wholly agnostic. He declined to express
himself on any question relating to the gods or the possible after life
of the soul, asserting that the practical interests of this life and the
duties of a man to his family and the state are numerous enough
and clear enough to occupy one’s whole time. When asked for some
model or code of such duties, he replied by the sententious
expression “When you are chopping out an axe-handle, the model is
near you,” meaning that it is in the hand, and that in a similar
manner in practical life we always have the rule of right action in our
own mind, if we choose to look for it.

The second great philosopher of China was Lao-tse, who lived in the
generation following Confucius (about 500 B. C.). His doctrine was
pantheistic and obscure, and his writings are considered the most
difficult to decipher of all the old Chinese classics. Nor can his
doctrine be called a religion. It was rather a mystical speculation on
the universe. All-Being, he taught, is born of Not-Being, and
existence, therefore, is an illusion.

Practically, all religions are looked upon as equally true. The

Confucian will frequent the Buddhist temples, and the Buddhist
priest will perform rites in the “house of reason,” as the Confucian
holy place is termed; or he will distribute tracts for the Christian
missionaries. The government is absolutely neutral in all religious
questions, and the persecutions which have been carried on against
the Christian missionaries have not been the promptings of
fanaticism, but dislike of foreigners and suspicion of their intentions.
The official documents of the Chinese government speak with equal
contempt of every form of religion, and the rulers would never
dream of interfering in any such question.134

Many of the Chinese are Mohammedans, Islam having been

introduced by sea and land within the first century of the Hegira.
The Chinese converts learn to repeat the Koran in Arabic, as it has
not been translated into their tongue; but few understand much of
it. Their rites and doctrines are learned by the verbal instruction of
their religious teachers. The Chinese Mohammedans, however,
recognize as their chief ruler the Khalif or Sultan, and not the
Emperor at Pekin, and hence the bloody revolutions which have from
time to time broken out among them.

Christianity was introduced by the Nestorians in the eighth century,

and now may be freely taught in any part of the realm. It has,
however, had little success. There are perhaps half a million Roman
Catholic and Protestant members. They belong to the lowest classes,
and can occupy no official position, owing to the conflict of their
dogmas with the teachings of Confucius and the agnostic principles
of the government.

Within the last generation or two the Chinese have displayed an

unwonted desire for emigration. They have swept down in hundreds
of thousands on the islands of Malasia, Australia, the Sandwich
Islands, Mexico, and the United States. We have as a nation felt so
impotent before them that, in open contradiction to the principles of
our government we have closed our ports to them, and warned
them from our shores. This feeble and ignoble policy is a disgrace to
us. Far better to admit them, and to train earnest men among us in
the Chinese language and customs, so that these foreigners could
be brought to a knowledge of the superiority of our religions and
institutions, and thus be united with us in the advancement of
mankind.

2. The Thibetan Group.

The mountain-ringed land of Thibet is an arid region from 10,000 to

20,000 feet in height, thickly inhabited by a people whose principal
interests in life are religious. It is the centre of northern Buddhism,
and at the holy city of Lhasa the living incarnation of the founder of
that cult is supposed to live. In the numerous monasteries, some on
almost inaccessible mountain sides, tens of thousands of monks pass
their lives in religious exercises. They are vowed to celibacy, and
throughout the land it is looked upon as a distinct degradation to
marry. The natural result is that the relations of the sexes are
relaxed, and their morals debased. Polygamy is not uncommon, and
in Thibet, more than anywhere else, we find the peculiar institution
of polyandry, where a woman has two, three or four recognized
husbands. It is usual for several brothers thus to have the same
wife.

The women are small but well made, and exercise an unusual
control in the affairs of life. The physical traits of both sexes are
Mongolian, though the eyes are rarely oblique. The culture is rather
low, the Thibetan not being an ardent agriculturist, but preferring
the pastoral life. He milks his cows and makes butter, which with
hides and fleece, leather and some local fabrics, are his principal
articles of trade.

In the Himalayan valleys to the south are several nations in which

the Asian blood dominates, such as the Ladakis of Cashmere, the
Nepalese, the inhabitants of Bhotan and numerous others. They are
generally mixed with Dravidian or Aryac blood, but speak dialects of
the Sinitic type.

3. The Indo-Chinese Group.

The regions we call Farther India and Cochin China are at present
inhabited by peoples speaking tonic, monosyllabic languages, who
are, however, generally of mixed descent. Some of them have
crimpled hair and a dark complexion, suggesting the presence of
some Nigritic blood; others have features more Aryac than
Mongolian, hinting at an ancient fusion of Hindoostanee strains.
These form the modern nations of Birma, Siam, Annam, Cambodia,
Tonkin, and Cochin China.

The Birmans have a well marked round head (about 83°), oblique
eyes, prominent cheek bones, and are of medium stature and sturdy.
Their color is a brownish yellow or olive. In religion they are
Buddhists, but they are by no means celebrated for honesty and
morality. By a curious freak of fashion, the dress of the women is
open in front, but it is the height of immodesty to show the naked
foot.

The Siamese call themselves “Thai,” under which designation come

also the Laos. They are a mild mannered people, without much
energy, but willing to be taught.

The Annamese and Tonkinese are somewhat superior in culture to

their neighbors, and of well marked Asiatic physiognomy. The
Cambodians, called Khmers, are a mixed people, descended partly
from Mongolian ancestry, partly from Dravidian and Aryac
conquerors who occupied their country about the third century, and
left behind remarkable vestiges of their presence in ruins of vast
temples and stone-built palaces.

II. The Sibiric Branch.

The branch of the Asian race which I have called the Sibiric, as
geographically designating its pre-historic home, has also been
called the Turanian, the Ural-Altaic, the Finno-Ugric, the Mongolic,
etc. Its geographical location is north of the Altai range, and the
Caspian and Black seas, and from the Pacific to the Atlantic ocean.
The languages of all its members are polysyllabic and agglutinative,
contrasting as much with the Sinitic stock on the one hand as with
the Aryac on the other. In physical appearance individuals of
reasonably pure descent present good specimens of the Asian type,
the skull brachycephalic, the face round, the nose flat at the root,
the eye small and black, the hair straight and coarse, the color
yellowish. They are divided into many tribes, most of whom were
until recently addicted to a wandering pastoral life, and though on
the lower levels of culture and without coherent social bonds, they
have at times loomed up as the most powerful and pretentious
figures in the history of the world.
Furthest to the east is

1. The Tungusic Group,

Which occupies the coast from the northern boundary of China to

Kamschatka, and westward to the Yenissei river. It embraces the
Manchus and the Tungus. The former, a bold hardy people,
possessed themselves of the throne of China early in the
seventeenth century, and continue to rule it by a military despotism,
adapted with consummate skill to the peculiarities of Chinese
character. This has led to an extensive fusion of Sinitic blood among
the Manchus, and also an improvement in their social status. They
have become Buddhists, and their language is losing ground before
the Chinese.

The Tungus to the north of them, inhabiting a vast district of forest,

swamp and mountain, east of the Yenissei river, are of ruder life.
They depend for subsistence on the chase and on their large herds
of reindeer. In religion they adhere to the worship of the powers of
nature, and are under the control of their priests or “shamans.” They
present a well marked Asiatic type, a brachycephalic skull (81°),
round face and oblique eyes, the hair coarse and straight, the beard
scanty. In stature they are of medium height, strongly built, and the
senses of sight and hearing unusually keen.

Like most nations dwelling in or near the Arctic zone, the disposition
of the Tungus is decidedly cheerful and affable. He is hospitable to
strangers, and honorable in his dealings. In habits, however, he has
no notion of cleanliness, and the Tatar name applied to him—tongus,
hog—expresses what his not over-nice neighbors think of his mode
of life.

The tribes were subjected to the Russian domination about 1650,

and have been gradually improving their condition. A portion of
them called Lamuts reside on the sea of Ochotsk, and have fixed
villages with houses built in the Russian style.135
 2. The Mongolic Group

had their original home in Mongolia, a vast arid country south of the
Altai range, and west of Manchuria. Before the Christian era they
had extended north beyond the mountains and occupied the land
around Lake Baikal, whence they proceeded easterly, and under the
name of Kalmucks have settled quite to the river Volga. Few of them
are agriculturists, it being their preference to wander over the
pastures with their flocks. Their religion is a debased form of
Buddhism grafted on their ancient fetichism. In physical type they
are true Asiatics, and are of a restless, warlike disposition.

In the extended region which they inhabit, stretching over seventy

degrees of longitude, they have had space to multiply until their
numbers once became a menace to all other nations of the Eurasian
continent. Under Genghis Khan, in the beginning of the thirteenth
century, they poured down in countless hordes on the cultivated
nations of Asia and Europe, and in a few years established a
monarchy, the then greatest in the world. About a century later his
descendant, the sanguinary Tamerlane, swept Asia from the Indian
Ocean to the Arctic circle; and at the close of yet another century
Baber, of the same redoubted lineage, founded the empire of the
Great Mogul (Mongol) in India, extending from the Indus to the
Ganges. Based, however, on despotism, barbarism and fanaticism,
these gigantic states disappeared in a few generations, leaving
scarcely a trace of their existence except the ruins of the higher
civilizations which they had destroyed.

3. The Tataric Group.

Derived its name from the Chinese word ta-ta, and is incorrectly
written Tartar. Another Chinese name applied to them was Tu-kiu,
from which is derived our word “Turk.”
The earliest home of the Tatars or Turks was in Turkestan, north of
the Plateau of Pamir and in the immediate vicinity of the Persian
Aryans. Long before the beginning of the Christian era their
predatory bands had repeatedly invaded the territory of the Aryans
and the Semites, and quite down to two centuries ago the states
which they had founded were looked upon with dread by the
mightiest potentates of Europe. The Chinese annals speak of their
inroads into that empire more than 200 years before our era.

At the period of the migration of nations which accompanied the

dismemberment and fall of the Roman Empire, the Tatars appeared
frequently in Europe, always as ruthless devastators. Attila, “the
scourge of God,” with his bands of Huns, the Avari, and the Bulgari,
who followed in his wake, the Turcomans and the Cossacks, and
finally the Osmanli Turks whose descendants now govern European
and Asiatic Turkey, and whose Sultan is the political head of the
Mohammedan world, all belong in this group.

It is needless to say that in these rovings they have undergone

much admixture. The modern Turk has more of the blood of the
Semite and the Circassian in his veins than of his Tartar ancestors;
but his language has maintained a singular purity, and the Tartar
hunter, the Jakout, in the delta of the Lena on the frozen ocean,
finds no difficulty in understanding its ordinary expressions. The
Jakout speaks indeed the purest and most ancient form of the idiom,
“The Sanscrit of the Tatar,” as it has been called by Friedrich Müller.

The peculiarity of this language is that it has a law of vocalic

harmony, by which the various suffixes added to the root change the
vowels they contain in accordance with the vowel of the root. It has
not only a pleasing sound, but superior flexibility and an unusual
capacity to express fine shades of meaning. It is, however, losing
ground both in Europe and Asia, as are all the agglutinative
languages.
Next to the Turks, the Cossacks and Kirghis Tatars are prominent
members of the stock. They are closely related, being branches of
the same dialectic family. The former wander over the steppes
between the Sea of Aral and the main chain of the Altai. It is not
known when they occupied this region, but it was within historic
times, and they drove from it a people of higher civilization,
acquainted with the use of bronze and brass, and dwellers in
cities.136 The Kirghis themselves build no houses, but dwell in felt
tents called “yourts.” They did not cultivate the soil, deriving their
food from their flocks and herds, but of late years have begun a
careless agriculture. In religion they profess Mohammedanism, but
in reality they cling to their ancient Shamanistic superstitions.

4. The Finnic Group

Has lived for certainly two thousand years or more in Northern

Europe. It is mentioned by Tacitus, and its traditions as well as its
dialects support this antiquity. That it ever extended, as many
theorists pretend, into Central or Southern Europe, may now be
dismissed as an obsolete hypothesis, disproved by craniological
studies and a closer scrutiny of the alleged linguistic resemblances
which have been urged. The probability is that the Finns and Lapps
had the same ancestors as the Samoyeds of Northern Siberia, who
once lived on the upper streams of the Yenissei in the Sajanic
mountains and around Lake Baikal. The Laplanders are said still to
retain some reminiscence of the migration, and the verbal affinities
of the Finnic and Samoyedic demonstrate an early relationship.137

The eastern members of the group are the Ugrians in the

government of Tobolsk, some tribes on the Volga, and the Permians
on the Kama river (an affluent of the Volga). The Magyars of
Hungary are a branch of the Ugrians who possessed themselves of
the land in the ninth century, and who still retain their language, not
remote from the Finnish.
The present Finnland was first occupied by the Lapps or Laplanders,
who were driven northward and westward by bands continually
arriving from the east. The Finns, who call themselves “Suomi,”
which is the same as the initial syllables of “Samo-yed,” are
subdivided into the Esthonians and Livonians on the Baltic, south of
the Gulf of Finland, the Tavastes, Karelians, and others to the north.

The physical type of the members of the Finnic group has given rise
to much discussion. Many individuals are blondes, with light hair and
eyes, and with dolichocephalic skulls. Such are especially numerous
among the Esthonians, Karelians, and Tavastes. But it must be
remembered that for two or three thousand years these tribes have
been in contact with the blonde and dolichocephalic type of the
Aryans, represented by the ancient Teutonic and Slavonic groups
(see Lect. V). It is not in the least surprising therefore to find the
Finnic group everywhere deeply infused with Aryac blood. Even the
remote Lapps are no exception. Nominally there are 25,000 or more
of them. But Prince Roland Bonaparte says as the result of his recent
observations among them, “Pure Lapps no longer exist;”138 and
when this is true of that isolated people, how much more is it of the
tribes in closer proximity to the Eurafrican race? We may conclude
with Professor Keane that the genuine traits of the Finnic group are
“fundamentally and typically Mongolic,” i. e., Sibiric.139

There is no reason to suppose that any of the Sibiric peoples

extended southerly in Asia or Europe much beyond their present
boundaries. It has been a mania with many ethnographers,
especially linguistic ethnographers, to discover “Turanian” peoples
and dialects in numerous parts of southern and central Europe. They
would have it that the Basques, the Etruscans, the Ligurians, the
Pelasgians, were “Turanian;” that the prehistoric inhabitants of
Palestine, the Hittites, and the Shepherd Kings of Egypt, were also of
this ilk. They are like those other ethnographers who find
“Mongoloid” indications everywhere, in America, in Polynesia, even
among the Bushmen of South Africa. As Friedrich Müller says of
these writers, “Mongolian” is a sack into which everything is
crammed by them. There is no true science in catching at superficial
resemblances or exalting remote analogies while fixed distinctions
are disregarded.

5. The Arctic Group.

In northeastern Siberia, close to the Arctic circle, and occupying the

territory between the Pacific and Arctic oceans, dwell a number of
tribes in a condition of barbarism. Their languages are in general
form of the Sibiric type; their physical traits vary, indicating frequent
admixture. In color they are rather dark, and the skull is generally
slightly dolichocephalic.

Of these the Chukchis occupy the extreme northeast of the

continent. Nordenskjold, who saw much of them, considers them the
mixed descendants of various tribes, driven from more hospitable
regions to the south.140 Some of them have a marked Mongolic
aspect, but the majority differ from that type. They are yellowish-
brown in color, prominent nose, tall in stature, and well built. They
are active hunters and fishermen. The Namollos are a sedentary
branch of the Chukchis, and both are related to the Koraks and
Kamschatkans. The Namollos live along the Arctic coast, near East
Cape, while the Koraks live to the south. “Kora” means “reindeer,”
and they are essentially the reindeer people, that useful animal
being their chief wealth. Close to East Cape, and southward along
the coast of Behring sea, are Eskimo tribes. They have lived there
from the first discovery of the coast, and doubtless long before.
Indeed, as far as tradition goes, the movements of the Eskimos have
been from America into Asia, and not the reverse, until they were
driven back by the advancing Chukchis.141

The Kamschatkans to the south are of small stature, but strongly

formed. They live upon fish, and are skillful in the use of dogs for
sleds. They number only about 2000 souls, and are disappearing.
The Ghiliaks live near the mouth of the Amoor river and on the
Saghalin islands. They are a mixed people, the cephalic index
varying from 74 to 85; some of them have abundant beards, which
is very rare among the pure Asiatics.142

The Aleutians, who occupy the long chain of islands reaching from
Kamschatka to Alaska, are of medium height, flat nose, black eyes
and hair, and mesocephalic. They belong to the American, not to the
Asian race.

Most of these peoples speak tongues differing widely among

themselves, but of the agglutinative type. They are in no way related
to the American languages, and are equally remote from the
Mongolian.

6. The Japanese Group.

The Japanese cannot claim purity of descent. Their complexion and

frequent crisp or wavy hair indicate that their Asian origin has been
modified by other blood. They were not the earliest inhabitants of
the archipelago they occupy, but moved into it probably about a
thousand years before the Christian era.143 The immigrants seem
from some linguistic evidence to have come from Manchuria or
Mongolia, and to have found upon the islands a different people, the
Ainos (properly Ainu) remarkable for their heavy beards and hairy
persons. These have now been driven to the northernmost portion
of the archipelago, where about 1200 of them still reside. It was
long thought that the languages of the Ainos and Japanese have
some affinities, but except in loan words and a general phonetic
resemblance, this has now been disproved. The Ainos seem
physically related to the Ghiliaks, and came from the north and west.
They are supposed to have been the first occupants of the Kurile
islands.

Like other mixed peoples, the Japanese vary so much in height, form
of skull, hue and bodily proportion, that it is impracticable to set up
any fixed type for them, further than to say that their general Asiatic
aspect is usually unmistakable to the trained eye.144 In mental
qualities they are gifted, being intelligent, artistic, brave, kind, and
honorable, fully alive to the benefits of a high civilization, and able to
accept with profit all that the western world has to offer.145 They are
monogamists, and the position of woman has always been respected
among them. The prevailing religion is the Shintoism or worship of
the powers of nature, but Buddhism, introduced in the 7th century,
has also many votaries. At heart, however, they are an irreligious
people, like the Chinese, and are unconcerned about the ideal and
the mystical. Many of their arts, like that of writing, were at first
learned from the Chinese; but they have improved upon them, and
given them other directions, as in the development of their phonetic
from the Chinese syllabic alphabet.

Japanese art has attracted in recent years the admiration of the

European world, and many motives in it have been accepted by our
lovers of decorative effects. It is indeed wonderful in its technical
finish, and its theory of composition has novelties which are worthy
of imitation, but it is devoid of that something which we call the
ideal; and its canon of proportion of the human body has never been
developed to approach the classical models.

There is an extensive literature in the Japanese tongue. Most of it

deals with practical subjects, and even the poetry is usually didactic
in spirit.

The Koreans seem originally to have come from the same stock as
the ancestors of the Japanese. They are of more positive Asiatic
type, and are a mixed people, the ruling class (the Kaoli) having
conquered the peninsula in the second century before our era. They
closely resemble the Loochoo islanders, and doubtless are
consanguine with them. Their industries are similar to those of
Japan, which country, indeed, obtained many of its arts from China
by way of the Korean peninsula.
 LECTURE VIII.
INSULAR AND LITTORAL PEOPLES.

Contents.—Variability of islanders and coast peoples. Physical

geography of Oceanica. Ethnographic divisions.

I. The Negritic Stock. Subdivisions. 1. The Negritic Group.

Members. Former extension. Physical aspect. Culture. 2. The
Papuan Group. Location. Physical traits. Culture and
language. 3. The Melanesian Group. Physical traits. Habits.
Languages. Ethnic affinities of Papuas and Melanesians.

II. The Malayic Stock. Location. Subdivisions. Affinities with the

Asian Race and original home. 1. The Western or Malayan
Group. Physical traits. Character. Extension. Culture.
Presence in Hindostan. 2. The Eastern or Polynesian Group.
Physical traits. Migrations. Character and culture. Easter
Island.

III. The Australic Stock. Affinities between the Australians and

Dravidians. 1. The Australian Group. Tasmanians and
Australians. Physical traits. Culture. 2. The Dravidian Group.
Early extension. Members. Culture. Languages.

Before proceeding to the ethnography of the American continent, I

would have you take a rapid survey of the inhabitants of that
extensive archipelago whose islands are thickly dotted in the Indian
and Pacific oceans, and ascertain as far as may be the relationship in
which they stand to the population of the adjacent coasts.
 Scheme of Insular and Littoral Peoples.

Mincopies, Aetas,
Schobaengs,
1. Negrito Group. Mantras,
Semangs,
Sakaies.
Papuas, New
2. Papuan Group.
I. Negritic Stock. Guineans.
Natives of Feejee
Islands, New
Caledonia,
3. Melanesian Group.
Loyalty Islands,
New Hebrides,
etc.

Malays,
Sumatrese,
Javanese,
Battaks,
1. Malayan Group. Dayaks,
Macassars,
II. Malayic Stock. Tagalas, Hovas
(of
Madagascar).
Polynesians,
2. Polynesian Group. Micronesians,
Maoris.

III. Australic Stock. Tasmanians,

1. Australian Group.
Australians.
2. Dravidian Group. Dravidas, Tamuls,
Telugus,
 Canarese,
Malayalas,
Todas, Khonds,
Mundas,
Santals, Kohls,
Bhillas.

It was Darwin’s theory that the distant progenitor of man was an

amphibious marine animal, and certainly from earliest times he has
had a predilection for water-ways and the sea-coast. The lines of
these have always directed his wanderings, and it is not surprising
therefore that nowhere do we find the physical types of the race so
confusingly amalgamated as in the insular littoral peoples. Not only
is transit easier in these localities, but on islands especially there is a
more rapid intermingling and a closer interbreeding than is apt to
occur in continental areas. This not only blends types, but it has
another effect. It is well known from observation on the lower
animals that such close unions result in the formation of more plastic
organisms, liable to present wide variations, and to develop into
contrasting characters.146 This holds good also of mental products.
For instance, you might suppose that the dialects of the same island
or the same small archipelago would offer very slight differences.
The reverse is the case. In the same area the dialects of an island
differ far more than on the mainland. This is a fact well known to
linguists, and is parallel to the physical variations.147 The
ethnographer, therefore, is prepared to attach less importance to
corporeal and linguistic differences in insular than in continental
peoples.

Physical Geography of Oceanica.—The island world of the Indian and

Pacific Oceans is divided geologically into two regions, Australasia
and Polynesia. The former, as its name denotes, is really a
southeasterly prolongation of the continent of Asia, and was united
to it in late tertiary times. The huge islands of Sumatra, Java and
Borneo are separated from the Malayan and Siamese peninsulas by
channels scarcely a couple of hundred feet deep; and from these a
chain of islands extends uninterruptedly to the semi-continent of
Australia. All these islands are of tertiary formation, and the
subsidence which separated them from the main took place at the
close of that geologic epoch.

The Polynesian islands, on the other hand, are of recent

construction. They are submarine towers of coral, erected on the
crests of sunken mountain ranges rising on the floor of a profoundly
deep sea. Nevertheless the flora and fauna of Polynesia resemble
that of Australasia in its strongly Asiatic character.

The islands of the Indian Ocean present some singular anomalies.

Ceylon, though so close to the Indian peninsula, is not a geological
fragment of it; while Madagascar, though four thousand miles away,
was unquestionably once a part of Southern Hindostan.148 This,
however, was in remote eocene tertiary times, and long before man
appeared. The hypothesis, therefore, advanced by Hæckel and
favored by Peschel and other ethnographers, that the Indian Ocean
was once filled by the continent “Lemuria,” and that there man
appeared on the globe, must be dismissed so far as man is
concerned, as in conflict with more accurate observations.

Yet one must acknowledge that it has some plausibility from the
present ethnography of the islands and coasts of the Indian Ocean.
There is a general consensus of opinion that the earliest occupants
of these regions were an undersized black race, resembling in many
respects the negrillos of Austafrica. Upon these was superimposed
an Asiatic stock represented by the modern Malays; and the union of
these two strains gave rise to the anomalous tribes which occupy
Southern Hindostan, Australia, and some of the islands.

This historic scheme, which has a great deal in its favor, permits me
to classify the great island-world and its adjacent mainland into
three ethnographic categories as represented on the diagram.
Of these the most ancient is

I. The Negritic Stock.

This embraces three subdivisions, (1) the Negritos, (2) the Papuas,
(3) the Melanesians.

1. The Negrito Group.

The Negritos may be called the western branch of the stock. It is

noteworthy that they are located nearer to Africa, and that they
more distinctly resemble the Negrillo stock of that continent than do
the Papuas. To them belong the natives of the Andaman Islands
known as Mincopies, the Semangs, Mantras, and Sakaies of Malacca,
the Aetas of the Philippine Islands, and the Schobaengs of the
Nicobar Isles.149 It is highly probable that they inhabited a large part
of Southern Hindostan, perhaps before it was united to the
Himalayan highlands (see p. 88), and some have been reported in
Formosa.

They are believed to have been the original possessors of Borneo,

Java, Sumatra and the Celebes Islands, as well as parts of Indo-
China; but except in some mixed tribes, as the Mois of the latter
region, their stock has disappeared from those localities. It is
noteworthy that not a trace of their blood has been found in Asia
north of the Hindu Cush and Himalaya ranges.150 Some writers have
thought that they proceeded along the eastern islands as far north
as the Japanese archipelago, and would explain some of the present
physical traits of its inhabitants by an ancient infusion of Negritic
blood.

In physical aspect they are of small stature, not more than one-
fourth of the adult males reaching five feet in height; their color is
black, hair woolly, nearly beardless, and the body smooth. The nose
is flat, the face moderately prognathic, and the skull generally
globular (mesocephalic index 80°-81°), but on the Philippines and in
Indo-China rather dolichocephalic. Their forms are symmetrical,
though they are thin-legged, without calves; their movements agile
and graceful.151

They are averse to culture, and depend on hunting and fishing. As

weapons, they know the bow and arrow, the lance, and the
sarbacane or blow-pipe, but have not acquired the art of chipping
stone. When they use that material, they split it by exposure to fire.
They are timid and distrustful of strangers, and they well may be, as
they have been pursued remorselessly by slave-catching pirates, and
were constantly exposed to the brutal aggressions of their stronger
neighbors.

The portrait presented of their tribal customs is rather pleasing. The

social organization is based on the family, the heads of which elect
the tribal chieftain, and their respect for the dead amounts to a
religion. Beyond the ancestral worship they have few rites, though
some ceremonies are performed to appease the evil spirits, and
others at the time of full moon and thunderstorms, and at births and
deaths. Among their myths is one relating to a mythical great
serpent, who seems to be a beneficent deity, pointing out to them
where game abounds, and where the bees have deposited wild
honey. They are monogamous, and neither steal nor buy their wives,
the lover arranging the matter with his chosen one, and then
sending a present to her father. They have learned the luxury of
tobacco, and prize it highly, but for alcoholic beverages they have no
longing. As they are migratory, their house building is limited to
shelters of light materials, and for clothing a breech-cloth is
sufficient.152

In so many respects, geographical as well as physical, do these

dwarfish blacks stand between the Negro peoples of Austafrica and
Australasia that we are not surprised at the conclusion suggested by
Prof. W. H. Flower, that they may be “the primitive type from which
the African Negroes on the one hand, and the Melanesians on the
other, may have sprung.”153

2. The Papuan Group

Is found in its purity on the great island of New Guinea and the
chains east and west of it, but even there it discloses considerable
diversity. In color the Papuas vary from a coal black to a dark brown,
their hair is woolly, and there is considerable on the body and face,
stature medium, legs thin. Their lips are thick, and the nostrils
broad, but the nose is high and curved. Yet the best observers agree
that they vary extremely in physiognomy, and that in New Guinea,
tribes of equally pure blood have the skull sometimes broad,
sometimes long. These variations we may attribute to the influence
of insular conditions, or to some intermixture of blood.154

The Papuas belong to the lowest stages of culture. Some of their

tribes do not know the bow and arrow, and few of them have any
pottery. Their languages are agglutinating, but have this peculiarity,
that the modifications of the root are generally by prefixes instead of
suffixes, in this respect reminding one of the African rather than the
Sibiric families of tongues.

Their territory includes parts of the New Hebrides, the Loyalty Isles,
New Caledonia, Viti, and a variety of smaller groups. These islanders
are usually of mixed type, and are known as “Melanesians.” The
natives of the Feejee Islands are an excellent specimen of these, and
their archipelago forms the dividing line between the Papuan and
Polynesian groups.155

3. The Melanesian Group.

The Melanesians, of all the islanders, present in individual cases the

strongest likeness to the equatorial African Negro; yet among these
there is that prevailing variability of type so frequent in insular
peoples. Their color passes from the black of the typical Negro to
the yellow of the Malayan; their hair, generally frizzly, may be quite
straight and of any hue from black to blonde. These variations are in
individuals or families, and are not owing to mixed blood.156

Unlike the Polynesians, the Melanesians are agricultural in habits,

and sedentary. They build artistically decorated houses, are
acquainted with the bow and arrow, occasionally make pottery, and
construct shapely canoes, though not given to long voyages. The
women are modest and chaste, and their religion is principally a
form of ancestral worship.

The languages of these islanders betray their compound origin. In

form and in the pronominal elements they stand related to the
Malayan and Polynesian idioms, and in structure approach
sometimes the richness of the former. In the Viti, for example, both
prefixes and suffixes are employed, and the possessive is added to
the noun. The root words are monosyllables or dissyllables, and
drawn from the Papuan idioms, and the phonetics are much richer
than the Polynesian.

These facts go to show that the Melanesians are physically and

linguistically a mixed people, a compound of the woolly-haired black
Papuas, whom we may suppose to have been the aborigines of
Melanesia, with the smooth-haired, light-colored Malays, who
reached the archipelago as adventurers and immigrants. As their
tongues form, as it were, the second stratum of structure when
compared with the Polynesian dialects, we can go a step further and
say that the ethnic formation of the Melanesian islanders occurred
subsequently to the construction of the Polynesian physical type and
languages.157

The ethnic relationship of the various adjoining islanders to the

Papuas has been studied by many observers, but its solution has not
yet been reached. The Papuas themselves impressed Hale as partly
Malayan—“a hybrid race,”158 and Virchow calls attention to the fact
that a broad zone of wavy-haired peoples intervene between the
Papuas and the pure Malays, shading off into the Australians on the
one hand and the Veddahs of Ceylon on the other.159 This is very
significant of the ethnic origin of the inhabitants of Australasia.

It is borne out by an examination of the Papuan languages. These

are quite dissimilar among themselves, and appear to have been
derived from a number of independent linguistic stocks. While these
were originally distinct from the Malayan, it is a recognized fact that
all the Papuan, and still more all the Melanesian dialects, have
absorbed extensively from Malayan and Polynesian sources, and we
are certain, therefore, that a similar absorption of Malayan blood has
taken place.160

II. The Malayic Stock

Is by far the most important group of peoples with whom we have
to do in the area we are now studying. Many ethnologists, indeed,
set it up as a distinct race, the “Malayan” or “Brown” race, and claim
for it an importance not less than any of the darker varieties of the
species. It bears, however, the marks of an origin too recent, and
presents Asian analogies too clearly, for it to be regarded otherwise
than as a branch of the Asian race, descended like it from some
ancestral tribe in that great continent. Its dispersion has been
extraordinary. Its members are found almost continuously on the
land areas from Madagascar to Easter Island, a distance nearly two-
thirds of the circumference of the globe; everywhere they speak
dialects with such affinities that we must assume for all one parent
stem, and their separation must have taken place not so very long
ago to have permitted such a monoglottic trait as this.

The stock is divided at present into two groups, the western or

Malayan peoples, and the eastern or Polynesian peoples. There has
been some discussion about the original identity of these, but we
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!

ebooknice.com