Global Medicine in China: A Diasporic History 1503611930, 9781503611931

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G L O BA L M ED I C I N E I N C H I N A

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GLOBAL MEDICINE IN CHINA A Diasporic History WAYNE SOON

Stanford University Press Stanford, California

Stanford University Press Stanford, California

© 2020 by the Board of Trustees of the Leland Stanford Junior University. All rights reserved.

No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and recording, or in any information storage or retrieval system without the prior written permission of Stanford University Press. Printed in the United States of America on acid-­free, archival-­quality paper Library of Congress Control Number: 2020939903 ISBN 978-1-503-61193-1 (cloth) ISBN 978-1-503-61400-0 (paper) ISBN 978-1-503-61401-7 (electronic)

Typeset by BookComp, Inc. in 10.25/15 Adobe Caslon Pro Cover design: Rob Ehle

Cover photograph: X-ray examination in “Curative Unit 11,” ca. 1938–42. Rare Book and Manuscript Library, Columbia University

CO N T EN T S

Acknowledgments

vii



List of Abbreviations

xi



Note on Romanization



Introduction: Diasporic Medicine

1

Prewar International Strategies

17

2

Wartime Military Medicine

59

3

Making Blood Banking Work

95

4

Transnational Politics of Military Medical Education

125

5

Reconstructing Biomedicine across the Taiwan Straits

155



Conclusion: Legacies of Global Medicine

197



Glossary of Chinese Characters

209

xiii 1

Notes

213

Bibliography

273

Index

295

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AC K N OW LED G M EN T S

Many scholars, friends, and colleagues helped make this book possible. I want to thank my mentors at Princeton: Ben Elman, Janet Chen, and Katja Guenther. Their unwavering support, guidance, advice, and patience were critical in helping me complete this book. They inspired me with their ideas and offered words of encouragement throughout this writing process. Susan Naquin, Sheldon Garon, Chih-­p’ing Chou, and Brad Simpson have also supported my work in so many ways. I have been fortunate to spend much time researching in Taiwan for this book. I appreciate the kind hospitality, generous support, and thoughtful advice from Sean Lei, Chang Che-­chia, Chia-­Ling Wu, Wen-­Hua Kuo, Paul Katz, Ren-­Yuan Li, and Michael Shiyung Liu. I thank Michael especially for introducing me to scholars and relevant archival materials in Taiwan and the United States. James Lin was my comrade-­in-­arms in Taiwan and remains one of the strongest advocates of my work. In Singapore, I thank Seung-­Joon Lee, Greg Clancey, Huang Jianli, and Michael Fischer for their assistance during my research trips there. Nurfadzilah Yahaya, Ja Ian Chong, and Jack Chia from the National University of Singapore have been exceptionally generous with their time and insights on my book manuscript. John P. DiMoia and Haidan Chen, whom I met in Singapore and who are now in Seoul and Beijing, respectively, have been invaluable in aiding me with my research.

viii

ACKNOWLED GMENTS

I presented parts of my book in conferences and workshops around the world. I thank Angela Leung, Wen-­hsin Yeh, Peter Perdue, Fa-­ti Fan, Madeleine Yue Dong, Joan Judge, Dagmar Schaefer, Eugenia Lean, Marta Hanson, Carol Benedict, Sigrid Schmalzer, Bill Johnson, Bill Kirby, Rob Culp, and many others for their insightful comments and helpful suggestions on my work. This project would not have been possible without the generosity of Vassar College Research Committee Award, Vassar College Professional Editing Grant, Princeton University East Asian Studies Program, Princeton University History Department, Princeton University Institute for Regional and International Studies, Rockefeller Archive Center Grant-­in-­Aid, the Taiwan Fellowship, and the Lee Kong Chian Fellowship. I appreciate the help of archivists and librarians around the world in locating materials for my book. In China, the Second Historical Archives in Nanjing, National Library of China, Capital Library of China, Xiamen University Archives, Beijing Municipal Archives, Kunming Municipal Archives, Kunming Library, and the Yan’an Library; in Taiwan, Academia Historica Archives, Academia Sinica Institute of Modern History Library and Archives, Kuomintang Party Archives, National Taiwan University Library, National Archives Administration, and National Central Library; in Hong Kong, the Hong Kong University Library; in the United States, National Archives at College Park, Library of Congress, Hoover Institute Archives at Stanford University, Mudd Manuscript Library and Gest Library at Princeton University, New York Public Library, Rockefeller Archives Center, and the Rare Books and Manuscript Library at Columbia University; in the United Kingdom, the University of Edinburgh Library and Archives, Cambridge University Archives, and the National Archives at Kew; in Singapore, the National Library of Singapore and the National University of Singapore Library. I thank Marcela Maxfield, Sunna Juhn, and two anonymous reviewers at Stanford University Press for their valuable advice and suggestions. Marcela and Sunna were truly wonderful editors to work with and made the experience of finishing this monograph a pleasant one. I thank the Johns Hopkins University Press for allowing me to republish an edited version of my article “Blood, Soy Milk, and Vitality: The Wartime Origins of Blood Banking in China, 1943–45” which first appeared in the Bulletin of the History of Medicine 90, no. 3 (2016): 424–54. I also appreciate the vice president of

ACKNOWLED GMENTS ix

the American Bureau for Medical Aid to China (ABMAC), John Watt, for permitting me to reproduce images from the ABMAC and United China Relief collections. My wonderful colleagues in the History Department, Asian Studies Program, and the Dean of Faculty office at Vassar College have been enthusiastic supporters of my research. I thank them from the bottom of my heart. I especially thank Michelle Whalen and Jim Wang for their administrative support for this project. My graduate school colleagues continue to inspire me with their academic passions. I thank April Hughes, Kjell Ericson, Wah Guan Lim, Yulia Frumer, Scott Gregory, Brigid Vance, Paul Kreitman, Maren Ehlers, Margaret Ng, Chunmei Du, Shellen Wu, Howard Chiang, Daniel Trambaiolo, and many others for their friendship, advice, and support. My undergraduate mentors at Carleton College—Seungjoo Yoon, Jamie Monson, Al Montero, and Susannah Ottaway—remain great supporters of my research. I also thank Ying Jia Tan, Mary Augusta Brazelton, David Luesink, Hsiao-­wen Cheng, Peter Harris, Harry Wu, Tae-­Ho Kim, Sidney Lu, Jamyung Choi, Ryan Murphy, Betsy Schlabach, Eric Cunningham, Ashton Liu, Dazhi Yao, Michele Thompson, Nick Bartlett, Evelyn Shih, Gina Tam, Nicole Barnes, Angelina Chin, Margaret Tillman, Joe Lawson, Louis Römer, Kirsten Wesselhoeft, Hilary Smith, Evan Dawley, Arunabh Ghosh, Hyungsub Choi, Victor Seow, Emily Baum, and many others for their comments, advice, and friendship. I dedicate this book to my family. To my parents, Soon Heong Toh and Agnes Tan Yin Foong, and my brother and sister-­in-­law, Soon Sze Meng and Rachel Yeo, for their steadfast support throughout the years. To my wife, Honghong Tinn, for her limitless patience, understanding, love, and insights through this extended process. To my son, Toby Soon, for bringing so much joy and inspiration to my life. To anyone I inadvertently missed—thank you.

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A B B R EV I AT I O N S

ABMAC CCP CCM CRCMRC COVID-­19 EMSTS FOA JCRR KMT NAACP NDMC NMAC PRC PUMC RAC ROC UCR USC

American Bureau for Medical Aid to China Chinese Communist Party classical Chinese medicine Chinese Red Cross Medical Relief Corps Coronavirus Disease 2019 Emergency Medical Services Training School Foreign Operations Administration Sino-­American Joint Commission on Rural Reconstruction Kuomintang (Chinese Nationalist Party) National Association for the Advancement of Colored People National Defense Medical Center National Medical Association of China People’s Republic of China Peking Union Medical College Rockefeller Archives Center Republic of China United China Relief United Services to China

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N O T E O N RO M A N I Z AT I O N

I have utilized the conventional hanyu pinyin used in Mainland China to romanize most names and institutions. However, I have kept the commonly known names used by members of the Chinese diaspora and Chinese politicians to refer to themselves and their communities and places, either at an earlier time or at present. Their names and terms are rendered in the original regional languages, followed by the hanyu pinyin form in parenthesis at the first mention.

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G L O BA L M ED I C I N E I N C H I N A

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I N T RO D U C T I O N

Diasporic Medicine

in february 1938, Chinese Canadian doctor Jean Chiang arrived in Yan’an, the main Communist stronghold in China.1 She described “miserable” living conditions.2 Often built in caves, Yan’an’s local hospitals in 1939 had no telephones, no centralized offices, and no record keeping. Patients had to bring their own bedding, which was frequently ridden with lice. As a result, typhus spread. Patients were examined on heated slabs of concrete, or kangs, which took up the entire length of an examination room, so that a doctor or nurse seeking to cross the room had to crawl over them. Patients suffering from emergency conditions often waited up to three hours for a stretcher. Women had trouble obtaining natal care and safe abortions. In one cave, two people were killed when the walls and ceiling collapsed. Chiang’s team immediately went to work addressing these conditions. She and her colleagues replaced the kangs with proper wooden platforms on trestles. They put fresh bedding on top of these examination tables in rooms that now accommodated up to five patients. During their eight months in Yan’an, Chiang and her team constructed 22 hospitals in caves, creating separate rooms for examination, surgical, and obstetrical services. They constructed a central space for registration, which served as an admissions-­and-­discharge ward. They performed complicated surgical procedures, delivered about one hundred babies with only four untimely deaths, and provided medicine for women suffering from sexually transmitted diseases.

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Largely forgotten today, Chiang and her team brought critical medical care to the Chinese Communists, who urgently needed it in their war against the Japanese and ultimately against the Chinese Nationalists. She was among a group of medical personnel dispatched from Chinese Nationalist–held areas to Communist regions by Robert Ko-­Sheng Lim (Lin Kesheng 1897–1969), the head of the Chinese Red Cross Medical Relief Corps. Like Chiang, Lim belonged to the Chinese diaspora, having been born in Singapore and raised in Edinburgh. Chiang arrived in Yan’an with the international support of the wartime Red Cross, funded primarily by Overseas Chinese in Southeast Asia, North America, and Western Europe. It was Chiang Kai-­shek ( Jiang Jieshi 1887–1975), the leader of China and the Chinese Nationalist Party, who in 1938 appointed Lim to head the Chinese Red Cross Medical Relief Corps. Lim’s mission was clear: to remedy the wartime medical situation. Chiang Kai-­shek and his Chinese Nationalist Party, also known as the Kuomintang or KMT, seized power in China in 1927. They nominally unified a divided China, which had suffered deep divisions after the fall of the Qing government in 1911. The KMT went on to lead the National Government forces against the Japanese during the Second World War, which in Asia lasted from 1937 to 1945. After Japan’s capitulation in August 1945, Lim reconstituted his military-­medical complex as the National Defense Medical Center in Shanghai. Comprised of a general hospital, a medical school, a research laboratory, a dental institute, a nursing college, a blood bank, and the first pyrogen-­free fluid plant in China, the center assisted Chinese soldiers and civilians in Nationalist-­held China. However, as the civil war between the Chinese Communist Party (CCP), led by Mao Zedong (1893–1978), and the KMT escalated in late 1947, Lim and his colleagues found themselves caught between the two factions. Lim’s overseas supporters were also divided between the KMT and the CCP, resulting in an overall decline in financial support for Lim’s medical endeavors. By the end of 1948, Mao’s troops pressed close to the cosmopolitan city of Shanghai, after winning a string of victories against KMT forces in North China. Late in 1948, Chinese Nationalist General Chen Cheng ordered Lim to move the medical center from Shanghai to Taiwan. Many employees and students refused to heed Chen’s orders, feeling that Taiwan was a foreign land where they would be “forever banished from family and friends.” 3 At

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the same time, the Communists offered Lim the position of health minister in the new People’s Republic of China. Thus Lim and his colleagues—whose medical program had been instrumental to both the Chinese Communists’ and the Chinese Nationalists’ victories over the Japanese—faced the difficulty of choosing sides. The importance of the Chinese diaspora in shaping medicine in twentieth-­century China is reflected in Lim’s dilemma. By maneuvering through the unpredictable and sometimes hazardous contingencies posed by domestic and transnational actors and circumstances, Overseas Chinese managed to endow China with new medical institutions, knowledge, and practices. This book argues that Overseas Chinese were central to the development of biomedicine in modern China and were most active there and in Taiwan from 1910 to 1970. Their Western education, diasporic identities, and transnational connections were central to their efforts at making biomedicine work. Their ambitious agenda was at times facilitated, and at times constrained, by the vicissitudes of international financial support, domestic politics, transnational opposition, and local resistance. Even as they drew on the powers of the KMT government to expand their biomedical institutions from the late 1920s to the 1970s, they did not always support the KMT’s firm stance against classical Chinese medicine (CCM) or indeed against the CCP. Their desire to extend biomedicine to as many Chinese people as possible was reflected in their outreach to proponents of CCM and in their inclusive extension of biomedical care to the CCP.

Why Military Medicine Matters

By 1900, biomedicine (or scientific medicine) had become firmly associated with the rise of laboratory science, the advent of germ theory, the expansion of public health, and the growing professionalization and specialization of medical education in Western Europe and the United States.4 Overseas Chinese who received their medical education in Britain, France, or the United States were familiar with the latest biomedical research and joined other medical specialists in propagating this knowledge and its corresponding practices in China in the mid-­twentieth century. At this time, medical agents from abroad could operate freely because Qing China (1644–1911) had acceded to foreign demands to open its borders after suffering a series

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of military defeats to the Japanese and various Western forces in the latter half of the nineteenth century. By the twentieth century, Western missionaries interested in biomedicine sought to develop new pharmacological practices in treating patients,5 even as their endeavors had roots in their prejudicial representations of a sick and grotesque Chinese body in the late nineteenth century.6 Japanese medical officers and their collaborators propagated a violent form of hygienic modernity in the city of Tianjin in North China. They forced the Chinese in Tianjin to accede to their vision of a clean city by demanding that residents rebury their dug-­up deceased relatives as well as round up beggars in chain gangs to clean up the streets.7 In Beijing, the Rockefeller Foundation in the United States took over the running of the Peking Union Medical College in 1915 and transformed the institution into the preeminent biomedical institution in the country.8 In the central Chinese cities of Nanjing and Shanghai, Chinese reformers in the late 1920s joined these foreign powers in instituting public health and promoting Western medicine.9 Their efforts to delegitimize CCM were opposed by its practitioners, who nevertheless had begun incorporating ­elements of biomedical diagnosis into their classical approaches to treating diseases.10 While collaborating with Japanese, American, European and indigenous Chinese biomedical reformers, Overseas Chinese considered their greatest success to be their promotion of military biomedicine during the Second World War. They established a military medical complex comprising the Chinese Red Cross Medical Relief Corps (1938), the Emergency Medical Service Training School (1939), and China’s first blood bank (1944). These organizations, all located in Southwest China, trained more than 15,000 medical personnel and established delousing, blood banking, preventive medicine, and similar practices that saved more than 4 million lives, helping preserve China’s ability to defend itself against Japan. Central to making biomedicine work were the efforts that Chinese reformers made to raise the money and resources needed for the aforementioned medical organizations. Because China’s political leadership rarely funded the reformers’ agenda, the latter raised money from foreign governmental and nongovernmental organizations, as well as from members of the Chinese diaspora. They undertook letter-­writing campaigns, convened

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international conferences, conferred with aid representatives, met with politicians, and gave speeches to audiences across the world—all in an effort to raise much-­needed funds for the Chinese Red Cross Medical Relief Corps. Between 1938 and 1939, these efforts culminated in the accumulation by Robert Lim and his Overseas Chinese supporters of substantial financial contributions. Remarkably, between 70 and 95 percent of these contributions (2 million Chinese dollars or 3.68 million US dollars in 2019 terms) came from the diaspora community. The success that greeted this fundraising venture was not lost on American aid organizations, which, in some of their fundraising literature, cited the financial generosity of ethnic Chinese residing outside China. Curiously, the reformers’ success also attracted detractors in the United States and China, who criticized Robert Lim for exercising total oversight of these funds without any accountability. Nevertheless, critics could not deny the reality that these international funds facilitated the recruitment of key personnel, the import of new technology, and the construction of military medical facilities in wartime China. A wide variety of materials from 23 archives and libraries on three continents undergirds my global history of biomedicine in China. International correspondence of medical personnel, government documents, personnel files, autobiographies, conference proceedings, medical texts, military reports, oral history accounts, classified medical surveys, scientific papers, posters, magazines, and newspaper articles in archives, libraries, and databases in the United States, Britain, China, Hong Kong, Taiwan, Singapore, and Japan illustrate the centrality of the Chinese diaspora in shaping medicine and society in twentieth-­century China.

Why the Diaspora Matters

The Chinese diaspora was central to China’s medical development. Scholars have investigated the lives of Overseas Chinese in their new host societies, particularly in Southeast Asia and the Americas. These Overseas Chinese ranged from wealthy merchants to overworked manual laborers dubbed “coolies,” from tax farmers and local administrators to restaurant owners.11 Numbering more than 20 million from the 1840s to the 1940s,12 Chinese immigrants were seen by scholars as eager to put down roots outside China, leaving behind malevolent Qing officials and other sources of

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economic hardship. In Philip Kuhn’s words, many members of the Chinese diaspora never forgot the “Qing officials from whom so many emigrants [had] been glad to escape.”13 In 1911 and 1912, not a few Overseas Chinese actively supported successful efforts to overthrow the Qing dynasty. 14 Moreover, historians treating Overseas Chinese as protagonists in their monographs little consider their identities and experiences.15 Recent scholarship has challenged this approach. Shelly Chan argues that Overseas Chinese elites from Southeast Asia shaped the political and intellectual life of China beyond the 1911 revolutionary experience.16 Karen Teoh shows how Chinese women educators born in Malaya “re-­migrated” to China after 1949.17 It was not simply the Overseas Chinese intellectuals and merchants in Southeast Asia who were interested in shaping the future of China. I have dedicated much of the current book to delineating the medical endeavors that Overseas Chinese undertook on behalf of China, and I have devoted considerable attention to Chinese Americans and Chinese Canadians alongside the Chinese in Southeast Asia. Most of the Overseas Chinese medical personnel discussed in my book were descendants of Chinese migrants in the pre-­1949 period. The main protagonists—Lim Boon Keng (Lin Wenqing 1869–1957), Wu Lien-­teh (Wu Liande 1879–1960), and Robert Lim—descended from ethnic Chinese who had migrated from Guangdong and Fujian provinces to Southeast Asia in the late eighteenth and early nineteenth centuries. These protagonists came to prominence in China through the support of both influential Overseas Chinese and influential indigenous Chinese who had studied in the West and returned to their homeland to serve the Chinese government. In the prewar period, Alfred Sze (Shi Zhaoji 1877–1956), a Jiangsu native and Cornell-­ educated senior Qing diplomat, recommended that his superior appoint the Penang-­born Wu Lien-­teh to lead plague-­fighting efforts in Manchuria in 1910. Wu Lien-­teh had trained in medicine at Cambridge University and worked in various European medical institutions. Tan Kah Kee (Chen Jiageng 1874–1961), a wealthy Overseas Chinese businessman, founded Xiamen University in 1924 and appointed Singapore-­born Lim Boon Keng to lead it. Lim Boon Keng had been educated in the sciences at Edinburgh University and achieved prominence as a businessman and legislator in Singapore before assuming the role of President of Xiamen University. At Xiamen University,

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Lim Boon Keng sought to recruit Robert Lim to establish a science-­based university. Robert Lim, who had been born in Singapore and received his PhD from the University of Edinburgh, instead chose to take up a position in physiology at the Rockefeller-­funded Peking Union Medical College. At the college, Robert Lim facilitated the recruitment of fellow Edinburgh-­trained and Penang-­born Oo-­Keh Khaw (O. K. Khaw, Xu Yujie 1883–1983) from Xiamen University to head the parasitology department. During the Second World War, Chinese Canadian Yi Chien-­lung (Yi Jianlong 1904–2003), Chinese American Adet Lin (Lin Fengru 1923–71), and several other Chinese Americans assisted Robert Lim in establishing the first Chinese blood bank, which was located in Kunming. Robert Lim also worked closely with the Chinese Filipino Frank Co Tui (Xu Zhaodui 1897–1983) and the Chinese American Allen Lau (Liu Kongle) to raise funds from sympathetic members of the Overseas Chinese diaspora for his medical endeavors. Around 3,000 ethnic Chinese from British Malaya volunteered to become truck drivers and mechanics in China during World War II. They ferried medical supplies donated from the West along the Burma and Ledo Roads, which served as a bridge between unoccupied British India and China. Finally, ethnic Chinese students from abroad constituted almost 40 percent of enrolled students at schools run by Overseas Chinese, a percentage that was especially notable at Xiamen University and the National Defense Medical Center. Overseas Chinese developed diverse global and local strategies for reaching out to and working in China. They rallied not only fellow members of the Chinese diaspora in Southeast Asia but Chinese Americans and Chinese Europeans, as well. They also sought assistance from British, Japanese, Russian, and American residents in China. They enlisted the help of national and local elites, lobbied American and Chinese politicians, and sought assistance from indigenous Chinese in Chinese towns and cities where their ancestors and relatives in China were from. Overseas Chinese worked particularly closely with Americans to achieve medical goals in China. Moreover, American funding, medical supplies, and other support came not only from Chinese American organizations but also from the American Bureau for Medical Aid to China (ABMAC) and the United China Relief, the National Association for the Advancement of Colored People (NAACP), and the Eisenhower administration. Between 1948 and 1960, Robert Lim and his

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colleagues lobbied members of the US Congress to fund the National Defense Medical Center in China and Taiwan. In terms of local strategies at making biomedicine work, they adapted imported medical technologies to fit local conditions by modifying medical equipment and substituting local materials for imported ones. They strengthened workforces, logistics, operational abilities, and data-­collection abilities in institutions to gain, maintain, and disseminate biomedical power in China. Insofar as I, in this book, identify and analyze the strategies that Overseas Chinese employed to promote biomedicine, I share with historian Shelly Chan her sentiment that the diaspora “operated as a process, a strategy, and a paradigm to engage change with global dimensions.”18 It bears noting that, given the remarkably diverse populations to which the terms Overseas Chinese and Chinese diaspora apply, their analytical usefulness has been questioned.19 Moreover, my focus on the global strategies of Overseas Chinese medical personnel is linked to Chan’s highly productive discussion about how the Chinese diaspora configured, used, and challenged diasporic identities and strategies in different circumstances over time.20 Regarding membership in the Chinese diaspora, medical personnel who were born outside China or who grew up outside China would easily constitute members of the Overseas Chinese community. Not only did their childhoods, educations, and relationships take place outside China, but so too did their interest in shaping the future of medicine in China. China’s medical personnel who were born in China but who left to pursue higher education in North America and elsewhere are also rightly considered members of the Chinese diaspora, because they actively affirmed their sojourning experiences in their careers. For instance, while working at blood banks in China during the war against Japan, Chinese personnel who fit this profile (born and raised in China but educated abroad) drew extensively on their academic experiences outside China. Many of them collaborated with aid officials in the United States, worked alongside fellow members of the diaspora, and operated largely without hindrance from indigenous Chinese officials. Finally, many of these Overseas Chinese medical personnel moved to Taiwan after 1949 to reestablish the medical system they had developed in China. They had to redeploy their long-­standing diasporic strategies of international outreach and wartime adaptation to make biomedicine work on the island. In sum, I

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make the case that the identities, experiences, and freedoms characterizing Overseas Chinese were central to their effective development of biomedicine in China and Taiwan.

Resisting the Diasporic Intervention

Overseas Chinese faced numerous obstacles as they tried to maintain their global networks. Lim Boon Keng and Tan Kah Kee struggled to finance Xiamen University’s medical program, and often received such aid almost exclusively from fellow members of the diaspora. In the late 1930s, Overseas Chinese medical personnel operating in China found it difficult to import medical supplies due to poor transportation infrastructure and the Japanese naval embargo. Even when supplies could reach a destination in China, disagreement arose over their use. The New York–based aid group United China Relief disliked the medical policies put forth by Robert Lim in China and sought to undermine his leadership at the Emergency Medical Services Training School. Another obstacle faced by Overseas Chinese medical personnel in China was their struggle to maintain consistent support from fellow members of the Chinese diaspora abroad, especially in the postwar period, when a wedge divided their previously united wartime supporters along Chinese Nationalist and Chinese Communist lines. The biomedicine promulgated by Overseas Chinese in China met with a wide range of responses on the ground. In the 1920s, residents in Manchuria waved knives at medical officers, forcing them to release the residents’ loved ones from newly built quarantine facilities. When the nation’s first Chinese blood bank was set up in Kunming, diasporic medical personnel found that Chinese soldiers were refusing to donate blood and were urging their comrades to do the same out of fear that the procedure would sap them of vitality. My examination of how indigenous Chinese responded to new biomedical practices imported by Overseas Chinese reflects a wider academic interest in the variegated social, cultural, and economic responses of Chinese women, journalists, intellectuals, physicians, government officials, and others to imported and native concepts, practices, and products.21 By exploring the dynamic local and global forces that shaped Chinese medicine in the modern era, I bring to light often overlooked contingencies in this critical moment in China’s internationalization.

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Beyond the Nation: Connecting the Global and Local through the Chinese Diaspora

The efforts of Overseas Chinese to expand medical care were critical in sustaining Chinese resistance to Japan during the Second World War. This assertion has been backed up by recent scholarship that provides a more positive assessment of Chiang Kai-­shek and his KMT government’s military achievements against the Japanese. Rana Mitter and Helen Schneider reveal how the wartime KMT government provided social rehabilitation and welfare for the Chinese people.22 Furthermore, Stephen MacKinnon argues that Chiang and his generals were ready for a protracted war with Japan despite initial setbacks, countering Lloyd Eastman’s earlier criticism of a corrupt, weak, and ineffective Chinese army.23 Besides preparing for the defense of the Central Yangtze region of China years before war commenced, Chiang galvanized his troops for the fight against the Japanese invaders early in the conflict by executing the governor of Shandong for having quickly surrendered the region to the Japanese. As a result, the KMT military significantly slowed the Japanese advances in Xuzhou, located in the Central Yangtze region during the crucial battles of March and April of 1938. In assessing the long-­held assumption that “the Chinese military leadership had no coherent strategy,” MacKinnon concludes that the opposite was true.24 These wartime efforts, however, were not limited to actions taken by KMT civil and military leaders. In reality, as I argue here, the medical treatment of Chinese soldiers was a large-­scale critical endeavor that hinged on the leadership of global and diasporic actors transcending political boundaries, offering medical aid and expertise, addressing physical limitations and medical constraints, using imported medical technologies, and adapting them to local conditions. The adaptations, in particular, were as creative as they were effective: medical personnel used Chinese wine vats to substitute for manufactured delousers and, when wood poles proved to be scarce, constructed mobile showers from local bamboo tubes. With such modifications, medical professionals deloused 2 million pieces of garments and bedding from 1937 to 1942 and helped stabilize levels of scabies and relapsing fever on the Chinese front. Similarly, blood bank personnel converted imported medical technologies such as gasoline-­operated autoclaves to charcoal power, which was much more readily available than gasoline on the Chinese front. In the absence of

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running piped water, personnel at China’s first blood bank constructed a hand pump to move water from a well to a water tower, so that running water could cool the blood bank’s equipment. These creative adaptations of imported medical technologies to local conditions made such life-­saving medical practices as delousing and blood banking possible in wartime China. The endeavors of Overseas Chinese in China during the Second World War constitute the focus of recent pioneering research on medicine and society. John Watt emphasizes the importance of KMT and CCP political leaders in promoting and validating the efforts of domestic medical reformers in fighting epidemics and diseases in wartime China.25 Nicole Barnes takes a gender-­based approach to analyzing wartime medicine by showing how women were central in forging new intimate communities in hospitals, in homes, in medical training centers, and on battlefronts. The KMT’s success at extending control over people’s lives during the war was contingent on women’s emotional labor, professional expertise, and frontline medical assistance.26 The research by Watt and Barnes reveals the role of previously hidden groups of medical and political actors in tackling wartime epidemics and diseases. Likewise, as I demonstrate here, Overseas Chinese included medical experts who took on underappreciated roles in institution building, fundraising, and the adaptation of medical technologies and knowledge to local conditions in China during the Second World War. This reliance on adaptive forms of health care transformed biomedicine in China in a host of ways. First, biomedicine became transnational. In the prewar period, Overseas Chinese established new medical institutions in Chinese cities, promoted a Johns Hopkins model of long-­term medical education for bilingual middle-­class Chinese students, and relied largely on members of the Chinese diaspora in Southeast Asia. During the Second World War, the scope of monetary, medical, and financial assistance from the diaspora grew to encompass new donors around the world. Besides the generous financial donations of Southeast Asian Chinese, Overseas Chinese in Europe and North America began supporting the Chinese war effort, contributing to and volunteering in the Chinese Red Cross Medical Relief Corps. Second, Chinese biomedicine became mobile, as wartime medical units brought biomedicine to cities, towns, and villages in Southwest and Northwest China. Third, Chinese biomedicine became transpolitical, as these

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units supported medical development in both Nationalist-­and Communist-­ held areas. As a result, the promises and limitations associated with imported biomedical practices were often negotiated in the field, rather than in prewar China’s laboratories and universities, leading to the fourth change: an observable shift from elitism and scarcity in biomedicine to at least a degree of egalitarianism and universality. Finally, preventive medical care, composed primarily of delousing, vaccination, and special dietary programs, became central in wartime China as a result of the shift toward adaptive medicine introduced by Overseas Chinese. Taken together, these changes are attributable in no small part to the leadership of such Overseas Chinese as Robert Lim and to China’s growing body of Western medical knowledge. In writing this book on the Chinese diaspora’s contributions to wartime Chinese medicine, I join other historians of medicine in the effort to expand the field’s focus beyond strictly Western European and American contributions to biomedicine. Global health histories have recently addressed the international significance of, for example, classical Chinese medicine,27 Maoist-­era “barefoot doctors,” and China’s one-­child policy.28 These new entangled histories have challenged the “hegemony of Eurocentric teleologies and models of developmental stages and modernization in European or World History writing.”29 Proponents of entangled histories eschew a straightforward transfer of biomedicine from the West to the East for a sense of “reflexivity” in the “validity of [existing] analytical categories” by taking a transcultural perspective.30 The conventional analytical focus on elite medical interventions should be interrogated in light of the history of a diasporic, transpolitical, globally financed, adaptive, field-­based, and preventive biomedicine. Paying more attention to the underappreciated topics of rural medicine, military medicine, and international health organizations allows for a more accurate connection between biomedicine and ordinary people’s variegated encounters with it.31

Biomedicine with Overseas Chinese Characteristics

Chapter 1, “Prewar International Strategies,” traces Overseas Chinese physicians’ early strategies in developing biomedicine in China. Driven by highly educated medical personnel and students, prewar Overseas Chinese biomedicine became concentrated in cities such as Beijing and Xiamen. This process was contingent on directors’ ability to secure and maintain funding and

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control—whether from the Rockefeller Foundation, foreign governments, or the Chinese diasporic community—in their medical institutions. In 1910, Wu Lien-­teh convened the International Plague Conference, which elicited an outpouring of financial support from foreign powers for Manchuria. In contrast to Wu’s successful fundraising efforts among diverse groups in China, Lim Boon Keng’s appeals to the Chinese diaspora in Southeast Asia failed to secure funding for his proposed medical school at Xiamen University. Robert Lim’s rise to power within the Rockefeller-­funded Peking Union Medical College was a result not so much of altruistic, enlightened American supporters as of his personal ability to negotiate for a senior position at the college. As leaders of prewar medical institutions, these three doctors promoted the unity of biomedical organizations, the institutionalization of military medicine, the diversification of biomedical hiring practices, the implementation of harsh quarantine measures, the convening of scientific workshops and conferences, and the training of medical students. Even more critically, these individuals established the priority of laboratory science. Their efforts were supported, and at other times stymied, by a wide range of local actors ranging from Manchurians wielding knives to recalcitrant Javanese donors. During the Second World War, the Overseas Chinese medical establishment shifted toward wartime needs. They left behind elite, urban, civilian laboratories and adapted to the countryside and the battlefield, introducing transpolitical, mobile biomedicine for all. They ushered in new medical practices of delousing, preventive care, mass medical education, and blood banking. Chapter 2, “Wartime Military Medicine,” details how the Chinese Red Cross Medical Relief Corps in Southwest China embarked on an unprecedented expansion of medical relief across China. Led by Robert Lim, and funded largely by the Chinese diaspora in North America and Southeast Asia through the ABMAC, the medical relief corps saved lives across unoccupied China by dispatching mobile medical units across the country, particularly to rural regions. Comprised of a driver, physicians, nurses, and technicians, these small groups of medical personnel brought curative and preventive medical care, including delousing, immunization, and special dietary programs, to more than 4 million soldiers and civilians on the battlefront. In Communist-­held regions, they provided critical expertise in constructing and running hospitals. They also collected medical data on the

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war front and negotiated the acceptance of biomedical practices in the field. Because of the limited resources available to construct elaborate mobile delousers and shower units, the mobile medical units had to substitute inexpensive local materials for imported ones to make delousing work. By creatively adapting blood bank technologies imported from the United States to fit wartime conditions in China, Chinese Americans and Canadians established the first Chinese blood bank in Kunming, the subject of chapter 3, “Making Blood Banking Work.” Technological modifications such as the aforementioned mechanical hand pump could not quell public opposition to blood donations—especially opposition from Chinese soldiers. Indeed, few Chinese soldiers or, for that matter, civilians responded to nationalistic and altruistic appeals. Some feared that donating blood would lead to the loss of vitality, and others balked at the lack of economic incentives. Overseas Chinese medical personnel struck a deal, promising soy milk and eggs in exchange for blood. This application of economic value to the act of donating blood in the context of wartime scarcity convinced many Chinese to abandon their opposition to blood banking. Thus we see socioeconomic incentives for blood banking outweighing the usual emphasis on cultural taboos that Chinese people harbored toward Western societies. Chapter 4, “Transnational Politics of Military Medical Education,” explores the politics of military medical education in wartime China through the history of the Emergency Medical Services Training School. Established by Robert Lim, the school provided rapid training for large numbers of medical personnel through a three-­week medical curriculum taught in branch schools across the region. The school trained more than 15,000 soldiers, a significant expansion from the fewer than 300 students educated in the prewar Peking Union Medical College. To make the most of trainees’ time, Lim had them following regimented schedules and practicing field medicine. While this program raised the number of medical personnel significantly, Lim and his colleagues increasingly regarded it as inadequate. He proposed a six-­year medical program divided into three stages of two years each, which would allow students who might not be able to study continuously to work incrementally toward their degrees. However, leaders of the United China Relief organization in New York considered his proposal to be impractical for wartime needs. United China Relief persuaded local Chinese politicians

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and regional medical organization officers to oppose the six-­year program, alongside other facets of Lim’s leadership. Battling Lim’s supporters affiliated with the ABMAC in New York and China, United China Relief eventually succeeded in ousting him from his leadership position. This chapter thus reveals the precariousness of relying on support from the United States, despite its impressive scale and scope during the war. As the Second World War ended, Overseas Chinese personnel faced domestic upheavals and international challenges wrought by the escalating civil war between the Chinese Nationalists and Chinese Communists. As the Chinese diaspora’s loyalty became increasingly divided between the two parties, they donated less to Robert Lim. As a result, Lim faced severe financial constraints as he sought to reestablish his wartime complex in the form of the National Defense Medical Center in postwar Shanghai in 1946 and later in Taipei after 1948. Chapter 5, “Reconstructing Biomedicine across the Taiwan Straits,” examines how Lim maintained the center’s viability by merging rival Chinese medical institutions into the organization, commandeering Japanese resources left behind after the war, and flying to the United States to seek donors and allies. These high-­profile measures were met with vocal opposition from Japanese-­trained doctors who resisted the merger, from US officials unsympathetic to the Nationalist cause, and from former wartime colleagues who challenged Lim’s dominance over the field of military medicine. Nevertheless, Lim succeeded in reintroducing professional medical training, expanding China’s nursing program, and creating a dental program. He restarted a blood banking program and promoted an overseas fellowship program for the center’s faculty and students. By 1962, Lim and his successors had trained more than 14,000 medical personnel. While the development of a comprehensive medical center went unrealized in China, by 1970, the National Defense Medical Center in Taiwan had developed a comprehensive education program for physicians, nurses, and dentists and maintained a robust overseas fellowship program with the United States through the ABMAC. The center emerged as a diasporic institution, training many ethnic Chinese students from Southeast Asia, not a few of whom went on to become biomedical leaders and teachers in Taiwan. The continuities and changes in the epistemologies, practices, and material culture of biomedicine in China reflected how members of the Chinese

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diaspora were interested in making biomedicine work in a variety of political and economic contexts in the twentieth century. Being more than simply fortuitous choices or pragmatic strategies that would function to preserve their positions in China, the efforts of these Overseas Chinese reflected what historian Philip Kuhn calls their desire to bridge the gap between their communities abroad and China proper, rendering foreign ideas, commodities, and practices palatable to mainstream Chinese society.32 For these Overseas Chinese, the host society was as often China as it was the West or Southeast Asia. Although their knowledge production and institution building in the prewar period drew deeply from Western biomedicine, their shift to a flexible, field-­based approach signified determination to introduce medical practices to a much larger population on the war front. These new ways of knowing, learning, and doing biomedicine through military medicine also brought regimented training regimes, branch schooling, a portable medical curriculum, and philosophies of state medicine to China. Such values of universal health care and military medicine left important legacies on both sides of the Taiwan Straits after 1949.

l CHAP TER 1 '

P R EWA R I N T ER N AT I O N A L S T R AT E G I ES

in 1911, a plague sw ep t through Manchuria, eventually killing more than 60,000 people.1 In the Manchurian city of Fuchiatien (part of the present-­day city of Harbin), a tailor was alarmed to witness the sudden death of two of his eight apprentices at his shop. He buried their bodies quietly, without reporting their deaths to the authorities for fear that, in the midst of the plague, his shop would be forced to close. A few days later, four more apprentices passed away, and the tailor again concealed their bodies in the ground. Unnerved by their deaths, the tailor gathered his money, called in his debts, and brought 600 Russian rubles with him to the railway station in an attempt to flee the city. He tried to buy a ticket, but was stopped by a railway officer who, regarding the tailor’s home district as one with a high rate of the plague, refused to let him board the train. Filled with despair, the tailor returned home. Presently, he contracted the plague and died. His two remaining subordinates were delighted at his death. They appropriated his money and divided up his property. However, they too soon died, leaving medical personnel to find the tailor’s cash sewn up in the clothing of their dead bodies. This tragic account of the tailor and his subordinates, as reported by the Times of India in Manchuria,2 reflects the intertwining of the global and local histories of the Manchurian plague. More specifically, the story reveals the virulence of the plague, the despair of individuals, the power of the railway company and its quarantine measures, and the role of the international press

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in shaping the global perception of the plague. Not only Chinese but also Japanese, Americans, and Russians living in Manchuria suffered from its spread. Government representatives from these countries and international reporters considered the initial Chinese effort to fight the plague inadequate and ineffective. In response, the Chinese government dispatched Wu Lien-­ teh, the Penang-­born and Cambridge-­trained vice director of the Army Medical College, to Manchuria in December of 1910. In Manchuria, Wu unleashed the power of the Chinese state to combat the epidemic with the assistance of fellow Overseas Chinese physicians and indigenous Cantonese from his home province, Guangdong. Wu burned infected corpses against the will of the people, reversing long-­standing traditions against cremation. Wearing masks prominently when visiting patients, Wu led the opposition to a French doctor who argued that the plague could not be spread through the air. He compelled household members to report symptomatic loved ones to the authorities, instructed the local police to quarantine healthy indigents and immigrants susceptible to the plague, burned houses in which infected residents had lived, and prevented patients from prematurely leaving quarantine hospitals—sometimes prompting knife-­wielding family members to attempt rescues of patients. Wu promoted these harsh measures at an international plague prevention conference from April to May 1911, where he gathered experts from all over the world. His efforts culminated in the establishment in July 1911 of the North Manchurian Plague Prevention Service, which evolved into a comprehensive medical and public health center in North China. Wu Lien-­teh was one of several prominent Overseas Chinese doctors who propagated, disseminated, and institutionalized Western medicine and science in China from 1911 to 1937. Their underappreciated experiences prior to the Second World War reveal the importance of the Overseas Chinese in shaping medicine and society in prewar China. They developed medical practices that were urban-­based, institutionally oriented, globally funded, and autocratic in nature. Their efforts were sometimes stymied by a lack of resources from abroad and by resistance from local residents, practitioners of classical Chinese medicine, and other biomedical doctors. In their efforts to promote the professional study of medicine, these Overseas Chinese undertook production of medical knowledge in academic journals, classrooms, traveling



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exhibitions, museums, laboratories, and medical curriculum. In reaching out to wider populations, the Overseas Chinese regularized the collection and representation of medical statistics, intensified public health education, constructed expansive hospital wards, advocated biomedicine by rejecting zero-­sum discourses that pitted Western medicine against classical Chinese medicine, bolstered maternity healthcare, and developed professional medical societies. They conducted this outreach primarily through their leadership in biomedical and scientific institutions in Manchuria, Beijing, and Xiamen. This chapter illustrates how Wu Lien-­teh, Lim Boon Keng, and Robert Lim shaped their respective institutions in China—the North Manchurian Plague Prevention Service, Xiamen University, and Peking Union Medical College (PUMC)—from 1910 to 1937. My analysis of their contributions casts familiar stories of twentieth-­century Chinese society in a new light, confirming that their strategies were central to shaping Chinese biomedicine. The first story describes Wu Lien-­teh’s global strategies for biomedical interventions, and thus constitutes a shift away from the existing scholarly focus on the Qing and foreign responses to the 1911 Manchurian plague. Wu convened a successful international plague prevention conference in Manchuria, generating long-­term financial and political support for this objective. Furthermore, Wu was not afraid to embrace his critics, court foreign powers and indigenous elites, recruit fellow members of the diaspora, and reach out to classical Chinese medical doctors. The second story explores Lim Boon Keng’s repeated failed attempts to raise enough money to fund a medical school at Xiamen University from 1924 to 1936, revealing the serious limits of diasporic funding for biomedical projects in China. Contributing to the failure was his patron’s determination to fund the medical college with help solely from members of the Chinese diaspora. Even though Lim’s ultimate goal of establishing a center of medicine in South China did not succeed, he helped Xiamen University develop into a powerhouse for marine biology and related sciences. The third story emphasizes Robert Lim’s active negotiation for his position at PUMC as well as his subsequent efforts to facilitate the hiring of scholars of East Asian descent in an organization dominated by white scholars. From 1924 to 1936, Lim also made PUMC more relevant to the broader Chinese population by leading a group of PUMC colleagues in the Chinese war effort against Japan, by establishing a professional society

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for the study of physiology, and by introducing a more practical and multidisciplinary curriculum for Chinese students. The story of Lim’s endeavors augments existing narratives that mostly highlight Americans’ efforts to diversify and indigenize the Rockefeller-­funded PUMC. In sum, this chapter makes the case that the varied fundraising, management, and networking strategies of Overseas Chinese were critical in shaping the outcomes of their biomedical interventions.

Diasporic Origins

Wu Lien-­teh was born in Penang, and Lim Boon Keng and Robert Lim were born in Singapore. Penang and Singapore were part of the broader British-­controlled Straits Settlements, which in turn were components of a larger entity known as British Malaya, whose borders would have approximately overlapped present-­day Peninsular Malaysia and Singapore.3 Since its founding as a British colony in 1819, Singapore received large numbers of immigrants from China, with the population of ethnic Chinese growing steadily from 3,317 in 1824 to 54,317 in 1871, to 315,151 in 1921, to more than 1.5 million by 1970.4 From 1921 to 1965, more than three-­quarters of the population in Singapore was classified by the colonial authorities as ethnically Chinese, and the rest of the population were classified racially as Malays, Indians, Eurasians, and Others.5 A significant majority of the Chinese in Singapore descended from families in the Chinese provinces of Fujian (predominately southern Fujian) and Guangdong, where locals were known as Hokkien and Cantonese.6 It is likely that a majority of Penang residents were similarly classified as ethnic Chinese, and that a majority of these Penang Chinese were Hokkien.7 Wu Lien-­teh was born to a first-­generation Cantonese immigrant in Penang. Lim Boon Keng was third-­generation Hokkien, and his son, Robert Lim, fourth generation. Wu Lien-­teh left Penang in 1896 to study medicine at the University of Cambridge on the Queen’s Scholarship. The scholarship had been founded by the British governor of Malaya in 1885 to fund the education of young Malayans in the United Kingdom.8 At Cambridge, Wu took classes in the sciences, pharmaceutical chemistry, human anatomy, and physiology.9 After graduating in 1903, he conducted research with Ronald Ross at the Liverpool School of Tropical Medicine, bacteriologist Carl Fraenkel of Halle an



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der Saale, and immunologist Élie Metchnikoff at the Pasteur Institute.10 Upon Wu’s return to Penang in 1904, he embarked on an active antiopium campaign, which irritated the colonial government and local Chinese opium traders.11 To undermine his position, the British colonial authorities soon charged Wu with illegal possession of an ounce of the drug, which Wu had kept in his clinic.12 Wu saw this charge as a warning by the colonial government against his stance on opium and decided against staying in Malaya for the long term. In 1908, he moved to China to take up the position of vice director of the Imperial Medical College in Tianjin at the behest of Yuan Shikai, then the grand councilor of the Qing government. In 1911, Wu applied his Western education to combating the plague in Manchuria. Lim Boon Keng had won the Queen’s scholarship in 1887, almost a decade before Wu. In fact, he was the first ethnic Chinese in British Malaya to win the scholarship.13 At the University of Edinburgh, Lim studied botany, anatomy, practical physiology, institutional medicine, and pathology, and in 1891, medical degree in hand, he graduated with first-­class honors, the only student of the 204 graduates to be so recognized that year.14 Lim returned to Singapore in 1893, following a year of additional study at the University of Cambridge, and taught medicine at a local college. He received an appointment to the Straits Settlements Legislative Council in Singapore, a rarity as an ethnic Chinese man, as the body consisted mostly of white British men. In Singapore, he developed not only a keen interest in the affairs of China but also strong connections with reformers such as Liang Qichao and revolutionaries such as Sun Yat-­sen.15 After the Republic of China was founded in 1911, Provisional President Sun appointed Lim as the first head of the Department of Health in the Ministry of Internal Affairs, presumably because of his expertise and his support for the revolutionary movement. There, Lim supervised customs quarantine facilities, monitored the outbreak of viruses and plagues, and tracked the sales of medicine and recreational drugs (xihaopin).16 In 1921, he was appointed president of Xiamen University, where he worked toward establishing a medical college. Along the way, Lim started a biology program, which attracted world-­class scientists. Lim Boon Keng’s son, Robert Lim, was also born in Singapore. He grew up with his father in Edinburgh and, at the age of 16, attended the same university as his father. By 20, he had completed his undergraduate degree in medicine

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and surgery. Following a short stint in France as a medical officer in the British Army, Lim returned to Edinburgh to complete his doctorate in histology and physiology, as well as to teach briefly in the department as a lecturer. At Edinburgh, Lim published eight articles ranging from the histology of tadpoles fed with thyroid to the effects of adrenalin on pulmonary circulation.17 In 1924, he headed to the University of Chicago to conduct research with A. J. Carlson, a Swedish American physiologist. The Rockefeller Foundation sponsored Lim’s fellowship at the University of Chicago and later paid his salary, in Beijing, as the head of the PUMC’s Department of Physiology from 1926 to 1936. With his relevant experience in Edinburgh and Chicago, Robert Lim was an ideal candidate to develop a new system of scientific education and instruction in physiology in China. At PUMC, he promoted the study of physiology in the Chinese medical community, the development of military medical training, the unity of biomedical associations, and the broadening of faculty hiring practices. The endeavors of Lim and his fellow Overseas Chinese would not have come to fruition in China if not for funding from either the Queen’s Scholarship or the Rockefeller Foundation. The organizations enabled these Overseas Chinese to receive advanced degrees in medicine and to work in China.

Fighting the Plague with Global and Diasporic Connections

Wu’s efforts at fighting the plague were contingent on his ability to draw from his diasporic connections and from international powers in the region. He raised money and acquired other resources, which, in 1911 in Manchuria, enabled him to convene an international conference on plague prevention. His objective was to create a global consensus on the need for harsh interventionist measures. Wu’s engagement with Overseas Chinese and international powers were just as important in fighting the plague in Manchuria as were his better-­ known endeavors at working with local Qing authorities or at uncovering the pneumonic nature of the plague under the microscope. The strategies of indigeneity commonly attributed to Wu’s endeavors in China by scholars should account for the importance of his ability to leverage his diasporic background and international resources in the fight against the Manchurian plague. Scholars have shown the broader implications of new technologies in shaping Wu’s public health measures. By uncovering the pneumonic nature of



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the plague, he challenged existing notions that the plague was spread merely through rats.18 After concluding that this plague could spread through the air from one human to another, Wu implemented new measures to isolate sick patients from healthy individuals. He insisted that medical doctors, orderlies, and patients wear masks to prevent human-­to-­human transmission of the plague. In the face of opposition from residents, Wu drew on the power of the Qing state, seeking its approval to cremate diseased bodies.19 Purportedly, as a result of these medical interventions, the plague was brought under control in less than five months. His success has inspired scholars to research other aspects of Wu’s medical intervention in China. Researchers have so far investigated his published medical histories of China,20 as well as his invention of the hygienic “Lazy Susan” turntable, which is commonly found in Chinese restaurants as a rotating tray across the world today.21 His multifaceted interventions, aimed at changing the everyday hygienic practices of the Chinese, drew largely from the power of the Chinese state. To supplement the narrative of Wu as a plague fighter, historians have begun to contextualize his efforts in the broader history of plague intervention in the region. Scholars have highlighted how Russians in Manchuria,22 police in the Manchurian city of Fengtian,23 and Hong Kong authorities developed similar antiplague measures prior to Wu’s intervention in 1911.24 Even though such research now shows that Wu’s efforts were less original and groundbreaking than once thought, I argue that Wu’s global approach to fighting the plague, largely unexplored until now, played an important role in promoting Chinese biomedicine. To foreigners as well as to Chinese, Wu made visible the plague-­fighting efforts in China. By leveraging his overseas education, his international experience, and his connections with members of the Chinese elite and with foreigners in Manchuria, Wu secured the financial, material, and political support necessary for the development of biomedicine in China. Consequently, his antiplague organization grew steadily in Manchuria from 1912 to 1932, despite the vicissitudes of colonial and warlord politics in the region. Wu’s efforts at internationalizing biomedicine in China originated from his early efforts at exploiting his multiple identities. Wu was an Overseas Chinese person in China, a British subject from Malaya, a Cantonese-­ speaking native, and a Cambridge-­trained physician. During his stint as the

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vice director of the Imperial Medical College in Tianjin from 1910 to 1911, he paid visits to fellow Overseas Chinese such as Java-­born, Yale-­educated Lee Teng Hui,25 American-­trained Tang Shaoyi,26 and fellow Malayan Wu Ting-­fang.27 Lee Teng Hui (not to be confused with the first democratically elected President of Taiwan) would later become the president of Fudan University, Tang Shaoyi the first premier of the Republic of China, and Wu Ting-­fang an acting premier and prominent constitutional law reformer in China.28 Tang was instrumental in recommending J. W. Chun, a Cambridge-­ trained Chinese doctor, to Wu. Indeed, from 1915 to 1937, Chun was one of Wu’s closest colleagues.29 Wu also drew on his British citizenship, obtained by birth in the British Straits Settlements,30 and reached out actively to the local British ambassador Sir John Jordon. Jordon would later facilitate a generous donation to the establishment of Wu’s North Manchurian Plague Prevention Service.31 Furthermore, Wu secured the help of the British consul to rescue him from Japanese military officers who sought to detain Wu as he was leaving Manchuria in 1930.32 He also drew on his Overseas Chinese connections by enlisting Dr. Chen Sze-­Pang, a Singapore-­born and Cambridge-­trained doctor, to carry out autopsies on infected corpses in Manchuria and to acquire samples of the deceased’s organs and blood.33 Wu and Chen examined infected corpses under the microscope and found characteristic plague bacilli, which meant that the plague was pneumonic. Wu went on to conclude that the origins of the plague came from marmots rather than from rats.34 The pneumonic nature of the plague led Wu to argue that the plague was transmitted from one person to another, in contrast to his rival from Beiyang Medical College, Dr. Mesney, who had earlier argued that the plague was bubonic in nature and was correspondingly transmitted through rats.35 Furthermore, drawing on his native association with Guangdong and his status as a Cantonese speaker, Wu recruited two physicians from the province to assist him in Manchuria. These two physicians remained beside Wu during his entire career in China, through “prosperity and adversity.”36 The scope and scale of Wu’s multiple diasporic identities—as a Cantonese, an Overseas Chinese from Penang, a British subject, and a member of the English-­educated elite in semicolonial China—were instrumental in securing his personal freedom, as well as in promoting his medical endeavors, in China.



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Besides drawing from his Western education and Overseas Chinese connections, Wu Lien-­teh sought to reinforce China’s war on the plague with the international plague prevention conference that he convened in Manchuria in 1911. Beginning in April and held for more than a month, the conference attracted over four dozen participants from Russia, Japan, China, the Netherlands, the United States, the United Kingdom, France, Germany, Mexico, Italy, and Austria-­Hungary.37 The conference bolstered the reputation of Wu as a credible plague fighter and greatly improved the world’s perception of China’s plague prevention and, more generally, public health activities. Newspapers from the United States, the United Kingdom, India,38 China, Japan, and Singapore provided extensive coverage of the conference,39 helping transform the old view of an indecisive, weak, and parochial China into a new view of a capable, strong, and global China. In so doing, the conference had the effect of raising China’s international profile. The conference also had the unintended effect of generating a consensus for stringent quarantine polices and medical surveillance that targeted marginalized members of Manchurian society. Even as participants vigorously debated the etiology, diagnostics, treatment, and prevention of the plague, they came to a consensus on the importance of maximizing the levels of control over the population to prevent the spread of the plague in China and around the world. The delegates debated relevant issues in the broader context of the low level of trust in China and in Chinese efforts at epidemic control. The Japanese and Western presses denigrated the Chinese in woodblock prints, newspapers reports, and travelogues, drawing on their disdain for China over its repeated losses to foreign powers––the Sino-­Japanese War of 1895 and the Eight-­Nation intervention in the Boxer Rebellion in 1900 being the freshest in people’s memories.40 The Japanese defeat of the Russians in 1898 strengthened the former’s position in Manchuria, with the Japanese obtaining key territories and a railway infrastructure through the acquisition and development of the South Manchuria Railway Company. The power of the Japanese Empire contributed to the international press characterization of Chinese antiplague efforts as ineffectual and Wu’s role as marginal. For example, a month before the conference, the Japan Mail reported briefly on plague-­related disturbances in “several North Chinese cities” and only briefly mentioned the participation of Kitasato Shibasaburō and other Japanese

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doctors.41 Kitasato (1853–1931), a prominent Japanese bacteriologist, the first to cultivate a pure culture of tetanus and subsequently a developer of serum therapy for tetanus, was himself a critic of Chinese efforts.42 Kitasato opposed the leading role of Chinese doctors in organizing the conference, arguing that “the Chinese have no right to lay positions before the Conference or to claim a voice in the conference.”43 His negative views of the Chinese were shared by some American officials in Manchuria. One official claimed that he and his colleagues were constantly pressing the Qing government to do more to fight the plague, noting that “renewed representations have been made to” the Chinese leaders “by several members of the consular body, including myself, with a view on impressing upon him the seriousness of the situation.”44 The Americans also expressed frustration at Chinese reluctance to stop all train service from Mukden to Harbin.45 In short, American representatives, like international reporters and Japanese scientists, were skeptical of the will and ability of the Chinese to fight the plague. Overcoming this global skepticism was a tall task for Wu. Wu employed an unexpected strategy of acquiescing to his critics to achieve the greater good of pulling off a successful conference. To do so, Wu decided to cede the chair of the Bacteriology and Pathology Committee to Kitasato during the conference and arranged for Kitasato to sit next to him at the head of the table in several sessions. As seen in figure 1.1, a photograph of the Bacteriology Committee’s deliberation revealed Kitasato’s prominence, as he was seated to the left of Wu at the head of the table in a crowded room of medical experts. The absence of a caption explaining Wu’s position could have easily conveyed the impression that Kitasato was the head of the conference. After Wu ceded the Bacteriology Committee chair to Kitasato, international reporters began reporting positively on Kitasato and the conference.46 On April 5, 1911, the Japan Mail declared that “Kitasato [had been] elected as Chairman of the Plague Conference,” even though Kitasato chaired only one committee within the conference. In the United States, the New York Times, Los Angeles Times, Chicago Daily Tribune, San Francisco Chronicle, and Atlanta Constitution extensively covered Kitasato’s comments at the conference, lending further credence to the false impression that Kitasato, not Wu, was leading the conference.47 The Chicago Daily Tribune highlighted that “Dr. Kitasato, the noted Japanese bacteriologist, says, although no victim of pneumonic plague



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Figure 1.1.  International Plague Prevention Conference in session, 1911. Dr. Wu Lien-­ teh, organizer of the conference, with Prof. Kitasato Shibasaburō on his left. Source: University of Cambridge Repository, www​.repository​.cam​.ac​.uk​/handle​/1810​/281985. Photograph originally appears in Wu Lien-­teh, Manchurian Plague Prevention Service Memorial Volume: 1912-­1932 (Shanghai: National Quarantine Service, 1934).

recovers, this disease is more easily controlled than bubonic plague, as the pneumonic is contracted only from exhalations or expectorates.”48 The report referred to Kitasato’s explanation of the pneumonic plague in two long paragraphs, while the Chinese were only described “as making elaborate preparations” for the conference, with no mention of Wu.49 In reality, Kitasato played little role in uncovering the pneumonic nature of the plague in Manchuria. The credit should have gone to Wu and his collaborators. Nevertheless, subsequent reports in Japanese newspapers argued that Kitasato’s views were credible, popular, and “embodied in [the] final resolution” of the conference.50 These reports on Kitasato no longer criticized China for poor plague-­fighting measures. Wu’s decision to allow for the misperception of Kitasato as the chair of the conference dramatically improved the image of the conference through a positive review of Kitasato’s views on the plague. Wu diplomatically arranged entertainment for Kitasato, delighting the Japanese delegate and consequently shaping his positive views of the

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conference and the Chinese. For example, the weekend after the conference, Wu arranged for Kitasato and his fellow delegates to be treated by senior Chinese and international diplomats to lavish dinners, meetings, and sightseeing tours in Beijing and Manchuria.51 Kitasato and his fellow delegates traveled first class by train and stayed in the finest hotel rooms. They socialized with their international counterparts, not in formal conference gatherings, but in leisurely surroundings.52 The main recipient of all this sumptuousness appears to have enjoyed his experiences so much that he publicly made statements favoring China, which was a departure from his preconference hostility. He remarked that the “labors of the Chinese commissioners should be appreciated” given that they “spent a great expense of their own” to host the participants in a new hotel in Manchuria and brought in delicious food all the way from the cities of Beijing and Tianjin.53 Kitasato told reporters that he ended up spending 62 days in China, even though he initially wanted to stay for only 14 days.54 Critics saw Wu’s ceding of the limelight to Kitasato as an acknowledgment of the Japanese delegate’s fame and the Japanese nation’s power, yet Wu’s strategic decision to indulge, rather than challenge, Kitasato arguably created an informal platform on which his chief Japanese critic could naturally embrace not only Wu and his colleagues but also China and the Chinese plague prevention methods. While employing this strategy of diplomatic indulgence, Wu challenged widespread negative perceptions of China’s handling of the plague by promoting the use of harsh antiplague measures in Manchuria. At the beginning of the conference, Wu’s strategy was controversial with the local population in Manchuria. Indeed, Wu’s Chinese mentor, Alfred Sze, initially shared this view: The Chinese are apt to resent what they consider undue interference with, or intrusion into, their family life; and it has been a difficult official duty for us to carry out apparently cruel work—the quick separation of a plague case from his or her family relatives, removal of one member to the plague hospital and others to segregation camps, and so on.55

Such “cruel work” was sharply criticized by foreign physicians, local residents, and international journalists. Recall that a French doctor refused to wear a mask to treat patients as he opposed Wu’s idea that the plague was spread through the air.56 Classical Chinese medical doctors clamored to treat



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patients in their own clinics and hospitals, beyond the control of an external biomedical system.57 Manchurian residents refused to allow their deceased who had died of the plague to be cremated, as they felt that this step violated long-­standing Chinese values that supported the burial of preserved bodies.58 A Scotsman reporter went so far as to question the fundamental necessity of antiplague measures: Such precautions as isolation of sick, suspects, and contacts, post-­mortem examinations and cremation of the dead, hitherto unheard of in Chinese history, and opposed to age-­long prejudices of the people were enforced without

question. Whether the dying out of the epidemic was owing to the energetic action of the Chinese, Japanese, and Russian authorities, or whether it was due to some climatic or other influence, it is impossible at the present to say.59

Such skepticism and outright opposition, however, were not shared by the conference’s delegates. Many favored Wu’s interventionist approach. They argued that effective state intervention meant the burning of plague-­infested houses, the cremation of corpses, the construction of a segregation infrastructure, and the enforcement of transportation-­related quarantine measures.60 Participants argued that even healthy “beggars,” “waifs,” and “immigrants” should be isolated from the rest of the population during the Manchurian plague. These classes of people, according to the delegates, were most susceptible to the plague.61 As a result, Wu and his medical workers locked 4,187 people in railway wagons in Fuchiatien during the plague. Wu preferred wagons because they could be “procured easily” and “easily disinfected.”62 Doctors from the nearby city of Mukden favored comfortable and practical “boxes,” which were “built of galvanized iron over a framework of wood, and contained accommodation for different classes of patients.”63 They commented that railway wagons were too “expensive and large,” and those residing in wagons found it hard to prepare meals. The wagons-­versus-­boxes debate reflected the eagerness of medical elites to find the best way to quarantine as many potential carriers of diseases as possible—in this case, indigents—as efficiently as possible. These elites justified their harsh measures in the name of social welfare. Plague prevention officials also advocated the development of permanent institutions that constrained the movement of populations. To this end, Wu “instituted” an antiplague bureau for areas under his jurisdiction.64 The bureau’s plague prevention officials subjected patients to daily inspection in

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“barracks-­like” quarantine stations.65 During their regular visits to neighborhoods, officials pressured residents to report the deaths of family members, treated homes with carbolic acid and sulfur, and burned down plague-­ infested houses.66 With help from the bureau, Wu published newsletters to disseminate information on the plague and transformed temples into makeshift hospitals.67 Wu boasted that he had established a “military cordon” of 1,100 soldiers in Fuchiatien to restrict unnecessary movement in the population, ordered 600 police to enforce quarantine measures, appointed 53 experts to his antiplague bureau, and spent 100,000 Chinese dollars on vaccines.68 Clearly, Wu’s actions and rhetoric, which prioritized health over freedom, were premised on strong and permanent technocratic interventions in the everyday lives of Manchurians. Wu’s strategic combination of, on the one hand, acquiescence in the face of his critics such as Kitasato and, on the other hand, an almost dictatorially assertive approach toward fighting the plague on the ground shaped the press’s reinterpretation of the Chinese efforts at fighting the plague. Two months prior to the conference, the New York Times had characterized the Chinese battle against the plague as ineffective. According to the Times, not only did the Chinese “have no real police system” to control the plague-­infested city of Fuchiatien but also, in the absence of such a system, the Russians “let slip” a chance when they failed to dispatch their own military to the city to combat the plague.69 The Times also reported that Japanese authorities were threatening to send troops into Chinese-­held areas of Manchuria to stamp out the plague if the Chinese did not do more to combat it.70 Immediately after the conference, the Times praised the event, noting that delegates wanted to publish their findings so that “their investigations will benefit the world.”71 The Times also took the lead in refuting an earlier report by the Austin Statesman, which claimed that obstructionist Chinese delegates had “prevented the adoption of certain resolutions.”72 Like the Times, the Washington Post reported after the conference that Wu Lien-­teh “has earned unstinted praise for the fine work done by him in Harbin during the recent epidemic.”73 Similarly, the Scotsman praised the Chinese government for “acting with commendable promptitude and firmness with the epidemic.”74 The rhetoric of the Scotsman and the Post recast Wu Lien-­teh and the Chinese as essential to plague fighting in Manchuria, in contrast to the earlier journalistic charges of Chinese ineptitude.



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This reinterpretation of Chinese antiplague efforts laid a foundation for greater international support for Chinese efforts to eradicate the plague and extend biomedicine. Specifically, the shift in attitude motivated a wide variety of international and domestic actors to assist in the formation of a new permanent organization to combat the plague in Manchuria. After the conference, the viceroy of Manchuria gave Wu 21,000 British pounds (USD [2018] 2.84 million) for the establishment of the North Manchurian Plague Prevention Service (NMPPS, Dongshansheng fangyi shiwu zongchu).75 Wu swiftly established four antiplague hospitals in Manchuria,76 largely through funding from Maritime Customs, which—jointly run by the Qing government and the British Inspector General from 1854 to 1937—collected revenue, constructed lighthouses, collated metrological data, brokered diplomatic deals, and managed debts.77 When the Qing dynasty fell a few months after the conclusion of the plague conference, new Chinese officials and foreigners took charge of Maritime Customs. Wu lobbied the British, German, French, and American ambassadors to pressure the new Maritime Customs to continue funding the NMPPS. In 1917, Wu secured a firm commitment of around 9,000 British pounds per year (USD [2018] 609,723) from the Maritime Customs leadership.78 Wu recalled feeling “thankful” that he could “now go ahead with the work of organization without further interruption.”79 Despite foreign powers’ encroachment on Chinese sovereignty in Manchuria and elsewhere,80 Wu directed critical resources from them to his NMPPS by capitalizing on his Western background, his strong English-­language skills, and his newfound fame as an international plague fighter. And with money came talent. Wu was able to attract some up-­and-­ coming doctors of the day with his well-­funded organization. In addition to the aforementioned Dr. Chen Sze-­Pang from Singapore, the NMPPS hired 12 doctors including F. E. Reynolds, a young graduate of Edinburgh who had specialized in bacteriology; J. W. H. Chun, a graduate of Cambridge and London who came from a well-­to-­do family in Shanghai; and Robert Pollitzer, an Austrian pathologist and linguist who later became a senior official in the postwar World Health Organization.81 In brief, the goodwill that emerged from the international plague prevention conference translated into steady financial support and a reliable supply of resources and labor for the newly established NMPSS.

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Over the next two decades, Wu Lien-­teh expanded the NMPSS beyond its initial charge of fighting epidemics. By 1930, the NMPPS treated regular patients, ran hospitals and laboratories, accredited and promoted medical education, provided veterinary care, and supervised medical procedures throughout China. Even though the NMPPS sought to extend biomedicine to rural regions (for example, the vaccination of over a hundred aboriginal people in rural Manchuria in 1914), its initiatives were concentrated in Chinese cities.82 In 1915 in Harbin, Wu established a museum devoted to the plague, and in Shanghai he created exhibitions on the etiology, nature, and treatment of the plague.83 Wu gradually increased the numbers of quarantine hospitals and facilities in the cities of Newchwang (1919),84 Manchouli (1920), Antung (1922),85 Hailar (1925), and Harbin (1926).86 He oversaw construction of new laboratory facilities in Harbin (1924) and proposed a maternity healthcare unit (1926).87 The NMPPS’s plague prevention services more than doubled their number of supervised patients, from 15,000 in 1918 to about 33,000 in 1923.88 That figure increased to about 36,000 patients in 1926.89 The NMPPS also assumed accrediting roles by conducting bacteriological and chemical tests on the purity of water supplies, milk, and pharmaceuticals, as well as formulating questions for local medical examinations in 1917.90 In addition, the NMPPS in 1916 began regional veterinary treatment of cattle and horses, which elicited praise from members of the American Agricultural Development Farm and the American Manchurian Development Company.91 Russian officials across the border from Manchuria donated serum for the new service’s immunization of animals.92 The international cooperation that underpinned the expansion of the NMPPS raised the organization’s medical profile and revealed its ambitious attempts at expanding care and control over humans and animals in the region. By expanding in scope and size, the NMPPS helped justify its own existence. Wu framed the absence of epidemics under his watch as a sign of both the NMPPS’s success and its continued relevance, rather than as a reason for terminating the organization’s Manchurian duties. In 1917, he argued that “plague continues to be absent throughout Manchuria and North China making this the seventh successful [emphasis mine] year in which it had not occurred.”93 When epidemics did arise that the NMPPS had to fight, Wu drew most of his assistance from foreign powers in the region. In 1920, a cholera outbreak in Manchuria prompted Wu to seek assistance from local Japanese,



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Americans, British, and Russians.94 To assist the NMPPS, the American Red Cross dispatched doctors and nurses to the stricken region and supplied medicine to cholera patients there.95 The British consul in Manchuria donated money to the cholera prevention efforts. Local Japanese merchants in Manchuria donated 225 pounds of carbolic acid to disinfect homes,96 and the Russian Railway authorities lent Wu eleven railway wagons for the housing of convalescents.97 In contrast to the plague prevention efforts in 1911, when international powers in Manchuria worked independently to fight the plague,98 it appears that by 1920, the growing credibility of Wu and the NMPPS meant that members of Manchuria’s international community had grown in their willingness to work with Wu in fighting epidemics, thus concentrating the power of the Manchuria-­based antiepidemic measures in the hands of Wu’s organization. Wu turned the growing intrusion of Japanese, Russians, and other foreign powers in the region to his advantage by using their resources to further strengthen and legitimize the power of the NMPPS.

Reinterpreting Plague-­Fighting History

Manchurian residents maintained resistance to antiepidemic measures, despite the NMPPS’s successes. In 1921, Manchurians refused to report cases of bubonic plague in their homes to the NMPPS, fearing that cooperation would result in their being quarantined by the NMPPS and ostracized by their neighbors. Many residents accused local hospitals of failing to discharge patients even after they had recovered. Just as in 1911, Manchurians in 1921 again pointed guns and wielded knives when medical officers showed up at their homes to quarantine family members. They set loved ones in quarantine stations free by chasing away medical personnel.99 Wu regarded his time in Manchuria as a period that saw little resistance from the local population, despite locals’ long-­standing resistance to his endeavors from the beginning of his tenure in 1911 until 1932, when the Japanese invasion of Manchuria led to his departure from the NMPPS.100 The newly victorious Japanese authorities in Manchuria complained that the Chinese had resisted Japanese antiplague measures, with the familiar refrain that Manchurians had only reluctantly reported incidents of plague-­related deaths to local authorities. Ironically, Wu blamed the authoritarian and foreign nature of Japanese colonialism for the occupiers’ failure to solicit support for quarantine measures. He claimed to have had no such experience of

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noncompliance “during 20 years as the director of the service.”101 He added that if a doctor was kind and treated Manchurians as friends, they would “always [be] willing to give co-­operation.”102 Wu was thus not so subtly implying that the NMPPS had been, in contrast to its venal Japanese counterparts, a kind organization with a track record of full support from Manchurian residents. Such statements contradicted accounts of resistance dating back to 1911. By painting the Japanese antiplague measures in 1932 as ineffective while boasting about Manchurians’ compliance with previous NMPPS measures, Wu downplayed—to the point of denial—the actual fierce resistance exhibited by Manchurians to his antiplague policies. Wu devoted years of effort to disseminating his antiplague prevention methods abroad. From 1911 to 1937, Wu presented his research and experiences at more than two dozen conferences in ten cities around the world. He published his findings in the Journal of Hygiene, the American Journal of Hygiene, the Journal of Tropical Medicine and Hygiene, The Lancet, Epidemiology and Infection, and other British and American journals.103 From 1911 to 1937, he traveled to Japan, Korea, India, Singapore, Europe, and the United States as the head of the NMPPS and the National Quarantine Bureau (which he led after leaving Manchuria for Shanghai).104 His ability to represent China rested chiefly on his Manchuria-­based biomedical work, which in turn owed much to his diasporic background, his early experiences with medical conferences, his Western education, and his desire to foster epidemiological interventionist practices. Wu’s effective cultivation of global resources and of personal and organizational legitimacy meant that the NMPPS could expand beyond its initial epidemiological mission: the organization was soon providing general clinical services, establishing new medical standards, reorganizing biomedical infrastructure, conducting scientific research, and disseminating the research findings. Under Wu’s tutelage, prewar medicine in China became diasporic, institution-­based, urban, and, from the perspective of some critics, highly autocratic.

Changing Attitudes toward Classical Chinese Medicine

As their careers took off in China, Wu and his fellow Overseas Chinese doctors sought to promote biomedicine among classical Chinese medical practitioners. Wu, in particular, appeared to be a straightforward proponent of



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biomedicine and an unabashed critic of classical Chinese medicine (CCM) throughout his early days in Manchuria, but he took a much more conciliatory approach in the 1930s. In 1911, Wu disdainfully referred to CCM practitioners as “native doctors of the old school.”105 Wu further alleged that, during the Manchurian plague, these CCM practitioners had insisted on opening their own hospitals to treat plague patients only to close the hospitals within a week after having caused, through carelessness, the deaths of two physicians and seven nurses. Wu claimed that these deaths had “made a great impression on the people, who came to understand the danger of the disease and have since taken proper precaution against it.”106 In 1929, Wu joined the Chinese government committee led by Japanese-­trained physician Yu Yan (1879–1924) to abolish the practice of “native” Chinese medicine. The committee regarded CCM as “arbitrary,” “old-­style,” devoid of proper diagnostic practices, and more philosophical than practical.107 While the campaign failed to eradicate CCM, instead triggering widespread months-­ long protests by CCM practitioners,108 it did compel many such practitioners to adopt government-­sanctioned practices for licensing, administration, and education in the CCM field.109 A year after the government’s failed attempts to abolish CCM, Wu argued that the Chinese people could accept both CCM and biomedicine. This change of heart appeared to be motivated by his desire to reach out to critics of biomedicine. In his 1930 speech to the CCM-­oriented Chinese Medical Organization (Zhongyi yiyao lianhehui), Wu argued that both Western and Chinese medicine have their strengths (geyou suochang), and that the actual act of saving lives was more important than determining which medical system was better.110 By praising CCM in his speech, Wu courted the audience, urging it to be more receptive to biomedicine. In 1933, he repeated the same strategy in a speech in Hong Kong. While deriding contemporary CCM as backward, Wu Lien-­teh was careful to point out the contributions of four ancient Chinese physicians in surgery, anatomy, pharmacopeia, and epidemiology. In particular, he praised Han Dynasty physician Hua Tuo (140–208) for discovering anesthesia and performing challenging operations such as brain trepanning.111 Wu’s praise for Hua Tuo extended beyond speeches. In 1933, the same year as the Hong Kong speech, Wu and his coauthor Wong Chimin (Wang

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Jimin 1889–1972) witnessed the publication of their study The History of Chinese Medicine, whose main function was to graft recent theories and practices of Western medicine onto those of CCM.112 The book is notable for praising Hua Tuo’s use of “anesthesia and his marvelous skill as a surgeon.”113 The second edition of the book was published in 1936, and its first 240 pages draw an arc from the “indigenous art” of premodern Chinese medicine to the “decline of native practice” in the nineteenth century. The section ends with an ominous reference to “the struggles between old [classical] and new [biomedicine] forces” in the twentieth century.114 The next 570 pages detail the actors who brought “modern medicine” to China, beginning with the Jesuits in the late 1580s and ending with the Republican government’s “consolidation” of medical work in 1933.115 As the structure of the book suggests, Wu and Wang intended to show how biomedicine was the natural successor to what they termed “old” and “native” medicine. Even though Wu and Wang praised individual physicians such as Hua Tuo for their medical contributions in the ancient period, the authors aimed mainly to unpack the more recent histories of Western medicine by dedicating two-­thirds of the monograph to the history of Chinese biomedicine. The book does not ignore the history of CCM, as at least a third of the text details this period. In sum, Wu’s post-­1929 speeches and writings reveal a shift from his earlier anti-­ CCM stance to a more inclusive approach advancing the history, theories, and practices of medicine in China. Underpinning this inclusive approach was Wu’s clearly articulated view that CCM was inferior to the modernizing power of biomedicine. Like Wu Lien-­teh, Lim Boon Keng regarded the study of CCM as a means to strengthen the status of Western medicine in China. Curiously, though, Lim considered indigenous religious practices, and not CCM, to be the main impediment to Overseas Chinese communities’ acceptance of biomedicine. In 1897, he implored the Overseas Chinese population in Singapore to recognize that bacteria—not “ill-­tempered deities”—cause diseases.116 In 1936, Lim publicly declared that the faculty of his proposed medical college would use Western scientific methods to uncover the “virtues” of CCM and to correct what he saw as erroneous, “ancient” explanations of Chinese drugs.117 Lim argued that there was a “great deal” to learn from Chinese drugs from the “standpoint of chemistry.” He encouraged the Chinese people to consider the



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“scientific nature” of ancient physicians’ approaches to CCM, and stressed the importance of subjecting CCM pharmaceuticals to biomedicine. Wu and Lim contended with the thorny issue of CCM by adopting a conciliatory attitude that stood in marked contrast to the zero-­sum game promoted by Japanese-­trained ethnic Chinese biomedical physicians who sought to completely eliminate CCM from China. In discussing this issue, David Luesink refers to Japanese-­trained biomedical doctors such as Yu Yan and Tang Erhe (1877–1940), who “advocated a complete revolution and abolition of Chinese medicine.”118 Luesink attributes the “more liberal approach” adopted by Wu and Lim to their training in the United States and the United Kingdom, both of which practiced market-­based medicine. The pragmatism of the “liberal approach” adds a new dimension to existing narratives that have emphasized clashes between CCM and biomedicine. In promoting historical and biomedical studies of CCM, Wu and Lim were reinterpreting its virtues for a modernizing China. They juxtaposed their advocacy for a historically rich Chinese medical past and a geographically valuable China-­ based pharmaceutics with an embrace of a biomedical dream that was compatible with foreign ideas and practices.

Financing Diasporic Medicine in China

The strategy of some Overseas Chinese medical practitioners to solicit financial support for their professional endeavors was key to the successful promotion of biomedicine in China. Wu Lien-­teh maintained his expansive NMPPS by extracting a stable income from Maritime Customs and from foreign powers in Manchuria. Robert Lim worked without interruption at the PUMC from 1924 to 1936 because of the continuous support of the Rockefeller Foundation, which frequently offset the vicissitudes of the global economy. In contrast, Lim Boon Keng failed to establish a medical college at Xiamen University (Amoy University) in Fujian province because he and his patron, Tan Kah Kee (1874–1961), depended solely on fellow Overseas Chinese compatriots for funding, which was not forthcoming.119 Tan, though he had funded the establishment of Xiamen University himself, sought to raise funds from outside contributors for a medical college within the university. The strategy to limit fundraising only to members of the diaspora was a mistake worsened by Tan’s ongoing struggles to fund his business and his

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educational endeavors simultaneously. The struggles Lim Boon Keng faced reveal the limits of diasporic interventions. The financial origins of Xiamen University (Xiamen daxue or Xiada) appeared to portend well for the construction of a medical college similar to the more illustrious Rockefeller-­funded PUMC. A wealthy Overseas Chinese philanthropist from Singapore, Tan Kah Kee founded Xiamen University in 1922. Born in Xiamen, Tan moved to Singapore at 16 to help in the family business in the British colony. Tan later made his own fortune in Southeast Asia through the export and sale of pineapples and rubber products, in particular rubber shoes. Even though Tan’s wealth paled in comparison with the Rockefellers’,120 he was rich by any reasonable standard. By the end of the First World War, when the key currency circulating in British Malaya was the Straits dollar, his companies had earned net profits totaling 4.5 million Straits dollars (USD [2018] 18.5 million).121 By 1925, Tan was worth roughly 15 million Straits dollars (USD [2018] 122.4 million).122 Like the Rockefellers, who financed Spelman College and the University of Chicago in the United States,123 Tan funded such Singaporean educational institutions as the Chinese High School and the Anglo-­Chinese School.124 The Rockefeller Foundation generously supported the development of biomedicine across the world, with the foundation’s largest contribution ever made to a single project going to PUMC,125 and likewise, from 1924 to 1936, Tan donated more than 3.35 million Straits dollars to educational development in China, with the bulk of the donation going to the foundation of Xiamen University.126 It is no wonder that the director of a prominent Sino-­American architectural firm described Tan as “the Chinese Rockefeller.” He added that Tan planned to use up to 4 million Straits dollars (USD [2018] 17 million) to build and endow a “large modern university in Amoy.”127 The contemporaneous comparison of Tan to the Rockefellers suggested that Xiamen University would easily achieve its growth objectives, which included a medical college. Tan’s investment in Xiamen University, however, reveals fissures at the heart of his wealth. Tan’s initial funding for the university covered the establishment of only faculties of arts, science, commerce, and education, despite his earlier pledge to establish faculties of pharmacy, medicine, and journalism.128 As a result, Lim Boon Keng had to personally raise funds to build the medical college, a task not traditionally performed by a Chinese university



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president. Lim Boon Keng wanted to name his son, Robert Lim, chair of physiology and head of public health in the envisioned medical college.129 In addition, Lim Boon Keng wanted O. K. Khaw, a member of Penang’s Overseas Chinese community who had received his doctorate at Cambridge University, to head the medical hospital envisioned at Xiamen University.130 In 1926, Lim embarked on a fundraising campaign to construct a teaching hospital, which would be integral to the medical school: If we wish to build a hospital without having a medical school first, the hos-

pital would need to be overspecialized and the cost will be exponential (ze zechuan erfeibei), running into the hundreds of thousands, and this would

make the construction of the hospital a very difficult task. If we had a medical school established alongside the medical hospital, we would need just

half the resources to complete the entire project. If we can raise thirty to fifty thousand dollars, we can build the hospital without much difficulty.131

In Lim’s view, physicians at the hospital could use the equipment, classrooms, and libraries belonging to the medical college. Interns for the hospital could be drawn from the university, creating a complementary, beneficial, and cost-­saving relationship for both institutions.132 Lim also claimed that a philanthropist had donated land to the university near the port for the construction of the hospital.133 All that was needed to fulfill the promises of a medical college was funding for the hospital. Lim’s carefully crafted appeals for a hospital and a medical college failed to move hearts and minds among Overseas Chinese. In April 1928, Lim revealed that his 1926 fundraising drive for the hospital had attracted only about 60,000 Straits dollars, far short of the needed 400,000 Straits dollars.134 Lim attributed the delay in establishing the hospital to a lack of space for expansion. He claimed that, because several individuals owned the land set aside for the hospital, the university could not obtain any clear legal right to the land, hence the delay. In the end, Lim refurbished a local temple into a temporary hospital and dispensary with the financial support of a local Xiamen philanthropist and Overseas Chinese donors.135 Lim then claimed that the “building scheme of the [permanent] hospital was now in progress.”136 His optimism, however, was misplaced. Two years later, he praised the operations of the temporary temple-­ hospital-­dispensary and argued that, as soon as the hospital was fully up and

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running, he would “start a new medical faculty” and college.137 Clearly, the hospital did not materialize in the way he claimed it would.

Dependence on Diaspora for Funding

At a 1935 fundraising rally in Singapore, Tan Kah Kee, the “Chinese Rockefeller,” publicly revealed his reason for not appealing to foreigners for money. Tan told the audience of wealthy Overseas Chinese that dependence on foreigners for the university’s financial well-­being was “shameful” and did not “benefit our own descendants” from Southern Fujian (Minnan).138 Clearly, Tan was invoking native-­place sentiments, that is, emotional attachment to one’s cultural and geographical origins. To illustrate his opposition to foreign funding, Tan cited a personal experience dating back to 1918. That year, apparently, he donated more than 100,000 Straits dollars to an American religious organization seeking to establish a university in Singapore. Even though he and the church signed all the required agreements and chose a site for the university, the British government at the last moment forbade its construction. Rather than blame the colonial government for obstruction, Tan drew the conclusion that the British were rightly reluctant to allow a foreign power such as the United States to dictate the territory’s higher education policy. Tan likewise proposed that Chinese should not allow foreigners to dictate university education in Minnan. Tan blamed the lack of monetary support on Southeast Asia’s “poor economic prospects” (shi jing elie) rather than on a lack of patriotism.139 Explanations aside, the fact remained that few fellow Overseas Chinese donated money to the cause. The medical college was still in the proposal stage 14 years after the inception of the university and would not come to fruition during Lim’s tenure. Overoptimism—manifested in Tan’s inflated expectations for the initial investment and overestimation of his and Lim’s fundraising abilities—was a key reason for the dashed dreams of a biomedical school at Xiamen University. Another reason was Tan’s reluctance to expand his donor pool to foreigners, a decision that contrasted starkly with Wu Lien-­teh’s fundraising efforts for the NMPPS. Tan’s financial overcommitment to Xiamen University was exacerbated by the broader downturns in the global economy. Two years after the university opened its doors, Tan began to borrow heavily from banks in Singapore to



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sustain his business expansion as well as his support for the university. By 1925, Tan accumulated a significant debt of close to 3 million Straits dollars (USD [2018] 15 million), mainly to finance his education enterprise in China.140 In contrast, the Rockefellers largely maintained their financial support, even during the Great Depression years from 1929 to 1939, with their slightly reduced contributions to PUMC during this period fortuitously offset by the weakening of the Chinese dollar.141 More importantly, the Great Depression weakened Tan’s financial position, as his levels of borrowing sharply increased. Consequently, the interest on these loans snowballed and drained his ability to repay his debts.142 The Great Depression also lowered international demand for Tan’s pineapple and rubber products. Western countries enacted tariffs to protect their domestic industries during the Great Depression, which further reduced demands for Tan’s Southeast Asian rubber products.143 Reflecting the Japanese empire’s general expansion, Japanese merchants began to undercut Tan’s dominance in rubber shoes by producing and exporting large quantities of that product around the world.144 As a result, in June 1933, Tan suffered a record loss of 3.1 million Straits dollars. The accumulated interest on his bank loans rose to 500,000 Straits dollars.145 Shortly after, Tan declared bankruptcy and sold his businesses to his close relative Lee Kong Chian. Tan’s bankruptcy was a critical turning point for Xiamen University, even as he and Lim continued to raise money for the medical college. When Tan turned his vast business empire over to the new owner, he inserted a clause in the sale that compelled the new owner to remit a third to a fifth of the company’s profits to Tan’s educational projects at the university.146 This amount, however, was too meager to support the financial operations of the school, let alone fund the construction of a medical college. As a result, Tan and Lim asked the central government in Nanjing to subsidize the operations of the university. In 1934, Nanjing acquiesced to the request and gave Xiamen University 90,000 Chinese dollars (USD [2018] 550,000),147 the largest amount provided by the KMT government to any higher education institution between 1934 and 1936.148 In June 1937, Nanjing government finally agreed to Tan and Lim’s long-­standing requests that it nationalize the university,149 taking over all operations to the annual tune of 290,000 Chinese dollars (USD [2018] 1.7 million).150 Lim resigned from the university shortly after its nationalization.151 In sum, Tan and Lim’s dependence on limited diasporic money meant that they

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could not establish a medical college at Xiamen University. Tan simply did not have the resources to balance his philanthropic and business commitments in a worsening global economy. Not until 1996—nearly a full six decades later—did the university open a medical college, which incidentally was underwritten by a particularly wealthy Overseas Chinese donor.152

Building Global Sciences at Xiamen University

Even though the development of a medical college did not come to fruition, the amount of support for the idea from various quarters led to significant growth in both research and teaching in the fields of biology and zoology at Xiamen University. This growth depended on diasporic money, personnel, and resources from the United States. As early as 1922, Lim established the “Tan Kah Kee Institute of Science” (Chen Jiageng kexue yuan), where scholars conducted interdisciplinary research in chemistry, physics, biology, botany, geography, and zoology.153 Lim hired well-­known scientists to staff the institute and department, including parasitologist Reinhard Hoeppli, zoologist Sol Felty Light,154 zoologist C. Ping,155 zoologist Tse-­Ying Chen, engineer Liu Shuqi, and botanist H. H. Chung. Several of these scholars uncovered, identified, and classified new species of plants and animals in the Xiamen region and published their findings in Chinese and foreign academic journals such as Science and the Bulletin of the Fan Memorial Institute of Biology.156 Furthermore, Tse-­Ying Chen and H. H. Chung founded the university’s Marine Biological Association of China, where scholars conducted scientific research on aquatic life.157 The institutional growth of the sciences prompted the South China Morning Post to praise the study of biology and marine life at Xiamen University: The facilities offered by the University of Amoy for the study of biology, par-

ticularly in the field of marine life are scarcely equaled anywhere in the world. Out of the benevolence of Mr. Tan Kah-­kee, an Amoy overseas merchant

and philanthropist, founder and builder of the university, a large and beautiful biology building has been erected for this work, in which the spacious

laboratories, excellently equipped, are provided with an extensive, specially selected, rare library. Years of effort and large expense have been devoted to bringing together an immense collection of materials for study, much of which is now on display in the biological museum.158



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The much-­vaunted laboratories, library, and museums at Xiamen University facilitated summer workshops where scholars researched the “morphology, ecology, life history and food value” of the “fauna and flora of Amoy.”159 The 1930 Marine Biology Conference was supported by the Rockefeller Foundation and the China Foundation for the Promotion of Education, which had been set up by the United States in 1926 to dispense scientific grants from the Boxer Indemnity paid by China to the United States.160 The conference brought together scientific experts from all over the country, representing scholars of Chinese, American, British, and German origins and descent.161 Attending the conference were Robert Lim and five of his PUMC colleagues, as well as professors from fifteen other Chinese higher education institutions, including Lingnan University, Hangchow College, Fukien Christian University, Nanchang Academy, Shanghai College, Jinan University, Soochow University, the Bureau of Meteorology at Qingdao, Yenching University, and Xiamen University. Much of the discussion revolved around a sea worm found off the coast of Xiamen and referred to as amphioxus, which was important for its “link between the vertebrates and invertebrates, thereby assisting to make complete the theories of evolution.”162 A. M. Boring, a professor at Yenching University in Beijing, wrote in the journal Science that participants were “most hospitably entertained by the university,” and that “the whole venture is an instance of President Lim’s [Lim Boon Keng] scientific enthusiasm and one more of the far-­sighted ways in which the China Foundation is encouraging science developments in China.” Boring was so pleased with the conference and the efforts of the Institute that, as far as he was concerned, “biologists on sabbatical trips around the world ought to stop at Amoy.”163 The success of the conference led Lim Boon Keng to argue a year later that the university was ripe for the construction of a new medical school because the faculty had already fully developed a set of courses for the teaching of biology, chemistry, and physics, “which constitute the natural foundation of modern medicine and surgery.”164 A new medical school could cooperate with the members of Wu Lien-­teh’s new quarantine station at Xiamen in the task of promoting sanitation throughout China. As the head of the National Quarantine Service, Wu would help expand quarantine stations.165 The development of biology and marine sciences at Xiamen University depended on resources from America and scholarly support from all over the world,

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all of which set this growth apart from the ill-­fated medical school’s initial dependence solely on Overseas Chinese money. Even though the medical college failed to materialize, Xiamen University developed a strong science program that served as a major attraction to many prospective students. Enrollment at the university increased from 89 students in 1921 to more than 600 in 1935.166 Local newspapers celebrated its graduates. In 1947, a Xiamen Republican-­era gazetteer noted that, of the 122 graduates, 73 were from Xiamen University and, of them, 26 hailed from the science and engineering departments, forming the largest grouping of graduates.167 One of the college’s most famous graduates was Tseng Cheng-­Kui (Zeng Chengkui 1909–2005), who had studied under H. H. Chung from 1927 to 1934. Tseng went on to pioneer ocean farming and developments in marine algae during China’s post-­1949 period, becoming one of the country’s most eminent professors of marine botany.168 His success was representative of the university’s cumulative promotion of research and education in the sciences. As a result, the China Press declared that “science is the specialty of Amoy University.”169 Clearly, the unfulfilled biomedical dreams of Lim and Tan did not impede the university’s growth as a powerhouse in the sciences. It revealed, however, the limitations of funding biomedicine in Xiamen, showing that diasporic money and expertise alone were not always able to translate medical ideas into outcomes, given the volatile economic environment of the first half of the twentieth century.

How Robert Lim Diversified the PUMC

At the same time Lim Boon Keng was establishing a medical college at Xiamen University, Robert Lim was helping strengthen PUMC’s hiring, research, and teaching practices. The PUMC’s personnel files at the Rockefeller archives reveal that Robert Lim and Overseas Chinese actively negotiated for their leadership positions at PUMC, modifying earlier assertions that an altruistic PUMC leadership had actively recruited these individuals. Scholars have shown how the American Rockefeller Foundation and its subsidiary, the China Medical Board, sponsored, funded, and Sinified the college.170 Some of the research reveals how American John Grant helped introduce China to Western biomedical practices by establishing rural public health stations near Beijing,171 as well as how foreign PUMC professors promoted Western



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anatomy practices among the emerging archeological and forensic community in China.172 Historian Sean Lei, having adopted an indigenous perspective, shows how PUMC graduate C. C. Chen (Chen Zhiqian, 1903–2000) was as critical as John Grant in establishing rural public health in China.173 Supplementing the activities of altruistic foreigners and their eager indigenous counterparts, Robert Lim and his fellow Overseas Chinese worked hard to disseminate and localize biomedicine in China through PUMC’s power. They were also central in helping the PUMC localize and diversify itself. Lim went on to hire more non-­Western faculty, founded a professional society and journal for the study of physiology, promoted the consolidation of biomedical institutions, and enhanced the multidisciplinary curriculum at PUMC. These undertakings bolstered the PUMC’s relevance to the wider Chinese academic community and, indeed, to Chinese society generally. The story of the PUMC’s origins is the story of a well-­funded global institution that was based in China and that depended on its upper class. In the first half of the twentieth century, the Rockefeller Foundation spent a total of USD 54 million (roughly USD [2018] 800 million) on medical endeavors in China, and of this amount, a whopping USD 45 million (roughly USD [2018] 666 million) went to PUMC.174 This ample funding facilitated the development of biomedical research units, a teaching hospital, and a medical school at PUMC.175 PUMC had a highly selective enrollment policy, requiring high school applicants to show proficiency in English. Students who enrolled were predominately from the upper stratum of Chinese society and had studied in high schools opened by foreign missionaries.176 As a result, PUMC was seen as “an elite school that nurtured a select number of leaders in medicine.”177 PUMC emphasized the need to hire Chinese faculty members at the college. In 1925, only one of the fourteen heads of departments was ethnically Chinese.178 John D. Rockefeller Jr. argued for the diversification of board members and faculty during the college’s 1921 inauguration ceremony: “So we must look forward to the day when most, if not all, of the positions on the Faculty . . . will be held by the Chinese, when the Board of Trustees . . . will include leading Chinese.”179 This emphasis on diversification has led one recent scholar to claim that “PUMC easily recruited the first generation of Chinese medical scientists who had studied abroad.”180 Another scholar has

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argued that PUMC leaders, in offering Robert Lim a probationary period before hiring him, were the actors chiefly responsible for his position at PUMC.181 However, an analysis of Robert Lim’s personnel file at the archives reveals that—despite his strong credentials, experience, temperament, and recommendations—it took Lim two years to secure a visiting professorship and another five years to ascend to the head of the Physiology Department. Throughout this process, Lim actively negotiated for the terms of his hire, using as leverage an alternative job offer and the help of PUMC director Henry Houghton. The eventual diversification of PUMC was hard fought, rather than an outcome of its founding leaders’ altruism. The details of Robert Lim’s path to a job offer from PUMC are enlightening. First, in October 1922, after having obtained his doctorate from the University of Edinburgh a year earlier, Lim reached out to Roger Greene, the acting head of PUMC, to inquiry about the possibility of applying for a Rockefeller Foundation fellowship.182 Lim’s advisor at Edinburgh, Edward Schafer, praised Lim as one of “the few Chinese students who have prepared themselves for teaching the fundamental sciences.”183 Greene also received a letter of recommendation from Alfred Sze, who not incidentally had recommended Wu Lien-­teh to Yuan Shikai, enabling the former to work in China.184 Upon receiving these recommendations, Greene invited Lim to apply for the fellowship.185 Later, Greene reached out to Schafer,186 and both agreed that Lim should head to the University of Chicago to study with Dr. Anton J. Carlson, one of the world’s leading experts on physiology and gastric functions.187 A few months later, Greene sent Richard Pearce, a senior Rockefeller officer, to interview Robert Lim and members of the Edinburgh faculty, presumably to vet Robert Lim for a more permanent position at PUMC. In February 1923, not long after the meeting, Pearce praised Robert Lim as having a “very attractive personality” and “good English manners” and as being, on the whole, “quite an exceptional individual.”188 Pearce added that Lim bore “the entire responsibility” for the course on physiology at Edinburgh, and “at present [is] doing research in the field of gastric nutrition.”189 According to Pearce, Lim “has gone as far as he can at Edinburgh, and of course it is improbable that in England he should be appointed to a full professorship.”190 He added that the people at Edinburgh were “inclined to



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think he should return to China, but doubt if there is anything good enough for him there.”191 Lim indicated interest in working at Xiamen University, where his father had offered him the chair of the physiology department, but Pearce appeared to doubt whether this position would satisfy the ambitious job seeker. Pearce implicitly suggested that PUMC should offer Lim an academic position, given that he would likely see such a position as suitable for his aspirations. Despite the reception of this largely positive report from Pearce, Greene did not immediately reach out to Robert Lim. Greene knew from the report that Lim was highly competent and wrote back to Pearce, stating that “we have made an important find” and opining that Robert Lim “ought to be offered a full professorship if Professor Schafer’s estimate is confirmed by Dr. Carlson and Dr. Erlanger.”192 Greene did not, however, follow up with these two physicians for any reports on Lim. Three months after Pearce’s report, Lim wrote to Greene stating that he “had accepted the post of Director of Medical Research in the University of Amoy.”193 This news spurred Greene into taking active measures to hire Lim, but, even then, Greene took seven months before writing to Anton Carlson at Chicago to ask for his thoughts on Lim. Carlson praised Lim as “a first-­rate class man, both in teaching and in research,” and as the type of person who made an impression on everyone, even those who may have been prejudiced against the Chinese people.194 Carlson added that he would let Lim not only teach any course in physiology but also do so with his own laboratory. Carlson’s confirmation led Greene to immediately extend a formal and binding offer to Lim on February 7, 1924.195 This initial offer, however, was for a visiting associate professorship, not a full professorship, much less the head position in the Department of Physiology. Lim subsequently informed Greene that because Xiamen University had extended an offer of a full professorship and the chair of the Physiology Department,196 he would accept a position at PUMC only if it was a full visiting professorship. Greene acquiesced to Lim’s terms.197 Because the offer was for a two-­year probationary appointment, Robert Lim inquired of the incoming PUMC director as to the possibility of a more permanent professorship. Henry Houghton wrote to Greene in February 1925 to express his support for Lim’s appeal, “provided it was understood that we were not creating an

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obligation, or undertaking any commitment to give him the full professorship.”198 Houghton elevated Lim from visiting head to acting head of the Physiology Department. The provisional nature of the position, halfway between that of a visiting professor and that of a permanent one, was not particularly satisfactory to Lim. Writing to Houghton in April 1925, Lim stated that if his appointment were to rest on his race, and if the administration regarded him as even slightly inferior to the foreigner whom he was replacing, he would not accept his appointment.199 In this way, Lim was prompting Houghton to consider racial and national diversity, even though Lim appears to have rhetorically rejected the idea that race should be the primary consideration for his hire. In a long, carefully written reply, Houghton assured Lim that the job offer rested primarily on his scientific and academic suitability, but that PUMC felt an obligation to build up “as rapidly as seems feasible the Chinese membership of our staff.”200 He added that “in doing so, we want to avoid even the appearance of injustice to those Westerners who have served the college.”201 On March 3, 1927, Houghton formally offered the position of head of the Department of Physiology to Robert Lim,202 who at the time was deeply mourning the death of his daughter two months earlier in Beijing.203 In sum, Lim’s active pursuit of a departmental head position contrasts rather dramatically with the existing narratives, which have depicted PUMC administrators as engaging in an altruistic quest for racial and national diversity among faculty members. Houghton’s remarks on race and nationality quite clearly show that the college would hire ethnic Chinese for senior-­level positions only if the temperament, vision, and training of these applicants mirrored those of PUMC’s recent foreign employees. Lim easily met this often-­unstated requirement. PUMC boasted several foreign heads of departments: Davidson Black, head of anatomy, who had graduated from the University of Toronto;204 Bernard Read, head of pharmacology, who had graduated from the London College of Pharmacy and Yale University;205 Carl TenBroeck, head of pathology, who had graduated from Harvard Medical School;206 Adrian Taylor, head of surgery, who had graduated from the University of Virginia Medical School;207 and Paul Hodges, head of radiology, who had graduated from the University of Wisconsin and Washington University in St. Louis.208 Their credentials approximated the ones held by two ethnic Chinese heads of departments



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at PUMC. The head of biochemistry from 1924 to 1941, Dr. Wu Hsien (Wu Xian 1893–1959), had left China for the United States at age 18 to attend college at the Massachusetts Institute of Technology before obtaining his PhD in biochemistry at Harvard University.209 The head of the Bacteriology Department at PUMC from 1922 to 1942, Dr. C. E. Lim (Lin Zongyang 1891–1988), had been born in Penang, Malaysia.210 C. E. Lim (unrelated to Robert Lim) received his undergraduate diploma from the University of Hong Kong and obtained his PhD at Johns Hopkins University after completing some graduate work at the Liverpool School of Tropical Medicine in 1922. Before pursuing his PhD, C. E. Lim worked with Wu Lien-­teh in Beijing, reflecting the diasporic connections on which Lim relied in his early career.211 Robert Lim’s degree from Edinburgh University was comparable to the degrees earned by such PUMC international faculty as C. E. Lim and Wu Hsien. The University of Edinburgh’s medical school was the largest of its kind in 1920s Britain and one of the best nationwide.212 Dr. A. J. Carlson, with whom Robert Lim worked for a year at the University of Chicago, was a leading physiologist in the 1930s.213 All of these facts reflect the reality that Lim had to be as well qualified as his colleagues at PUMC and suggest that his ethnicity, language skills, temperament, recommendations, and natural proclivities for science were necessary but not sufficient for his appointment. Robert Lim’s international education at Edinburgh and Chicago, his active negotiations over the PUMC job offer with Greene and the fortuitously appointed Houghton, and his diasporic connections (including his father Lim Boon Keng) were critical to Lim’s appointment as the head of physiology at the university—a process that took, in total, more than five years. After becoming the head of physiology, Robert Lim facilitated the hire of several more non-­Western faculty members at PUMC, bolstering both its diversity and its localness. Lim sought to hire Oo-­keh Khaw (O. K. Khaw), who had obtained his bachelor’s degree from the University of Edinburgh and his doctorate from Cambridge University.214 Praising Khaw as a “good student and hard worker,” Lim recommended the prospective employee to Roger Greene in 1924.215 Upon reviewing Khaw’s application and Lim’s recommendation, Greene offered Khaw a position in PUMC’s Parasitology Department. At the time of the offer, Khaw was already serving in an administrative position at Xiamen University. He could not immediately accept

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Greene’s offer despite his reservations about the lack of resources for medical research at Xiamen.216 He felt obliged to help Lim Boon Keng, especially in the fall of 1926, when his presidency was challenged by iconoclastic intellectual Lu Xun (1881–1936) and Xiamen University students.217 Lu Xun had encouraged students in October 1926 to protest against Lim Boon Keng’s desire for students to accept a conservative vision of Confucianism undergirded by the learning of natural sciences as the guiding principle of the college. Lu Xun’s dissatisfaction with Lim’s leadership was compounded by his perception that Lim was systematically undermining the humanities in favor of the natural sciences at Xiada. Lu resigned from Xiada in January 1927, just five months after he arrived on campus. With the understanding that Lim Boon Keng would also tender his resignation (Lim did not resign) , Khaw moved to PUMC in 1928 to take up an assistant professorship of bacteriology.218 In 1935, Khaw was promoted by PUMC to the position of associate professor of bacteriology. After the Second Sino-­Japanese War broke out in 1937, Khaw was promoted to the position of associate superintendent of the Hospital and Public Outpatient service. In 1940, he became the acting head of the Department of Public Health at PUMC.219 Khaw’s key research there centered on clonorchis sinensis, a tropical worm responsible for the infectious disease clonorchiasis, which plagued many people in South China.220 Besides Khaw, Lim promoted H. C. Chang, a native of China who had studied at the University of Chicago, from an intern position to an assistant professorship of physiology in 1931.221 That same year, he hired the first Japanese faculty member at PUMC, Takao Kosaka, as an assistant professor of physiology.222 Robert Lim’s efforts at hiring more Overseas Chinese, indigenous Chinese, and Japanese scholars revealed that Lim was critical to the diversification of PUMC’s faculty members.

Biomedical Knowledge, Medical Professionalization, and Military Medicine

While conducting research and teaching at PUMC, Robert Lim reached out to the broader Chinese society by promoting physiology, unity among medical associations in China, and military medical training at PUMC. These agendas represent Lim’s understated effort to disseminate biomedical knowledge and practices across China, paralleling the better-­known efforts by John



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Grant and C. C. Chen in establishing rural health stations in China. In 1927, Lim established the Chinese Physiology Society, which also published the Chinese Journal of Physiology (CJP). Lim published prolifically in the CJP, which lent credence to the organization as well as the journal.223 A total of 45 articles by him appeared in the journal from 1927 to 1939, a figure greater than his 28 publications in Western journals from 1919 to 1926.224 Examples of research published in the CJP include collaborative PUMC projects relating to the physiology of nutrition and the nature of the nervous system. Another line of research, this time from the PUMC anatomy department, was undertaken by Wen Chao Ma and An Chang Liu, who examined the role of the Golgi apparatus in gastric secretion.225 Lim, in concert with Chung-­Lien Hou at South Manchuria Medical College, also researched whether nerve impulses could travel through a region of depression induced by narcotics.226 The research conducted by Lim and his colleagues shines a light on PUMC’s active scientific agenda, which positioned the college as a reputable producer of Western scientific knowledge in China and abroad. Lim and other prominent doctors promoted the professionalization of biomedicine in China. As president of the National Medical Association of China (NMAC) from 1928 to 1930, Robert Lim sought to unify two rival professional societies of Western medicine in China. His measures built upon earlier efforts by Liu Jui-­heng (Liu Ruiheng, 1890–1961), who had headed the NMAC from 1926 to 1928. Trained at Harvard University, Liu was the superintendent of the PUMC hospital from 1924 to 1928, the Chinese vice minister of health from 1928 to 1930,227 and the Chinese minister of health from 1930 to 1935.228 Liu advocated for the merger of NMAC with the Chinese Medical and Pharmaceutical Association to better advocate for the interests of Chinese biomedicine.229 The former organization comprised biomedical doctors educated in Britain and the United States, while the latter was made up largely of physicians trained in Germany and Japan.230 Robert Lim concurred with Liu’s proposed merger, even though he privately felt that a federation of associations might have been more feasible in the short run.231 While Lim did not succeed in bringing together the two organizations during his tenure, his efforts helped pave the way for the merger in 1932 under his successor, New Way-­Sung (Niu Huisheng, 1892–1937).232 Born in Shanghai, New obtained his MD degree from Harvard University and

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headed the Department of Orthopedic Surgery at the pre-­Rockefeller PUMC from 1918 to 1920.233 In 1929, he founded an orthopedic hospital in Shanghai, and in 1932 he founded the China Medical Association, which he had helped coalesce from smaller organizations and which he headed until war broke out in 1937. New’s hold on power, along with the prominence of Robert Lim and Liu, suggests that Anglo-­American-­trained ethnic Chinese biomedical doctors dominated the upper echelons of medical bureaucracies and colleges in China in the 1920s and 1930s, even though the formation of the China Medical Association was meant to signify the unity of China’s biomedical doctors. The growing influence of biomedical associations in China was further reinforced by C. E. Lim and Wu Lien-­teh (head of NMPPS), who held the editorship of NMAC’s National Medical Journal of China from 1920 to 1931.234 In sum, Robert Lim and his fellow Overseas Chinese and returnee Chinese colleagues at PUMC and NMPPS were instrumental in leading and unifying medical associations and promoting the practices and ideas of biomedicine in China through public-­and private-­ sector organizations. Robert Lim is well remembered for, among other accomplishments, the mobilization of PUMC students and faculty members on behalf of KMT troops in North China. As early as 1928, Lim called for Wu Lien-­teh to lead a new Shanghai-­based military medical institution that would supplant the Army Medical Services, which he thought was staffed by ineffective Japanese-­trained biomedical personnel.235 While such a plan did not materialize, Lim seized the initiative to establish a military medical corps when the Japanese briefly invaded Jehol (Rehe) in 1932. Together with Liu Jui-­ heng and 21 PUMC hospital staff members and students, Robert Lim spent three months in North China providing medical aid to wounded Chinese soldiers. He also tapped into wider Chinese Red Cross resources to set up a medical system that would treat wounded Nationalist soldiers directly on the war front, eschewing the long-­standing tradition of evacuating wounded soldiers hundreds of miles away to Beijing or Tianjin before treating them. In a particularly memorable incident, Lim prevented senior KMT officials in their motorcades from retreating without their wounded infantrymen, which earned him fame beyond academic circles. Dr. Robert McClure of the US Army commented on the event:



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He became famous to military people in China in 1932 when during the debacle of the Chinese army’s retiring from Jehol he showed most remarkable presence of mind. He was then in charge of a PUMC relief unit who were

going up to the front. When less than halfway to Jehol City, he met the front

coming back in the form of a disorderly stampede with the senior officers in their motor cars leading the process, the cavalry following, and the infantry in the rear. While he was to go on medical work, Bobby [Robert] Lim’s

judgement got the better of him and, seizing a pistol from a body-­guard, he and his troops of doctor-­aides decided that the first piece of work was to stop

the stampede. Standing in the middle of the road and threatening traffic with their pistols, they were able to stem the disorderly tide.236

After PUMC hospital staff and students returned from their service, Lim organized them officially into the PUMC Medical Corps. He instilled military-­style discipline among students, who underwent drills every two weeks and attended weekly lectures and demonstrations on first aid, field sanitation, and field medical administrations.237 Lim’s pre-­1937 endeavors heralded his later decision during the Second World War to lead 37 Chinese faculty and students from PUMC to Central China to aid in medical relief efforts.238 By leveraging his position as a senior faculty member at PUMC, Lim developed military medicine, unified biomedical associations, and promoted the broader study of physiology in the Chinese medical community.

Limits, Legacies, and Promises of Robert Lim at PUMC

Even though Robert Lim enjoyed resources his father lacked at Xiamen University, he too faced difficulties in implementing some of his plans for a more inclusive and interdisciplinary PUMC. As a senior PUMC staff member, Robert Lim was more limited in effecting change within his institution than were Wu Lien-­teh and Lim Boon Keng, who directed their own institutions with significant autonomy and power. For example, Robert Lim’s superiors at PUMC blocked his efforts to see the school relax its admissions policies, strengthen the interdisciplinarity of its scientific education, and take a principled stance against the Japanese when war broke out in 1937. In his classrooms, Lim taught biochemistry and pharmacology alongside his primary discipline of physiology. He argued for interdisciplinary

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research in the sciences by soliciting articles on biochemistry and pharmacology, in addition to physiology, in the Chinese Physiological Journal.239 In 1936, Robert Lim argued for the replication of his multidisciplinary teaching and research methods campus-­wide because they had improved student enrollment in his department. If this momentum was kept up, PUMC could evolve into a “teacher-­training” college.240 The school’s leadership, however, was reluctant to change its Socratic-­style teaching methods, which prioritized small classes, or its intimate and disciplinary-­based laboratory environment. As a result, PUMC graduated only 313 students from 1923 to 1943, although it should be noted that many went on to become medical leaders in their field.241 After the start of the war in 1937, Robert Lim joined Liu Jui-­heng and John Grant in asking that the school increase enrollment to address the medical needs arising from Japan’s invasion, but faculty members from the medical and nursing departments rejected the proposal, which ultimately doomed the idea.242 Finally, Lim was unable to persuade the leaders of PUMC to set up a branch school in unoccupied China during the war. PUMC leaders felt that such a decision would threaten their status in Beijing and place them in “extreme peril,” where the occupying Japanese authorities held power.243 The PUMC remained exclusively in occupied Beijing until 1941, when—with America’s entrance into the war—the Japanese closed the school entirely. Lim’s desires for a PUMC that served the needs of China across time and space were dashed by his limited powers as an employee there. After leaving PUMC to head the Chinese Red Cross Medical Relief Corps and Emergency Medical Services Training School in 1937, Robert Lim was able to transplant his vision for PUMC into these other organizations. As the rest of the book shows, Lim introduced interdisciplinary, political, and mass training of medical personnel in his organizations. He hired medical personnel from around the world to staff his institutions. Lim’s extensive wartime endeavors were built on his prewar work at PUMC. His time there gave him the opportunity to introduce military medical education, conduct interdisciplinary instruction and research, pursue diverse recruitment, and lead biomedical organizations. His prewar successes drew directly on his academic connections in Britain, the United States, and



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China—connections that secured his legacy as one of the leading biomedical experts in Republican China.

The Centrality of the Diaspora in Chinese Biomedicine

Overseas Chinese became critical agents in the development of public health, medical education, scientific research, and plague prevention measures in China from 1910 to 1937. Their interventions formed an institutional, outward-­looking, urban, elitist, scientific, and internationally financed system of biomedicine. Members of these medical and scientific institutions developed, practiced, and promoted autocratic forms of medical control, seeking to create docile Chinese bodies who would internalize the medical professionals’ versions of modernity and enlightenment. To reach out to the broader population, the Overseas Chinese facilitated and led medical corps, founded academic journals and wrote journal articles, embraced critics such as Kitasato, gave speeches promoting biomedicine, and introduced veterinary medicine. The Overseas Chinese placed classical Chinese medicine under the gaze of biomedicine, advancing the latter’s interests and power. They concentrated their activities in cities such as Beijing, Shanghai, Xiamen, and Harbin, even as they sought to bring biomedicine to rural regions of China. A combination of global and local strategies underlay the efforts of the Overseas Chinese to bolster their biomedical institutions. To raise awareness, money, and resources for the NMPPS, Xiamen University, and PUMC, Overseas Chinese professionals convened international conferences and workshops, solicited funds and additional support from Overseas Chinese communities, and carefully cultivated relationships with members of the Chinese government and foreign powers within China. The professionals drew on their ethnic affinity with China proper and their long-­standing contacts in Southeast Asia, Europe, and America to maintain their medical leadership in China. They hired faculty members from East Asia and the United States, diversifying the scientific expertise and ethnic composition of their organizations. Just as Wu Lien-­teh solicited the help of fellow Overseas Chinese and Cantonese in his fight against the plague in North China, Lim Boon Keng and Robert Lim relied on each other and on people such as O. K. Khaw to bolster their biomedical agendas in Beijing and Xiamen.

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Popular resistance to these goals limited the growth of Overseas Chinese–style biomedicine in China. Residents in Manchuria did not want their infected houses burned down, their deceased cremated, and their everyday movement restricted by medical personnel. They refused to report suspected cases of plague to authorities out of fear that loved ones would wind up in segregation camps, hospitals, wagons, or “boxes.” Indeed, family members developed elaborate plans to rescue their loved ones from these enclosures. Meanwhile, classical Chinese physicians provided alternative treatments during the Manchurian plague and vigorously defended their professions from concerted attacks by hostile biomedical personnel. Other elements of Chinese society also erected obstacles, as when Xiamen University students cooperated briefly with Lu Xun to oppose Lim Boon Keng’s autocratic policies underpinned by his views on biology, indirectly triggering the departure of a leading physician to the rival PUMC. German-­and Japanese-­trained biomedical doctors resisted attempts by Robert Lim, Liu Jui-­heng, and W. S. New to merge their organization with the National Medical Association of China. The PUMC leadership balked at Robert Lim’s proposals for a more interdisciplinary, inclusive, and nationalistic curriculum at PUMC. They ignored calls to establish branch PUMC schools in unoccupied China and chose to cooperate with the Japanese so as to preserve the PUMC’s existence in Beijing. While these acts of opposition restricted the overall development of Overseas Chinese–style biomedicine in China, they never rose to the level of systematic or structural impediments. Rather, the scarcity of wealth and the vicissitudes of colonial power did more to hamper the goals of medically inclined Overseas Chinese. Tan Kah Kee’s declining fortunes in the broader context of both his reluctance to solicit donations beyond the Overseas Chinese community and the weak global economy dashed Lim Boon Keng’s planned construction of a medical college at Xiamen University. Wu Lien-­teh had to leave his lifelong work in Manchuria after the Japanese occupied the region in 1931. Robert Lim could not always access the wealth and power provided by PUMC even though he had risen to the level of a senior staff member. All of these stories and struggles paint a clear picture: biomedicine in the early twentieth century permeated China via diasporic actors, yet their efforts were not impervious to the ebbs and flows of global political economy and individual contingencies.



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Primarily led by Robert Lim and his colleagues at PUMC, the pace of biomedical expansion in the prewar period would accelerate after war broke out in 1937. As the following chapters will show, Robert Lim used his position as head of the Chinese Red Cross Medical Relief Corps to raise funds among Overseas Chinese in Southeast Asia and America to establish a comprehensive military medical complex in Southwest China. With the establishment of the complex, Lim reached out to the countryside, militarized medicine, expanded healthcare, widened his already extensive reliance on overseas donors, and used local resources to substitute for imported medical technologies. Global medicine in the prewar period provided China with medical opportunities during the war itself. Robert Lim’s prewar experiences in organizing a rapid-­response military corps and in pushing for broader, more interdisciplinary education would yield, as we will see, palpable successes in an age of total war.

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WA RT I M E M I LI TA RY M ED I C I N E

In 1937 and 1938, the Japanese army occupied the northern and central Chinese cities of Tianjin, Beijing, Shanghai, and Nanjing in quick succession. The precipitous fall of these cities marked the beginning of the Second World War in Asia, known in China as the War of Resistance. Surging numbers of sick and wounded Chinese soldiers, refugees, and civilians fled south to the Central Chinese cities of Wuhan and Hankou. When, in late 1938, the Japanese overran these two cities, many Chinese fled with the KMT farther south to Changsha, Guiyang, and Chongqing. Other Chinese sought refuge in Yan’an and elsewhere in Northwest China, which was controlled by the Chinese Communist Party (CCP). Even though neither the KMT and the CCP nor their military wings trusted each other, they were nominally united against the Japanese. In both Northwest and Southwest China, civilians and soldiers suffered greatly owing to a lack of food, clean drinking water, and shelter. A medical director of a field hospital from the Chinese Red Cross Medical Relief Corps (CRCMRC, Hongshi zihui jiuhu zongdui) commented that the material conditions were so “awful” that there were no coverings available for the wounded, who “lie trembling in the cold all night.”1 A lack of anesthesia meant that many soldiers with internal wounds had to forgo surgery, as the pain would have been too great to endure.2 The insufficient resources reflected the growing inability of the KMT-­ controlled Chinese government to provide for its people. Nevertheless,

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officials struggled to improve the nation’s health care system. It was in this context that Chiang Kai-­shek, the leader of unoccupied China and the KMT, assigned Robert Lim the urgent task of designing an emergency wartime health care system. At the behest of Chiang, Lim left PUMC with a group of medical personnel and formed the CRCMRC, which became wartime China’s de facto health ministry. From its beginning, the CRCMRC’s aim was simple yet daunting: provide soldiers with curative medical services. It sought to create a medical system that could provide for the immediate treatment of injuries and diseases and for longer-­term care in mobile clinics and hospitals. The CRCMRC began operating in Changsha, a prominent city located in Central China’s Hunan Province.3 With the Japanese fast approaching the city in October 1938 after the fall of the neighboring cities of Hankou and Wuhan, Lim moved his headquarters southwest 300 miles, first to the city of Qiyang in Hunan Province, and later to Guiyang in Guangxi Province. From Qiyang, Lim dispatched numerous mobile curative and nursing units to Changsha for the frontline treatment of patients. From 1938 to 1940, the CRCMRC’s doctors and nurses treated more than 449,000 troops and 658,000 civilians for infectious, insect-­borne, and nutritional deficiency diseases; vaccinated almost 2 million patients; deloused more than 437,000 soldiers; dressed the wounds of more than 3.8 million soldiers; and stabilized and treated more than 20,000 fractures.4 Doctors also operated on more than 42,000 soldiers. These surgeries ranged from simple incisions and drainage to complex reconstructive plastic surgery for soldiers. As seen in figure 2.1, doctors often used portable X-­ray devices to diagnose patients before operating on them. Neither this emphasis on a large-­scale curative health care system nor the often imminent threat of being overrun by Japanese forces dissuaded Lim from assessing the feasibility of an extensive preventive health care system. A lull in the fighting after the fall of Hankou, in October 1938, afforded Lim the opportunity to deliberate on the nature of medical care in China. He soon decided that China’s wartime medical system must acquire what it so clearly lacked: an effective preventive health care system.5 This development of a preventive health care system reflected the catalyzation of Overseas Chinese doctors’ ambitious plans for developing biomedical and other scientific institutions in China. As the current chapter will



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Figure 2.1.  Dr. Yang of Curative Unit 11 conducting an X-­ray examination. Source: ABMAC Records, Rare Book and Manuscript Library, Columbia University (hereafter ABMAC Records), sometime between 1938 and 1942, box 77, file: Army Medical Administration No. 2. Reprinted with permission.

show, Robert Lim and his colleagues transformed Chinese medicine in four specific ways: controlling the spread of diseases and wounds, preventing outbreaks of disease, establishing geographical mobility, and attracting assistance (much of it financial) from Overseas Chinese worldwide. The first transformation of Chinese medicine centered on controlling the spread of diseases and wounds. To this end, the CRCMRC enjoyed a fair degree of success in the early years of the Second World War. Even though success was a question of mitigation rather than elimination, the organization treated more than 4 million Chinese soldiers and civilians from 1938 to 1940, representing a tremendous expansion of medical care from the prewar

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period. More critically, the CRCMRC through its mobile medical units made diseases and wounds visible on the war front and, by acting upon them, translated new knowledge of diseases and wounds into medical actions that extended the power of the state over the Chinese countryside. The second key wartime transformation of Chinese medicine centered on preventive medical care, composed primarily of delousing, inoculation, and special dietary programs. This focus, which stemmed partly from Robert Lim’s leadership and the growth of China’s medical knowledge, was also a practical response to limited resources. For biomedical practices to work in wartime conditions, a health care system must adapt to limiting circumstances and substitute inexpensive local materials for unattainable imported ones. Robert Lim and his colleagues in the Overseas Chinese community developed strategies for adapting local materials to preventive care tasks such as delousing and feeding soldiers. Geographical mobility was the third key wartime transformation of Chinese biomedicine, and the CRCRMC was at the center of this accomplishment. China’s health care system had to relocate, often rapidly, from urban areas in North and Coastal China to cities, towns, and villages in the rural Southwest and Northwest. The success of these relocations owes much to CRCMRC mobile medical units, whose function was to provide medical care to soldiers fighting on a front line, be it stationary or shifting. By extending medical care, management, and resources to the CCP-­held areas in Northwest China, the Overseas Chinese transcended the political rivalry between the CCP and KMT and supported health efforts among both groups. The analysis in this chapter of CRCMRC’s provision of medical care across political lines in unoccupied China seeks to reorient existing scholarly emphasis on Canadian doctor Norman Bethune’s medical work in CCP-­held areas. The fourth transformation that Chinese medicine underwent during the war was the massive infusion into China of assistance, much of it financial, from Overseas Chinese around the globe. Robert Lim’s strategic appeals for assistance in an all-­out war between China and Japan inspired many members of the Chinese diaspora to materially support the Chinese war effort. Besides the generous financial donations from Southeast Asia’s Overseas Chinese community (a continuity from the prewar period), new groups of Overseas Chinese from Europe, North America, and Hong Kong



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began donating generously to—and moving to China to work specifically for—the CRCMRC. Donations for CRCMRC operations between 1938 and 1940 totaled some 2 million Chinese dollars (USD [2018] 3.68 million). This enthusiasm signaled a dramatic break with the prewar reluctance of Overseas Chinese to help China modernize—a reluctance perhaps best exemplified here by the prewar paucity of Southeast Asian donors to Xiamen University’s proposed medical college. From 1937 to 1945, Overseas Chinese supported an expansive, mobile, adaptive, field-­based, data-­driven, and preventive wartime health care system in China.

Expansion of Medical Care through Mobile Medical Units

By encouraging mobile medical units to collect, collate, and report on the incidence of soldiers’ ailments, the CRCRMC pursued the bolder and wider aim of uncovering new biomedical knowledge related to medical problems encountered on war fronts. Lim’s observation that most soldiers suffered from diseases rather than from wounds was borne out by medical surveys in the field. In January 1939, the fourth CRCMRC report presented the first set of statistics, compiled from January to June 1938, about the nature of these diseases.6 In a survey of over 60,000 patients in the first six months of 1938, Lim and the CRCMRC revealed that, among Chinese soldiers, scabies was the most prevalent disease (30 percent), followed by malaria (11 percent), then bronchitis and other respiratory diseases (7 percent). In contrast to Wu Lien-­ teh’s prewar reliance on laboratories to uncover the plague bacillus in Manchuria, Robert Lim and his mobile medical units conducted relatively simple yet invaluable field surveys to identify the numerical incidence of diseases. The accumulation of such medical data contributed to Overseas Chinese people’s growing perception of the CRCMRC as an organization worthy of charitable contributions. Having surveyed the disease landscape, Lim responded to the prevalence of scabies by developing an extensive program of delousing, which served both preventive and curative functions. The main aim of delousing was to rid bodies of mites, lice, and ticks, which were thought then to be the primary vectors in the transmission of scabies and relapsing fever. Infected areas produced intense itching throughout the day and secondary inflammatory

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complications associated with scabies. During Lim’s visit to the war front, he saw “gross impetigo” and “huge ulcerations of the skin, especially of the leg,” among soldiers and civilians. He argued that one “had to go back to the Middle Ages” to find conditions where practically everyone on the front was afflicted by lice and scabies.7 Delousing required the placement of soldiers’ clothing in water mixed with sulfur and lime, which would kill lice and mites, and the construction of bathing stations for the removal of the organisms from bodies. These stations marked a major improvement, as most soldiers had little access to water and soap on the war front. Lim’s observations and actions reflect the urgency with which he and his colleagues sought medical knowledge and translated it into medical interventions. To treat scabies, Lim dispatched mobile units of trained sanitation engineers and doctors across unoccupied China to delouse soldiers and their clothes. As seen in figure 2.2, some areas had rather elaborate delousing stations for soldiers. The limited resources of rural China, however, meant that CRCMRC personnel were endlessly improvising with seemingly insufficient local materials. In some delousing stations, for example, trained engineers would set up portable steam delousers from local wood stripped and curved and then slotted together to form cylindrical delousers, roughly 1½ meters in height and diameter. Because of their shape, they were dubbed “army rice cookers.” Sanitation engineers and workers poured sulfur and lime in the “rice cookers” ( fan guo), which contained soldiers’ clothes. Additional hot-­air delousers were constructed similarly, with portable stoves creating steam to rid clothes of lice and mites. CRCMRC personnel also constructed rectangular bath stations, running water through elevated wooden poles with small holes from one end of the station to another. Water would fall in a shower-­ like fashion from the holes on the soldiers, who would then use the soap provided by the sanitary personnel to wash themselves.8 The soldiers were then inspected and treated for scabies and other infections. Despite their rudimentary designs, the innovative construction of these mobile delousing and shower units from local materials made delousing an effective undertaking on the Chinese war front. Lim’s delousing method was exemplary preventive and curative care. Bodies free of mites, ticks, and infected clothing were less likely to contract scabies or relapsing fever and were more likely to respond positively



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Figure 2.2.  Soldiers lining up to be deloused at a mobile delousing station, built by Red Cross Unit 62 for the 63rd Chinese Division. Source: ABMAC Records, sometime between 1938 and 1942, box 77, file: Army Medical Administration 2. Reprinted with permission.

to treatment if the ailments were already present. Interestingly, rather than import the new mite-­killing medicine benzyl benzoate applied to soldiers’ bodies, Lim opted for the less interventionist form of sulfur treatment.9 In its initial months, his ambitious preventive agenda saw an average of 77 wounded or sick soldiers deloused per day, including all their bedding and garments. That number increased rapidly. By the end of December 1940, more than 437,000 soldiers and 2.2 million articles of garments and beddings had been deloused.10

Privileging Preventive Medicine

The collection of statistical knowledge about diseases and wounds in wartime China did not necessarily lead to intuitive policy prescriptions. Lim did not embark on similar direct comprehensive attempts to deal in a curative fashion with the other sicknesses he surveyed. Rather than go down the list of diseases and tackle malaria or bronchitis, he spent most of his resources on nutrition

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programs, even though few Chinese soldiers were suffering from nutritional deficiency diseases. Lim and his colleagues found that, of the 68,603 soldiers whom the CRCMRC had treated from January to June 1939, only 2,124 soldiers (3 percent) had been suffering from nutritional deficiency diseases (a classification that included beriberi, nutritional edema, and general malnutrition), in contrast to the 7,632 soldiers (11.1 percent) who had contracted malaria. In the case of malaria, Lim wanted to prevent malaria outbreaks by instituting a mosquito eradication program in 1938, but by 1939, he settled on providing quinine to Chinese soldiers suffering from malaria. By 1940, Lim candidly admitted, “No attempt has been made to control the breeding of mosquitos.”11 In contrast, Lim strongly believed that a nutrition program would not only cure specific cases of malnutrition but also reduce malaria, bronchitis, dysentery, and a host of other diseases. He argued that poor nutrition and nondietary material privation were, together, largely responsible for respiratory diseases. In a Time magazine article published in the United States, Lim argued that pneumonia and tuberculosis could be overcome only with the provision of “adequate clothing and food.”12 Similarly, he asserted that a good diet and careful nursing were far more important in treating dysentery than pills.13 “Dietary treatments have been essential,” he argued, “since the majority of the patients suffered from chronic malaria and debility.”14 A lack specifically of protein in soldiers’ diets was, he further reasoned, the central factor explaining why wounds healed slowly and why “infections of all kinds [were] frequent in the undernourished soldiers.”15 Lim’s views were shared by two British medical observers, who argued that “many wounded men have to spend twice or three times as long in hospital as they would if they could be given a more nutritive diet during convalescence.”16 The process of translating medical knowledge from battlefields into practical medical interventions was contingent on Lim’s prewar Western studies and on long-­standing traditional notions of food as medicine in China. Lim’s interest in a wartime nutrition program followed from his research on the topic at PUMC. Years earlier, as the head of the Physiology Department, Lim extensively researched the nature of gastric secretions. In this regard, he worked closely with the head of the Biochemistry Department, Dr. Wu Hsien, who wrote and spoke extensively on nutrition in China. Wu himself was ambivalent, however, about enforcing nutrition as a state project. In a



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1928 article, he stated that “to think of dietary deficiency only in terms of . . . diseases is to miss the real significance of the recent advances of our knowledge of nutrition.”17 While agreeing with Lim that good nutrition improves an individual’s ability to fight diseases, Wu cited contemporaneous research to show that good nutrition only helps to raise “general resistance” to diseases and is less effective in treating specific aliments. Lim clearly did not share Wu Hsien’s tempered views on nutrition. Lim’s embrace of nutrition as a near panacea was rooted largely in traditional Chinese culture’s deeply held view that food is medicine. From Treatise on the Stomach and Spleen (Piwei lun) by Li Gao (1180–1251) to Compendium of Materia Medica (Bencao gangmu) by Li Shizhen (1518–93) to later notions of foods and beverages as medicinally “cooling” or “warming,” diet has been an important method for preventing and remedying illnesses and injuries in classical Chinese medicine. Chinese physicians have praised foods’ salutary properties, not just in the production of pharmaceuticals, but also in such the administering of acupuncture treatments, the interpreting of dreams, and so on.18 Unlike the earlier Ming and Qing governments (1368–1911), which had provided the public with little in the way of health care, Lim integrated traditional Chinese culture’s appreciation for medical foods into an expansive health care policy known as the Special Diet Service.19 The results of this program, which were far-­reaching for ordinary Chinese soldiers and civilians, are discussed in detail later in this section. Lim’s wartime preferences for preventive and dietary health care are partly attributable to the difficulties that China faced in obtaining Western medicine. China, as a geographical entity, was literally changing in shape and size during the war, and thus found it difficult to import medical products. Prior to the October 1938 fall of Guangdong, donated supplies were easily funneled through Hong Kong with the assistance of C. Y. Wu (Wu Zhangyao), an Overseas Chinese technical expert who had worked for the National Health Administration in prewar Nanjing. As major cities in South China fell one by one from October 1938 to May 1939, shipping options for the CRCMRC Supply Services became restricted. Supply Services struggled to transport medical supplies, which were typically delivered in small lots by circuitous routes over rail, road, and river. By the middle of 1939, however, the Japanese incursion into Guangxi Province meant that supplies could

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no longer go through Hong Kong. Supplies had to travel more slowly to China via the newly constructed Burma Road, which was a winding 700-­ mile mountainous route completed in 1939 to link Rangoon in Burma to Kunming in China.20 After the fall of large swaths of Burmese territory in 1942, the allies began airlifts across the Himalayan Mountains, known as “the hump,” to bring supplies from India to Chongqing. Medical supplies, even when they reached China, could not add up to the formation of a comprehensive curative pharmaceutical regime. Of the supplies that the CRCMRC acquired from foreign and domestic sources between June and December 1939, 93 percent were simple medicines, of which almost 40 percent were cholera vaccines and quinine for malaria. There was very little imported medicine for nonmalarial or gastrointestinal diseases. Less than 7 percent of medical imports were first-­aid dressings or complex diagnostic equipment such as microscopes.21 Because the food for the nutrition program could be procured locally and bought with money raised abroad, the program was more viable than were efforts to import medicine, particularly given that proper diets not only helped ailing soldiers recover from their condition but also protected healthy soldiers from contracting illnesses and from succumbing to wounds. The crux of the wartime nutrition program was the aforementioned Special Diet Service inaugurated at Zhiyang sometime between August and December of 1938. The CRCMRC intended the program to serve preventive and curative functions, instituting it “in view of the inadequacy of the normal hospital diet for the prevailing types of medical cases, and the need for a special diet for the prevailing types of medical cases.”22 Each military unit was offered a diet of five meals a day: soft rice cooked with spinach soup, hot cow milk or soy milk with four biscuits, thin noodles (gua mian) with liver and meat soup, thin noodles cooked with blood and meat soup, and soft rice cooked with meat and spinach soup.23 This diet was meant to help soldiers recover from their illnesses or wounds, as well as to prevent illnesses from taking hold in the first place. Soldiers suffering from nutritional deficiency diseases such as beriberi received additional rice noodles to bolster their vitamin B intake. The aim was to raise daily caloric intake for soldiers from an average of 2,500 to 3,000. By the third week of the program, 1,287 soldiers were on the Special Diet.



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Changing the content of soldiers’ diets was another key aim of the Special Diet Service. The Service distributed to soldiers a series of nutritional “calendars” (shibing yiyang rili) that suggested unpolished brown rice, corn, millet, and sorghum as alternatives to the preferred polished (white) rice, which was scarce on the war front and was thought to contribute to beriberi disease among soldiers.24 The CRCMRC encouraged soldiers to consume more beans, not to overcook vegetables, to use more oil-­related products in cooking, and to drink up rice broth. Couched in the language of saving the nation through the adoption of scientific nutrition (yingyang jiuguo), the Special Diet Service reflected the CRCMRC’s concerted effort to fundamentally change the diets of Chinese soldiers. Lim expanded the program in 1939 to include Special Diet kitchens in every military hospital. In a hospital, patients had a choice of a liquid, soft, or supplementary diet, depending on their medical conditions. Bolstering supplementary diets involved the disbursement of cod liver oil and powdered milk by medical personnel to soldiers suffering from malnutrition.25 The CRCMRC worked with academics, such as Cornell University–trained Shen Tong (1911–92), a professor of physiology at Qinghua University who conducted nutritional surveys of soldiers to improve their diets.26 The 1939 expansion of the Special Diet Service assisted a total of 321,493 soldiers by the end of 1940, marking a dramatic increase from the first six months of the program, during which only 6,184 soldiers received the treatment.

Limitations and Innovations of the Preventive Program

The twin pillars of Lim’s military medical program (prevention and diet) had their limitations, despite spurring innovations on the war front. For the nutrition program, the erratic supply of unpolished rice and green vegetables on the war front meant that the vitamin B1 needed to prevent cases of beriberi did not reach all soldiers.27 Beriberi cases remained high, even as their incidence fell over time. To compensate for the lack of vitamin B1, Lim proposed the distribution of milk powder and cod liver oil, as well as shorter cooking times to retain nutrients in vegetables.28 Even milk powder, which was donated by the American Red Cross, appears to have been in short supply by 1941.29 In the absence of “cheap leafy vegetables,” military medical personnel gave plant roots to soldiers suffering from vitamin A deficiency. Lim also sought

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to introduce direct drips of vitamins into patients suffering from serious cases of malnutrition and beriberi.30 In addition, to compensate for soldiers’ lack of meat, which led to nutritional edema, Lim advocated the use of beans and soybeans, which were a readily available alternative source of protein.31 The limitation of finite resources also reduced the efficacy of delousing. There was simply not enough wood or sulfur to properly delouse everyone in the field or to construct the much-­needed shower stations. Moreover, portable stoves and a reliable water supply were often unavailable, meaning that hot air delousers to dry clothes were often not constructed alongside the sulfur units.32 To cope with these challenges, the CRCMRC embraced the philosophy of adapting local resources to preventive care practices and of refining outreach and training programs for military personnel. Wine vats, which were plentiful in Chinese inns in rural market towns, were used by sanitation engineers in lieu of wooden cylinders for the construction of delousers, and bamboo tubes replaced scarce wooden poles in the showers.33 Sanitation engineers and officers also taught commanders in each unit how to set up delousing and shower units. By January 1940, soldiers could set these up on their own under the supervision of sanitation engineers, allowing the limited numbers of engineers to reach out to more units and soldiers. The Special Diet Service’s intervention ultimately had mixed results. Soldiers suffering from nutrition-­related diseases as a percentage of soldiers suffering from all diseases increased from 3 to 4.8 percent from January 1939 to December 1940, but there was an intervening drop to 0.8 percent during the period from January to June 1940. Moreover, the spike from 0.8 percent in June 1940 to 4.8 percent in December 1940 likely resulted more from an increase in detection rates of diseases, rather than a reflection of the effectiveness of the Special Diet Service. In any case, what was more remarkable about the program was the ability of the CRCMRC to institute the Special Diet for more than 300,000 soldiers in the short period of two years. Soldiers ate better after the Special Diet intervention. Even though an improved diet might not have helped them avoid malaria, dysentery, or bronchitis, well-­fed soldiers fought these diseases better and faster than their poorly fed counterparts. Robert Lim claimed that when protein was introduced into Chinese soldiers’ diets, it helped dysentery patients recover much more rapidly than



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they would have otherwise.34 In sum, the nutrition program was ambitious and highly adaptive to wartime circumstances even though it did not fulfill all of its aims. Likewise, the delousing program saw mixed success. Delousing appears to have brought down incidences of relapsing fever, even though it could not prevent a July 1939 to June 1940 spike in the figures for typhus fever. The spike could also be attributed to medical personnel being more adept than they had been just a few months earlier at diagnosing typhus fever, whose rates were likely declining steadily despite statistical appearances to the contrary. As seen in table 2.1, by 1940, the incidence of relapsing and typhus fevers had decreased to roughly 1939 levels, suggesting that delousing controlled—but did not bring down to zero—the rates of lice-­and mite-­transmitted diseases in wartime China. Identifying the number of people suffering from diseases (disease rates) as a percentage of the total number of people deloused (sample size) can give us clues about the effectiveness of delousing. As shown in table 2.2, the percentages of deloused soldiers and civilians suffering from these three diseases went down in the same period, with the exception of an unusually Table 2.1.  Cases of Relapsing Fever, Scabies, and Typhus Fever among Soldiers and Civilians, 1939–1940. Source: CRCRMC Reports, Robert Lim’s Papers, Institute of Modern History Archives, Taiwan (hereafter Lim’s Papers).

Relapsing Fever Scabies

Typhus Fever

January–June July–December January–June July–December 1939 1939 1940 1940 537

20,414

38

117

23,816

39

207

68,091

1,495

402

28,422

241

Table 2.2.  Percentages of Deloused Soldiers and Civilians Suffering from Various Lice-­ and Mite-­Transmitted Diseases, 1939–1940. Source: CRCMRC Reports, Lim’s Papers.

Relapsing Fever

Scabies

Typhus Fever

January–June July–December January–June July–December 1939 1939 1940 1940 3%

116%

0.03%

0.3%

53.5%

0.02%

0.6%

193.7% 2.12%

0.1%

7.6%

0.01%

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sharp increase from January to June 1940, possibly due to the aforementioned higher detection rates by medical personnel improving their training. 35 In sum, the delousing efforts were effective in lowering—but not eliminating— rates of lice-­and mite-­transmitted diseases. This effectiveness derived largely from Lim’s adaptation of limited resources to local circumstances, but the limited nature of the effectiveness equally suggests that finite resources may have led to insurmountably suboptimal health care outcomes.

Expansion of Medical Relief amidst Wartime Dangers

The propagation of mobile medical care became characteristic of Overseas Chinese personnel’s wartime medical practices in China. Mobile medical care appeared in the form of mobile medical units. These units introduced KMT-­controlled rural China to Western biomedical ideas, practices, and technologies related to delousing, nutritional science, surgery, and inoculation. Interestingly, the fierce political rivalry between the KMT and the CCP—only nominally allied with each other throughout the Second World War—did not prevent Robert Lim and other KMT-­affiliated medical personnel associated with the Chinese diaspora from leading mobile medical units to assist CCP strongholds in Northwest China. Mobile units emerged as key to the CRCMRC’s operations and were instrumental in spreading knowledge of biomedicine throughout China. Twenty-­eight mobile units of around 20 personnel each were created out of the available war front medical personnel.36 The brutal fighting between KMT and Japanese forces in Hankou and Wuhan in mid-­1938 prompted the CRCMRC to form curative units that performed surgery on soldiers and dressed their wounds on the front. Owing to increases in resources provided by Overseas Chinese communities and to the establishment of the Emergency Medical Services Training School, the number of curative units grew to around 50 by the end of 1938,37 and 100 by the end of 1941.38 With the establishment of more dressing stations on the frontline, these curative units dressed more wounded soldiers over time: 1.22 million in 1940 and 1.7 million in 1939 as compared to 950,287 in 1938.39 These dressings prevented infections of soldiers’ wounds, enabling them to heal faster. While most of the units after 1938 appeared to take on curative functions as their primary responsibilities, the CRCMRC’s internal reports noted



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that the units were also tasked with a preventive-­care agenda, regardless of whether the patients were affiliated with KMT or CCP forces. Lim emphasized this point in the seventh report of the CRCMRC: The Red Cross is consecrated to the service of the wounded and sick arising

out of war, be they regular soldiers, partisan guerillas or peaceful toilers . . . Thus the Red Cross devotes its supports primarily to the Medical Service

of the Army, but everywhere in front war [sic] areas, aid is given to peasants and refugees, and in the rear . . . to victims of air aggression. Service is to-­day interpreted in terms of prevention, viz.40

To Lim, such preventive services meant preventing death, suffering, infection, deformity, and diseases. To this end, mobile medical units were to be small and nimble, and by 1940, an ideal mobile medical unit was to consist of only 16 medical personnel that would provide antiepidemic, preventive, and basic curative care for the population.41 Units devoted to prevention, as well as those curative units that aided in preventive efforts, were dispatched throughout the country. For example, by mid-­1939, mobile delousing units had reached as far east as Jinhua in Zhejiang Province, as far west as Chongqing in Sichuan Province, as far north as Ganguyi in Shanxi Province, and as far south as Liuzhou in Guangxi Province.42 Many of the delousers were eventually constructed so close to the war front that “the booming of guns [could] be heard.”43 By mid-­1940, mobile units had reached as far south as Nanning in Guangxi Province and as far west as Xiaguan in Yunnan Province.44 As shown in map 2.1, the mobile medical units were situated in more than 13 provinces in unoccupied China. By contrast, during the prewar period, Overseas Chinese medical personnel, researchers, and professors in China had concentrated their biomedical activities in large cities such as Beijing, Xiamen, Shanghai, and Harbin. The unpredictability of war meant that mobile medical units often had to take on responsibilities beyond their assigned roles. On the front line in April 1939, two members of the 33rd Anti-­epidemic Curative Unit succumbed to typhus fever, the disease they had been charged with combating. At the end of March 1939, after being sent to the war front near Hengyang City (Hengyang Shi), the leader of the 49th Preventive Unit contracted relapsing fever yet hid it from his fellow medical workers for fear of “undermining the

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抗戰中中國紅十字會救護總隊分佈

Jehol

Chahar

Liaoning

Suiyuan

Korea 山 西

Shandong

Shanxi Gansu

Shaanxi

Henan

南 河

Jiangsu Anhui

Sichuan

Hubei

Chongqing

Tongyang Kinghua Zhejiang Hunan

Guizhou Jiangxi

Guiyang Yunnan

Guilin Guangxi

廣 Guangdong

Fujian

Formosa

東

Map showing distribution of Chinese Red Cross Field Units during the Sino-Japanese hostilities Hainan

Current War Zones Location of Chinese Red Cross Medical Relief Corps Field Units

Map 2.1.  Approximate reconstruction of the map showing the distribution of CRCMRC mobile medical units, 1940. Dots represent the mobile medical units, and the shaded area represents the fighting zones of contact between the Chinese and Japanese in 1940. Source: United China Relief records, Manuscripts and Archives Division, New York Public Library, Astor, Lenox, and Tilden Foundations (hereafter UCR Records), box 1, folder 6. Reprinted with permission.

confidence” of those around him. A week later, the Japanese bombed the unit, demolishing its delousing plant and Special Diet kitchen and wounding a unit member. Many civilians were also injured as a result of the bombing. The unit quickly converted itself from a preventive unit into an evacuation unit and led the rescue efforts in Hengyang.45



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Transpolitical Medical Intervention in the Communist Base Areas

The CRCMRC, as noted above, provided curative and preventive care to isolated, rural, and undeveloped Communist base areas. Mao Zedong and his followers established their headquarters in Yan’an in rural northern Shaanxi Province in 1935 and ruled over around 15 million people in the nearby area known as the Shaanxi–Gansu–Ningxia Border Region, or the Shaan–Gan– Ning border region. Other Communist leaders established another base area near Beijing and Tianjin known as the Jin–Cha–Ji border region, which ruled over 10 million people. In justifying medical assistance to the Communists to critics within the KMT, Lim argued that the Communists would sabotage Japanese transportation systems, forcing the enemy to station “enormous garrisons” in nominally secure areas rather than on the war front, and thus reducing the threat to KMT forces.46 Toward the end of 1938, Lim dispatched a total of 3 mobile medical units to assist medical work in Yan’an and the border regions. Prior to World War II, these regions had been considered among the most remote, inaccessible, and improverished in all of China.47 Consequently, they had had little contact with biomedicine prior to the war and no medical schools until 1938,48 when the first Western-­style hospital opened its doors in Yan’an.49 Unlike the many Overseas Chinese and Americans in general who saw Yan’an as a place where contented and tenacious residents lived in a democratic and egalitarian society,50 CRCMRC personnel were critical of the conditions there. One staff member who shared her critical views of Yan’an was the Overseas Chinese leader of the 29th CRCMRC unit, Dr. Jean Chiang (not related to Chiang Kai-­shek). Jean Chiang had grown up in Montreal, Canada, where her father had been a professor of Chinese studies at McGill University.51 She described life in the base area: The housing conditions were miserable. . . . The walls and ceilings of the caves had no support and something collapsed (two students were killed in this

manner). The illumination and ventilation were also very poor, and there was no furniture. . . . Each patient had to bring his own bedding, which was often

lice-­ridden. . . . The equipment of the hospitals was insufficent. There was a very small supply of drugs, practically no surgical instruments and only a very few obstetrical instruments.52

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The population in the area, partly because of its insufficient medical supplies and rampant poverty, was rife with malaria, dysentary, smallpox, stomach ulcers, and respiratory diseases.53 Wounded soldiers lay all night on brick ledges without blankets, and lacking anesthesia, surgeons refused to operate on them.54 In confronting this situation, Chiang and her medical units intensified their curative and managerial interventions. Nurses provided the wounded and sick with whatever treatments were available. Makeshift beds were introduced in place of the uncomfortable ledges. Chiang also provided maternal and obstetrical services to women in the base areas. Her unit and others reorganized local hospitals, adding 22 caves to the existing structure. The result was that 120 additional patients could be housed and treated there. Of course, such improvements only partly alleviated the surging demand for medical care. Because of hospitals’ scarce resources and the scarcity of hospitals themselves, CRCMRC units admitted only people who required long-­term medical and nursing care or who were slated for surgery. These same units furnished hospitals with X-­ray machines that often served to determine how serious a respiratory disease was, particularly in suspected and confirmed cases of tuberculosis, and thus to determine which cases warranted further in-­patient treatment.55 CRCMRC units were also active in Shandong and Anxi Provinces, where the Communist Eighth Route Army and New Fourth Army, respectively, were located. In Shandong, home to the Jin–Cha–Ji border region, medical units established mobile clinics in local temples, where personnel dressed, X-­rayed, medicated, and operated on sick and wounded Communist soldiers.56 The CRCMRC dispatched a unit composed of 3 doctors, 2 nurses, and 17 ambulance workers to the New Fourth Army camps and took over the running of the rear base hospitals in Anxi so that New Fourth Army medical doctors could move to the front. Lim also visited the medical unit to show his support for the medical personnel affliated with the New Fourth Army.57 The CRCMRC sought to develop an ambitious preventive-­care program in Communist-­held areas through the construction of medical infastructure. In Yan’an, the army sanitary corps constructed incinerators, trenches, latrines, netting, and cesspools in the local hospital and city. Medical personnel innoculated residents with the typhus vaccine. A small bathing area and delouser were constructed near the admission ward of the hospital so



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that patients could be bathed and deloused before admission. In Shandong, the CRCMRC units also established mobile clinics in local temples, where they established operating, dressing, and X-­ray rooms and ministered to sick and wounded Communist soldiers of the Eighth Route Army.58 New Fourth Army officers were so enthusiastic about the mobile units in Yan’an and Shandong that they urged Lim to send along more antityphoid, anticholera, and antismallpox vaccines for the inoculation of the entire New Fourth Army. The New Fourth Army also voiced a desire to replicate the delousing stations, baths, and sanitary latrines in other base areas.59 The New Fourth Army’s enthusiasm appeared to be shared by ordinary base-­area residents. Medical units reported that residents offered tea and presents as symbols of appreciation for treatments, even though medical personnel generally did not accept them. For example, a typhoid patient came in a stretcher for medical care, with a chicken strapped on his side as payment.60 By contrast, some units reported that Chinese in base areas occasionally exhibited “indifference” toward biomedicine, which had been limited to larger cities, prompting many locals to prefer Chinese medical or “herb doctors.”61 At the same time, residents from the local countryside were known to demand “injections” of treatments—a key practice of biomedicine. By the 1930s, many Chinese in and around base areas had come to believe that, when injected into the body, any medicine—including virility concoctions of dubitable efficacy—must be effective. Biomedical doctors derided these folk mixtures merely as distilled water blended with some unknown stimulants. They were sold by businesspeople as cure-­all ampules, bearing names often associated with the male reproductive cell: sperm.62 In any case, medical personnel had to explain to residents that they could not inject medicine into their bodies at will. All in all, local people’s reactions to Western medicine in base areas were varied, ranging from hostitility to indifference to enthusiasm. The CRCMRC’s efforts in Communist-­held China have been largely forgotten in contemporary China. Today, discussions of medicine in wartime China tend to center on Dr. Norman Bethune, a Canadian doctor who came to China in 1938 specifically to assist the CCP.63 This focus follows from Mao Zedong’s own postwar valorization of Bethune as a model communist who sacrificed his life to work in base areas.64 Mao’s praise of Bethune has also inspired Chinese studies on Bethune dedicated to uncovering his life and

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times.65 While Bethune was influential in assisting the CCP in blood transfusions, surgery, and medical training, his premature death in late 1939 meant that his time in China amounted to less than a year. In contrast, the curative and preventive CRCMRC units committed several years of financial, logistical, and medical resources to CCP-­controlled base areas. At least eight mobile units of around a hundred medical personnel in total were sent by the CRCMRC to the base areas from 1938 to 1940.66 Besides exerting their mangerial expertise, these units could relocate quickly: with only ten minutes’ notice before the Japanese entered a base-­area village, a mobile unit by 1940 could evacuate all wounded soldiers along with supplies hastily packed in saddle bags. Yan’an authorities, the New Fourth Army, and the Eighth Route Army all welcomed the efficacy of these units.67 Overseas Chinese– style medical care, achieved by the innovative deployment and operations of mobile medical units, was available in both Nationalist-­and Communist-­ held areas. The medical units inoculated, deloused, and operated on soldiers and civilians in the base areas and provided essential first aid to soldiers and civilians. Mobility and preventive medicine became emblematic of Overseas Chinese–style medical care, regardless of the regions’ or the patients’ political affliation. The resulting popularity of these medical units facilitated their extension of biomedical practices and ideas from prewar urban coastal areas to the wartime rural regions of Southwest and Northwest China.

Rise of the Global Chinese Diaspora in Wartime China

Residents who received medical treatment from the mobile units in the base areas expressed gratitude for their free medical care. The “free” care, however, was paid for, in part, by ethnic Chinese living abroad. Overseas Chinese aid organizations provided money, supplies, labor, knowledge, and expertise, representing the broadening and deepening of the scale and scope of Overseas Chinese participation in the Second World War. Decades before the war broke out, from the 1880s to 1911, many Overseas Chinese had already sought to contribute to China’s development by donating money and resources to Late Qing reformers and Republican revolutionaries.68 As shown in chapter 1, several Overseas Chinese medical and scientific elites sought to develop Western medical and other scientific institutions across China from 1911 to 1937. In the same period, Overseas Chinese in British Malaya, often led by



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Tan Kah Kee, periodically donated money toward medical and humanitarian relief efforts in China.69 Recall that Tan donated much of his fortune to Xiamen University during this period. In 1926, he used the Shantung Relief Fund to organize medical relief for Chinese soldiers and civilians injured in skirmishes with Japanese forces in Jinan. Tan raised more than 300,000 Straits dollars (USD [2018] 2.42 million) for the fund.70 Yet this was mostly a one-­off event of large-­scale donations for a public cause in the period before the Second World War. The extent of involvement in China, however, by the Chinese diaspora in North America,71 Britain,72 Hong Kong,73 and other parts of Southeast Asia was limited largely to private remittances to families and relatives.74 The outbreak of the war in 1937 saw many of these Chinese shifting part of their remittances to the medical relief efforts led by Robert Lim. Many members of the Chinese diaspora would even physically travel to China, leveraging their expertise and knowledge in support of medical relief in China. These members of the Chinese diaspora were aware specifically of Robert Lim because his governance skills had impressed many Overseas Chinese medical personnel, earning him a strong reputation in the wider community prior to the war. In 1937, he was the only senior doctor and administrator to leave his position at PUMC in Beijing to assist the war effort. Prominent Overseas Chinese doctors O. K. Khaw and C. E. Lim stayed on in occupied Beijing and were subsequently promoted to higher positions within the PUMC’s bureaucracy. As for doctors not associated with the PUMC, Wu Lien-­teh and Lim Boon Keng moved to Malaya and Singapore, respectively, after 1936, just before the war broke out. Only Dr. Yen Fu-­ching (Yan Fuqing 1882–1970), the former president of Yale-­China Medical College (1914–26) and vice president of PUMC (1927–28), stayed in unoccupied China. Chiang named him head of the National Health Administration, a position he filled from 1938 to 1940, during which time he dealt chiefly with municipal and rural health care.75 National health care was to be led by Robert Lim and the CRCMRC. Just as Wu Lien-­teh had drawn on his diasporic identity to staff the NMPPS with fellow Cantonese and Overseas Chinese in the 1910s, Robert Lim tapped into the expertise of Overseas Chinese during the Second World War. Lim worked closely with Penang-­born C. Y. Wu, incidentally the former assistant to Wu Lien-­teh and technical expert to the National Health

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Administration in Nanjing.76 C. Y. Wu became the director of the Hong Kong Bureau of the Chinese Red Cross in 1937 and director of the Transportation and Supplies Department of the CRCMRC in 1938. His responsibilities centered on helping Lim ship supplies from the West to China via Hong Kong. Hong Kong was then a British colony, and remained neutral in the fight between China and Japan until Japan invaded the island in December 1941. From Hong Kong C. Y. Wu shipped goods to KMT-­held cities—Shanghai and Nanjing (1937), Hankow and Changsha (1938), and Guiyang and Kunming (1938–40). Once in these cities, the supplies were redistributed to the rest of Free China. In 1939, C. Y. Wu made a trip to Burma to aid the movement of supplies via the Burma Road. Wu also traveled to Java and Malaya to raise medical transportation funds among local Chinese leaders and to persuade local colonial officials to permit donations from these individuals to the CRCMRC.77 Without his tenacity in Hong Kong and elsewhere, channeling the world’s resources to wartorn China would have been far more difficult. Hongkongers joined Chinese Americans and Canadians in donating to the China Defense League, which in turn paid for the supplies that the CRCMRC medical units brought to the Communist base areas. The League, whose purpose was to support the Communist base areas in Northwest China, had been founded by left-­leaning Soong Ching-­ling (Song Qingling 1893–1981), who was the wife of the late Sun Yat-­sen, the first president of the Republic of China. The China Defense League described the Communist base areas as “guerilla areas,” or “border areas,” to appeal to an Overseas Chinese audience who might be wary of supporting the Communist regime. Representative of this impulse was the League’s 28-­page 1940 report, where the League avoided the term Communist in favor of terms such as Eighth Route Army, Yenan (Yan’an) Region, and International Peace Hospitals.78 The League worked closely with the China Aid Council, which was another pro-­Communist aid organization, this one based in New York.79 The League drew its support from a wide variety of donors from across the globe. For example, the League gifted base areas with five Studebaker trucks donated by the Chinese Patriotic League of Ontario. For the Communist New Fourth Army, the March 1939 shipment contained HKD 60,000 (USD [2018] 297,534)80 worth of supplies, weighing 50 tons in total and including four cases of supplies from the Chinese Civilian Relief Committee of New



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York and the China Medical Committee of Victoria.81 In October 1940, the League successfully raised HKD 4,000 (USD [2018] 16,486) from a music and dance recital in Hong Kong.82 In March 1941, the League presented a fundraising performance by the left-­leaning German playwright Ernst Toller, who, having been stripped of his German citizenship by the Nazis in 1934, was living as a refugee in the United States.83 The League’s ability to attract global support meant that the CRCMRC could successfully deliver medical assistance to China’s anti-­Japanese forces, the primary beneficacies of which were somewhat ironically Chinese Communists, rivals to the central government led by Chiang Kai-­shek. Several Overseas Chinese medical students from Hong Kong University also traveled to Kunming to aid Robert Lim. One was Eva Ho Tung (He Xianzi, 1862–1956), daughter of the Hong Kong millionaire Sir Robert Ho Tung.84 Tung was the first female graduate of Hong Kong University Medical School, as well as the the first woman doctor to direct a mobile medical field unit in China.85 Her participation was considered “patriotic” post-­facto; some Hongkongers saw it as foolish at the time. Another female Hongkonger (whose name remains anonymous in the archival record) left to work for Robert Lim in Guiyang in 1940 and was promptly chastised by her friends and family for “scandalizing” them. She chose to work in China under absymal conditions instead of living a comfortable life of “silk gowns” and “tea parties” in Hong Kong.86 The walls of her office in Kunming were sagging, rain was seeping through a corner of the roof, and she had few supplies to work with in her job as a bilingual assistant to Robert Lim. She believed, however, that only in China could she substantively aid China. She also remarked that she was much more comfortable than the soldiers on the front. The stories of these two women reflect the enthusiasm of quite a few Hongkongers who physically participated in the medical relief efforts in China despite the often harsh conditions there. These participants constitute a significant broadening of pro-­CRCMRC activities beyond remittances sent from afar. Robert Lim also sought the assistance of British Chinese. In 1940, he appealed in the British press for Overseas Chinese and sympathetic Britons to provide medical assistance to China. Besides money, blankets, vaccines, and sundries, he urged British readers to support shipments of trucks to China, where the vehicles could transport the aforementioned materials to far-­flung

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destinations. Lim also urged the British public to lobby their representatives for legislative changes that would permit shipments of essential spare parts, tires, and fuel to China.87 Sympathetic journalists and editors wrote positive pieces on the China Defense League, further enhancing its fund-­raising activities in Britain, America, and Southeast Asia. A reporter for The Scotsman helped raise funds for the CRCMRC by emphasizing the depravity of the wartime situation, encouraging the British to donate “5 pounds to keep 2 [refugees] full for a month.”88 A similar letter of appeal regarding the “hard pressed” Red Cross appeared in the Manchester Guardian on July 11, 1939. It cited Agnes Smedley, a wartime American journalist who wrote extensively about her time working alongside Lim in the area of medical distribution.89 Smedley praised Lim’s bravery, recounting an incident where he saved soldiers on the war front despite Japanese aerial bombing that put his life in danger.90 Freda Utley, a British reporter who spent several months in China, wrote a book, China at War (1939), elaborating on the achievements and challenges of Lim and his compatriots.91 More than 8,000 miles away, the editor of the Singapore-­based Straits Times reviewed Utley’s book favorably and, in the process, emphasized Lim’s role at the CRCMRC: In Miss Utley’s description of her investigation into the ambulance and Red

Cross services in China, there is a flattering account of the work which a Straits-­Chinese, Dr. Robert Lim, is doing for China. Dr. Robert Lim, the

son of Dr. Lim Boon Keng, has “set his hands to cleaning out the Augean stables of the Chinese Army Medical Service.” . . . Dr. Lim has been able to put the task of caring for the wounded on a new basis. Whereas the Chinese army medical service has hardly any trained nurses, [and] is short of properly

equipped hospitals and medical personnel, Dr. Lim has been able to secure the services of many brilliant men and has also enlisted a new type of educated Chinese to work as nurses and dressers.92

It is worth noting that both Utley and Smedley wrote highly of Lim, despite their skepticism toward the KMT. Positive assessments of Lim were made in the wider context of long-­ standing support by the Southeast Asian Chinese diaspora for China’s development. When the war broke out, ethnic Chinese there were inspired to



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support medical relief efforts in China. Ethnic Chinese in Singapore placed advertisements in the Singapore Free Press and Mercantile Advertiser on June 4, 1938, soliciting donations for not only the Chinese Red Cross Society but the local St. Andrew’s Hospital Sanatorium as well. Tickets were priced at 3.50 Straits dollars for diners and 2.50 Straits dollars for nondiners. At the local New World Cabaret in September 1938, local ballroom dancers taught a session of ballroom dancing to raise funds for the CRCMRC.93 In another case, an ethnic Chinese swimmer from Hong Kong, Yang Shau King, who went by the monikor “the Chinese Venus,” gave swimming demonstrations at Batavia (present-­day Jakarta) to raise funds for the organization.94 Dancing, eating, and swimming—activities of local Chinese elites in Singapore and Indonesia—were platforms for fundraising for the CRCMRC, reminiscent of similar efforts in China.95 Many Overseas Chinese from present-­day Singapore and Malaysia (then British Malaya) traveled to China to assist in medical relief efforts by becoming truck drivers and mechanics. In total, 9 batches of 3,000 volunteers transported supplies in vehicles along the Burma Road from Rangoon to Kunming, enabling supplies from the West to reach the CRCMRC. Many had never before set foot in China. A 17-­year-­old ethnic Chinese volunteer in Singapore recounted his voyage to China: During the voyage, we were not nervous. It was like an adventure . . . because we were going to help our country, and because so many of us had never been

to China before. Even though we [had] lived all our lives in the Nanyang

region [South Seas, referring to present-­day Singapore and Malaysia], China was in our blood. . . . You might think it was foolhardy. We definitely knew it

was dangerous, but most of us were young men and so we were quite positive about getting through the war alive.96

Many volunteers were not as fortunate as this young man, who survived the war. A third died from disease and wounds (often from aerial bombings), and another third never returned to Singapore or Malaysia because the extremely slow rate of repatriation led them to give up out of despair: only the remaining third managed to make their way home after the war.97 The first batch of returnees, however, had to postpone their departure from China until October 26, 1946, more than a year after the war had ended.

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The outbreak of the Second World War also brought into stark relief the growing importance of the Chinese American community as a significant donor base for China. Prior to World War II, Chinese Americans’ involvement in China took the form mainly of donations to railway construction projects and private remittances to family members.98 As Japan expanded its control over Chinese territories in the 1930s, potentially threatening American interests in the Pacific, Chinese Americans emerged as powerful opponents to Japanese aggression.99 In June 1936, the New York Times reported that, outside New York City’s Japanese consulate, Chinese Americans had protested against Japanese encroachments on Chinese territories.100 Eighteen months later, in December 1937, sympathetic Americans such as Dr. Frank Co Tui, a Philippines-­born Chinese, and Dr. Maurice William, a Russian-­born American, who had supported Sun Yat-­sen, formed the American Bureau for Medical Aid to China (ABMAC). ABMAC was created to provide China with ambulances and medicine that would serve ordinary citizens as well as wounded and disabled soldiers.101 Within a year, the core leadership group of ABMAC also included George Vincent, a sociologist and head of the Rockefeller Foundation, and Donald Van Slyke, a Dutch American biochemist who had spent a year at PUMC before the war. In contrast to the China Defense League and the China Aid Council, ABMAC did not directly support the Communist base areas in Northwest China, instead concentrating its support on Robert Lim and the CRCMRC headquartered in KMT-­held Southwest China. In fact, Lim was ABMAC’s official representative in China. A month after its inception, ABMAC launched several campaigns including a benefit party to raise funds among Swarthmore College alumni, fundraising appeals in the popular Readers’ Digest, and “Bowl of Rice” fundraising parties.102 The “Bowl of Rice” party emerged as a formidable tool for fundraising that spread from the United States to Hong Kong two years later.103 By 1939, ABMAC fundraisers held dinners, bridge, and mahjong parties, sold Christmas and New Year’s cards, and conducted piano recitals.104 Chinese Americans responded generously to ABMAC’s fundraising efforts. On the East Coast in April 1938, about a hundred Chinese students from Columbia, New York University, Cornell, Harvard, Princeton, and other universities participated in a campaign drive to raise USD 20,000 for



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a ton of antimalarial quinine destined for China.105 High school and college students on the East Coast collected USD 8,000 to buy and ship emergency drugs and first aid materials to China. Some 1,500 Chinese laundrymen in the New York Chinese Hand Laundry Alliance donated five ambulances, valued at USD 10,000, to the CRCMRC.106 While donating to the New York–based ABMAC, Chinese Americans on the West Coast responded to calls to support the CRCMRC. Women pawned their jewelry, young boys shined shoes, and young ladies sold flowers to raise funds for the San Francisco–based China War Relief Association. The quintessentially American game of football was also played between San Francisco and Los Angeles Chinese to raise funds for the China War Relief Association, which donated its proceeds to the CRCMRC.107 In total, from 1938 to 1940, ABMAC managed to designate more than 500,000 Chinese dollars for the CRCMRC.108 This figure excludes the USD 500,000 (USD [2018] 8.9 million) worth of supplies sent by ABMAC to China in 1940.109 It was significant that such widespread support for ABMAC occurred before the repeal of the Chinese Exclusion Act, which banned Chinese immigration into the United States. It was only in 1943, two years after the Pearl Harbor bombings and the inclusion of China as an official ally of the United States, that the act was repealed, a result of efforts by the Chinese government, Chinese American groups, and US administration officials and legislators. In sum, the multifaceted interactions between Kunming-­based Robert Lim, Hong Kong–based C. Y. Wu, and the ethnic Chinese communities in Hong Kong, Southeast Asia, the United States, and Britain boosted charitable donations and activities that aided China’s medical relief efforts. Not a few contributors risked their lives for the cause, driving supply-­laden trucks, directing field units, and treating wounded soldiers so that the CRCRMC might succeed in its mission. The labor, expertise, generosity, and sacrifices of these individuals were critical to the sustenance and growth of China’s military medical complex, particularly in the Southwest.

Global Funding of the CRCMRC

An analysis of the money received by the CRCMRC for its operations from 1938 to 1940 reveals the critical importance of Overseas Chinese in sustaining the organization. According to the financial records of the CRCMRC,

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Overseas Chinese during this period donated around 1.2 million Chinese dollars, making up almost 35 percent of the donations.110 This figure translated to at least USD 120,000111 at the time (USD [2018] 2.1 million). It is worth keeping in mind that this figure does not include Chinese Americans, who donated through ABMAC and United China Relief (UCR), a New York– based umbrella relief organization. While we cannot know for sure the exact percentages of support by the Chinese diaspora to ABMAC and UCR, we do know that these organizations explicitly appealed to this demographic group as their main donor base. It is likely that at least half of donations to ABMAC and UCR came from Chinese Americans. Take for example the sponsors of items sent to China for the month of September 1939.112 The Chinese Cultural Theatre Group raised USD 502 for 375,000 sulfanilamide pills; the Chinese Embassy, the Chinese Student Christian Association in Boston, and the Seattle Chinese Patriotic League sponsored 50 microscopes costing USD 6,750; the Chinese embassy, the Chinese Christian Association in New York, the Indianapolis China Committee, the Chinese Student Club at the University of Michigan, and four non-­Chinese individuals and organizations sponsored 200 sphygmomanometers for the amount of USD 2,900. Along the same vein, UCR specifically targeted the Chinese American community for donations. For example, a Margaret Lee of Los Angeles organized members of her Chinese American girls’ club to raise funds after hearing an appeal from Soong Mei-­ling (Song Meiling 1898–2003), the wife of Chiang Kai-­shek, to support the UCR.113 This evidence suggests that many Chinese Americans strongly supported the endeavors of ABMAC and UCR. Therefore, a conservative estimate would be that about 60 percent of the CRCMRC’s funding came from the donations of Overseas Chinese, amounting to around 2 million Chinese dollars (USD [2018] 3.68 million). An estimated 98 percent of the operating budget of the CRCMRC, or around 3.35 million Chinese dollars (USD [2018] 5.9 million), came from members of the Chinese diaspora, American aid organizations, and Red Cross organizations around the world. In contrast, as seen in figure 2.3, the remaining 2 percent of the CRCMRC’s funding came from local sources, including the Department of Health, the Shanghai-­based Red Cross, and the International Red Cross in China.114 Besides contributing money, Overseas Chinese donated almost all the vehicles the CRCMRC used in its mobile outreach. By the end of December

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Figure 2.3. Chart shows the breakdown of the financial support for the CRCMRC from 1938 to 1940. Among Overseas Chinese, those from Southeast Asia and America donated the most. ABMAC was the largest American aid organization to donate to the CRCMRC. Source: CRCMRC Reports, Lim’s Papers.

1939, Overseas Chinese in America, Hong Kong, and Southeast Asia had donated 212 of the CRCMRC’s 215 Studebaker motor vehicles.115 Furthermore, the upward trend of donations meant that the CRCMRC could allocate more funds to its various departments and programs.116 As seen in figure 2.4, CRCMRC spending increased slightly across back-to-back six-month periods between 1938 and 1940 despite inflationary pressures. Specifically, spending increased from 435,000 Chinese dollars (USD [2018] 1.62 million) in the July–December 1938 period to more than 1.6 million Chinese dollars (USD [2018] 1.72 million) in the July–December 1940 period. The increase in the funds and materials available to the CRCMRC corresponded to higher numbers of Chinese treated and immunized by the organization. Over time, more sick people were treated (33,834 in 1938 versus 640,106 in 1940); more wounded soldiers were treated (1 million in 1938 versus 1.7 million in 1939 before dipping slightly to 1.2 million in 1940 because of the relative stalemate between the Japanese and Chinese forces); more Chinese civilians and soldiers were deloused (475 in 1938 versus more than 375,854 in 1940); and more were immunized (420,484 in 1938 versus 962,972 in 1940).

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Figure 2.4. Graph of CRCRMC’s expenditure in Chinese Dollars, 1938–40. Source: CRCMRC Reports, Lim’s Papers.

Universalizing Care through Military Medicine

The global foundations of the CRCMRC allowed the organization to undertake an unprecedented expansion of medical treatment in wartime China. As shown in table 2.3, the results were impressive compared to the prewar period. Far more people were treated, immunized, deloused, and fed by the CRCMRC during the 1938–40 period than by any other China-based organization before or during the war. For example, the CRCMRC treated and immunized more patients than the prewar Central Field Health Station and the National Health Administration School Health Program established by PUMC professor and Harvard graduate Liu Jui-heng. Furthermore, the CRCMRC immunized more people during the 1938–40 period than did Wu Lien-teh’s Shanghai-based National Quarantine Bureau during the 1931–32 period, which constituted the zenith of the latter organization’s operations. More significantly, the CRCMRC funded novel preventive medical programs such as delousing and state nutrition programs.

Diasporic Transformation of Chinese Biomedicine

Robert Lim and his fellow Overseas Chinese were central to making medical relief in China possible. Robert Lim’s strategy of working with medical professionals within the Chinese diaspora, appealing for funds and resources

Table 2.3.  National-­Level Health Care Organizations in Republican and Wartime China, 1929–1940. Sources: Wu Lien-­teh and Wu Chang-­ yao, National Quarantine Services, 189–213; Iris Borowy, Uneasy Encounters, 205–28; Ka-­che Yip, Health and National Reconstruction in Nationalist China, 82, 127; CRCMRC Reports, Lim’s Papers. National-­Level Healthcare Organizations

Director

Chinese Red Cross Medical Relief Corps

Robert Lim

National Quarantine Service

Wu Lien-­teh

National Health Administration School Health Program

Liu Jui-­heng

Central Field Health Station

Liu Jui-­heng

Total Numbers of Patients Treated >4 million (1938–40)

Number of ­Patients Immunized 1,965,468 (1938–40)

Number of ­People, ­Garments, and Beddings Deloused

Number of ­People on the Nutrition Program >300,000 (1938–40)

3.3 million (1938–40)

>2.2 million (1938–40)

Budget ­(Chinese Dollars)

10,000 (1931–33)

Unknown

None

None

Unknown percentage of 1.2 million dollars of the NHA’s overall Budget (1931–33) 1.5 million (1931–33)

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beyond the usual constituency of Southeast Asian Chinese, and working with US-­based ABMAC was critical to the effectiveness of such biomedical practices in China as delousing, Special Diet services, and mobile medical treatment. Many Chinese outside of China proper, especially those from Hong Kong, saw opportunities to provide medical assistance in China after the country suffered not only rampant departures of key prewar medical and scientific elites but also the sidelining of other elites who chose to work in Japanese-­occupied China. Some 3,000 Overseas Chinese from British Malaya drove trucks under challenging conditions to ensure that medical supplies from the West could reach China. The Chinese diaspora from Europe, North America, and Southeast Asia donated at least 2 million Chinese dollars to the CRCMRC and the China Defense League. Overseas Chinese who wanted to aid China were able to transcend political and military boundaries erected by Chinese Nationalists and Communists and were critical in making biomedical institutions and practices work throughout Free China. By identifying multiple medical deficiencies in wartime Yan’an and by expanding medical care in Communist-­held areas, the Chinese Canadian obstetrician Jean Chiang and New York–based China Defense League officials helped counter the Japanese and, ironically, helped support the CCP.117 These activities revealed what was hidden to many foreign observers whose sympathies lay with the CCP: its inability to independently improve medical conditions in areas under its control. The professed apolitical nature of Overseas Chinese–style biomedicine had political consequences. Chiang Kai-­shek’s early acceptance of Robert Lim’s efforts to aid the CCP meant that the Chinese Communists gained valuable knowledge and practice in military medicine. Denial of this resource would have limited their ability to fight a war against the Japanese and, as it so happened, the KMT. With Chiang’s green light, Lim and thousands of anonymous Overseas Chinese saved the lives of soldiers and civilians in the Communist-­held areas, even if Communist leaders later completely excised these tremendous contributions from official CCP history, which instead valorized Norman Bethune, a self-­ identified communist from Canada, as the key individual who assisted the CCP forces’ base areas during the Second World War. The growing participation of Overseas Chinese in China’s prewar biomedicine decisively transformed it from its origins as a laboratory-­informed,



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urban-­based, and elite-­driven institution into a mobile, data-­driven health care system that was more universal than its predecessor. Perhaps above all else, adaptation became emblematic of medical care in wartime China. Mobile medical units brought new preventive and curative practices to army camps and rural communities. The efforts of these units resulted in the delousing, inoculation, treatment, surgery, and evacuation of more than 4 million Chinese soldiers and civilians. The CRCMRC’s universalizing of health care from 1938 to 1940 reflected Robert Lim’s 1937 calls for the establishment of Chinese “state medicine,” where the government “must be responsible for all medical work” and curative and preventive medical care must be “provided without charge to the people” through reasonable taxation.118 Ultimately, the health care system that took shape in wartime China was financed neither by Nationalist tax receipts nor by foreign governments. Instead, Overseas Chinese and American aid organizations provided it with the cash, equipment, and personnel it needed to operate. Strategies to fund it were operationalized in the context of America, Hong Kong, and Southeast Asia. These funds contributed to the treatment of more than 4 million patients from 1938 to 1940, most of them soldiers. This figure draws from the fact that the C ­ RCMRC dressed more than 3.8 million wounded soldiers, vaccinated almost 1.9 million soldiers, and deloused more than 437,000 soldiers and their 2.2 million garments and beddings from 1937–1940.119 Even if all the soldiers who received dressings were also immunized and deloused, the CRCMRC would still have treated around 3.8 million soldiers. Given that the Chinese Army comprised around 4.3 million soldiers by 1941 (the Chinese Army began with approximately 1.7 to 2.2 million soldiers in 1937), it appears that health care coverage was almost universal for soldiers, as they enjoyed preventive and curative treatment in various forms from 1938 to 1940.120 Combined with the CRCMRC’s treatment of more than 658,000 civilians for insect-­borne, infectious, and nutritional deficiency diseases from 1937 to 1940, it was clear that the organization treated at least 4.4 million soldiers and civilians. As a singular organization, the CRCMRC treated more people in China than any other medical institution from the Nanjing decade (1927–36). The wartime military medical complex also strengthened China’s knowledge of diseases, catalyzing and accelerating the prewar accumulation of scientific data.121 In their dual role as healers and surveyors, mobile medical

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units compiled medical information in the field for diagnostic and treatment purposes. Such information, when reported in various internal reports and aid organization newsletters, provided an important quantification of the work of the CRCMRC, as well as a critical justification for the organization’s continued existence, particularly in the eyes of potential donors. Data did not determine destiny, however, as individual interpretations of medical issues remained a prominent feature of wartime Chinese medicine. For example, because Robert Lim observed that scabies was the most common disease afflicting Chinese soldiers, he logically developed an expansive delousing system. At the same time, the fact arising from the data collected of malaria as a serious problem among soldiers did not result in the widespread distribution of mosquito nets. Lim preferred using the more inexpensive Special Diet Program to treat such diseases. His belief that a proper diet would boost soldiers’ immune systems and thus ward off malaria and other diseases reveals how some imprecise statistical reasoning, coupled with insufficient resources, shaped medical governance in wartime China. Adaptation became emblematic of wartime military medicine. In aspiring to provide medical care for as many people as possible, mobile medical units made do with the resources available in wartime China. Medical units substituted bamboo poles for wooden poles in showers, wine vats for scarce strips of wood in delousers, old knives for scarce surgical instruments in operating areas, and clay pots for autoclaves in the sterilization of medical equipment.122 The mobile medical units constructed hospitals in the caves of hilly Yan’an rather than devoting resources to building hospitals from the ground up. On the macro level, Robert Lim’s focus on the relatively inexpensive Special Diet Program rather than on an expensive pharmaceutical regime characterized the adaptiveness of Chinese medicine on the war front. Yet, even within the Special Diet Program, many soldiers had to consume plant roots instead of fresh vegetables, as the latter proved hard to obtain. Such substitution clearly had its limitations, as it could not substantially reduce incidences of diseases, even though it could mitigate their rise. While adaptation was a key to the success of the CRCMRC, biomedicine on the front lines remained subject to the cruelest of limitations. Similar challenges and promises in adapting foreign biomedical knowledge and technologies to wartime conditions were seen in the history of the



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first Chinese blood bank. The following chapter shows how Chinese Americans and their allies successfully established the first Chinese blood bank in New York before bringing the bank to wartime Kunming in 1944. Robert Lim and his blood bank personnel creatively and successfully adapted imported such blood bank technology to local wartime conditions. However, they were much less successful in persuading soldiers and civilians to donate their blood. Blood drives were often met with apathy and even outright hostility. What ultimately made the blood banks work was local elites’ use of economic incentives to persuade Chinese students and professionals to donate blood: in China, social divisions explained many of the complex personal considerations underlying people’s acceptance or rejection of what can properly be called diasporic medicine.

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M A K I N G B L O O D BA N K I N G WO R K

In March 1945, Dai Jitao (1891–1949), a senior KMT official,1 grew ill after flying into Kunming, a city in Southwest China. Suffering from fainting spells, Dai attributed them to his long-­standing anemia. China was then in the midst of a world war. Over dinner, Dai’s comrades told him about the possibility that a fresh infusion of blood would revitalize him and that the four-­month-­old blood bank in town could prove to be the remedy to his problems. Dai had been trying a relatively new Western medical method of injecting liver extract to improve his anemic condition without much success.2 He visited the blood bank the following day and was warmly welcomed by its director, Yi Chien-­lung. Yi tested Dai’s blood and announced that a transfusion of fresh red blood cells would indeed increase his low red blood cell count. Later, over a meal, Dai confided to his comrades that he was excited that the blood transfusion might improve his condition. He was ready to sign up for the transfusion the following day, but his comrades warned him that patients had become sicker and died after undergoing blood transfusions at the blood bank.3 To make things worse, Adet Lin, a senior American-­educated blood bank staff member and daughter of prominent Chinese scholar Lin Yutang, warned Dai that there was an infection rate of 14 percent with the blood bank’s transfusions. Worried, Dai struggled to sleep that night. He weighed his options: continue feeling sick or go in for a risky but potentially curative medical

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procedure. The next morning, he decided that he would take a chance on the transfusion because he believed Adet Lin would do her best to make sure nothing would go wrong. At the blood bank, Lin inserted a tube into Dai’s veins and allowed the plasma solution contained in an inverted bottle to drip slowly into his body. After the transfusion, Dai waited anxiously for any negative results. When Lin announced that a million foreign red blood cells had been infused into Dai’s body, increasing the patient’s hemoglobin levels from 80 to 90 percent, he was exceedingly happy and told his friends that “he never had an effect this striking when receiving his many injections of liver extract.”4 Dai’s dilemma prior to his positive experience with the first Chinese blood bank reflected the concerns many Chinese had as they grappled with the new technology and the underlying ideas of blood banking and transfusions. Many Chinese did not share Dai’s willingness to experiment, and their opposition could be partly attributed to prevailing ideas about blood. As Shigehisa Kuriyama and Bridie Andrews have argued, many Chinese felt that ideally blood should circulate within the body and that any loss of it represented a loss of vitality.5 Improvements in health should involve not blood transfusions but the consumption of blood-­boosting medicine.6 Therefore, many Chinese refused to donate blood because they thought that doing so would deplete their vitality; yet, as I will show, this belief was neither the only nor the most important factor influencing whether or not Chinese donated blood. This chapter makes three arguments on how blood banking worked in wartime China, illuminating the promises and perils of military medicine in a wartime context. First, the chapter argues that Chinese people considered not only cultural reasons, but also reasons related to economics, altruism, peer pressure, and emotional connections, when trying to decide whether to donate blood to China’s first blood bank. My approach complements narratives that focus on the conflicts among elites over the proper role of classical Chinese medicine (CCM) in China.7 Scholars have revealed how CCM physicians, when facing the anti-­CCM sentiments of both senior KMT politicians and Western-­trained physicians in China, maintained their cultural relevance in early-­twentieth-­century China by simultaneously co-­opting Western diagnostic practices and maintaining CCM-­style practices.8 In contrast to previous research, this chapter explores biomedicine on the everyday



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level, revealing that Chinese considered socioeconomic and emotional incentives alongside cultural and epistemic perceptions of blood. During the war, Chinese people’s openness to economic incentives such as soy milk and eggs in exchange for blood supports Wen-­Hsin Yeh’s and Frank Dikötter’s arguments that ordinary Chinese were largely open to the ways in which Western capitalism and material culture reconfigured institutions and everyday life in twentieth-­century China.9 Moreover, my findings resonate with Sean Lei’s and Nicole Barnes’s research on just how central both socioeconomic values and emotional labor were to Chinese people’s reactions to new medical practices and new medical practitioners in China.10 The response to socioeconomic incentives for blood donations was not only a Chinese phenomenon. Susan Lederer argues that blood donors in the United States were also motivated by monetary compensation prior to and during the Second World War.11 Kara Swanson has modified Lederer’s argument by showing that even as terminologies such as professional donors and bank deposits reflect the market-­based nature of blood banking, many Americans chose to donate blood out of altruism or patriotism. Blood banks were also sites of exclusion, as many Americans were denied the opportunity to donate or receive blood because of their race.12 Blood banks of the twentieth century were not completely market-­based entities but institutions embedded within America’s diverse social and cultural contexts. William Schneider argues that many people living in Sub-­Saharan Africa were motivated to give blood after seeing how superior the effects of hospital-­based blood transfusions were to the effects of other practices such as vaccinations and lumbar punctures.13 As I will show, the wartime experiences of China were similar to those of the United States and Africa. Classical Chinese views of blood, which ran counter to the idea of blood banking, failed to stop a good number of Chinese from supporting blood donations. Many, if not most, of these Chinese donors donated blood in exchange for material compensation. What was unique in the Chinese case was the effective role of local elites in supporting blood banking in wartime China. University and labor leaders used their resources to provide soy milk and eggs to potential donors, thus developing a cross-­class alliance among students, laborers, and medical personnel. In contrast, China’s blood bank personnel were much less

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effective at connecting with potential donors and relied on indirect military-­ or government-­based coercion to solicit donors. Second, Overseas Chinese medical experts from the United States and Canada were central to the success of China’s first blood bank. They brought their international connections and knowledge from North America to wartime China. In chapter 2, I showed how the Chinese diaspora in North America donated money, vehicles, and other supplies to Lim’s CRCMRC from 1938 to 1940. This chapter further explores the contributions of Overseas Chinese by highlighting how their biomedical expertise was critical in making the first Chinese blood bank work in 1944, even as they struggled at times with living in China. To establish a blood bank in China, Overseas Chinese studied the intricacies of blood banking at Columbia University, established a test blood bank in the city’s Chinatown, and solicited support for the Chinese blood bank from local civil rights organizations and community groups. After moving to China, these Overseas Chinese struggled with the Spartan living conditions in their new homeland and reminisced about the favorable working and living conditions back in the United States. These individuals’ overall transnational commitment to blood banking stood in stark contrast to the existing narrative that emphasized only their patriotic contribution to the US military or their indirect financial support of China, which came all the way from the United States.14 Their encounters with ordinary Chinese soldiers and civilians in a renovated hospital in Kunming and in abandoned temples in rural Yunnan revealed that the Overseas Chinese were intent on putting their North American education to use in China during the Second World War. Third, Chinese Americans adapted US peacetime blood-­banking technology to China’s military medical units, which—being mobile—could bring blood transfusion practices to Chinese people in far-­flung regions of the country. The innovations of these Chinese Americans were part of a broader effort to grasp how East Asian technical and medical experts adapted, tinkered with, and reinvented Western technology in local Chinese contexts.15 In operating the first Chinese blood bank, medical personnel substituted human labor for mechanized automation when facing electricity shortages, substituted plentiful charcoal for rare gasoline when fueling machinery, and experimented with transfusion techniques to mitigate



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contamination problems. For mobile blood banks, the medical personnel transitioned from peacetime hospitals and laboratories to wartime fieldwork.16 It was these personnel who etched the traits of adaptability and mobility on Chinese wartime medicine.

Diasporic Origins of the Bank

The first Chinese blood bank was conceived by Robert Lim and originated in 1944 in New York City. The blood bank was Lim’s third institution in his wartime military medical complex, which also included the CRCMRC (1938) and the Emergency Medical Services Training School (1939). To establish and develop these institutions, Robert Lim drew not only on his previous training, experience, and standing as a prominent Overseas Chinese physician but also on his particular expertise at raising funds, many of which came from ABMAC. Lim’s eagerness to start a Chinese blood bank peaked in 1942, as he was convinced that it would boost medical relief efforts. In this regard, he wrote to ABMAC to see if the organization would support such an endeavor.17 The ABMAC board backed Lim’s plan and agreed to train personnel for the blood bank. The board chose Helena Wong and Yi Chien-­lung, two Overseas Chinese doctors based in America, to study in New York with Dr. John Scudder, a professor of surgery at Columbia University and board member of the Blood Transfusion Betterment Association. Scudder, a strong advocate of blood plasma banks, would instruct Yi and Wong on the production of blood plasma from whole blood.18 After his stint at Columbia, Yi, who had received his postdoctoral training in pharmacology and therapeutics in Canada, was sponsored by ABMAC to conduct more studies at Bryn Mawr Hospital on how to operate a blood bank. For the project, Robert Lim recruited several Chinese Americans in addition to Yi and Wong. C. F. Fan, the bank’s bacteriologist, had completed his MD and PhD at the University of Wisconsin–Madison, and China-­born technician Louis De Fott had spent most of his life in America. Other personnel—Jean Liu (nurse), Lueatta Chen (assistant), Ruth Derr (nurse), Adet Lin (publicist), and Betty Eng (assistant)— were working or studying in the United States. To test the envisioned Chinese blood bank, ABMAC began a trial run of the bank in New York City on June 7, 1943. ABMAC wanted to give

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the Chinese American doctors and nurses experience in blood banking with blood collected from Americans that would later be shipped in plasma form to China. This experience allowed for cross-­racial alliances as well as for much-­needed experience. Chinese Americans being a distinct minority in the United States, ABMAC had to reach out to minority groups that were neglected by mainstream blood banks to achieve their target of 1,000 donors. On July 22, 1943, Helen Stevens, the executive director of ABMAC, wrote to Walter White, then secretary of the National Association for the Advancement of Colored People (NAACP): Knowing deeply you and your people are interested in breaking down all racial barriers, we are hoping that you will cooperate with us in securing blood

donors for our blood banks. Needless to say, no distinction is made at the blood bank as to race and color.19

Two central motivations underlay this outreach. First, even though the personnel at the trial-­run blood bank had not noted underlying cultural beliefs that would predispose Chinese Americans to antithetical views of blood donations, New York City was home to few healthy Chinese Americans who could donate enough blood for the trial-­run target to be reached.20 Second, African Americans’ donations to the bank would reflect the “universal character” of the blood bank and contribute to general education about the need for “world brotherhood.”21 The appeal to African Americans was thus more than an attempt to build an altruistic transracial alliance: it reflected the practical limitations and the political nature of a Chinese blood bank in the United States. Helen Stevens’s appeal was thus a significant contrast to the stand taken by the American Red Cross, which segregated the blood of African Americans and other racial minorities from the blood of whites because it believed that most white Americans had fears of unsegregated blood. The NAACP worked toward reversing such discrimination, writing frequently to the Red Cross as well as to sympathetic editors, scientists, and politicians throughout the 1940s.22 The Red Cross, however, ignored the NAACP’s calls for desegregated blood. On August 3, 1943, Walter White wrote to all its New York branches, urging them to “show the contrast between the China Blood Bank and the American Red Cross.”23 On the very same day, the NAACP’s newsletter published this call to arms.24 White personally brought members



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Figure 3.1.  Women donating blood at the Chinese Blood Bank in New York. Source: ABMAC Records, box 78, file: Chinese Blood Bank B 1 to 50. Reprinted with permission.

of his staff to the Chinese blood bank on August 13, 1943.25 A photographer captured the image of an African American woman donating blood alongside her white counterpart at the blood bank in New York in figure 3.1. The photograph conveyed a message of racial equality that was absent in, among so many places, mainstream American blood banks. In protest of the Japanese occupation of China, 25 Japanese Americans also donated their blood to the Chinese blood bank.26 Several of these donors belonged to the Japanese American Committee for Democracy, an activist group formed in 1940 to explicitly defend “American democracy.”27 Thus, by donating blood for China, they wanted to display their patriotism toward the United States and change the country’s unfavorable attitudes toward Japanese Americans. Unsurprisingly, Overseas Chinese actively supported the blood bank. Donald Van Slyke (1883–1971), the president of ABMAC, appealed directly to them:

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I urge all overseas Chinese to contribute to the blood bank for supply of

plasma to [the] Chinese Army. This is an important service to the cause. Every life saved by this means keeps one more soldier in action. It is a grand opportunity to help in a positive and personal way.28

The appeal to Overseas Chinese was also evident in the name of the blood bank. Rather than call the establishment “China’s Blood Bank” (Zhongguo xueku), ABMAC called it “the Chinese People’s Blood Bank” (Huaren xueku), an inclusive moniker appealing to ethnic Chinese in the United States, regardless of whether or not they or their parents had been born in China. This inclusiveness encouraged 84 people, most of whom were Chinese Americans, to donate blood in the first week of the bank’s trial run. They were motivated by altruism and nationalism and saw this opportunity as a way to support the war effort in China. By November 1943, a total of 1,157 donors had given blood to the bank. As a result, the bank surpassed its target of 1,000 donors.29 The blood collected was then filtered into blood plasma before being shipped to China. The initial practical limitations of appealing solely to the Chinese American community motivated the blood bank to reach out to other communities within the United States. Individual communities found it in their own interests to donate. African Americans donated to protest the American Red Cross’s segregationist policies; Japanese Americans donated to support the American position in the war and to boost their own community’s image; white Americans saw the blood bank as a way to modernize China’s military complex; and Overseas Chinese saw it as an opportunity to do their part for the war effort in China. Besides the significant amount of money raised for the war effort as described in chapter 2, the Chinese in New York also gave their blood.

Meanings of Blood in China

The New York Times reflected on the success of the bank stateside and its move to China: 817 donors, including Americans, Chinese, Negroes, Hindus and Japanese, had given blood since it opened in June. The bank will be closed on November 1 and taken to Changsha in central China, where it will be the first blood bank in that country.30



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Yet, the blood bank personnel would find it comparatively difficult to operate in wartime China, given that the Chinese were not accustomed to blood transfusions and banking at the same levels as New Yorkers. Even though the modern blood bank as an institution only emerged in 1937 in Chicago, by 1941, the practice of blood banking had taken off in the United States after an ambitious Blood for Britain program was launched across the country to solicit blood for wounded British soldiers.31 A National Blood Bank program took over the program, in 1942, after the Japanese bombing of Pearl Harbor, with almost 100,000 Americans donating blood weekly at its peak.32 These programs had the overall effect of accustoming New Yorkers towards blood banking, a concept largely foreign to Americans before the Second World War. Like blood banking, New Yorkers would have been aware of blood transfusions by the Second World War. The modern practice of blood transfusion drew on long-­standing Western medical traditions that had involved letting blood leave the body as part of the curative process. In contrast, blood in the Chinese medical tradition was meant to circulate within the body in abundant amounts. Yet in antiquity, bloodletting was evident in both cultures, as seen in the Yellow Emperor’s Inner Canon (Huangdi neijing) and the Hippocratic tradition.33 These traditions only diverged after the Han Dynasty in China (25–220). Bloodletting began to be seen as dangerous in China, as a loss of blood meant an excessive loss of vitality, which would disrupt the balance of the body’s yin and yang.34 In Western Europe and the United States, bloodletting remained an important cure for everyday aliments until the 1820s, when physicians gradually abandoned the practice. Eventually, pains, aches, and fevers would be treated with infusions of blood.35 Nonetheless, this dramatic mid-­nineteenth-­century shift in thinking about blood’s role in the body did little to change the fact that, on the eve of the Second World War, most Westerners accepted, as common medical practices, both the extraction of patients’ blood from their bodies (expulsion) and the injection of one person’s blood into another person’s body (transfusion). The Chinese mapped concepts of blood onto long-­standing ideas of qi, or vital energy. Just as qi is supposed to flow freely through the meridians or channels in a healthy body, blood should circulate freely within the body. Chinese regarded blood stasis—that is, stale internal pools of blood breeding germs and ultimately diseases such as tuberculosis—as particularly

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problematic, and by the early twentieth century, Chinese doctors had mapped imported ideas of germ theory onto the blood-­stasis idea.36 The emphasis on dissipating pools of stale blood, however, did not mean that blood should flow outside of the body. What was needed was an increase in the quality and flow of blood in the body. This could be done, it was asserted, through pharmaceutical products such as Renzao zilai xie (man-­made blood) readily available in most Chinese cities by the 1930s.37 During this decade, most Chinese thought that blood should remain in the body. The value of Western blood transfusions was only slowly impressing itself on the literate population, usually through Western-­trained physicians and their patients. An English-­language Chinese newspaper reported in 1931 that Liu Jui-­heng had administered a direct blood transfusion into one of his patients, a KMT general, Feng Yi-­pei, during a surgical procedure.38 Around the same time, the PUMC, which catered mostly to an urban and upper-­class clientele, claimed that, from 1921 to 1931, it had drawn blood from 1,473 individuals for 932 patients.39 In Wuxi in January 1937, a Western-­ trained Chinese doctor explained the concept of blood-­type compatibility to a diverse audience and emphasized that, unlike “traditional” Chinese midwifery, Western-­style birthing used blood transfusions.40 Events like these resulted in a situation where Chinese belonging to the urban upper class might have heard of or even experienced blood transfusions prior to 1944, but on the whole, the practice was foreign to the Chinese masses. Similarly, blood banking was discussed briefly in the magazine Western Wind Supplement (Xifeng fukan), which targeted Chinese audiences interested in the West. Many Western Wind articles were Chinese translations of North American journal articles.41 One article in 1940 was a translation of an American report on the formation, in New York, of the Madison Blood Donors’ Club, which claimed to have “dealt away” with cumbersome bedside donations of blood by creating a blood bank (ningxue yinhang).42 Members had to pay to use the pooled blood, although patients who could not pay could use the blood for free. This kind of “public-­spirited” (jigonghaoyi) blood bank, according to the translators, could be replicated in any city in the world with enthusiastic leadership and sacrificial spirit. Western Wind introduced the concept of plasma in another translation of an article, this time from the popular American Medical Association magazine Hygenia.43 Plasma,



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according to the author, was preferred because of its portability, its resistance to infection compared to whole blood, and its usefulness in raising the blood pressure of soldiers suffering from shock. In sum, Western Wind celebrated American blood banks, detailed the advantages of plasma, associated public spiritedness and free-­market logic with these medical trends, and insisted on their exportability—namely, to China. The most literate members of Chinese society would have been aware of these ideas. Robert Lim sought blood donations from Chinese soldiers. This goal was reflected in the name he gave to his blood bank in China: rather than call it Ningxue yinhang (literally “Blood Bank”), Lim’s colleagues and he named the bank Junyishu xueku (literally “the Blood Storage Unit of the Army Medical Administration”).44 They envisioned that the wartime blood bank machine would be fed by soldiers: soldiers as donors and recipients. Perhaps Lim was confident that his CRCMRC Special Diet Services, set up in 1938, would provide enough nutrition to soldiers that they could donate blood without suffering any negative health outcomes. Despite his optimism, Lim had some basic reservations about Chinese soldiers, who he argued were mostly “farm boys” resistant to the idea of donating blood because they regarded the loss of blood as a loss of vitality.45 According to Lim, only veterans of the Burma campaign and other soldiers who had seen firsthand the efficacy of blood infusions would be convinced of the utility of blood donations. In the absence of compelling visual proof, it would be almost impossible, he claimed, to elicit donations of blood from the average Chinese soldier. Clearly, Lim found himself dependent on a population in which he lacked sufficient faith. And indeed, as I will show later, several Chinese officers sought to prevent their men from donating blood because of a deep conviction that the act of donating blood would sap them of critical strength. Such ingrained opposition to blood donations was not the only reason why only some soldiers donated blood. Many soldiers avoided donating their blood because either their superiors gave them insufficient reason to trust the medical procedure or blood bank personnel gave them insufficient material incentives to overcome a natural reluctance to donate blood. Other soldiers questioned the altruism and collectivism attributed to blood banks and looked with skepticism on the idea that soldiers needed to deposit their blood in banks rather than carry it with them in their backpacks. Some

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soldiers who volunteered to donate blood were not able to do so because they were deemed too unhealthy by the blood bank personnel. In some cases, officers supported blood donations and ordered subordinates to give blood only to encounter resistance and even outright refusals. The coercive nature of the KMT military, coupled with insufficient relevant information on blood banking, discouraged soldiers from voluntarily donating blood. In July 1944, Robert Lim and Yi Chien-­lung asked General Du Yuming (1904–1981), a senior KMT general, for help with the blood-­donor problem. He agreed to provide 20,000 donors from his troops in Kunming. Upon hearing this news, Yi was ecstatic and wrote to ABMAC confidently, “Even if we accept only a few thousand, that will keep us busy for a few months.”46 For reasons unknown, Du chose not to send these soldiers directly to the blood bank. Instead, he authorized blood bank personnel to acquire blood donations at nearby military camps. Many of these camps had been constituted hastily from abandoned temples on the war front. The medical personnel had

Figure 3.2.  Medical personnel examining Chinese soldiers gathered to donate blood. Source: ABMAC Records, box 78, file: Chinese Blood Bank B 1 to 50. Reprinted with permission.



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to procure mobile units to travel up to 15 miles on poorly maintained roads to reach the sites. Soldiers who chose to donate did so for a variety of reasons, even though most of them were unsure what the medical practice entailed. Some soldiers donated “quite willingly and were cooperative,” reflecting their sense of altruism.47 Others were motivated by the “soybean milk and eggs” offered for their blood, even though complaints were heard that such compensation was inadequate.48 Summoned by military superiors, most donated in a wider context of coercion. Figures 3.2 and 3.3 clearly show soldiers standing in the hot sun, awaiting inspection of their suitability for blood donations and presumably commanded to do so by their officers. As they waited patiently to be bled, many soldiers were shocked to find out they had been rejected. Blood bank personnel rejected half of the soldiers at the Fifth Infantry military camp, claiming that most of the cadets had malaria and fever.49 In another trip to Chinese army headquarters in September 1944, blood bank personnel drew blood from only 33 of the 400 soldiers who assembled.50 This phenomenon

Figure 3.3.  Dr. Helena Wong examining Chinese soldiers. Source: ABMAC Records, box 78, file: Chinese Blood Bank B 1 to 50. Reprinted with permission.

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was repeated in the next camp visited. There, most of the 150 soldiers who showed up were rejected because their veins could not be found, a sign of malnutrition. The high rejection rates, combined with other factors, discouraged soldiers from donating to the bank. Chinese officers learned of these high rates of rejection and advocated open resistance to the bank. On one occasion, an officer encouraged his soldiers to shout down the visiting doctors and nurses.51 A few soldiers thereafter spoke loudly, angrily, and at length against giving blood. Adet Lin and the rest of the blood bank personnel tried to convince the commanding officer of the “harmlessness of hemoglobin and blood pressures tests,” but the officer would not be budged. Interestingly, several of his soldiers offered to donate blood. In the end, the blood bank personnel were able to draw 100 cc of blood, a figure well shy of the usual 200 cc. The blood bank personnel returned to the bank “pretty disgusted” and claimed that officers had “exaggerated the seriousness of [blood] donations.”52 The personnel blamed group psychology and the general ignorance of the officer corps for the resistance found in the rank and file. In October, the team again ventured out to military bases in search of blood donations, but could not find even one place suitably hygienic for the mass procedure: flies abounded in the little villages in which these soldiers were based, and the blood drawn would consequently be contaminated. Helena Wong concluded that “from the experience of this month’s [October 1944] work, we learned that the general response of the army to blood donation was not very favorable.”53 Soldiers’ resistance to blood donations was viewed by medical elites narrowly in terms of a hostile group psychology. The evidence, however, suggests that medical elites adopted groupthink and failed to consider individual soldiers’ concerns. The blood bank personnel, for example, largely saw soldiers-­ as-­donors as a given. Furthermore, the bank had few resources with which to compensate soldiers for their blood, and, as noted earlier, soldiers protested that soy milk and eggs were “hardly compensation for the blood” taken from them.54 Wong’s report revealed the dichotomy between the medical elites and their donors: It takes a certain amount of blind insensitive stubbornness to take blood from these soldiers. It is a sad business; however, I feel we are justified and

right because the plasma goes back to them, and the ones that give can afford



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the amount we take from them. What hurts is that these soldiers are expecting to go to the front soon.”55

Wong may have revealed a degree of self-­righteousness in her juxtaposition of what she perceived to be her noble mission with the uncooperative KMT soldiers, even as she sought to explain their recalcitrance by referencing their fears of going to the front. Wong was also clearly frustrated at the inability of the soldiers and their commanders to understand the altruistic function of a blood bank. Adet Lin reflected on her colleagues’ attempts to force soldiers to donate: If donors don’t increase in numbers, to answer the demand for plasma at the

front, we must get the army to supply donors. Irrespective of right and wrong, to give blood under orders is psychologically bad and we are bound to have more cases of [uncooperative] reaction.56

Even though Lin believed that giving blood under orders was bad, she went along with the existing program of soliciting army donors, even as she sought to reach out to civilians by launching an outreach program. To the other blood bank personnel, soldiers should internalize the concept of a greater good— that donating blood today might not save you in the future, but it would help save one of the men fighting beside you. This unarticulated greater good as well as the dismissal of their fears made little sense to the soldiers, who had little knowledge of either blood transfusion or banking. The pattern in which soldiers were summoned by their superiors to donate blood, the soldiers’ subsequent discomfort with the high rates of rejection by medical personnel, their resultant failure to show up in significant numbers for blood donation, and their reception of mixed messages about the effects of blood donation from their immediate superiors and blood bank personnel suggested that many soldiers found the process of blood donation to be a coercive, condescending, and confusing experience.

Reaching Out to Civilians

In contrast to their approach towards soldiers, blood bank personnel launched an ambitious campaign to solicit civilian donors. Attempts by blood bank personnel to minimize confusion, however, were not much more successful. Adet Lin advertised the ideas of blood donation and banking widely

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in Kunming to reach out to “readers and the educated class” because “the ideas of the blood bank and blood donations [were] still strange and slightly frightening to most people, even though there’s a great deal of curiosity.”57 In July, Lin mailed mimeographed appeal sheets with simple rules for donating blood to 60 organizations, savings banks, and schools in the city. One hundred seven letters were sent out in August 1944 to urge organizations to give their employees a day off to donate blood.58 Lin also distributed more than 5,000 comic strips detailing the virtues of donating blood to the bank. In addition, four movie theaters agreed to run the bank’s advertisements for blood donations for two weeks. Yi, Wong, and Lin also lectured to visitors at the blood bank, the local bureau of public health, the doctors’ association, the Young Men’s Christian Association, the Expeditionary Forces Headquarters, the Biology Society, and the Chinese Medical Society. Blood bank personnel went on local radio to spread the message. Besides mailing information sheets and working with local associations, Adet Lin worked closely with the media to disseminate news about the blood bank. As early as July 1944, Lin invited representatives of the Central News Agency and six local newspapers to visit the blood bank and urged them to write favorably about its progress. The response to the blood bank, however, was lukewarm. Adet Lin complained in an August 22, 1944, letter to Stevens that she had “learned to believe donors [only] when they are actually here.”59 Less than a month later, Lin remarked that “regarding civilian donors, the letters we sent out to 100 organizations seem to have brought no result.”60 The reason given by the blood bank personnel was that the bank was far away from the city. Lin was partly right. By August 1945, only 8 percent of donated blood was collected at the blood bank itself—the rest was drawn by mobile units sent out to various civilian and military institutions.61 Another possible reason for the lack of donors was a cultural aversion to blood donation. Journalists who covered news on the blood bank revealed that many Chinese felt that blood is so inherently a part of the body that every drop must be preserved.62 Others, they reported, could not donate because they thought that donating blood would be unfilial, going against their parents’ gift of life (which included one’s blood, hair, and skin).63 Yet, the low rates of initial blood donations must also be attributed to the blood bank personnel spending most of their time coping with the challenges



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posed by wartime China rather than reaching out to prospective donors. By 1944, “Free China” led by the KMT was geographically limited to several provinces in the Southwest, with the Japanese and CCP occupying the rest of the country. Kunming, located in the Southwest province of Yunnan, was a city based largely on tourism, extraction of resources, and trade in basic commodities and which required relatively less electricity and power.64 The sudden influx of migrants and their academic, industrial, and administrative institutions from all over the country to Kunming after 1938 made it difficult for Kunming to cope with the demands in electricity and fuel. Even as Kunming struggled to keep up with the increasing pressures on its infrastructure, it had to welcome the arrival of diesel electric generators, autoclaves, electrical incubators, plasma processing equipment, and glassware from New York for the new blood bank.65 Some of these machines were inevitably compromised as they made their way for five months from New York via Bombay over land and sea.66 The arrival of this equipment made the blood bank possible, but the lack of electricity and fuel coupled with the constant bombing of the city by the Japanese air force from 1940 to 1943 left no doubt why a 100-­watt bulb would typically illuminate at a 30-­watt level in Kunming.67 Unreliable electricity meant that it was impossible to run all the blood bank machinery at all times. Electricity was needed to run the following equipment: the autoclave, which sterilized blood bank equipment; the plasma-­processing centrifuge, which spun tubes of donated blood for hours until the plasma was separated from the collected whole blood; the dehydrator, which dried off the liquid plasma to obtain the dry powdery plasma; and finally, the refrigerator, which stored the plasma under cool conditions to inhibit bacterial growth. To overcome the lack of electricity, the bank had imported diesel generators, but they were often underutilized because of the high price of fuel and damage sustained during shipping. Moreover, the erratic electricity meant that the water could not be pumped up from the well into the 40-­ foot water tower for storage. As a result, there was no running water to feed the drying machine’s water-­cooling meters for dehydrating plasma. Furthermore, the water was very hard and left excessive residue and scale on the cylinder wall of the plasma cooling system. The scale acted as insulation that trapped the heat in the cylinder and pistons. This heat broke

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down the lubrication oil within the cooling engine, with damage resulting to the compressor. As a result of problems with electricity, fuel, and water, the blood bank could only process 300 donation units per week. It is no wonder that Yi told Helen Stevens in April 1945 that the bank had “more donors than we can handle.”68 To resolve these problems, the blood bank personnel began modifying blood processing machines to fit local conditions. They transformed automated equipment into machines operated by hand. At Robert Lim’s suggestion, technician De Fott constructed a hand pump to move water from the well to the water tower, so that running water could be used to cool blood processing equipment.69 Similarly, De Fott created a mechanical hand pump to crank the plasma-­pooling unit instead of depending on an automatic pump operated by electricity.70 To get better-­quality water that did not leave residue everywhere in the machines, Lim paid 2 Chinese dollars per day to laborers to haul water from a cotton factory to the blood bank. In addition, De Fott converted the gasoline-­operated autoclave and coffee boilers to charcoal power. Charcoal was cheaper and more abundant than gasoline in Kunming.71 Finally, the blood bank settled for liquid plasma on several occasions because of the lack of electricity and water to run the dehydrator. Besides seeking to adapt the blood bank equipment to wartime conditions in Kunming, the blood bank personnel also had to tinker with imported blood bank machinery to cope with cases of contamination. In October 1944, a General Cheng withdrew 10 units of liquid plasma from the bank on the pretext of bringing that blood to soldiers in Baoshan, Yunnan.72 Instead, Cheng’s subordinates administered a blood transfusion to General Du Yuming in Kunming after Du dislocated his hip joint. Du became extremely sick and almost died. Cheng argued that Du’s sickness was due to the unclean blood used in the transfusion, and sent the rest of the plasma he withdrew from the bank to Southwestern University and the Central Epidemic Control Bureau for testing. Both institutions found four separate kinds of bacterial contamination. The news of the bacterial infection spread rapidly throughout Kunming, and donor rates collapsed from 600 to 20 per week in the last two weeks of October. There were 311 fewer donors in the following month. Dr. Yi admitted candidly:



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The incident of plasma transfusion to General Tu as mentioned in my special reports to Gen[eral] Lim has to a certain extent interrupted our donor’s

campaign.73 It took several months for us to build it up, but it was almost knocked out within one week by unfavorable propaganda . . . We feel of

course very sad about this incident.74

Upon investigation, Yi found that the rubber stoppers from America had puncture holes that allowed outside air to be drawn into the high-­vacuum plasma bottles and consequently contaminate the plasma within. Yi quickly adopted a new way of minimizing infection. He switched from high-­ volume plasma bottles that trapped a high level of vacuum to lesser-­volume dumbbell-­shaped bottles whose sleeve-­type rubber stoppers could be used to create the proper vacuum.75 In December 1944, Yi received the new rubber stoppers he had ordered, and he told all personnel to apply alcohol sponge and iodine paint on the rubber stopper when they withdrew the transfusion needle from donor bottles.76 In addition, Yi employed ultraviolet rays to detect the smallest amount of dirt at the blood bank. These reforms worked, with cases of contamination falling perceptibly after April 1945. More innovatively, in response to the relatively low numbers of donors visiting the bank, it developed mobile units to reach out to civilians and soldiers. As the head of the CRCMRC, Robert Lim had developed, from 1938 to 1942, mobile medical units to delouse, perform surgery, and provide emergency dressings and evacuation for Chinese soldiers on the war front.77 Similarly, in September 1944, he and Yi Chien-­lung procured and developed mobile blood bank units to reach out to soldiers and civilians.78 Blood bank personnel, dressed in white and consisting of three doctors, two nurses, and four assistants, would ride in these mobile units to army and labor camps, as well as schools and universities to bleed potential donors.79 As a result, the bank saw an increase in the number of donors from 146 people in August 1944 to 492 in September 1944. By the end of the war in August 1945, mobile bank units accounted for 92 percent of the blood drawn from donors. Such extensive use of mobile blood banking, which reflected the mobility and portability of Chinese medical care during the war, had been unprecedented.80 Containing problems that arose from the logistical challenge of moving equipment from New York to Kunming and the daily operations of the

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blood bank occupied much of the blood bank personnel’s time. Jean Liu, the head nurse, claimed she worked late nights every day preparing up to 350 bleeding bottles, more than seven times the amount she had to prepare in New York.81 Dr. Lueatta Chen complained that nobody appreciated her pooling and processing of blood late into the evening. Yi Chien-­lung dismissed technician De Fott in July 1945 allegedly for slacking off at work and for falling in love with a local college student. It appears, however, that De Fott was fired because he could not cope with working round the clock and adapting and repairing equipment on his own.82 Dr. Fan, the bank’s bacteriologist, was dissatisfied with the overwhelming amount of work at the bank and sought to leave for an academic position at Nanjing University.83 Adet Lin, who was in charge of the blood bank’s publicity, was called on by Robert Lim in February 1945 to undertake secretarial and translation work for Lim’s other work.84 While Yi Chien-­lung and others lectured at several organizations in Kunming, they were so overworked that they had to depend mostly on Adet Lin to persuade millions of Kunming residents who had hardly heard of blood transfusion and banking to donate blood. Lin received enough material resources from the United States to print information sheets, give talks at institutions, run advertisements in newspapers, and invite journalists, but did not have enough workforce within the bank to promote blood banking. The time and effort at adapting blood bank technology and disseminating information about blood banking was often a zero-­sum game. As I will show in the next section, such work often came at the expense of personal health.

Americans in China

Jean Liu’s complaint that she had to work much harder in China compared to her time in New York was representative of the desire of Chinese Americans at the blood bank to make comparisons of their lives in China with their time in the Americas. Their identity as Chinese Americans or Canadians was integral to their lives at Kunming. When John Scudder visited the blood bank in Kunming from New York in 1944, Adet Lin and the blood bank personnel treated him to an “excellent Shanghai-­style” Chinese restaurant in the city whom they compared to a “picturesque-­ly . . . old Louisiana (sic).”85 By comparing the façade of a Chinese restaurant to a specific architectural style



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in the American South, Lin was relating to her American upbringing with her fondness for Shanghainese food. Furthermore, Ruth Derr sought to make sense of her sickness in China as an American. Diagnosed with a uterine fibroid, Derr lamented that she should have completed a “thorough check-­up in the [United] States,” to detect her disease sooner.86 She also confided to an ABMAC official that she feared developing “osteomyelitis of the lower jaw bone” after seeing a soldier contract the same disease in combat.87 After undergoing surgery in China to remove her fibroid, she remarked that she would like to leave China and land a job on the East Coast of the United States. She clearly wanted to live in the United States after the war, rather than remain in China. Derr connected her fears of getting sick in China with her regret at not resolving the issue in the United States earlier as well as hopes of making her permanent home in the United States. Finally, the Chinese Americans drew on their experiences in New York to implement blood banking and transfusion in China. Yi Chien-­lung stated that he was “going to run this blood bank [in Kunming] in a simpler way than what I did in New York.”88 This simpler way involved the use of liquid plasma in China instead of the dry plasma deployed in New York, and converting automated blood bank machines to mechanical ones to overcome the problem of unreliable electricity supply in China, which would have rendered fully automated machines unusable. Yi recognized that blood bank machines originated in the United States in a context of stable electricity and clean water, and this recognition enabled him to make the necessary modifications to make them work in China. Furthermore, Adet Lin asked ABMAC to ship from the United States to China “short films for entertainment,” preferably “technicolor Walt Disney” or “some short comedy.”89 Lin argued that these popular films “would take away some of the profound seriousness about the nature of the blood bank” when shown to donors waiting in line.90 The blood bank personnel valorized American health care, architecture, and films in their personal and professional lives in Kunming. Their lives and experiences in North America shaped the medical personnel’s perception of successes and failures at the blood bank. Their efforts, however, were inadequate in making the blood bank work. It took the personal touch of local institutional leaders to make the blood bank work in China.

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Participation of Students and Laborers at the Blood Bank

The adaptation of blood bank technology to wartime conditions and the efforts at reaching out to civilians were necessary but proved insufficient for the blood bank to work in China. What eventually worked was the participation of local elites who compensated workers and students for donating blood. The advent of a local blood economy changed the dynamics of donations and induced many more civilians to contribute. Schools and work-­units created opportunities for local elites to provide avenues for emotional spectacles that moved recalcitrant individuals to donate. As a result, the mobile blood bank units met with relatively more receptive audiences in schools and work places. The blood bank’s visit to National Southwestern Associated University (Xinan lianhe daxue or Lianda) in October 1944 revealed the importance of participation by local leaders.91 The dean and faculty members of Lianda were enthusiastic about blood donation. Furthermore, they were committed to urging their students, who were supportive of the war effort against the Japanese, to donate.92 They knew many students could not afford better-­ quality food outside of the university because of wartime austerity. Recall that the huge influx of administrators and refugees as well as aerial bombing by the Japanese had severely taxed the infrastructure of Kunming and limited the availability of fresh food in the city and the university. Food at the university was scarce, unhygienic, and of extremely poor quality. The college’s food committees would wait until mid-­afternoon before the local markets closed to buy battered cabbage leaves and bits of pork skin to save money.93 In addition, the Lianda kitchen was infested with flies, rat droppings, fleas, and bugs. By 1943, breakfast was no longer provided by the university. It was in this context that Lianda professors decided to offer every blood donor a bowl of soybean milk as well as three fresh eggs, from donations of 100,000 Chinese dollars (USD [2018] 2,540) by the university’s alumni.94 Such altruistic efforts appear to have been inspired by the blood bank’s attempt at providing similar refreshments at the physical blood bank to attract donors.95 Indeed, just as some donors were attracted to such nourishments at the bank, these food and drinks were important as sustenance for hungry students on campus. As a result, many students decided to donate, with several even attempting to lie about their age to donate.96 The blood bank personnel collected 125,000 to



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150,000 cc of blood, a relatively high amount.97 The high rates of donations suggest that the endorsement by the faculty as well as their efforts to offer eggs and soy milk in exchange for the hungry students’ blood were crucial to the success of the mobile blood bank’s visit to Lianda. Besides the professors at Lianda, labor leaders at the Burma Road Construction Bureau welcomed the blood bank personnel on October 26, 1944, to their work site 68 kilometers from Kunming.98 The bureau organized a “blood donation committee.” The committee put up elaborate signs, shared the bank’s bulletins, and set up posters everywhere to spread the news about blood donations among its workers, guards, and students and farmers in the area. Students from a nearby school held up a large triangle flag that said “Chung Sin School Blood Donation Corps” to welcome the blood bank personnel. Similarly, all 190 donors were given soy milk as well as eggs after they donated, courtesy of the school’s refreshment committee. The total amount of blood collected on this one trip was 47,160 cc, more than the amount collected in August. It was significant that those who donated the most to the blood bank were students and laborers in institutional settings in a civilian context. In contrast to the Chinese military, which eschewed economic incentives for their soldiers to donate blood, civilian institutions allowed local leaders to provide a systematic top-­down economic means of compensation that changed perceptions of blood donation. In addition, these organizations provided emotional spectacles that transformed attitudes on the subject. On a November 1944 trip to Central Electric Works, several young men who were initially unwilling to donate changed their minds after seeing an older employee cry when he was turned away because of his old age.99 At the Chuan-­tien Railroad Company, 30 girls from the nearby Kunhwa high school registered to donate after being influenced by older peers, but most were rejected because they appeared younger than the minimum age of 18 years old.100 At a telephone manufacturing facility on the hills of Kunming, department heads and workers turned blood donation into a competition.101 Emotional spectacles, watched by many laborers at these technical institutions, inspired more donations. The social interpretations of blood in these civilian groups were multifaceted and diverse. Archival materials suggest that students and laborers in

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the above-­mentioned groups did not articulate epistemological opposition to donating blood. They were uncharacteristically enthusiastic about donating blood, motivated by the commodification of blood, which, in turn, altruistic and nationalistic labor and university leaders facilitated. Peer pressure, emotional connections, and competitive desires also played significant roles in persuading many to donate, revealing the intimate personal reasons for blood donations.

Retrospective Nationalism

The diverse social meanings of blood did not, however, change the blood bank personnel’s perception of what worked. Even after successful visits in 1944, blood bank personnel still saw nationalism as the key to motivating people to donate. This was reflected in the 5,000 red comic strips (Lianhuan tu) that Adet Lin printed in May 1945 as part of her campaign to reach out to civilians.102 As seen in figure 3.4, the comic strip sought to link nationalism with blood donation. The comic first encouraged reluctant bankers and businessmen to donate: “Who says businessmen do not love their country? I am willing to donate blood to the war front.” It then linked the civilian donations to actual participation at the war front: “Donating blood on the home front results in a reduction of blood loss at the war front”/“I am a healthy citizen, I want to donate to the war front”/“Those at the home front are donating blood to us, let us charge ahead.” Clearly, these nationalistic messages reflected the ideal cross-­class alliance that the blood bank personnel sought to create. Furthermore, the comic strip prominently showed three national flags of the Republic of China, which highlighted the importance of saving the nation through blood donation. But these comics did not take into account other economic, cultural, and personal reasons that actually motivated people to donate in 1944. In retrospect, the highest number of donors was in the months of October–November 1944, when many students and laborers donated. Solely nationalistic appeals for walk-­in volunteers did not attract many donors in 1945. Once again, the blood bank relied on the local government to summon civil servants to donate blood to the mobile units. These donors were civil servants living in Kunming hostels, who, in the words of a Kunming-­based US Army captain, were a group of “half volunteers,” motivated “half by orders.”103



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Figure 3.4.  Blood bank poster featuring a comic strip. Source: ABMAC Records, box 4, file: Blood Bank 1945. Reprinted with permission.

Legacies of the Blood Bank

After the war, the blood bank moved to the newly created National Defense Medical Center in Shanghai, led by Robert Lim.104 Loyalty to a unified nation faded as the civil war between the Nationalists and the Communists intensified, greatly reducing the patriotic motivation to donate. At the same time, other medical institutions in Shanghai accelerated the commodification of blood. Shanghai, which was the prewar financial center of China, emerged as a site for buying and selling blood in the postwar period. Blood “dealers” emerged as middlemen for hospitals and reportedly bought and sold blood plasma for $25 per unit.105 The dealers claimed their organizations were “blood transfusion banks” (shuxie yinhang), as opposed to the Lim’s blood bank (xueku). Yinhang is a literal translation of the word bank, while Xueku translates as blood storage units. Yinhang thus reflected the market-­based approach towards blood in postwar China. These shuxue yinhang acted as middlemen who dispatched willing donors to hospitals if and when blood was needed for surgery, rather than a site for the processing and storage of whole

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blood and plasma.106 Similar trends emerged in postwar Beijing, with one donor boasting he sold 100 cc of blood for 20,000 Chinese dollars (roughly around USD 67).107 In 1949, the National Defense Medical Center relocated with the KMT forces from Shanghai to Taipei, Taiwan, as the Chiang regime faced imminent defeat on the mainland by the Chinese Communists. The blood bank was not reconstituted as part of the center in Taiwan because its personnel chose other vocations. It would take the KMT on Taiwan until 1954 to reinstate blood banks. Another Overseas Chinese doctor, Penang-­born and Edinburgh-­trained O. K. Khaw, constructed and led the first American-­style blood bank on Taiwan with the help of Americans.108 Khaw also designed the blood bank at Keelung hospital, which opened in 1955.109 Since then, Taiwan has developed one of the most extensive outreach programs for blood donations anywhere in the world. Ubiquitous mobile units appear at important education and shopping sites and tourist attractions throughout the capital city of Taipei.110 Mobile blood bank units, which began as vehicles for outreach during the war, provided a legacy for the development of similar units in post-­1950s Taiwan. In Communist China, the Beijing municipal government sought to ban the buying and selling of blood in the late 1950s and 1960s, arguing that a socialist ideal of donating blood must reject the pernicious market-­based approaches of the previous regime, which brought its bad practices to Taiwan.111 This suggests that the buying and selling of blood continued in China for a decade after the Communists’ victory in 1949. It would, however, take until the 1990s for blood banks to flourish in the country. The first university-­ located mobile blood bank unit appeared in 1999 at Qingdao, and the first US-­style blood banks emerged in Beijing in 2002 at the United Family Hospital, a Sino-­American joint venture.112 Yet, it was difficult for the Chinese central government to regulate the market for blood, as reflected in the outbreak of HIV virus in Henan province in the 1990s. Their attempts at covering up mismanagement of blood collection and processing procedures by profit-­oriented local officials and businessmen resulted in the needless contraction of AIDS by 300,000 people.113 Moreover, the proliferation of donors who were paid for their blood in the context of massive corruption scandals associated with the Chinese Red Cross in the 2000s points also to



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a long-­standing tension among different Chinese stakeholders over the economic and societal values of blood donation and banking.114

Social Meanings of Blood in Wartime China

This chapter reveals the multiplicities of social meanings of blood associated with the first Chinese blood bank and reflects a more diverse range of attitudes towards blood banking. The Chinese were not simply influenced by cultural notions of blood associated with their medical traditions. Clearly, many soldiers and civilians refused to donate blood because they equated blood loss with a loss of vitality. Others saw donating blood as violating their parents’ wishes. Blood to them was meant to circulate in the body in abundant amounts. Yet, at the same time, others were eager to exercise their patriotism and act on altruistic feelings. Americans of different races and politics saw donating to the blood bank as an opportunity to display their patriotism and their political views. In Kunming, university and labor leaders generously donated soy milk and eggs to facilitate a proto-­market blood economy in their institutions. Cultural and political reasons were only half of the story. Soldiers in 1944 and civil servants in 1945 were summoned by their superiors to donate blood. Coupled with cultural fears of donation and high rates of rejection by blood bank personnel, some officers and soldiers understandably refused to donate blood. Emotional fears felt by soldiers were transformed into emotional acceptance by laborers, who chose to donate after seeing their colleagues or friends donating. Finally, what was most effective for a majority of donors was the promise of eggs and soy milk for blood by local elites. Its economic value in the context of wartime scarcity was enough for many to abandon opposition to blood banking. Commodification, which spurred many Chinese to donate blood in exchange for monetary rewards, accelerated after the war. The local elites’ facilitation of economic and emotional incentives in their institutions persuaded the Chinese people to donate blood. Thus, considering the changing socioeconomic values and emotional reactions of the Chinese becomes methodologically critical to understanding modern Chinese medicine and society. The expertise and identities of Overseas Chinese at times assisted, while at other times hindered, their work at the blood bank. Adet Lin launched a

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civilian campaign that focused largely on dispelling cultural opposition to blood banking through heightened patriotism. Her efforts played a role in encouraging people to donate. However, as outsiders to the Chinese military culture in wartime China, the Overseas Chinese’s unsympathetic treatment of potential soldiers-­donors greatly hindered their efforts at soliciting blood. The ultimate success of the blood depended on the ability of Chinese diaspora medical personnel to encourage the intervention of local elites, who provided incentives for people to donate. Besides reaching out to the public, they had to spend most of their time coping with limited electricity, water, and fuel, as well as high-­profile cases of blood contamination and other wartime challenges. Such understated tinkering and adapting of imported technology to wartime conditions was critical to the operation of the first blood bank in China. The blood bank personnel mechanized automated equipment, substituted local for imported materials, and replaced contaminated equipment. In particular, the development of mobile blood bank units represented the importance of medical outreach and reflected the enduring philosophy of portability in Chinese-­style Western medical care. The fortuitous success of the bank saved lives. In total, the Chinese blood bank in wartime Kunming distributed 2,317 units of blood plasma, of which 1,153 were directed towards active Chinese combat units and 362 units to civilian and army hospitals. By the end of the war, the bank distributed 65 percent of the processed plasma, while the rest remained in storage.115 In a field report, 95 percent of wounded soldiers who were treated with plasma recovered from their wounds as a result of an infusion of blood from the plasma.116 Major William King of the Fifth Headquarters of the US Army Group praised the bank’s plasma: The whole blood obtained from voluntary donors among the Chinese Armies

was, of course, more satisfactory as far as extreme cases are concerned, but the plasma did its job well in primary and secondary shock cases, awaiting cor-

rective surgery. In addition to the use of plasma on the battlefield, Chinese

plasma was also used in the treatment of nutritional edema with quite satisfactory results.117

The separate worlds of the Overseas Chinese and the rural Chinese underpinned the successes and failures of the blood bank. Dr. Helena Wong



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talked about how the fear of donating blood was diminishing by November 1944. They became more relaxed and, during one of their trips, picked red winterberries in the countryside to bring back to the city. “With the wind blowing and sun shining,” they trekked through a bushy mountain path to view a stone-­carved sleeping Buddha. During the Burma Road Construction Bureau visit in October 1944, Lin remarked, “some ex New Yorkers could not help being amazed to find themselves walking in the moonlight of Burma Road.”118 With the creation of a mobile unit that brought blood donation to rural Chinese, these Chinese Americans had the unexpected opportunity to see more of rural China. The reference to New York, however, suggests that they kept a separate identity of their past as Americans even though they had signed up for the war effort against the Japanese. The wartime rural geographies inspired these tourist-­like reflections. Other aspects of their lives revealed these subtle differences. Examples included Ruth Derr’s valorization of health care and work opportunities in America as she grappled with her fears and sicknesses in China, Adet Lin’s comparison of a Shanghai restaurant with the Louisiana-­style building, and Yi Chien-­lung’s discourses on the adaptation of American blood bank equipment to Chinese conditions. Their experiences reveal how the two communities of Overseas and local Chinese often lived separate lives even as they fought against the Japanese in the same city of Kunming. China’s experience with its first blood bank was similar to underground blood bank movements in occupied Holland, but there the Nazis left the Dutch blood banks alone,119 unlike the Japanese, who sought to destroy the blood banks and other related institutions in Kunming.120 Compared to the sudden and subsequently long occupation of Allied countries by the Axis powers on the Western front, the Nationalist Chinese war of attrition against the Japanese from 1937 to 1945 revealed how remarkable it was to set up and manage a viable blood bank under relatively more challenging conditions. War framed the wider context, but individuals who responded to different incentives and concerns assisted the blood bank to achieve its aims of saving lives in wartime China. The multiple challenges and promises in establishing the blood bank were also seen in the efforts of Robert Lim and his colleagues in training a sizable corps of medical personnel to aid in medical relief. Just as Yi Chien-­lung

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faced challenges in managing the morale, training, and outreach of the bank personnel, Lim faced severe challenges in training a diverse group of untrained Chinese civilians and soldiers for wartime medical work. Chinese politicians, generals, and rival American aid official compounded the challenge to Lim’s work. The following chapter shows how Lim greatly expanded biomedical training in wartime China, even as he dealt with global opposition over the timing, scale, and scope of medical education. Lim and his opponents debated over whether medical training should be made more accessible, essential, and swift, or whether it should remain selective, challenging, and deliberative for wartime and postwar China.

l CHAP TER 4 '

T R A N S N AT I O N A L P O LI T I C S O F   M I LI TA RY M ED I CA L ED U CAT I O N

Robert Lim struggled to fill the rank-­and-­file positions of his CRCMRC, despite considerable support from Overseas Chinese donors and medical personnel. Dr. H. Talbot, a British surgeon working at the Nanchang General Hospital in southeastern China,1 argued that “it is this shortage of personnel that is counting against” the organization.2 Pestered by swarms of flies, wounded soldiers lay by roadsides waiting for overstretched medical personnel to evacuate them to the nearest hospital for treatment.3 Some of the CRCMRC personnel were merely orderlies or conscripted soldiers doubling as medics. Compounding the shortage of medical personnel was what one newspaper editor termed the state’s “scattershot” approach to providing rural China with medical training and care, resulting in “the loss of millions of lives and billions of dollars.”4 In response to these problems, the National Health Administration assigned Robert Lim the task of establishing a new medical training center in central China. There, military personnel would learn the skills necessary to staff the CRCMRC. Lim established the center in Changsha in May 1938. The center’s Chinese name is literally translated as the Wartime Hygiene Training Center (Zhan shi weisheng xunlian zhongxin). Lim gave the school an English name, as well: the Emergency Medical Services Training School (EMSTS). Lim later developed branch schools of the EMSTS closer to the front lines. The concept of “emergency medicine” likely originated from similar plans drawn up in Britain in the 1920s for a

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comprehensive military medical response to the high rates of medical casualties during World War I.5 China’s establishment in 1938 of the EMSTS predated by one year the materialization of Britain’s own Emergency Medical Services, which was a response to the country’s entrance into World War II. This chapter makes three specific arguments about the global history of military medicine in wartime China through the global history of the EMSTS. First, Lim and his colleagues ushered in a new form of medical training that emphasized large-­scale and interdisciplinary education supported by a portable curriculum. Soldiers trained in highly regimented environments traveled shorter distances to branch schools, consulted newly written comprehensive medical manuals, and worked closely with the CRCMRC. The EMSTS’s training program lasted for one to three months, so that medical personnel could be trained quickly for rapid deployment on battlefields. An understanding of Lim’s innovations in military medical education augments the existing scholarship, which attributes fundamental changes in medical education to the post-­1949 CCP. Mary Bullock and Mary Brazelton have shown that the CCP militarized medical education, expanded enrollment, introduced ideological campaigns to expel bourgeois elements, and infused the PUMC curriculum with Soviet-­style medicine as well as classical Chinese medical learning after taking over the PUMC in 1951.6 Kim Taylor points out that, in 1956, the CCP introduced apprentice-­style education to supplement formal classroom education for Traditional Chinese Medicine (TCM) trainees, despite initial reservations about the utility of such practical training. According to Daqing Zhang and Fang Xiaoping, the CCP sought to maintain a high quality of medical training in the 1960s and 1970s, even as they sought to increase the number of doctors working in rural regions. The CCP’s pursuit of balance between these competing goals rested on an active calibration of student qualifications, school curriculum, and the schools themselves.7 This post-­1949 expansion of medical education, however, drew also from the wartime educational experiences shaped by Robert Lim and the Chinese diaspora. Lim debated with his colleagues in China and the United States over the minimal qualifications of medical students and the length of the EMSTS training program. Providing the basis for increases in medical school enrollment in 1950s China, Lim tripled the number of Chinese people educated in biomedicine by training more than 15,000 personnel



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at the EMSTS from 1938 to 1946.8 The school ushered in new characteristics of medical training such as mass medical education, military medicine, and practical education that the CCP later adopted. This precedence in medical education reflects the broader arguments put forth by Julia Strauss, William Kirby, Morris Bian, and Janet Chen in describing how the CCP after 1949 drew on earlier precedents attributable to the KMT’s state-­building efforts, economic planning agendas, and poverty-­alleviation strategies.9 However, it was not just KMT government officials who supplied blueprints and infrastructure for the Chinese Communists’ subsequent consideration. Through their interactions with a variety of domestic and international actors, Robert Lim and his colleagues developed and promoted medical ideas and practices that persisted in the postwar period. Second, the Overseas Chinese financed the EMSTS by collaborating with indigenous Chinese elites as well as with American aid organizations. The Chinese diaspora promoted the value of self-­reliance by selling in-­house vaccines and by providing medical rehabilitation and vocational training for disabled veterans in newly constructed orthopedic centers. This prudent financial management in the early days of the center brought to fruition some of Lim’s prewar visions for a more practical, interdisciplinary, and militarized form of medical education in China. Third, this chapter reveals behind-­the-­scenes conflicts among Robert Lim, the American Bureau for Medical Aid to China (ABMAC), and United China Relief (UCR), all brought to light by an analysis of correspondence found in multiple archives among Chinese and American medical personnel and aid workers. While Lim and his associates received overseas assistance from 1938 to 1940, they became embroiled in conflict with their American financial patrons. The newly constituted UCR clashed repeatedly from 1941 to 1943 with ABMAC, Robert Lim’s first large-­scale patron. In 1941, a newly constituted UCR replaced ABMAC as the overseer of EMSTS funds, after the latter organization nominally merged with UCR along with several other US aid organizations. UCR sought to wrest control of the EMSTS from Robert Lim and his ABMAC patrons. To achieve this goal, UCR needed to undermine Robert Lim; to do so, UCR set out to challenge Lim’s proposal that a six-­year medical training program replace the existing three-­month one at the EMSTS. The six-­year program was conceived by

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Lim as an opportunity for students to take classes in increments of two years leading toward a medical degree. Such a program promised flexibility while assuaging critics who increasingly saw the original three-­month program as too short for the adequate training of medical personnel. UCR, ignoring the finer details of Lim’s plan, accused him of proposing an unrealistic program and thus of neglecting the present needs of wartime China. Such accusations eventually led to the compilation of a full-­fledged dossier on Lim’s alleged transgressions, including accusations of mismanaging funds in a dictatorial and unaccountable manner. UCR played its field directors, the KMT’s anti-­Lim generals, and ABMAC’s Chongqing representative against Robert Lim and the program. The KMT government eventually sided with UCR and fired Lim. This incident paradoxically represented the apex of EMSTS’s strength, for the scheme showed how much Lim and his collaborators had achieved. This was very much a case of success earning the ire of jealous opponents. The scheme also revealed Lim’s fundamental dilemma in depending on his American patrons for continual support of EMSTS programs. The sudden change in the balance of power among financial patrons in the United States greatly undermined Lim’s medical endeavors in China.

Characteristics of Military Medical Training

Robert Lim’s medical endeavors included a new dimension as he founded the EMSTS, which unshackled him from the restrictions he had faced during his time at the PUMC. In 1938, Lim established three-­month medical courses that trained military personnel from a wide range of educational backgrounds. This wartime approach was a break from the prewar PUMC’s exclusive admissions and research-­intensive education model.10 Recall from chapter 1 that prospective students at PUMC had to be bilingual and had to possess 3 to 4 years of prior undergraduate training in physics, chemistry, and biology.11 This meant that only a very small percentage of the Chinese population would qualify for enrollment, given that the overall literacy rate in early Republican China (1911–1937) was estimated to be around 20 percent.12 The Rockefeller Foundation, by amply funding laboratories, textbooks, and salaries for administrators and professors, provided PUMC students with an intimate classroom environment highly conductive to learning. In contrast, the EMSTS admitted students of mostly middle-­school and high-­school



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caliber and taught mostly through demonstrations and field exercises that did not require English-­language skills or well-­funded laboratories. Robert Lim adopted this new approach in the thick of warfare in May 1938 in Changsha, where the KMT armies were fighting the Japanese in Central China on multiple fronts. He constructed the EMSTS to “meet the urgent need of training recruits for different medical organizations”— for the Anti-­Epidemic Corps of the Bureau for Health, the Chinese Red Cross Medical Relief Corps, and the Army Sanitary Corps.13 According to an EMSTS report, “The need was so pressing that only short periods of training were given so as to enable the trainees to enter the service without delay.”14 This short one-­month training began in Changsha in June 1938 and was interrupted only briefly owing to the exigencies of war. The school had to uproot itself several times, from Changsha to Zhiyang in November 1938 and then from Zhiyang to Guilin, finally ending up in Guiyang in Guizhou Province in February 1939.15 The school remained in Guiyang until the end of the war in August 1945, even though the location and status of its branch schools changed over time in response to the shifting geographical boundaries of the Chinese war front. In Zhiyang, EMSTS began admitting women trainees. In December 1938, 43 out of the 219 admitted students were women.16 After moving to Guiyang, the EMSTS established two-­month classes for four types of trainees: medical officers, assistant medical officers, medical subordinates, and medical orderlies.17 Graduating from the reorganized school in July 1939 was the first batch of 142 students, among whom were 10 surgical officers and 26 assistant medical officers.18 The school targeted high school graduates as potential students. Many trainees would have already served roles as medical officers in Chinese military units. Yet only 67 percent of these medical officers had received some prior formal medical training, while only 15 percent to 23 percent of other types of admitted students had any medical training.19 So many trainees were unqualified because the EMSTS lacked both the mandate and the resources to control the admissions process, and thus had to train people from nearby military units. These units paid for both the transportation of the trainees to the school and their living expenses once there.20 To train these students, the EMSTS developed a curriculum that focused on giving them the maximum amount of medical knowledge in the remarkably short three-­month period.21

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As we learned in chapter 1, Robert Lim advocated for a more practical and interdisciplinary curriculum during his time as the head of Physiology in the prewar PUMC, but the American leadership at the school then stymied many of his initiatives. As the head of the EMSTS, Lim was able to integrate some of these prewar ideas of practicality and interdisciplinarity into the organization’s curriculum. Rather than focus on PUMC-­style pure sciences, Lim instructed the EMSTS to teach general medicine, laboratory medicine, surgery, sanitary engineering, preventive medicine, and medical tactics.22 Lim emphasized practical drill-­based training, which constituted a shift away from the lecture-­and-­research teaching so prominent in the prewar PUMC. As shown in figure 4.1, some of these practical drills were held in a training hospital on the premises of EMSTS and provided hands-­on training in surgery and autopsies. It was at the hospital that students underwent around half of their training (figure 4.2), learning skills gleaned from lessons ranging from theoretical case studies to surgical instruction.23 From 1938 to 1943, more than six thousand students were trained in this fashion at the EMSTS.24

Figure 4.1. EMSTS trainees observing an operation. Source: ABMAC Records, sometime between 1940 and 1942, box 77, file: Army Medical Administration No. 2. Reprinted with permission.



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Figure 4.2.  EMSTS Army Hospital in Guiyang, China. Source: ABMAC Records, 1942, box 77, file: Army Medical Administration No. 3. Reprinted with permission.

Biomedicine through Branch Schools

To attract more students to EMSTS, Robert Lim created branch schools of the EMSTS so that military units would be able to receive short-­term medical training at a nearby school. The concept of branch schools (fenxiao) was a historically rare phenomenon, and none of the universities in China had had any such schools prior to the war. Because these branch schools were closer than the central school in Guiyang to many Chinese military units, the units increasingly expressed a willingness to pay for transporting their trainees to the branches.25 At the same time, however, the KMT government increasingly constrained the amount of money that the units could spend on transporting and feeding these trainees, most of whom came from combat and communications divisions.26 Fortunately, the units’ financial limitations were alleviated by the EMSTS center’s promise that all branch schools would use a similar curriculum, which heralded the uniformity of the EMSTS educators’ medical curriculum just a few months later. Each branch school was organized on the pattern of the EMSTS Central School, and the departments

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of each branch school mirrored those of the Central School: Medical Tactics, Surgery, Preventive Medicine, Sanitary Engineering, and so on. By the end of 1941, Lim had created five branch schools to serve five designated war areas in the provinces of Shaanxi, Jiangxi, Hubei, Sichuan, and Hunan, places where the presence of biomedicine had been relatively scarce in the prewar period. By 1942, more than 40 percent of trainees were being trained in the branch schools, which graduated 2,013 students from February 1939 to June 1942, in contrast to the Central School, which graduated around 2,756 students in the same period.27 Robert Lim envisioned the branch schools as more than simple educational facilities where soldiers received basic training in biomedicine: the schools should evolve to become comprehensive medical centers. Ideally, each one should have a hospital, an outpatient reconstructive surgery center, an antiepidemic unit, a mobile X-­ray unit, a medical inspection unit, a transportation unit, and an equipment warehouse.28 Such a vision required the formation of large comprehensive mobile medical units that would serve the needs of the frontlines without requiring the evacuation of patients to—and the training of soldiers in—the rear. However, the contingencies of war made such a vision difficult to implement. By 1944, several of the branch schools had either merged or been forced to close.29 After failing to resolve their disagreements amicably, EMSTS trainees revolted against their faculty in Paocheng at the first branch school. As a result, the first branch school was merged with the third branch school to keep students in line. The second branch school fell under Japanese hands, and the fourth and fifth branch schools were evacuated to Guizhou after a fresh Japanese assault that year. The unpredictability of the front made it impossible for many of the branch schools to operate well after 1944. Yet, when the branch schools were in operation, they provided many Chinese the remarkable opportunity to acquire a basic medical education, thus helping them save the lives of many more fellow Chinese in the war against Japan.

Promises and Limits of a Comprehensive Medical Center

While the branch schools did not develop into full-­fledged medical facilities, the EMSTS central school at Guiyang emerged to become a comprehensive medical center by 1942, with an orthopedic center, a vaccine plant, a



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publishing unit, a training hospital, and a fully operational laboratory. Lim argued that it was critically important for the EMSTS organization to train soldiers capable not only of providing medical relief for—but also of healing and rehabilitating—wounded and disabled soldiers, many of whom would otherwise have been neglected. The rehabilitation program, in particular, provided vocational training for soldiers and veterans with disabilities. At the school, the EMSTS personnel conducted physiotherapy and hydrotherapy for wounded soldiers. The latter form of therapy took place in locally constructed wooden tubs, many of which permitted patients to engage in diverse exercises for injured joints. Lim also used advanced technology such as infrared radiation and short-­wave diathermy on wounded soldiers when such equipment was available.30 Patients who were convalescing but reasonably fit worked in orthopedic workshops, producing some 100 artificial limbs for fellow soldiers by December 1941. Many patients received job training to assist in their reintegration into Chinese society, particularly in the fields of knitting, shoemaking, shoe repairing, tailoring, soap making, plaster-­of-­Paris refining, bamboo work, umbrella making, and carpentry. By the end of 1941, the orthopedic center had treated more than 500 patients. A total of 736 patients were admitted to the orthopedic center from July 1939 to December 1941, with a 71 percent discharge rate and a 4 percent mortality rate.31 The patients were likely to be regular soldiers, and the school was on average two-­thirds full. Besides reaching out to veterans through the establishment of China’s first orthopedic center, Robert Lim and his EMSTS colleagues distilled their experiences into six manuals published for the trainees and for the wider medical community: “Medical Support Services” (Weisheng qinwu), “First Aid and Surgical Services” (Waike), “Internal Medicine” (Neike), “Nursing” (Hubing), “Prevention of Communicable Diseases” (Fang yi), and “Public Hygiene” (Huanjing weisheng).32 Lim hoped that the manuals would “serve not only as a collection of text-­books for students but as a set of practical guides for field workers.”33 As shown in table 4.1, each manual comprehensively covered various medical topics. In the preface of each manual, Robert Lim wrote that the purpose of these manuals was to overcome the problems associated with the relative newness characterizing Western medicine, which he called “new medicine” (xinyi).34 China’s lack of trained personnel and adequate machinery resulted in the

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Table 4.1.  Topics Covered in the EMSTS Manuals. Sources: Robert Lim, Zhan shi wei sheng gong zuo gui cheng; Zhang Xianlin ed. Zhan shi; Zhou Shoukai ed., Zhan shi; Zhou Meiyu ed., Zhan shi; Shizheng Xin and Rong Qirong, Zhan shi. Title of Manual

Medical Support Services First Aid and S ­ urgical Services Internal Medicine Nursing

Prevention of C ­ ommunicable Diseases

Topics Covered

Military Tactics, Evacuation Strategies; Chain of Command; First Aid and Evacuation Teams; Hospitals (Frontline and Rear); Antipoison Bureau

Treatment of Burns, Wounds, and Fractures; Treatment of Internal and Brain Injuries; Surgical Operations on Various Parts of the Body Communicable Diseases; Diagnostic Testing of Blood, Stool, and Phlegm; Cultivation of Germs for Laboratory Use; Blood Transfusion

Hospital Quarantine Methods; Disinfection; Presurgical Assistance; Injection; Pharmaceutical Preparation; Hospital Laundry; Patients’ Dietary Needs General Quarantine Principles; Prevention of Dysentery, Plague, Tetanus, etc.; Diagnosis of Communicable Diseases; Inoculations

“lackluster” (buzheng) quality of the country’s doctors and nurses. Lim urged medical personnel to embrace uniform training and, in this way, to become “one in spirit.” Therefore, these textbooks proposed to unify ideas in Western medicine through its “simplicity” (jianyao), “economy” (jingji), “wide range” (tongyong), and “accessibility” (yixing). According to Lim, the manuals were accessible because they eschewed medical theories and excluded procedures that required expensive equipment. Lim and his colleagues included many graphs, statistics, and drawings in the manuals, and the left-­to-­right Western-­ style writing with a point-­by-­point, matter-­of-­fact arrangement suggests a deliberate “get-­to-­the-­point” format. The textbooks used case-­study approaches to discussing the treatment of various ailments and drew amply on Western visual representations of the body. In addition, the content and structure of the manuals reveal Lim’s agenda of “Sinifying” Western medicine in tandem with global trends in medical representations. Such efforts were not alien to the Chinese context—practicalization and case-­study approaches in medical texts were common in premodern China. In the Ming dynasty, for example, practical household healing manuals, medical primers, and collections of



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medical cases became widely available despite the contraction of state medical education and relief. 35 From 1938 to 1942, the EMSTS distributed about 20,000 copies of the manuals—not counting those given to EMSTS trainees—to military organizations across China.36 These practical manuals provided a relatively straightforward case-­study guide for EMSTS trainees and the wider Chinese population on the practices and ideas of biomedicine. Besides developing new textbooks for medical instruction, the EMSTS established fieldwork in wartime China. Professors and students from the EMSTS Central School’s Department of Pathology learned to detect parasites and bacteria in the laboratory,37 and, in December 1941, left for Hunan to investigate allegations that Japanese planes were dropping sacks of rice infested with plague-­carrying fleas. Although unable to prove beyond all doubt that the Japanese had unleashed such fleas on the region, the team’s bacteriological laboratory-­based studies confirmed the existence of the plague in the area. Chinese politicians, Soviet investigators, and historians of many nationalities would later use this incident to establish the brutality of the invading Japanese forces. In the People’s Republic of China, numerous contemporary accounts of the Second World War refer to this incident as a fact rather than as an allegation.38 In another example of fieldwork, students who had trained in the EMSTS Central School’s Department of Preventive Medicine departed with their professors to Xi’an to construct delousing and bathing facilities for soldiers.39 Similarly, students and their instructors in the Department of Sanitary Engineering initiated a water chlorination program in the Ninth War Area near the Yangtze River.40 By 1940, as the situation on the war front stabilized, Robert Lim began conducting laboratory research on the curative treatment for bacillary dysentery, typhus fever, and Salmonella infections afflicting Chinese soldiers. In the case of dysentery, Lim was interested in seeing if sulfaguandine and sulfapryridine, two drugs invented in the 1930s, were effective treatments.41 Dysentery is a disease that was long thought to be best treated with plenty of fluids and bed rest, particularly insofar as Western pharmaceutical interventions prior to the 1930s were consistently ineffective.42 All 12 patients whom Lim treated with sulfaguandine and sulfapryridine allegedly underwent remarkable recoveries, even though it was unclear whether he had obtained permission from the patients for this trial.43 Lim’s extensive medical training

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in Britain and America allowed him to access the latest medical research on dysentery, and he readily applied the research to live Chinese patients. This practice constituted a shift from his earlier experiments with dogs and rabbits at the PUMC.44 Even though Lim’s pharmaceutical treatment appeared successful, questions have persisted regarding the ethics of Robert Lim’s patient interventions at the EMSTS Central School. More controversial was Lim’s experimental injection of blood plasma into patients suffering from nutritional edema—a procedure that represented the marriage of his dual interests in blood transfusion and nutrition.45 Unlike the former case of dysentery, where Lim built on research already conducted in America, his blood plasma injections were very much a solo endeavor. An improved diet rich with protein was widely thought to be key to treating nutritional edema.46 There appeared to be no research in America that justified the highly controversial idea of injecting blood plasma into nutritional edema patients.47 Fortunately, all three patients injected saw their health improve and their edema disappear. The development of a comprehensive medical center and an intensive practical curriculum was not enough to create a truly competent medical force, according to Robert Lim. Lim established an unprecedented regimented program to maximize the students’ three months of training. Trainees at the EMSTS woke up at dawn and, after washing up and attending reveille, listened to a lecture given by the school’s director.48After the speech, they began military drills lasting an hour and a half. Medical training classes of 50 minutes each began at 8:30 a.m. and ended at 4:20 p.m. After these sessions ended, students would then have dinner, after which they attended a final class on political science or military music till 5:30 p.m. They then, starting at 6 p.m., had 40 minutes for recreation, followed by studying from 6:50 to 8:30 p.m. Roll call was at 8:30 p.m. and bedtime for trainees was at 9 p.m. The lives of these trainees differed greatly from their nonmilitary student counterparts not only prior to the war but during the war as well. As Wen-­ hsin Yeh suggests, prewar students generally enjoyed a high degree of autonomy in the 1920s and began withdrawing from politics and current affairs in the 1930s just as the KMT was seeking to “partify” (danghua) the everyday life of students on campuses.49 During the Second World War, Lianda students were willing to make sacrifices for the war effort, but were prevented by



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the KMT government from leaving the campus to fight on the front lines.50 Though their lives were marked by a degree of poverty, they were never subjected to the same degree of discipline as their EMSTS soldier-­student counterparts.51 The degree of control and militarization on the EMSTS Central School campus was significantly more pronounced than on prewar and even wartime campuses. Medical training at the EMSTS Central School and its branches was marked by relatively short stints and a focus on discipline, practical drills, and fieldwork.

Financing Overseas Chinese-­Style Biomedicine

Four groups of donors helped fund the development of the EMSTS, especially in its early years of 1938 to 1939. First, political elites in China and abroad gave a total of USD 71,914 (USD [2018] 1.28 million) directly to the EMSTS during this period. Soong Mei-­ling (Song Meiling 1898–2003), Chiang Kai-­shek’s spouse, donated 80,000 Chinese dollars to the center in 1938 (USD [2018] 304,320).52 Tan Kah Kee, the Singapore-­based businessman, gave an unspecified amount to the EMSTS through his fund relief organization, the Malayan China Relief Committee for Funds. Hu Shih (Hu Shi 1891–1962), Quo Tai-­chi (Guo Taiqi 1888–1952), and Wellington Koo (Gu Weijun 1887–1985), representatives of China in the United States and the United Kingdom, respectively, also donated to the EMSTS.53 The US ambassador to China, Nelson Johnston, donated USD 5000 (USD [2018] 89,000) to the EMSTS.54 US consul-­general in Shanghai Clarence Gauss (1887– 1960), UK ambassador to China Sir Archibald Clark Kerr (1882–1951), and Sir Horace Seymour (1885–1978) also donated small amounts to ABMAC. In contrast to the financial support of Overseas Chinese, Chinese elites, and foreigners, the Chinese government gave 83,000 Chinese dollars (USD [2018] 315,718) to the EMSTS through the Bureau of Military Medicine and the Public Health Training Institute, representing roughly a quarter of the total direct donations to the EMSTS.55 Second, left-­leaning Chinese diaspora groups such as the China Aid Council in New York, the London Chinese National Relief Fund, and the China Relief Committee in Singapore gave HKD 10,730 (USD [2018] 53,443) to the EMSTS through the China Defense League.56 Recall in chapter 2 that the League had been formed in 1938 primarily to solicit support for the

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medical relief efforts of the Chinese Communists and that Robert Lim had received funding from the League to extend medical support to the Communist base areas through the CRCMRC. Even though the League never explicitly articulated why it supported the EMSTS in its literature, it extensively commented on Robert Lim’s “revolutionary” work with the CRCMRC, whose endeavors the EMSTS was established to explicitly support.57 Third, Overseas Chinese organizations and US companies provided materials needed to run the EMSTS. The Chinese Patriotic Association of New England, the Scottish Rite Masons of Virginia, the Chinese Embassy Fund, and the China Emergency Relief Committee in Los Angeles donated vehicles to the EMSTS.58 The Emergency Medical Relief Committee for Honolulu paid for the construction of the EMSTS Training Hospital on the central school campus. The Boxer Indemnity Fund provided for the ABMAC’s printing plants, and a sympathetic British public donated surgical equipment to the organization. US companies donated tires, sewing machines, blankets, tents, and canvas for stretchers used during EMSTS operations.59 Fourth, Overseas Chinese supported the EMSTS indirectly by donating to ABMAC. From 1938 to 1939, the unspecified amount of money ABMAC gave to the EMSTS went into the construction materials for its vaccine plant, laboratory equipment, workshop tools, trucks, and library texts.60 The united effort of indigenous Chinese elites, Overseas Chinese, and sympathetic American and British individuals and organizations resulted in generous funding of both the inception and the expansion of the EMSTS. Excluding the cost of material support and unspecified ABMAC donations, Overseas Chinese and foreigners donated approximately USD 108,000 [USD (2018) 1 million)] to EMSTS projects from 1938 to 1939. In 1941, the EMSTS made and sold vaccines to raise funds for the school, even though such efforts contributed to less than 12 percent of the organization’s revenue. With the financial assistance of a Chinese American donor, Robert Lim established a vaccine plant at the EMSTS Central School. From March 1941 to June 1942, the plant produced 6 million doses of a smallpox vaccine as well as a total of 6.2 million doses of a cholera vaccine, combined cholera and typhoid vaccine, combined alum-­precipitated tetanus toxoid and typhoid vaccine, and concentrated plague vaccine.61 During the first few months, the vaccines were produced for the CRCMRC at a



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slight loss. After July 1941, the vaccines began making a profit to sustain the operation of the organization. The vaccine plant and the EMSTS organization’s other efforts at self-­ sufficiency in 1941 were a response to the pressing need for diversified revenue sources. In its early years, which extended from 1938 to 1940, the EMSTS drew support from multiple individuals and organizations with distinct political leanings. After 1940, however, ABMAC took on the overwhelming majority of the funding of the EMSTS. For example, 88 percent of EMSTS revenue came from ABMAC between 1941 and 1942.62 The dependency on ABMAC appeared to promote stability because Lim and the EMSTS, rather than having to depend on the vicissitudes of individual donors and groups, could rely on a steady source of income from a highly supportive organization. Yet, as this chapter shows, this dependency on ABMAC meant that the fate of Lim and his organization was increasingly tied with that of ABMAC. When ABMAC came under attack by UCR in the United States from 1941 to 1943, it appeared inevitable that Lim and the EMSTS would also find themselves in the UCR’s crosshairs. Underpinned by this financial precarity, the issue of who would control the EMSTS manifested itself in the UCR’s opposition to Robert Lim’s six-­year medical program.

Criticism of the EMSTS and the Limits of Transborder Recruitment

Robert Lim and his collaborators wanted a six-­year program to replace the existing three-­month program. Even though Lim publicly defended the merits of the three-­month program in 1939, he strongly believed that it suffered from many deficits remediable only through a longer program. This proposal, however, would later attract the ire of UCR officials, who used this issue to undermine Robert Lim. Publicly, Lim defended the three-­month program vigorously in the official ABMAC newsletter to assuage critics of the program. Lim asserted in May 1944, a few months before his premature departure from the EMSTS, that around 10 diseases were responsible for around 80 percent of all diseases on the war front, and that an “ordinary person with some simple training” could easily diagnose them.63 Such a skill would fill the urgent need for medical personnel to staff dispensaries, which would often see up to 50,000

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patients a day. To Lim, an EMSTS-­trained graduate in charge of a dispensary would be able to detect diseases in half to three-­quarters of the patients, be they soldiers or civilians. Many of these patients were considered an “average case which responds to an average way of treatment.”64 Even though Lim admitted that it would take a certified medical doctor to identify the degree of a disease’s severity, the three-­month program constituted a “statistical approach” to the unrelenting demands of medical relief in wartime China.65 By presenting diseases and patients as statistics that had to be understood and resolved quickly, Lim was appealing to his Chinese and American critics to support the three-­month program despite concerns about the qualifications and expertise of such trainees. Given China’s wartime needs, it was better to serve many people adequately than to serve a few expertly. In other words, the exigencies of wartime were not lost on Lim, who well understood that almost no Chinese patients could receive first-­class medical care under the existing medical regime. His public defense of the three-­month program contrasted with his privately held views, which in fact aligned with those of his critics. Lim quietly replaced the length of training from the initial one month to two months in 1939, as he felt strongly that one month was woefully inadequate.66 In 1940, without any controversy, the length of courses was increased again—this time to approximately three months and a week.67 This three-­month course, however, could not resolve the inadequacy of the trainees. Lim wanted to expand the pool of EMSTS recruits beyond the existing high school graduates to include middle school graduates. To Lim, middle school graduates lacked the prerequisite scientific knowledge to adequately understand the EMSTS training program. In order to sustain the principle of mass medical training, Lim saw the need to develop a longer-­term program that would allow the EMSTS to adequately train these middle-­school-­educated soldiers, who made up a large percentage of soldiers in the Chinese army. Training these middle school trainees would resolve the issue of insufficient high school graduates, as indicated by the head of nursing at the EMSTS.68 Furthermore, many of the eligible high school graduates were located in military units that increasingly refused to pay for their EMSTS-­related transportation and living expenses, despite the presence of nearby branch schools.69 These units had been receiving very little financial assistance from the government’s



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Army Medical Administration, which was in charge of distributing resources to military units on the war front. To reduce reliance on the Army Medical Administration, the EMSTS starting in July 1939 sought to recruit potential high-­school-­educated trainees from Guangdong province and across the Guangdong border in the British colony of Hong Kong.70 Recruiting the Cantonese in these regions was challenging, as the Japanese had occupied parts of Guangdong province by 1939, and travel by potential recruits from these regions back to Southwest China was likely to be difficult.71 Despite hoping to recruit thousands of people, fewer than a hundred people in Guangdong and Hong Kong signed up to be potential trainees at the EMSTS.72 This lackluster success at recruitment likely pushed the EMSTS to accelerate the process of recruiting existing middle-­school-­educated soldiers in Southwest China. Lim thus quite understandably argued that the “main obstacle to the development of the training program has been the difficulty of obtaining enough students.”73 The lack of qualified trainees, the lackluster results in civilian recruitment, and the growing public criticism of the short training program drove Robert Lim to broaden recruitment and deepen the quality of education through a six-­year “stage” medical curriculum. The proposed medical program would consist of three stages, each lasting for two years. A student could complete a stage and, if unable to stay for the full six years, could leave and then return to the EMSTS at a later date to complete the other stages. The first stage was geared particularly toward middle school graduates, even though all recruits, including those with high school degrees, would have to complete this stage. In the first year of the first stage, students would study the basic sciences, mathematics, and English, which would prepare them for stage one’s second year: a combined curriculum of physics, chemistry, and biology (also known as combined sciences), as well as surgery, preventive medicine, and laboratory demonstrations. In the second stage, students would focus on clinical and social medicine applicable to war-­front needs rather than develop specialized knowledge as in a typical prewar medical curriculum. In the last two years of the program, students would focus on clinical medicine, surgery, and prophylaxis (social medicine). The clinical and surgical aspects of the third stage emphasized orthopedics, tuberculosis, laboratory diagnoses, dermatology, pediatrics, and nutritional and communicable diseases. The prophylactic

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aspects of the third stage emphasized the organization and implementation of preventive care. Students would also learn about creating a health care system on the national, provincial, and rural levels. Other topics included how to organize hygiene programs and implement sanitary measures in different contexts in China.74 This comprehensive medical program differed from prewar prolonged residencies and restricted enrollment of students.75 Lim thought that the prewar model, which required full-­time students to finish a five-­to six-­year program at a medical training school under the close mentorship of professors, was impractical. In contrast, the benefit of the stage education was that students would eventually be able to complete their education even if they dropped out along the way, as long as they had completed a stage’s worth of classes.76 Thus, the proposal for stage education held true to the existing wartime principles of training as many students as possible.77 In addition, the new stage program, if implemented, would focus on field service and technical training alongside academic research and lecturing. The new proposed curriculum would require students to take at least four laboratory classes ranging from introductory topics (clinical laboratory science and parasitology) to advanced ones (bacteriology and immunology).78 Each class would last about six months. Whereas the advanced classes would involve traditional laboratory drills and lectures, the introductory laboratory science class would require students to spend time with an actual CRCMRC unit. This focus on field medicine and flexible medical curriculum received the approval of the ABMAC Chongqing committee, and the EMSTS began preparation for such a program in 1942.

Global Politics in the Shaping of Local Medical Education

Lim pressed for the six-­year stage medical program in publications and speeches and, privately, in his communications with key KMT leaders. It is clear that the ABMAC leadership in New York fully endorsed him and that he received approval for the program from the KMT government.79 Yet this six-­year program became the focal point of the UCR’s criticism of Robert Lim’s leadership.80 UCR preferred a program that stressed accountability and met immediate wartime concerns. In contrast, Lim preferred efficiency and adaptability on the ground, without sacrificing the long-­term vision of



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postwar reconstruction. The meeting of two historical contingencies—the promotion of a six-­year medical program and the rise of UCR vis-­à-­vis AMBAC—revealed the clash between the local medical interests and global aid organizations’ politicking. In the following section, the individuals who opposed Lim and his six-­year program will be referred to as the pro-­UCR camp. These two organizations’ disagreements led to the mobilization of international stakeholders that infused transnational complexities in an already complex configuration of domestic disputes. The expansion of the UCR’s powers was highly fortuitous and had its roots in the organization’s institutional design. Formed on March 2, 1941, UCR consolidated the fundraising efforts of eight separate organizations: ABMAC, American Friends Service Committee, the China Emergency Relief Committee, the China Aid Council, the American Committee for Chinese War Orphans, the Church Committee for China Relief, the American Committee for Chinese Industrial Cooperatives (Indusco, Inc.), and the Associated Boards for Christian Colleges in China.81 Interestingly, ABMAC joined UCR as the largest component organization in terms of personnel, funds, and programs. However, each organization’s equal representation on the board diluted ABMAC’s power to influence UCR. In 1941, Henry Luce (1898–1967) and other board members appointed Dwight Edwards (1883– 1967) to the position of UCR director.82 Edwards was not a medical doctor, but a missionary in the Young Men’s Christian Association from 1902 onwards, and rose to become the senior secretary of the association in China.83 Even though membership would erode its autonomy, ABMAC was willing to join UCR because the latter organization presented itself as primarily a fundraising organization that would meet infrequently. Such a weak organization would not encroach on the independence of any component organization.84 For example, in March 1942, the ABMAC board clearly stated in a joint agreement between both parties that UCR would take over only ­ABMAC’s fundraising and fund-­allocation functions, and everything else would be determined by ABMAC’s board in New York.85 UCR could not cancel ABMAC’s program unilaterally, and if UCR did so, ABMAC could resort to its own separate fundraising activities. In addition, UCR could not hold on to gifts of more than 10 dollars explictly directed to ABMAC. Finally, UCR representatives could not commit to any plans within China

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without the permission of ABMAC. In sum, ABMAC expected a high degree of independence in exchange for its participation in UCR. ABMAC’s position was undermined by UCR’s unexpected success in fundraising, which strengthened its position vis-­à-­vis its component organizations. By the end of 1942, UCR had raised more than USD 5 million (USD [2018] 77.3 million).86 It did even better in 1943, raising over USD 8.5 million (USD [2018] 123.8 million),87 more than 15 times the amount ABMAC had raised in 1940.88 ABMAC’s own budget increased from roughly USD 200,000 in 1940 to USD 1 million in 1941 after joining UCR (UCR now funded ABMAC), with a slight dip in 1942, before reaching a total of USD 1.4 million (USD [2018] 20 million) in 1943.89 A total of USD 41 million (USD [2018] 529 million) was raised by UCR from 1941 to 1942.90 In January 1942, B. A. Garside (1894–1989), one of the founding directors of UCR, praised it as an “economical and effective fundraiser” and argued that, in effect, the organization had moved from a “confederation” to a “strong federation, in which some of the participating agencies could or should” no longer be autonomous.91 A strong federation would clash with both ABMAC’s insistence on “complete autonomy” and ABMAC’s interpretation of UCR as a community chest comparable to United Way and created by participating agencies as a fundraising device. A few days before Garside expressed his praise, another UCR director allegedly told ABMAC “to play ball” and not to worry, as the organization’s departure from UCR would be no “big deal.”92 A cursory look at the wider context of funding might suggest that UCR was destined to have the upper hand in any conflict with ABMAC, given its ability to raise funds more effectively. But the reality was that, regarding UCR’s programs in China, UCR was dependent on its component organizations, especially ABMAC. The presence of ABMAC’s long-­standing medical relief programs in China justified UCR’s outreach to the American public. Without ABMAC, UCR would be making requests for donations in a vacuum. UCR was thus determined to have a say in how ABMAC programs were run in China. From July 1, 1942, to June 30, 1943, UCR used ABMAC as a channel for funding more than 22 million Chinese dollars (USD [2018] 5.3 million) of EMSTS’s budget of 24 million Chinese dollars (USD [2018] 5.8 million). Consequently, UCR wanted oversight over ABMAC programs in China.93 UCR created the Coordinating Committee



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in Chongqing to disburse funds directly to activities of component organizations within China. Each organization would send a representative to sit on this new committee. Unfortunately for Robert Lim and his ABMAC allies in New York, ­ABMAC’s representative to the Coordinating Committee, George Bachman, was much more sympathetic to UCR than to his directors in New York and Guiyang. In a March 22, 1943, letter to UCR, Bachman decried both Robert Lim’s unnecessary focus on long-­term training projects in the “present emergency” and his impractical investments in extensive construction projects. He argued that funds should be used only for urgently needed purchases and for short-­term courses that would meet the immediate needs of the Chinese army.94 As a result, Bachman recommended the approval of only half of the proposed budget for the EMSTS’s branch schools, completely undermining Lim’s position in China.95 Bachman’s eagerness to undermine Lim resulted in underfunding of the branch schools, which ironically went against Bachman’s interest in providing short-­term training through these institutions. UCR acknowledged the defection of Bachman and decided to call for the board to suspend the UCR and ABMAC’s funding of the EMSTS. Instead, it was argued, the institution should receive support from the government-­ funded Army Medical Administration.96 The cutting of funds was confirmed later by a confidant of Henry Luce, the owner of the weekly news magazine Time, who reported to Luce on February 28, 1944, that UCR director Dwight Edwards had tightened the purse strings of ABMAC because Edwards was “not satisfied with either the administration or the reports he got concerning the way Dr. Robert Lim, one-­time head of the Chinese Army Medical Corps and ABMAC crony, was spending UCR money.”97 According to Edwards, the EMSTS was an elitist institution that had trained only a few hundred soldiers even though it had received vast sums of money from abroad.98 When the ABMAC directors rebutted Edwards’s allegation by stating that the EMSTS had trained more than 7,000 soldiers by April 1943,99 Edwards intensified his campaign by publishing a wide-­ranging critical report in May 1943 focusing on Lim and ABMAC’s alleged lack of accountability, cooperation, and relevance.100 Edwards opened the report by emphasizing that the EMSTS was Lim’s personal show. The lack of accountability was evident when the American Red Cross, ABMAC, and individual Overseas Chinese sent funds to

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Lim and he allegedly used them indiscriminately. Moreover, Lim left unclear the ownership of the medical supplies that were sent to him from America. High salaries were paid to EMSTS personnel without any oversight of their performance. A proper audit was never conducted of EMSTS receipts and expenditures. As a result, the EMSTS was deemed unaccountable and, thus, unfit for total independence. During its inception, the EMSTS was allegedly under the control of the Chinese Red Cross (a separate organization from the CRCMRC). Later, Robert Lim’s protégé secured the EMSTS’s independence so as to prevent the Chinese Red Cross from controlling the EMSTS budget. Robert Lim also refused to work with the Army Medical College, which Edwards claimed was an exemplary training institution.101 Dwight Edwards also criticized the six-­year program as being excessively long. He argued that the six-­year plan was a reflection of Lim’s unreasonable commitment “to the larger scheme of medical education rather than to the present immediate projects.”102 He further argued that that plan had not been approved by the Chinese Ministers of War and Education and had been rejected by the Medical Committee of UCR. Edwards then recommended that grants not be given to Lim directly and that any subsequent grants to the EMSTS should be based on careful oversight, with the aim of putting a stop to the existing “grandiose medical set-­up centering around a personality.”103 The six-­year program was no longer simply impractical. To Lim’s critics, it suffered from a lack of both accountability and medical relevance. Donald Van Slyke, then president of ABMAC, wrote an 18-­point rebuttal to Edwards shortly after he had voiced his concerns about Lim and the EMSTS.104 Rejecting the UCR’s overemphasis on accountability, Van Slyke laid out ABMAC’s history of efficiency and effectiveness. He also revealed that C. T. Wang (Wang Zhengting 1882–1961), the head of the Chinese Red Cross in Hong Kong, wanted ABMAC money and supplies to be channeled first through his organization and then to Lim. Wang had served as minister of foreign affairs from 1924 to 1931 and seized control of the Chinese Red Cross in Hong Kong from Robert Lim’s Overseas Chinese ally C. Y. Wu in early 1939. This coup occurred during the time Wu left Hong Kong for a two-­month work-­related trip to the Dutch East Indies, Burma, and Malaya.105 C. T. Wang’s actions were less of an accountability issue than a personal vendetta, now taken on by the pro-­UCR camp against ABMAC



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and Lim. Therefore, Van Slyke defended ABMAC’s direct transfer of funds to Robert Lim on the grounds that such transfers not only prevented the money from falling into the hands of unauthorized parties but also constituted the most efficient way to satisfy financial needs at the front. Van Slyke also emphasized that Lim had no role to play in deciding how the money got to China—it was solely the ABMAC board’s discretion. In addition, the EMSTS was a military medical institution from its origins and had no reason to be part of Wang’s Chinese Red Cross in the first place. Van Slyke reiterated the importance of Overseas Chinese support for the EMSTS. He argued that “the confidence of the overseas Chinese in the organizations headed by Lim afforded ABMAC part of its reason for its support” of the Chinese Red Cross Medical Relief Corps and Lim’s other endeavors.106 Van Slyke explained why there was a lack of cooperation between the EMSTS and the Army Medical College: the Japanese-­and German-­trained doctors at the college, he stated, were refusing to work with the American-­ trained physicians at the EMSTS. The quality of education was low at the Army Medical College, and textbooks were inaccessibly written in German. He argued that rather than force the schools to combine, competition had resulted in the college’s adoption of EMSTS methods. Noting his hope that these schools would cooperate organically in the future, he concluded that the Army Medical College simply could not replicate the EMSTS’s success in training 7,000 medical officers and technicians. Accusing Lim and the EMSTS of uncooperativeness was wrongheaded and counterproductive: it was more important, Van Slyke insisted, to investigate whether cooperation had value in the first place and whether competition would strengthen military medicine in China. Turning to the six-­year program, Van Slyke defended it on the basis of various nuanced points. First, he insisted that medical experts had already examined the program and that their findings pointed to its high degree of practicality for China. Second, the ABMAC and UCR medical committees in New York and Chongqing had approved the program, suggesting that Lim had consulted with them on the nature of the proposed program. Third, UCR should not worry about the need for ABMAC to fully fund the six-­ year program, given that the war was likely to be over before then. The postwar Chinese government could then decide to pick up the rest of the funding

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for the program after ABMAC’s initial funding. Fourth, all equipment for the course could be provided by China Lend-­Lease funds and should be of no concern to either ABMAC or UCR.107 Van Slyke attributed the values of efficiency, deliberateness, and boldness to Lim and ABMAC’s endeavors, and contrasted these values with the unaccountability and impracticality that he attributed to the proposals favored by the pro-­UCR camp. Little is heard of Robert Lim’s voice in the archives, but we do get a glimpse of his full thoughts on this issue in his letter to Van Slyke on February 23, 1943.108 In the letter, Lim wrote that C. T. Wang and Surgeon General C. Pan had apparently alleged that Lim’s accounts of his professional responsibilities were at best unclear, that he had mishandled incoming supplies, and that he was actively aiding the Communists.109 George Bachman, Dwight Edwards, and Phillips Greene (director of the American Red Cross in China from 1942 to 1943 and faculty member of the Hsiang-­Ya Medical College from 1923 to 1927 and again from 1927 to 1941)110 came to believe this criticism of Lim, and added an additional charge of their own: that Lim had expropriated USD 90,000 from UCR and ABMAC funds for his own investment purposes, setting the stage for the later investigatory intervention of Bachman, Edwards, and Greene into Lim’s affairs. In his letter, Lim expressed awareness that he was on his way out and sought to secure his legacy by urging Van Slyke to maintain the integrity of both the EMSTS and its affiliated programs. The early interventions by C. T. Wang, C. Pan, and others might have been crucial to Lim’s own interpretation of his eventual dismissal, but it is clear that conflicts between the two camps, as well as the relatively easy target of a supposedly impractical six-­year program in the midst of wartime exigencies, were the factors that led to Lim’s ouster. If Robert Lim had needed to interact only with his supporters at ABMAC, the anti-­Lim allegations circulated by C. T. Wang, C. Pan, and others would likely have gained little or no traction. The veracity of UCR’s allegations was seen differently by both camps and their perceptions reflected their hardening attitudes towards Lim’s importance in shaping wartime medical education. Neither side changed its minds over time: UCR and its allies repeatedly pressed their points about a corrupt, dictatorial, and stubborn Lim who placed his interests above the country, and ABMAC leaders defended Lim as an accountable, deliberative, and bold



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leader who placed China’s medical needs above all. The two camps developed two different visions for the trajectory of China’s military education system. The pro-­UCR camp wanted an accountable and cheaply financed EMSTS that focused on short-­term training for immediate concerns. In contrast, the pro-­Lim camp wanted a long-­term training program that emphasized veteran rehabilitation and would lay a foundation for postwar medical training. UCR was very much involved in the contemporaneous present (the war); the EMSTS had its eyes on post war China’s military-­medical establishment.

Marshaling Transnational Support

While exchanging highly accusatory letters with each other, the two camps marshaled their allies. A contingent of the pro-­UCR camp, comprising Edwards, Bachman, and Greene, visited KMT general Ho Ying-­chin (He Yingqin 1890–1987) on November 5, 1942. Their goal: convince him to turn his support from Lim and the six-­year medical program to the pro-­UCR camp.111 The delegation told Ho that any future American support for medical relief was not contingent on the KMT’s support for Lim and his programs, and that UCR and the American Red Cross were eager to back any new initiative by Ho. Receptive to the delegates’ appeal, Ho began complaining to the delegates about how Lim’s organization was “giving rise to a new group of men within the army medical program but having a political color of their own and proving rather unwilling to cooperate and quite outside the army discipline.”112 Ho’s reference to “political color” reflected his disagreement with Robert Lim on how much political training EMSTS graduates should receive in the institution. Ho’s reference might have also referred to Lim’s provision of medical assistance to the Chinese Communists through these medical personnel. Ho’s anxiety over disloyal medical personnel led him to conclude his meeting with the three delegates by pledging to withdraw his support for the six-­year program. About a week later, Ho and Chiang Kai-­shek summoned Robert Lim and Loo Chih-­teh (Lu Zhide 1901–79) and told them to justify the six-­year program. A graduate of PUMC (1924) and New York University (1929), Loo was the deputy director of the EMSTS and the director-­general of the Army Medical Administration. A student of Lim’s at PUMC, Loo would later, in 1943, take over the running of the institute. During the meeting, Lim and Loo vigorously defended the program.

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They later reached out to T. V. Soong (Song Ziwen 1891–1971), their close ally and a brother-­in-­law of Chiang Kai-­shek’s, to persuade Chiang and Ho of the six-­year program’s merits.113 Soong’s reply was ambivalent, as he voiced reluctance to support the program in front of Chiang and Ho. Chiang and Ho subsequently removed Lim from his position as the head of EMSTS, largely as a result of the critical meeting between the pro-­UCR camp and Chinese officials. 114

Rehabilitation of Lim and ABMAC

The controversies surrounding Robert Lim’s six-­year training program and the politicking by UCR and their allies in the Chinese government brought down Robert Lim on August 12, 1943, when he was forced out as the head of the EMSTS. This act represented the end of neither his career nor the EMSTS itself. His allies continued to lobby Chinese officials not only to reinstate him but also to prevent UCR from intervening in the affairs of ABMAC and, more generally, those of China. Lin Yutang openly declared his support for Robert Lim and ABMAC in their tussle against UCR. Based in the United States during the Second World War, Lin Yutang was one of China’s most prominent bilingual Chinese intellectuals, writers, and inventors. Lin had hidden in Robert Lim’s house in 1926 to avoid arrest by a Beijing warlord seeking to purge Beijing University of critics, and thereafter remained close friends with Lim.115 As the previous chapter shows, Lin Yutang’s daughter, Adet Lin, would later move from the United States to Kunming to help Robert Lim set up the first Chinese blood bank in 1944. In his open letter attacking the pro-­UCR camp, Lin Yutang suggested that he would bring the issue of reinstating Robert Lim before Chiang Kai-­shek. He warned UCR that any attempt on their part to merge the EMSTS and its programs with other organizations would leave the former organizations “strangled.”116 He urged ABMAC to withdraw its participation from UCR if the latter organization continued its politicking, which, Lin suggested, might result in “Edwards destroying Lim.”117 Finally, Lin urged UCR to curtail its powers along the lines of the British and Russian war relief organizations in China, to recall UCR field agents who had targeted Lim, and to halt the Coordinating Committee’s rubber stamping of pro-­UCR interests in New York.



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Lin Yutang’s letter did not have an immediate impact, but it became an important weapon in the pro-­ABMAC’s camp counterattack. Personnel associated with the camp (including ABMAC director Alfred Kohlberg) exchanged several rounds of letters with various UCR officials and Henry Luce from December 1943 to May 1944 on this issue, and several included Lin Yutang’s letters in them.118 These letters revolved around the similar issues of financial and medical accountability, the perceived overintervention by UCR officials into ABMAC affairs, and the illegitimate meeting between UCR leaders with Chinese officers. As a result of these interventions, some changes were made in favor of ABMAC. First, UCR was concerned enough to convene a special committee to investigate Kohlberg’s charges, even though the committee eventually dismissed all charges against Edward Carter and the pro-­UCR members.119 Second, George Bachman, ABMAC representative to the Coordinating Committee, was recalled to New York on October 6, 1942 and replaced with a more pro-­Kohlberg/Van Slyke/Lim candidate, P. Z. King ( Jin Baoshan 1893 –1984).120 Third, on December 14, 1943, the UCR board promised not to interfere with the administration of ABMAC projects, even as the board defended the continual use of field directors to calibrate programs on the ground.121 Another relief for ABMAC was that EMSTS was not merged with other organizations after Lim’s departure, even though the institution rarely developed new initiatives after Lim’s tenure. Under Loo Chih-­teh’s leadership, there were attempts in 1944 to revive the six-­year program in the form of a longer eight-­year medical training program, but that program was not supported by UCR and never went beyond the planning stage. The vaccine plant and orthopedic center ceased to exist after Lim’s tenure. Despite the lack of new initiatives, the EMSTS continued to strengthen its core mission in providing short-­term courses for medical officers and other military personnel.122 The EMSTS trained more than 9,000 personnel after Lim’s departure, representing the continual strength of the center in providing for short-­term medical training. More successful, however, was the propagation of a three-­year nursing program. According to the head of nursing services at EMSTS, General Chou Mei-­yu (Zhou Meiyu, 1910–2006), General George Armstrong of the United States Army funded the nursing program, and the National Professional Women’s Club in the United States provided professional nursing assistance to EMSTS.123 Educated in Britain,

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Lim named China’s EMSTS after the British’s Emergency Medical Service. Towards the end of the war in 1945, Lim’s successor reorganized the EMSTS into the Army Medical Field Service School, likely named after the US Army Medical Field Service School. This change of name reflected the dominant role the United States took in supporting military medicine in China by the end of the Second World War. Because Lim was appointed as the surgeon general of the Chinese Army (Junzhengbu junyi shu shuzhang) in 1945,124 he was given some control over this new Army Medical Field Service School.125 Even so, Lim’s departure as director of the EMSTS meant the closing down of wartime initiatives such as the orthopedic and vaccine plant and the continuation of a policy that emphasized speed over quality in medical education.

Promises and Perils of Transnational Medical Politics

As we can recall, chapter 1 of this book shows how Lim Boon Keng failed to establish a medical school at Xiamen University in the prewar period because the Overseas Chinese community did not donate enough money to support such an enterprise. Lim Boon Keng’s overdependence on diasporic funding for a medical college somewhat mirrored Robert Lim’s inability to fully cope with the increasing reliance of the EMSTS on UCR, even though the displacement of ABMAC by UCR was beyond Lim’s control. Lim’s financial relationship with his international supporters thus reflected the many promises and perils of transnational finances. As a member of the Chinese diaspora, Robert Lim attracted the support of fellow Overseas Chinese in the initial funding and operation of the EMSTS. Allies in Britain and the United States came to the EMSTS’s assistance during his tenure as the organization’s director. International funding from the Chinese diaspora of all political persuasions made the EMSTS a reality. Yet, as Lim and his organization came to depend more and more on ABMAC for funding after 1940, their fate became more and more intertwined with that of their American patrons. ABMAC’s power struggles with UCR impeded the operations of the EMSTS and undermined Lim’s leadership position in China during the Second World War. Transnationalism also manifested itself in the transpacific debate over the curricular direction of the EMSTS. The two main sides in the debate marshaled their resources to claim control over the EMSTS. Lim and his



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collaborators saw the six-­year “stage” program as an appropriate solution to the insufficiently broad base of Chinese trainees, not only for the war effort, but indeed for the eventual relief and reconstruction of postwar China. The stage program was also a response to the criticism that graduates of the three-­month program were simply too poorly trained for effective service. In contrast, Lim’s opponents saw his six-­year program as self-­serving and impractical. It became a metaphor for the litany of alleged misdeeds of the organization, which included unaccountability, uncooperativeness, and even disloyalty. Even as aid was seen to be broadly forthcoming from the United States to China, the precarious nature of American financial assistance increased over time, as shown in the history of the EMSTS. Global money and diasporic expertise translated into considerable success for the EMSTS in terms of diverse offerings and lives saved. In various short-­term training classes from 1938 to 1946, the EMSTS trained 15,131 military personnel, of whom 6,374 were trained as medical officers.126 In contrast, the PUMC graduated only 313 students from 1923 to 1943.127 EMSTS graduates, though not as fully trained as Western medical doctors and nurses, represented a tripling of medical personnel in China in eight years—from 12,000 in 1938 to around 37,000 in 1946.128 Many of these personnel went on to serve as members of the Chinese Red Cross Medical Relief Corps, which treated more than 4 million people on the war front. This Overseas Chinese–style military medical training was characterized by brevity, regimentation, mass education, military medicine, portable curricula, branch schooling, practicality, drills, and CRCMRC-­oriented collaboration and fieldwork. Because the EMSTS emerged as a comprehensive medical center, its military medicine included activities emblematic of the Second World War: medical experimentation, orthopedic rehabilitation, vaccine production, publication of medical manuals, and so on. Even as it kept faith with its vision of unifying and propagating modern medicine in China, the EMSTS remained dedicated to addressing the country’s immediate wartime needs and subsequent reconstruction needs. As the next chapter shows, the EMSTS was reconstituted as the Army Field Medical Service School and later, in 1946, as the National Defense Medical Center located in Shanghai. The Center moved with the KMT government to Taiwan in 1949, and offered not only long-­term programs for

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the training of doctors, dentists, and nurses but also short-­term programs for the training of military field unit personnel. The Center also grew to become part of a comprehensive medical network, treating thousands of Taiwanese patients daily. As we will see, the Communist government in the People’s Republic of China during the 1950s capitalized on the much-­admired legacy of the EMSTS, and nowhere was this act of capitalization more evident than in the government’s militarization and nationalization of the Peking Union Medical College.

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R E CO N S T R U C T I N G B I O M ED I C I N E AC RO S S T H E TA I WA N S T R A I T S

Writing to his son in the United States in late 1947 and early 1948, Robert Lim and his wife remarked how they overcame high levels of inflation, student unrest, and political instability to reestablish the wartime military medical complex in the city of Shanghai.1 The Second World War had ended in September 1945, and the new National Defense Medical Center (NDMC, Guofang yixueyuan) was taking shape in postwar China. Leaders of the center drew on wartime successes and failures in developing the medical curriculum, treating patients, deploying mobile medical units, and rehabilitating veterans. However, a few months later, Lim was ordered by a senior KMT general to move the center to Taiwan, in anticipation of the fall of Shanghai to the Chinese Communists. Lim found that many of his trusted subordinates from his wartime days as well as newly recruited students from around the region refused to move more than 430 miles to the island. Lim was worried that it would be impossible to relocate and rebuild the NDMC in Taiwan, putting to an end the cumulative experience in developing military medicine since the beginning of the Second World War. The lessons from wartime experiences were central to the postwar reconstruction of biomedicine. During the Second World War, Robert Lim was ousted by his critics from his directorship of the EMSTS partly for his advocacy of a six-­year medical training “stage” program to replace the existing three-­month training program. When he reconstructed medical training

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at the NDMC, Robert Lim developed a creative solution to resolve the tension between quality and speed in medical training. The NDMC offered two tracks: an academic track in the medical, dental, or nursing school that lasted approximately six years and a vocational track in the medical services school that lasted around four years.2 To alleviate concerns that the NDMC was educating too many trainees too quickly, Lim sought to enroll a total of 3,000 students. Eventually, a total of 1,604 students at NDMC enrolled between 1946 and 1949.3 Both numbers were between the PUMC’s graduation of around 300 students from 1923 to 1943 and the EMSTS’s training of more than 15,000 medical personnel from 1938 to 1946. Lim’s revised training tracks and enrollment figures directly addressed the wartime issues of the quality and timing of medical education, while providing a range of options to interested students.

Tensions between Prewar Ideals and Wartime Adaptation

This chapter charts the efforts of Robert Lim at resolving the ongoing tensions between prewar biomedical ideals, which envisioned large-­scale research hospitals that would draw researchers, patients, and students to China’s technologically intensive and resource-­rich centers, and the wartime expediency arising from strategies of adaptation, practicality, and substitution.4 The postwar creation of biomedical institutions in China drew on both aspects. Reconstruction of biomedicine in China required making use of wartime strategies of fundraising globally and modifying imported technologies, but also implementing a postwar vision of expansion and universalism. The promises and elusiveness of peace due to the civil war between the CCP and the KMT meant that leaders of military medicine had to draw amply from their experiences during the Second World War by doubling their efforts at reaching out to the central KMT government, to ABMAC, and to the Overseas Chinese community. The postwar vision of medical expansion led to the issuance of several directives calling for the expanded use of mobile medical units, the creation of an expansive medical training center that emphasized both depth and practicality, and the commandeering of Japanese resources. It also gave rise to appeals to move beyond existing aid organizations such as the ABMAC to



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include new forms of official assistance from the United States government. Many of these ideals came to fruition through the work of the NDMC. By 1947, the center showed promise of a comprehensive medical center with the training of more than a thousand medical personnel, the development of several medical research projects, and the delousing and treatment of troops and generals on the war front against the CCP. As a result, Robert Lim and his colleagues built on wartime experiences to develop a postwar medical system that exhibited mass medical education with broad-­based learning and practical internships, mobile medical healing units that doubled as medical surveyors, and temporary and portable facilities that mimicked fully built-­up medical centers. These promising postwar efforts were interrupted by the rapid conclusion of the Chinese Civil War, and reconstruction efforts ultimately shifted from mainland China to Taiwan in late 1948. The moments in which the center relocated to Taiwan were fraught with extraordinary challenges and difficulties, ranging from the lack of space to host the institution to the lack of aid from the United States, to the inherent political tensions that were exacerbated by the KMT’s rule in Taiwan. That lack of resources stemmed partly from the reluctance of many doctors and nurses to move to Taiwan from mainland China. Attempts at reaching out to local Taiwanese doctors, as well as the wartime strategies of outreach to the Overseas Chinese and Americans, were intensified. Faculty members’ early days in Taiwan were marked by desperation, poor living standards, and a lack of facilities. The centrality of the Overseas Chinese in institutionalizing biomedicine carried over in Cold War Taiwan, even as their function changed over time. The broader role of the Chinese diaspora shifted from primarily being donors of medical assistance to China to being subjects of the Cold War rivalry between a Communist China and a “Free China” on Taiwan. The NDMC and its American allies saw recruitment of Overseas Chinese medical students as a battle for the hearts and minds of the Chinese diaspora, which justified the expansion of the NDMC to draw them into the Republic of China (ROC) in Taiwan. Dwight D. Eisenhower, who was elected president of the United States in 1953, significantly endorsed such a vision, and his administration increased aid to the NDMC. Eisenhower provided the opportunity for the organization to bring to fruition the ideas and practices embodied in wartime

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military medical medicine through the construction of faculty and student housing, laboratories, and research centers. The postwar reconstruction of the NDMC embodied the experiences of prewar American-­style institutions and the practices of wartime military medicine. By the 1970s, the NDMC emerged as a physical comprehensive medical training, research, and treatment center in Taiwan, even as it meant that the elements of portability and mobility that had embodied wartime medicine were no longer in place. The NDMC sought to bolster both the depth of the curriculum and the practical internship components of military medical education while maintaining the wartime commitment to training as many doctors, nurses, sanitary engineers, and other medical personnel as possible. By 1962, more than 14,000 medical personnel were trained by the NDMC. The center slowly took on a visible research profile in the 1960s and 1970s. The process of reconstruction was a highly fortuitous process but, as I will show, took a fairly long time to come to fruition. The commandeering of Japanese resources and drawing on wartime experiences (1946–49), the import and adaptation of wartime equipment for reconstruction (1949–54), and the development of a Cold War strategy to reach out to the Overseas Chinese (1955–70) were critical factors for institutionalizing biomedical training and research in postwar China and Taiwan.

Establishing the NDMC in Times of Disunity

In 1945, Robert Lim called for the creation of a comprehensive medical training and treatment center that would draw on the expertise of civilian and military medicine.5 The center was to provide long-­term professional training for doctors, dentists, and nurses as well as shorter-­term programs focusing on training field units in specialized techniques. The school also sought to provide intensive short-­term courses on medicine for soldiers of all ranks. By incorporating both long-­term and short-­term training at the new postwar medical center, Lim sought to bridge the wartime tension between the need to train medical personnel in the shortest possible period of time and the desire to ensure that these medical personnel would be well trained and qualified to administer medical assistance. To supplement teaching and research, the new center would have a fully equipped laboratory, medical museum, and research library, as well as auxiliary buildings such as an auditorium, barracks, staff quarters, training areas, and recreational facilities.



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Lim considered the NDMC as central in the fight against Chinese Communism through training of the doctors, nurses, dentists, military medical officers, medics, and technicians needed to sustain the KMT troops in the battlefield.6 This consideration was a shift from his wartime position, when Lim saw the CCP as important in the overall fight against Japan during World War II. Recall in chapter 2 that Lim dispatched several mobile medical units with supplies to base areas held by the CCP. This support, however, partly soured his relationship with wartime KMT leaders. After the Second World War ended, Robert Lim increasingly perceived the Chinese Communists as a threat to national unity. As early as 1946, Lim saw the “communist insurgence” as a factor for creating an environment that was not conductive to the proper training of medical personnel. Yet, Lim at that time also blamed most of China’s medical ails on the economic fallout of the long conflict with Japan.7 By 1947, Lim expressed privately that the Chinese Communists were a deeply negative influence on NDMC’s students and that they were stirring up protests among the students at the center. In a letter to his son, he said: The students are too well organized to have thought it all out by themselves. Besides their requests were I think unreasonable. They asked, not only for

more food money which was justified, but also for higher pay for professors, for the civil war to stop, and for various other conditions regarding the or-

ganization of certain schools, examinations, etc. I believe the latter requests

were put to them by communists; it followed their propaganda pretty closely.8

In 1948, Lim shared his fears with his son that things “could be very much worse, especially if the Communists were to gain control,” in reference to his optimism of the future in China under the KMT.9 By 1949, Lim was lecturing openly in the United States on how the “Chinese Communists sabotaged all efforts towards rehabilitation in China proper.”10 Robert Lim’s evolution on the CCP was less ideological than practical, in that he believed that the problem with Chinese Communism was its disruption towards the peace and unity of the country that would facilitate the growth of biomedicine and NDMC in China. To Robert Lim, reconstruction was key to the success of biomedicine in postwar China. In justifying the construction of the NDMC, Lim argued:

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Unfortunately, emergencies will continue for some time to come, and will call

for emergency measures, but steps towards reconstruction [emphasis mine] cannot wait, for only as the latter progresses can the former be eventually eliminated.11

The faith that reconstructing China would reduce the levels of political turmoil allegedly caused by Communism in China did not come to fruition in mainland China, as the NDMC was forced to move to Taiwan as the civil war began to turn in favor of the CCP. By December 1948, when the Chinese Communists reached out to Robert Lim to persuade him to stay on in China, Lim had already made up his mind to reject such overtures and instead bring the promises of biomedicine from mainland China to Taiwan.12 In reality, Lim’s anticommunist vision for the NDMC was plagued by factional politics. Wartime disagreements between rival institutions reemerged in postwar China. The inception of the NDMC already saw internal squabbles among different institutions. Lim had proposed to bring together two wartime medical institutions—his ally and student Loo Chih-­teh’s Army Medical Field Service School and his rival Zhang Jian’s (1902–96) Army Medical College (Junyi xuexiao)—to form the basis of the new NDMC, which would be based in Jiangwan, Shanghai. Medical personnel at the Army Medical College opposed folding their institution into what they saw essentially as Robert Lim’s organization. The Army Medical College was a small outfit that trained medical personnel during the war and was backed briefly in 1944 by Robert Lim’s rivals—George Bachman and the United China Relief—to counter Lim’s much larger EMSTS, later renamed the Army Medical Field Service School.13 ABMAC officials and Robert Lim considered the Japanese-­and German-­ trained doctors at the Army Medical College to be inferior to the British-­ and American-­trained physicians at the EMSTS. In contrast, Army Medical College doctors thought that the British-­and American-­trained physicians at the EMSTS were arrogant, given that their medical skills were not necessarily better than those of doctors trained in Japan and Germany. The head of the Army Medical College, German-­trained Zhang Jian, was unsurprisingly reluctant to merge his organization into the proposed NDMC in 1946, in full knowledge that Robert Lim would be the director of this new institution. Both sides marshaled their allies: Zhang gathered support from KMT generals in



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his home province of Guangdong, and Lim sought the help of General Chen Cheng (1897–1965).14 Chen was then the chief of general staff and director of the Northeast Headquarters of the Chinese Army.15 He would subsequently become the governor of Taiwan in 1949, and later the premier and vice president of the ROC in Taiwan. At a meeting to discuss the merger, Chen spoke up in support of Lim: Whoever of you want to bring down Robert Lim, you have to first defeat me. If you cannot defeat me, then you cannot bring down Robert Lim. We feel

that Robert Lim is a real talent. He not only has a firm foundation in medicine but is also extremely patriotic. Under his leadership, he can definitely

attract capable teachers and technicians, which will lead to the expansion of the military medical system.16

Chen’s exhortation and lobbying proved effective as Chiang Kai-­shek ordered Zhang Jian to merge his Army Medical College into the newly formed NDMC. Zhang reluctantly agreed and became deputy director of the NDMC, sharing the same position with former EMSTS head Loo Chih-­teh. Some Army Medical College doctors refused to join the NDMC, including those who were appointed to head the new Dental and Pharmaceutical Departments at the new NDMC. Even though the KMT government could compel the Army Medical College to fold into the NDMC, it could not compel Zhang to force his subordinates to join the NDMC. NDMC’s support for the KMT’s endeavors during the Chinese Civil War divided traditional donors to Lim’s endeavors, particularly in the Overseas Chinese community. Historian Wang Gungwu argues that the KMT began to lose support from major groups among the Overseas Chinese community in Southeast Asia after the Second World War.17 The Overseas Chinese were increasingly aligning with indigenous nationalists in Southeast Asia with the displacement of Western colonial regimes, thus turning the diaspora’s attention away from China. Moreover, many Overseas Chinese increasingly believed that the KMT was incompetent and corrupt and did not deserve the same level of support that it received during the Second World War. Unprecedented criticism of the KMT emerged in the local papers in Singapore by 1947.18 Overseas Chinese leaders such as Tan Kah Kee began to openly support Mao Zedong and the CCP over Chiang Kai-­shek and the

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KMT.19 This opposition to the KMT translated into reluctance to support the NDMC and was in contrast to the wartime situation in 1938, when Lim’s Chinese Red Cross Medical Relief Corps had received almost a third of its funding from the Overseas Chinese in Southeast Asia. Robert Lim struggled to raise funds from his traditional ally despite ­ABMAC’s regaining of its full autonomy after 1945. From 1941 to 1945, ABMAC tussled with the more powerful UCR after UCR sought to absorb ABMAC into its ranks. After the Second World War, UCR struggled to maintain its purposes after turning its focus towards supporting education in China under the new auspices of United Services to China (USC).20 Few donors supported this change of direction, and USC ended up winding down its fundraising endeavors in 1950. In 1966, USC merged with ABMAC, its wartime rival. USC’s precipitous decline meant that ABMAC charted its postwar direction without any interference from the former. In 1946, ABMAC adopted a new policy of diversifying its funding to a wider variety of medical institutions. As a result, the NDMC and its nursing department were slated to receive only 125,000 Chinese dollars of the total budget of 1,400,000 Chinese dollars in 1948, with the rest going to the newly reconstructed Beijing, Shanghai, Lanchow, Xiangya, Nanjing, and Canton Medical Schools.21 Furthermore, the money for NDMC was primarily directed towards foreign fellowships for NDMC’s doctors to have short stints in American medical schools, rather than towards aiding the operational costs or the construction of the new buildings. Likewise, ABMAC, which had hitherto supported Lim’s endeavors, became increasingly reluctant to support the organization. Lim tried valiantly to get ABMAC’s full support behind NDMC, and he wrote to then head of ABMAC Magnus Gregerson on March 1948 to ask for more funding from ABMAC, in the spirit of giving “equal consideration [to all medical institutions] in the allotment for funds for medical equipment.”22 Gregerson ignored Lim, and Lim wrote a few days later to Allen Lau, appealing to him and the other Overseas Chinese in ABMAC, such as Frank Co Tui, to push for more funding for the NDMC.23 ABMAC, which had been the most reliable partner of Lim in America, became much more ambivalent about Lim’s endeavors in postwar China, at least until 1948. Because of the reduced levels of funding from the Overseas Chinese and ABMAC, Robert Lim turned to the US Army for assistance in 1946. The US



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Army agreed to help fund NDMC, and money was funneled to the institution via Colonel George Armstrong. Colonel Armstrong was the chief of the Personnel Division at the Office of the Surgeon General of the United States Army and served in China from September 1943 to June 1946 in various capacities, the final being theater surgeon general of China. 24 Armstrong gave Robert Lim USD 8,000 in 1945 (USD [2018] 112,000) and another USD 2,000 USD in 1946 (USD [2018] 25,850), which made up the budget for the proposed NDMC for the years of 1945 and 1946.25 The NDMC used up almost all the money for 1946, presumably to remodel hospitals left behind by the Japanese for the NDMC. In 1947, NDMC did not receive any money from the US Army, but instead depended on other sources amounting to 35 million Chinese dollars (USD [2018] 11,000).26 This amount was marked simply as “investment” in the audited accounts. It was used up by the end of the year, evidence of how crucial it was in the setting up of NDMC’s programs in its first year of operation. However, it was clear that Armstrong’s support was ad hoc in nature, as the US Army did not have a formal aid program for China, which was then the purview of the State Department.27 Even though the US State Department at various moments promised aid to the KMT, little of it came to fruition.28 Robert Lim left China for the United States to seek out new streams of funding as well as search for procurement possibilities in July 1948 on the pretext of attending a polio conference in New York. His initial meeting with ABMAC representative Allan Lau was productive, and Lau became instrumental in assisting the flow of money and supplies from the United States to the NDMC. In his subsequent meetings with ABMAC directors, Lim convinced ABMAC to grant the NDMC nursing school the freedom to decide on how to spend ABMAC funds, rather than having to seek prior approval from Lim’s rival within the organization. It was a small but important victory for Robert Lim and Chou Mei-­yu, the head of the nursing school at NDMC. He also reached out to pharmaceutical companies in America, and one company promised to ship gelatin for the creation of blood plasma at the NDMC. Lim also secured new cultures and Triton-­X 155 from the Army Medical School at Walter Reed Medical Center for his colleagues at NDMC through his contacts in America. 29 During his trip to the United States, Lim met with the United States Army and Navy procurement

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representatives, as well as Minnesota congressman Walter Judd. The latter promised to lobby the US government on behalf of Lim, but ultimately had limited success as the government withheld aid until the early 1950s, when the NDMC was already in Taiwan. It was in this context that Robert Lim commandeered Japanese resources in China. Robert Lim applied to the KMT government to have dental equipment from the wartime Shanghai-­based Tokyo College of Dentistry and the Osaka Dental Manufacturing Cooperation turned over to the NDMC.30 Lim also appropriated laboratory, radiological, serological, and electrical supplies formerly owned by the Japanese medical personnel.31 More importantly, he sought to have the Japanese hospitals in Shanghai turned over to the NDMC, which the government ultimately did in August 1946, bequeathing six hospitals of approximately 1.5 million square feet of floor space to the NDMC, as shown in figure 5.1.32 These buildings were repaired and remodeled for the NDMC, and by 1947 held the NDMC General Hospital, central

Figure 5.1.  National Defense Medical Center in Shanghai. Source: ABMAC Records, 1946, box 78, file: Army Medical Center, Kiangwan ( Jiangwan), Shanghai. Reprinted with permission.



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supply offices, warehouse, residents’ dormitory, garage, guard house, swimming pool, greenhouse, animal house, laboratories and classrooms, barracks, latrines, medical service corps schools, etc.33 In sum, the appropriation of Japanese premises and equipment allowed the NDMC to reduce its reliance on foreign assistance.

Transnational Buffers to Civil War Problems

The establishment of the NDMC was celebrated in both China and the United States. Prominent visitors toured the NDMC from October 1947 to January 1948, including Soong Mei-­ling, Congressman Judd, chief of the US Military Advisory Group General John Lucas, and US ambassador Leighton Stuart. They were reportedly pleased with the progress of the NDMC despite the very limited resources the institution had to work with.34 The NDMC was also fortunate enough to be partly insulated from the wider fallout of hyperinflation and student unrest during the Chinese Civil War period, because of its transnational connections to the United States. Inflation was a general scourge in Shanghai from 1945 to 1949, as prices of many goods and services increased more than four thousandfold during this period. The propensity for the Nationalist government to resort to the printing press to finance its growing military expenditure,35 the postwar efforts of unions at bidding up their wages,36 the ineffective emergency price control measures in 1947 and 1948 that succeeded only in creating a vast black market,37 and the failed currency reform in 1948 were representative of a period that seemed utterly chaotic.38 Robert Lim and his wife Tsing Yi could cope with the high levels of inflation. Despite Tsing Yi complaining to her stepson in America that it cost 125,000 Chinese dollars to subscribe to a newspaper for one month in 1947, 39 she admitted that things were improving after the war, and affordable buses were again plying the streets of Shanghai by March 1947. 40 Though the NDMC found difficulty in sourcing food even in the Shanghai black markets, it nonetheless was able to provide for the soldiers’ meals. A key reason was that the NDMC received much of its funding in US dollars, which mitigated the erosion of the Chinese dollars in this period. Even by October 1948, the NDMC students were provided with one dish, one cup of soup, and two big bowls of rice at 8 US cents at the school’s cafeteria.41 Robert

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Lim admitted that while funds for the NDMC were inadequate given the “economic deficiency, civil war and inflation,” he was “get[ting] along with the little we have.”42 Besides inflation, the KMT government also faced widespread student protests on the streets of Shanghai, which also affected the NDMC in 1947 when the Army Medical School students protested the proposed merger of their institution with the NDMC. They put up posters in their compound in Shanghai and outside the houses of Loo Chih-­teh and Robert Lim.43 Chen Cheng warned students that they would be treated harshly if they did not end their opposition. Because of his intervention, as well as the shared knowledge that the merger was a done deal, student leaders called off these demonstrations. Fortunately for Lim and the NDMC personnel, there were no other recorded cases of student unrest despite alleged Communist infiltration into the campus.

Biomedical Promises in Postwar Shanghai

In the short period of time that the NDMC was in Shanghai, the center was active in training medical personnel and treating Chinese soldiers and civilians. The NDMC offered two tracks of learning at the center—an academic track in the medical, dental, or nursing school that lasted approximately six years, and a vocational track in the medical services school that lasted approximately four years.44 Teaching all four quarters of a year, faculty members offered classes on biomorphics, biophysics, biochemistry, surgery, social medicine, and medical engineering.45 From 1946 to 1949, a total of 1,504 medical students and officers and 100 nurses took classes at the NDMC. These figures were significantly fewer than the 5,400 students envisioned by Robert Lim in 1946, when he first drafted the plan for an NDMC, and the 15,000 medical personnel trained by Lim during the Second World War from 1938 to 1945.46 Clearly, the lack of resources had limited the number of students trained, even though a figure of 1,500 was substantial given the tremendous constraints of the civil war. Moreover, the NDMC students were far better trained than their EMSTS counterparts during the war. They became critical members of the ROC medical corps when the KMT retreated to Taiwan. Besides training soldiers, the NDMC drew from wartime practices to develop safer ways of treating soldiers and civilians. In particular, the



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experiences of running the wartime Chinese blood bank profoundly shaped treatment and research opportunities at the NDMC. During the war, blood bank personnel processed collected blood into blood plasma using imported blood banking equipment from the United States. However, because the saline used to hold the blood plasma was often contaminated with pyrogens (substances typically produced by bacteria that caused fever when introduced into the body), the plasma was contaminated at times, which made patients ill. In the postwar period, Lim and Loo sought to tackle this problem by manufacturing pyrogen-­free fluids for use. In 1947, the pyrogen-­free fluid plant came to fruition at the NDMC with a donation of money as well as 30 tons of equipment from ABMAC.47 As seen in figure 5.2, NDMC scholars injected pyrogen-­free fluid into rabbits to test the quality of the fluid before allowing the liquid to be used on actual patients. Furthermore, as seen in figure 5.3, the NDMC also provided members of the Chinese National Relief

Figure 5.2.  NDMC personnel injecting rabbits to test the effects of the absence of pyogenes in fluids on animals. Source: ABMAC Records, 1946, box 84, file: Pyrogen-free fluid plant ABMAC. Reprinted with permission.

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Figure 5.3.  NDMC workers loading pyrogen-free fluids onto Chinese National Relief and Rehabilitation Administration trucks for use in a cholera epidemic in Shanghai. Source: ABMAC Records, 1946, box 84, file: Pyrogen-free fluid plant ABMAC. ­Reprinted with permission.

and Rehabilitation Administration with pyrogen-­free fluid in their efforts to combat cholera in Shanghai. Furthermore, ABMAC approved both the sale of gelatin as a blood plasma substitute from the United States to the NDMC and research on gelatin at the center.48 As a result, pyrogen-­free substances ensured safer intravenous injections of saline and other medicine, and gelatin helped save lives on the war front. Faculty members at the NDMC also conducted research on citrinin (a penicillin substitute for infection), radioactive studies in animals and human beings, tuberculosis immunization in the army, plastic surgery, and



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vaccines in the army.49 Such research revealed the continuities in focusing on practically oriented research projects on medicine for the wider Chinese public at the center. While the decision to move to Taiwan ultimately disrupted these projects, they reflected the NDMC’s ambitious research agenda.

Surveying Diseases and Disseminating Biomedicine

Besides training soldiers and conducting research, NDMC medical personnel worked closely with the Chinese military medical relief corps to disseminate practices of biomedicine among the wider military and civilian community. Robert Lim did so as the surgeon general of the Chinese Army, a position he held concurrently with his job as head of the NDMC. Despite firing Lim from the EMSTS directorship in August 1943 because of the increasing conflict between EMSTS and the center’s American patrons, Chiang Kai-­shek appointed Lim as assistant surgeon general less than a year later. His appointment suggested that Chiang continued to recognize Lim’s expertise and experience. In 1945, Chiang appointed Lim as surgeon general of the Chinese Army. Lim sought to increase the size and functions of mobile medical units to formulate a postwar biomedical system that bridged the wartime development of mobile units (1937–45) and the prewar development of large medical centers that catered mainly to the Chinese elites (1910–37). Lim argued for the development of mobile hospital expansion units alongside existing mobile clinical units.50 New mobile “clearing units” were needed to evacuate less serious cases from hospitals to treatment centers. “Rehabilitation” mobile units served a dual function of evacuating soldiers without serious physical injuries and assisting them in postwar rehabilitation. Furthermore, mobile “reconditioning units” were needed to dispatch recovered soldiers away from hospitals to veteran rehabilitation centers, so as to alleviate the crowdedness of local hospitals. To this end, Lim dispatched mobile hospital expansion units to treat surgical and medical cases of casualties left over from the Sino-­ Japanese war period, and sent clearing units to evacuate less serious cases to treatment centers near the general hospitals in Guiyang, Chongqing, and Xian. He also commanded the sending of mobile delousing units to the army camps across the country to rid soldiers of the mites and lice that afflicted their bodies. For example, from January to March 1947, more than 7 million

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people were deloused with steam to prevent diseases such as scabies which are spread by ticks and lice.51 Furthermore, Robert Lim designated these mobile units as surveyors of the medical conditions of postwar China. Their duties documenting the disease landscape in China were an extension of the functions of mobile units during the Second World War. As early as January 1938, these mobile units began to collect rudimentary data on the types of sickness in China. As seen in the first two reports of the CRCMRC ( January–June 1938), the relatively sparse numerical medical data were embedded within a word-­based narrative of wartime medical relief. These data were of an aggregate nature, and there were no substantive graphs. By the fourth report ( January–June 1939), Lim published extensive tables of wartime medicine in specific locales across China. These tables represented finer breakdowns of medical interventions— for example, there were eight categories of operations (abdomen, chest, plastic, amputations, sequestrectomy, removal of foreign bodies, incision and drainage) and fifteen categories of treatment of wartime illnesses (such as gonorrhea, beriberi, and scabies) undertaken by medical personnel. By the seventh report ( January–June 1940), there were ten categories of operations and seventeen categories of treatment of wartime illnesses. The new surgical categories were now incision and drainage, debridement, sequestrectomy, amputation, removal of foreign bodies, excision of scars, repair of hernia, aneurismorrhaphy, secondary closure of wounds, and skin grafting.52 These new categories suggested that CRCMRC surgical operations became more precise, complicated, and wide-­ranging as the war progressed. The increase in the numbers of categories represented gestures towards the increase in medical interventions in wartime China, as well as the growing sophistication of wartime medical collection during this period. These medical tables represented a fervent attempt at documenting what Lim saw as problems that the Chinese faced in their seven-­year war with Japan. It was a shift from a narrative-­based explanation towards a quantitative-­based justification for more intervention in medicine. The efforts in making these data legible became just as important as the production of the expertise in healing. Making these data legible involved drawing on parallel efforts from the United States. Lim accessed tables on the length that US soldiers took to recover after being admitted to a hospital before returning to duty. He also



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received information on the distribution of battle losses of the United States army in the different arms of service.53 While Lim repeatedly emphasized the limits of commensurability of using such American-­style statistical methods and interpretation onto the Chinese context in his report, such data collection did shape his decision to standardize and intensify data collection and presentation in the immediate postwar period. By 1949, Robert Lim was able to draw up 13 data sets on the total number of sick and wounded soldiers from August 1937 to 1948, the number of sick and wounded from 1937 to 1948 compared with other countries in World War I and World War II, the anatomical distribution of wounds by percentage, the number of wounds and weapons concerned, the pathological distribution of sick soldiers, the cost of inpatient stay in hospitals in 1948, and the types and distribution of battle losses among different divisions in the army.54 In many of these datasets, explicit comparisons were made between the Chinese cases with foreign cases, in particular, those from the US Army, the British Army, German Army, and the Japanese Army in various theaters. Furthermore, these tables connected the medical situation during Second World War China (1937–45) with that of post–Second World War China. Take the result of hospitalization of soldiers in China from 1937 to 1948 in table 5.1, for example. It revealed relatively constant and high rates of mortality (21.05 percent) and desertion (28.68 percent) from hospitals during the war.55 The rates of hospitalization did not abate significantly, and soldiers continue to face the problems of wartime injuries and sickness. By showing the continual struggle of soldiers and veterans into the post-­1945 era, Lim was perhaps justifying a continuation of wartime medical policy in a “peacetime” era, even as the Chinese Civil War between the KMT and the CCP was well underway. These data also represented a significant effort in making wartime and immediate postwar data available in a tabulated and comparative format. Whether or not these data were accurate (Lim and his surveyors did not leave behind writings on the process), we do know it was an extension of the social surveys increasingly done by indigenous Chinese by the 1930s. However, no surveys prior to 1947–48 show wartime casualties in such a format as Lim did, which points to the deepening of statistics collection and categorization that took over in the 1930s by indigenous social scientists, who were in turn influenced by earlier American efforts in the 1910s and 1920s in North China.56

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Table 5.1.  Reconstruction of a Table Titled “Result of Hospitalization (1937–1948).” Source: Lim’s Papers. Results of Hospitalization (1937–1948)

Admissions ­Carried Over Total

Discharges: Died Deserted Disabled Returned to  Duty

Total

Remainders: Hospital ­Convalescent Unit: Total

1937–1944 (7½ war years) Total % 2,130,502 -­

439,878 -­21.05% 599,413 -­28.68% 75,896 -­3.63% 974,936 -­46.64%

1945–1947 (3 postwar years) Total %

1947 (1 year) Total %

1948 January–June (6 months) Total %

568,302

333,801

254,114

527,923 40,379

257,389 76,412

157,892 102,222

79,153 -­16.98% 29,682 -­12.82*% 17,167 –14.70*% 85,212 -­18.28% 36,163 -­15.62% 21,760 –18.63% 5,828 -­5.00% 19,780 -­8.54% 29,587 -­6.35% 272,128 -­58.39% 145,954 -­63.02% 72,021 –61.67%

2,090,123 -­100%

466,080 -­100%

231,579 -­100%

116,776 –100%

40,379 -­

102,222 -­

102,222 -­

132,032 5,306

2,130,502

568,302

333,801

254,114

*68.41% Sick    *71.38% Sick

Intervention in the Chinese Civil War

More importantly, these tables reveal that the Chinese Army medical services led by Robert Lim treated more than 490,000 patients during the civil war period from January 1945 to June 1948. According to tables on the results of hospitalization as well as summary of casualty ratios, more than 250,000 soldiers were evacuated in 1947 to rear hospitals or treated by mobile hospital units. In 1947, 63 percent of the 333,801 admitted KMT soldiers returned to duty after a stint at the hospital. The rest of them deserted, died, or became unfit for active duty. In 1948, the figures collated for the January to June of that year reveal a higher number of soldiers treated at the hospitals (116,776), but with a rate of return to duty comparable to 1947 (61.7 percent). A total number of 490,103 soldiers were treated and returned to duty from January 1945 to June 1948. This collation of these figures shows the multiple roles of



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mobile medical units. They evacuated soldiers, embarked on preventive medical care in the form of delousing, treated soldiers, and tracked the progress of their medical and military status. Lim and his colleagues thus drew generously on their earlier wartime experiences to save the lives of soldiers in civil war China. The treatment of more than 400,000 soldiers by the Chinese Army Medical Services, however, did not ultimately turn the tide in favor of the KMT. Lim could only deploy the well-­trained NDMC personnel directly on the battlefront (as opposed to serving in rear-­end support as surveyors, evacuators, and first aid providers) towards the end of the civil war, presumably because it took time for the NDMC to assemble enough faculty members and students to head to the war front. Towards the end of 1948, NDMC mobile surgical and first aid units comprising 150 medical personnel left for Shanghai to Xuzhou to assist KMT troops in the Battle of Xupeng (known on the CCP side as the Huaihai Campaign).57 However, by the time they got to Nanjing en route to Xuzhou, the Communists were completing their takeover of Xuzhou.58 They were instead redirected to assist the work of a military hospital in Nanjing. Shortly after, they were asked to return to Shanghai in preparation for the eventual move of the NDMC to Taiwan. The short-­lived interventions of the NDMC in the civil war did not preclude faculty from providing medical assistance to KMT leaders. In a prominent case, the NDMC operated on General Chen Cheng, the chief of staff of the Nationalist army. Chen was surveying his troops in North China in 1947 when he suddenly felt unwell. He was admitted to a hospital in North China and diagnosed with a duodenal ulcer. Upon hearing about Chen’s conditions, Dr. Loo Chih-­teh had Chen evacuated from North China to Shanghai and arranged for the NDMC head of surgery, Dr. Zhang Xianlin (1902–69) to operate on the general.59 After several hours of operation, Zhang successfully removed the ulcer from Chen’s stomach, saving his life. Chen Cheng felt that the NDMC was indispensable to his personal health as well as to the health of the nation. After the Nationalists’ debacle in Manchuria in October 1948, Chen thought that it was time that the NDMC should move to Taiwan. In December 1948, Chen ordered the complete transfer of NDMC personnel and equipment to Taipei, Taiwan.60 Chen’s command was part of Chiang Kai-­shek’s plan to establish his last redoubt on the island. Taiwan was then

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under the control of the ROC, which took back the fairly prosperous island in 1945 after 50 years of Japanese rule. The NDMC was the only medical institution in China that was asked to move to Taiwan, as neither the prestigious prewar medical institutions of PUMC nor the Hsiang-­Ya (Hunan-­ Yale) Medical School was asked to do so. NDMC’s fate was tied together with the fate of the KMT government, which had ruled China since 1927.

Managing the Move to Taiwan

Many medical personnel were reluctant to move to Taiwan, as they saw no future with the KMT on the island. This decision depleted the NDMC of much-­needed personnel. Robert Lim wrote on the doctors’ dilemma: The reason why so many [NDMC personnel] have not been able to come

to Taiwan is chiefly one of the financial and political uncertainty. To many, Taiwan is a “foreign” country, a place where one would be for ever [be] banished from family and friends! The expense of bringing one[’s] family and relatives appeared prohibitive, and in view of the political uncertainty, the

possibly that after arrival in Taiwan the NDMC might be adversely affected or abolished so that financial support might cease deterred many who feared unemployment in a “foreign” environment.61

Zhang Xianlin, the surgeon who successfully operated on General Chen Cheng in 1948, passed around a sheet of paper for volunteers to move to Taiwan with the NDMC.62 Nobody signed. Then Zhang signed his name and passed the paper around a second time. This time, a few doctors penned their names, but they were still the minority among the medical personnel. Among those who chose not to go with the NDMC in 1949 was Zhang Jian, the deputy head of NDMC and former director of the Army Medical College.63 Zhang left Shanghai for Guangdong to head the education bureau in the reorganized KMT government, then moved to Taiwan in time before the KMT collapsed on the mainland. He later joined the NDMC. In 1951, Zhang Jian was forced out of the NDMC after being accused of being anti-­ Chiang. He left the NDMC for private practice in Hsinchu, and migrated to America in 1985. Many medical personnel were not just concerned about leaving their families on the mainland or facing potential unemployment in Taiwan, as



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Robert Lim claimed. Chinese medical personnel trained in Anglo-­American medicine had reason to believe that Communist China was likely to demand their expertise. At the same time that Sun Fo (Sun Ke 1891–1973), the new premier of the ROC, asked Robert Lim to take up the position of minister of health in late 1948,64 the Communists announced through their radio stations that they would appoint Robert Lim as minister of health if he would stay on the mainland.65 When Robert Lim rejected their overtures, the procommunist media in Shanghai began claiming that Lim was a Chinese person who did not know Chinese characters. They portrayed Lim as a doctor who “lost his job as the Minister of Health” because he could not handle his two appointments as the head of the NDMC and the Ministry of Health at once.66 Furthermore, a female doctor at NDMC who was the wife of a senior CCP cadre invited doctors to parties at her house and sought to persuade them to go to Manchuria instead of Taiwan, where the Communists would allegedly pay well for their services.67 As a result of her persuasion as well as the general reluctance to move to Taiwan, only slightly more than a third of the faculty and half of the students decided to move with the leadership of NDMC.68 It was no wonder that Lim said in March 1949 that the center lost so many staff that he could not be sure how to restart the school in Taipei.69

Survival and Adaptation in Taiwan, 1949–1952

Upon arrival in Taiwan, the NDMC found rebuilding the institution on the island a struggle due to the lack of proper infrastructure, space, and resources. At Shuiyuan, a small plot of land near the National Taiwan University in Taipei, Robert Lim had less than one-­fifth of the space he had had at ­Jiangwan, Shanghai. The buildings at Shuiyuan had been the barracks of the Japanese artillery forces before 1945 and were much more modest than the plethora of hospitals and clinics left behind by the Japanese in Shanghai that the NDMC had taken over.70 Moreover, as faculty members recalled, there was absolutely no proper infrastructure for living, teaching, and research in Taipei. Trainees had to consume army rations because there was no canteen where fresh food could be cooked.71 They sat on small stools in classrooms and wrote on long wooden benches in front of them.72 There were not enough laboratories and classrooms to host the already few professors who moved from Shanghai to Taiwan.

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Even though Robert Lim faced severe challenges in setting up the CRCMRC, EMSTS, and the first Chinese blood bank during the Second World War, he had several months in each case to develop their infrastructure. The timeline for the move for NDMC from Shanghai to Taipei was more compressed, as Lim and his deputy, Loo, felt the additional pressures to quickly provide housing, food, and jobs for the medical personnel who chose or felt compelled to come over from China to Taiwan. More troubling for the NDMC was the reduction in support from ABMAC, its main source of funds. In January 1949, Allan Lau of ABMAC could not raise the USD 50,000 (USD [2018] 529,500) that Lim had requested a month before, citing the division of the Chinese Americans into different political camps as the key reason.73 Official aid from the US government was not forthcoming to the NDMC from 1949 to 1954, despite the gradual alignment of the United States government’s interests with Taiwan in the early 1950s because of the outbreak of the Korean War. 74 The relative lack of official aid to NDMC suggests that support for the ROC in Taiwan was more rhetorical than substantial and represented a continuity from the prewar and wartime period in China, when there had been little official medical aid from the United States to China. It also highlighted that biomedical endeavors were highly contingent on global fundraising, as there was very little support from the KMT government. The international viability and legitimacy of the NDMC and its affiliation with the KMT were at stake from 1948 to 1954. Even though there was limited monetary support from ABMAC and the US government, Lim leaned on Lau of ABMAC to divert resources bound for mainland China to Taiwan to assist NDMC. On March 1949, three ships bound from the United States to Shanghai were diverted to the port of Keelung in Taiwan, bearing just over 6,008,000 pounds of Quonset huts, drugs, bandages, classroom, engineering items, and lab equipment, of which 14,474 cases were for medical items.75 Similarly, a Pan American Airways aircraft from the United States to Shanghai landed in the same month in Taipei bringing more drugs and amino acids for patients and researchers.76 The US Army-­Navy Procurement Office and Allan Lau worked closely on these shipments; part of the groundwork of their cooperation had been laid when Lim was in America in 1947 making close contacts with various parties. The fortuitous diversion of medical supplies from Shanghai



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to Taipei was a political act, and done with the acquiescence of the US Army, US Navy, and ABMAC. The combined effort of the three actors saved the NDMC from oblivion. These initial supplies, which would not be sent again to Taipei until the late 1950s, were crucial to the reconstruction of the NDMC on the island. The importance of wartime prefabrication technology from the United States in the form of Quonset huts helped reestablish the NDMC’s infrastructure in Taiwan. Designed by the United States Navy in 1941, these aircraft hangar–like buildings were made of a lightweight prefabricated structure of corrugated galvanized steel with a semicircular cross-­section. More than 153,000 of them were produced during the Second World War.77 In the postwar period, they were exported to US bases in South Korea and later to South Vietnam. Lim brought 19 of them to Taiwan and converted them to classrooms, living quarters, and research facilities for the NDMC.78 To overcome the lack of storage spaces for equipment, all laboratory apparatus and supplies pertaining to similar or allied disciplines were centrally placed in one storeroom in a Quonset hut, instead of distributed evenly to all departments.79 Triple bunk beds were installed in the Quonset huts designed as living quarters. However, these living quarters were cramped and vulnerable to communicable diseases. A physician recalled that he contracted tuberculosis from his bunkmate, who was sick and had a bed above his.80

Mergers, Exchanges, and the Politics of Postwar Taiwan

Besides working to build up the basic infrastructure for the NDMC, Lim drew again on his immediate postwar experience to resolve the problem of lack of medical personnel. Robert Lim sought to merge the National Taiwan University College of Medicine (NTUCM, Taiwan daxue yixue yuan) with the NDMC, just as he had incorporated the Army Medical College into the NDMC in 1946. Such a strategy would allow NDMC to instantly have more facilities, professors, students, and accommodations. Lim approached Dr. Tu Tsung-­ming (Du Congming 1893–1986) to inquire if an amicable merger was possible. Tu headed the post-­1945 NTUCM and previously headed the precursor to NTUCM, the Japanese-­era Taihoku Imperial University’s College of Medicine.81 Lim told Tu that a merger would bring benefits of economies of scale and medical unity similar to the establishment of the wartime National

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Southwestern Associated University which had brought together the prewar institutions of Beijing, Qinghua, and Nanjing universities. However, Tu rejected Lim’s proposal, arguing that it would create unnecessary conflict between NDMC and NTUCM personnel, especially in leadership positions. Tu was also concerned that the more experienced professors from the mainland would undermine the growth of the younger Taiwanese professors at the NTUCM. Tu expressed his opposition in the context of a major political event recently experienced by Taiwanese residents in 1947, known as the February 28 or 228 Incident. The incident unfolded on February 28, 1947, when a police officer in Taipei City struck an elderly Taiwanese woman for selling cigarettes illegally. Local Taiwanese confronted the police officer, and a crowd gathered. The officer fired his weapon, killing bystanders. The next day, the Taiwanese held protests in Taipei, and the protests soon spread throughout the island. What was initially a response to police brutality became a wider protest against KMT’s early rule in Taiwan. Many Taiwanese, especially local elites, thought of the regime as intensely corrupt and one that privileged mainlanders unfairly over the Taiwanese in local political and economic appointments. Initially, the mainland troops and officials quickly folded under domestic pressure, and local Taiwanese took over the reins of governing the island. However, the KMT government soon sent reinforcements from the mainland to Taiwan in March 1947, crushing the rebellion. They arrested many Taiwanese elites as well as mainlander elites on suspicion of opposing the KMT government.82 The KMT government allegedly killed between 10,000 and 20,000 Taiwanese and wounded around 30,000 Taiwanese, many of whom were doctors.83 Along with other groups of elites, many doctors fled the island in the ensuing years of martial law known as the White Terror period.84 Among those taken into custody during the 228 Incident were students and faculty members of the National Taiwan University, as well as their families.85 Tu himself was targeted for arrest by the KMT government, but managed to avoid incarceration after gaining the confidence of visiting senior KMT general Bai Chongxi during his visit to Taiwan to assess the aftermath of the incident. Tu also agreed to serve as a provincial councilor under the new governor appointed by Chiang Kai-­shek, affording him some protection from the capriciousness of the KMT state.86



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Tu’s status as a provincial council member, together with Robert Lim’s decision not to bring in KMT state power to force a merger, were likely factors that prevented NTUCM from being merged into NDMC. Lim could have taken a different position, just as he did during the Chinese Civil War, when he intentionally merged the Army Medical College with the NDMC in China in 1946. Moreover, Robert Lim’s deputy and successor, Loo Chih-­ teh, took the typical KMT position that there were no differences between the Formosans (Taiwanese) and the Chinese. In a 1962 speech, Loo argued that everyone living on Taiwan was a “Mainlander,” just that some had lived on the island longer than others.87 Any differences would be akin to separating “New Yorkers” from “Americans.” This was very much the standard KMT argument on the nature of ethnicity on the island from 1945 to the 1980s, with some variations across time and space. It was perhaps fortunate for NTUCM that a more inclusive Robert Lim was still in charge of making key decisions in 1947, even though Loo and the KMT leaders had by that time wielded significant power in Taiwan. Lim and Tu transcended a seemingly intractable political divide by exchanging faculty between the two institutions. Lim invited NTUCM Professor Ye Su (born 1908) to help restart the Pathology Department at the NDMC, as no pathologist came to Taiwan from the mainland. Lim also invited psychology professor Lin Tsung-­yi (Lin Zongyi 1920–2010) to head that department at the NDMC,88 despite the involvement of Lin’s family in the February 28 Incident. Even though the NDMC leadership after Lim remained very openly pro-­KMT, and the NTUCM was much less so, these professional exchanges transcended political differences and helped advance the growth of subdepartments in both institutions. NDMC professors shared their expertise in pharmaceuticals and nursing with the National Taiwan University faculty and students, which allowed the latter to start similar programs on their campus. These transpolitical exchanges aided both institutions as both sides drew upon each other’s strengths. Making the best out of the challenging situation did not equate with physical and academic comfort for faculty members and students. Despite the infusion of Quonset huts, faculty members regularly had classes out in the open due to the lack of classrooms, and meals were often consumed sitting outside in the fields. Cadavers for research were in short supply in

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Taiwan, in contrast to the abundance of cadavers available in Shanghai.89 Salaries remained low as resources were channeled to the broader project of reconstruction. Several faculty members had to sell their blood or hold private consultation outside of their working hours just to make ends meet.90 Morale was low: many reminisced about their relatively comfortable lives in Shanghai, even as they knew in their hearts they would never again return to mainland China. One faculty member remarked that, back in his days in Shanghai, he saw how the Chinese government would allocate the best resources for the NDMC despite the challenges of the civil war. 91 Wang added that classes in Shanghai were conducted without interruption, and the basic instruction was reportedly delivered in a firm and accurate manner. These remarks were perhaps subtle criticisms of the KMT government, which had asked the NDMC to move to Taiwan but had only provided the center with small parcels of land and buildings in poor condition. Their inability to return to the comforts of mainland China meant that they too become “diasporic,” and displaced, even though Taiwan had been ceded by the Japanese to the ROC in 1945 and Taiwan would comprise almost the entirety of the ROC after 1952. In Taiwan, there was not enough for the living to survive on, and not enough of the dead to research on.

Creating the Image of Vulnerable Overseas Chinese

The fruition of the promises of wartime military medicine only fully emerged after 1953, with the establishment of the Foreign Operations Administration (FOA) under the newly elected US president Dwight D. Eisenhower.92 The FOA took over State Department duties relating to international development, assistance to private foreign relief organizations, programs for aiding persons who had escaped from Communist areas, and operating functions with respect to United States participation in the United Nations Technical Assistance Program.93 Advocates of the NDMC saw an opportunity to solicit the support of members of the FOA to assist the medical institution. Heading the department was Harold Stassen, a former governor of Minnesota who hailed from the same state as Congressman Judd, a firm backer of Taiwan.94 Judd stressed at the first meeting in May 1954 with Robert Lim, the US assistant secretary of defense, a Rockefeller Foundation representative, the executive director of ABMAC, and the director of US Public Service to pay



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special reference to “11 million overseas Chinese,” who were vulnerable to the Communists’ calls for them to head to Mainland China for medical studies.95 There was an urgent need to have them move towards Taipei instead of Beijing, which had become the capital of the PRC led by the CCP. Robert Lim concurred, arguing that 90 percent of the 11 million Overseas Chinese were from Fujian, speaking the same dialect as the people of Taiwan, and thus amenable to the educational conditions and linguistic environment of the island. A few attendees concluded that Taipei would become the “second Cairo” in Asia, drawing students from Vietnam, Thailand, Philippines, and other pro-­American states in Southeast Asia.96 Loo Chih-­teh, who by now had taken over the reins of NDMC after Robert Lim’s move to the United States to fulfill his long-­standing desire to return to academia, also saw this new initiative as an opportunity to attract more funding for the institution. At the second meeting in Washington, Loo declared his intention to raise admission rates for Overseas Chinese applicants. This would entail raising the overall rate of admission from the present 10 percent to 25 percent of applicants, with special quotas reserved for international students.97 To accommodate more students, Loo called for a massive expansion plan that included the construction of new dormitories, classrooms, laboratories, and residences. It also meant increasing the number of faculty, administrative, and technical personnel, as well as the sponsoring of more scholarships for NDMC students and faculty to study in the United States. These measures would raise student enrollment by 60 percent from the current 220 students to 352 students per annum. In so doing, this not only would raise the number of competent medical and other personnel for “Free China and other Southeast Asian nations,” but would also “divert the stream of those [Overseas Chinese] now going to Communist China and thus constitute a signal psychological gain for the forces of freedom.”98 Loo’s ambitious agenda for NDMC dovetailed with Judd’s wider aims of promoting anticommunism in the region. The working group consequently endorsed the proposal.99 A medical committee made up of doctors from Harvard University, the University of Minnesota, and the University of California accepted the NDMC proposal.100 But it was Harold Stassen who first replied favorably, recommended the Foreign Operations Administration proposal to the medical

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committee, and appointed B. A. Garside of ABMAC to disburse the first USD 114,000 (USD [2018] 1.08 million), to the NDMC to allay ABMAC fears of being sidelined.101 The act of giving was explicitly political, aligning the interests of the newly elected Eisenhower administration with those of ABMAC, Judd, and the NDMC. A few days later, it was apparent to the NDMC that the Foreign Operations Administration had approved a sum of USD 1.2 million (USD [2018] 11.2 million) to be disbursed to the institution over three years. Garside, whose relationship with Lim and Loo had had its ups and downs since the Second World War, delighted in his new role and quickly approved Loo Chih-­teh’s request to spend USD 100,000 (USD [2018] 936,000) on laboratory equipment and the rest on new buildings such as an audiovisual laboratory and on local administrative assistance for the NDMC.102 The Overseas Chinese had now become objects of interest of a variety of actors by 1954. American conservative politicians, US government officials, NDMC personnel, and even Robert Lim appropriated the specter of vulnerable Overseas Chinese for their own purposes. Similar efforts by the Ministry of Education in Taiwan to enlist the help of the United States government to compete with the mainland authorities for the enrollment of Overseas Chinese were also pursued independently around the same time.103 The ministry received assistance from the newly formed Sino-­American Liaison Committee in 1954 to expand and improve educational infrastructure to accommodate an increase in the Overseas Chinese enrollment in Taiwan. These independent efforts yielded the result of a much more international NDMC. At the NDMC, more Overseas Chinese enrolled with the resources provided by the FOA. As shown in figure 5.4, more Overseas Chinese medical students enrolled at the NDMC from 1954 to 1958 as a percentage of the overall number of students, hitting a high of 49 percent in 1956 (34 out of 69 students).104 This rise, however, was temporary, as it settled to a rough average of 15 percent by 1959, which persisted till 1981. It was clear that Loo considered the Overseas Chinese more as an important short-­term tool to solicit official funding from the United States government than as a long-­term strategy once other forms of funding were available from the United States. For example, Loo did not reply immediately to Lau’s request on January 18, 1955, when the latter inquired about the logistical and financial aspects of training of Overseas Chinese students at the NDMC.105

B I O M E D I C I N E A C R O S S T H E T A I WA N S T R A I T S

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Figure 5.4. A graph showing the number of Overseas Chinese and ROC nationals enrolled at the NDMC from 1951 to 1981. Source: Guofang yixue yuan, Guofang yixue yuan yuan shi, 381–89.

Allan Lau had asked Loo to account for the number of Overseas Chinese students admitted between 1953 to 1954, the total number of Overseas Chinese who had studied in Taiwan, regulations covering military training for Overseas Chinese students, the cost of transportation for Overseas Chinese students, and the cost of training a student for one year at the NDMC, as well as the number of NDMC Overseas Chinese students graduating and returning to their homes. Lau claimed that these details were needed to inform potential donors on the cost of training an Overseas Chinese student from Singapore, Thailand, Indonesia, or the Philippines at the NDMC. However, it took Loo two-and-a-half months to state in a report that the NDMC admitted 18 Overseas Chinese medical and pharmaceutical students in 1956.106 This figure was lower than from the years of 1952 (19), 1951 (33), and 1950 (12), even though it was somewhat higher than the admission figures for 1953 (4) and 1954 (1). In addition, Loo admitted that the Overseas Chinese students paid for their own education and had to render two years of military service, which differed from the earlier understanding from ABMAC that self-paying Overseas Chinese need not serve the ROC military. Such a view was confirmed by Major T. M. Peng of NDMC in a July 29, 1954, meeting, where argued that the Overseas Chinese students should be

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self-­supporting “and required to serve in the army for only two years after graduation.”107 No officers of NDMC mentioned facilitating a return trip for these students, suggesting that part of serving in the military was to prepare these students to become ROC citizens in Taiwan. It was clear that the NDMC preferred a policy of assimilating Overseas Chinese into “Free China,” in this case the ROC on Taiwan, diverging from the Americans who preferred that these Overseas Chinese return to Southeast Asia to build up the medical services there, to validate the superiority of a noncommunist medical system. Even though the NDMC could provide quality medical education for Southeast Asian Chinese with this expansion brought about by Foreign Operations Administration money, it was unable to provide the monetary or personal incentives for the Overseas Chinese to come in large numbers or for them to leave Taiwan and return to their home countries.108 The loss to Southeast Asia was Taiwan’s gain. Yeh Shin-­Hwa (Ye Xinhua, 1928–2017), a prominent nuclear scientist and doctor in Taiwan, was an example. Yeh grew up in the Dutch East Indies (present-­day Indonesia) and received his secondary education in Hangzhou, China.109 After completing high school, he enrolled as an NDMC student in Shanghai in 1948. Before long, he was asked, like many of his friends, to move to Taiwan. Yeh supported the move, because he thought that the Communists were “using people as instruments for their own purposes” (gongchandang ba ren dang cheng gong ju). After graduating in 1955 from the NDMC, Yeh worked as a radiologist at the 801 General Hospital in Taiwan. After eight years as a radiologist, he enrolled at Stanford University to study nuclear medicine. Upon returning to Taiwan in 1968, Yeh set up the first nuclear medicine center at the Taipei Veteran Hospital. Even though Yeh never returned to work in postindependence Indonesia, his expertise greatly benefited the growth of nuclear medicine in Taiwan, and he became a beneficiary, like many, of the NDMC’s policy of allowing Overseas Chinese students to enroll in its facilities back in the days of the civil war. The Foreign Operations Administration–funded expansion of the NDMC in the 1950s greatly expanded the NDMC’s capabilities. From 1955 to 1957, the organization not only provided for the initial construction of buildings and lab equipment, but also sponsored 15 fellowships for local students and faculty, subsidized the salaries of 42 instructors and the cost of



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running administrative and teaching departments, paid for 1,000 mosquito nets, bought 1,200 mattress covers, and funded the construction of 12 dormitories of 40 students, 6 classrooms, and 18 faculty residences.110 The NDMC as well as the Council for United States Aid supervised the construction of the buildings, through a new official contract known as the Counterpart Fund Agreement.111 In addition, the Foreign Operations Administration’s support for the NDMC in 1954 opened doors for the NDMC to benefit from other US aid projects. The International Cooperation Administration and the Council for US Aid funded NTD 53 million, or around USD 1.33 million (USD [2018] 12 million) in 1956 for the construction of the Veteran General Hospital in Taipei (Taibei rongmin zong yiyuan).112 The hospital was subsequently given to the NDMC as a teaching hospital, which remains a key affiliate of the NDMC to this day. Unofficial aid also continued to pour in. Chinese Americans donated generously to ABMAC in solidarity with the international noncommunist camp after the outbreak of the Korean War, and, in turn, ABMAC had the funds to donate USD 120,000 (USD [2018] 1.02 million) to the NDMC in 1960 to construct an “ABMAC village.” This village hosted faculty members in 10 four-­family residential units, allowing them to leave their accommodations in the Quonset huts.113 In addition, the Upjohn Company in the United States donated 9 million multivitamins to NDMC personnel.114 Furthermore, the National Federation of the Business and Professional Women’s Clubs in the United States, together with ABMAC and the China Medical Board, contributed funds intermittently from 1945 to 1956 to support the NDMC Nursing School,115 and American nurses such as Gertrude Hodgman, the director of nursing at New York University, flew to Taiwan to assist General Chou Mei-­yu.116 Finally, former ABMAC director Alfred Kohlberg’s family donated USD 130,000 (USD [2018] 1.08 million) to build the three-­story Alfred Kohlberg Memorial Laboratory at the NDMC in 1962, as well as an unspecified sum for the Ida Kohlberg Kindergarten at the ABMAC village after Alfred Kohlberg’s death in 1960. 117 The Cold War might have saved Taiwan and, by extension, the NDMC, but it was contingent on the efforts of transnational actors in Taiwan and United States, many of whom had worked in the field of biomedicine since the pre–Civil War days. Understanding of the active agency of the NDMC

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leaders in reaching out to their American counterparts complements recent scholarship that emphasized the role of Taiwanese technocrats, technologists, and experts in corralling resources, implementing policies, and facilitating development with the assistance of US aid agencies specifically set up to help the ROC, namely the Council for United States Aid and the Sino-­American Joint Commission on Rural Reconstruction ( JCRR).118 Moreover, NDMC’s multifaceted Cold War strategy in the 1950s was a harbinger for the broader ROC government’s strategy in the 1960s. This Cold War strategy in the 1950s manifested a decade later when the ROC authorities declared Taiwan in 1968 “as a model province of China,” in contrast to the allegedly failing Communist Chinese economy mired in the excesses of the Cultural Revolution. The ROC’s rhetoric revealed the Cold War ideology that underpinned the rationale for Taiwan’s scientific and technical development.119 Moreover, the NDMC’s 1950s recruitment of Southeast Asian Chinese predated the JCRR and the Taiwanese government’s technical assistance to South Vietnam from 1961 to 1974 and to pro-­American regimes in Southeast Asia after 1972 through the Asian Vegetable and Research Development Center. Established in South Taiwan, the center extended agricultural technical assistance to the Philippines, South Korea, and Thailand.120 In the long run, the Overseas Chinese immigrants arguably shaped Taiwanese society as much as technical assistance aided the ROC’s foreign policy goals. By staying in Taiwan of their own volition, they affirmed the superiority of an anticommunist society that valued their expertise in biomedicine, even though they might have betrayed the original intention of the Americans for them to return to Southeast Asia. Their experiences as highly skilled immigrants to Taiwan, however, were not fully representative of the struggles faced by other types of immigrants. Many Southeast Asian migrants, especially working-­c lass migrants who could not claim ethnic Chinese descent, faced discrimination by their Taiwanese employers in their workplace.121 Even ethnic Chinese intellectuals and cultural entrepreneurs from Malaysia were often seen as outsiders to Taiwanese society,122 even though they were often well assimilated in Taiwanese society due to their long-­standing consumption of Taiwanese popular culture from the Malaysian Chinese media.123 Still, the multifaceted imaginations and roles of the Overseas Chinese in Southeast Asia were central to the



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consolidation of the NDMC in Taiwan and also to the post–Cold War identity of the ROC regime.

The Emerging Fruition of Wartime Biomedicine in Taiwan

The postwar NDMC maintained its wartime philosophy and commitment to training as many medical personnel as possible without sacrificing the depth of the curriculum, as it had had to during the Second World War. As early as 1947 when the center was taking shape, Robert Lim was aware of the problem of such a trade-­off: With larger numbers [of students], it is to be expected that the average

scholastic standard will be lowered. On the other hand, the number of able students should be raised. By making every effort to maintain adequate standards, and adopting the honor system to cultivate available talent, quality need not be sacrificed to quantity.124

During the Second World War, leaders favored a short three to four months of mass training of medical personnel to treat the wounded and the sick in China. However, this form of training appeared to be so much less rigorous than the prewar six-­year medical education that Robert Lim had proposed an alternative six-­year stage medical curriculum to bring greater depth to the medical education. The proposal was ultimately shelved in favor of the status quo. Part of that proposed six-­year plan would have introduced a “premedical” program that would bring potential trainees up to speed to embark on a medical program. Potential trainees would improve their rudimentary knowledge of science, mathematics, and language under that premedical program. At the NDMC, such a vision came to fruition as an initial preparatory program of four months was built into an extended six-­and-­a-­ half-­year medical program by 1963.125 These four months sought to provide potential medical students with the necessary premedical knowledge needed to succeed at the NDMC. Furthermore, the NDMC sought to extend its wartime emphasis on developing a curriculum that stressed the practical studies and implementation of the sciences. During the Second World War, such an emphasis manifested in the instruction of combined sciences (an interdisciplinary curriculum of

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physics, chemistry, and biology), the provision of learning through fieldwork and demonstrative drills, as well as placing students with actual Red Cross personnel. In Taiwan, the policy of the wartime emphasis on combined sciences continued in the formal establishment of the Biophysics, Biochemistry, and Biomorphics Departments. The Biomorphics Department, for example, handled all teaching in general biology, comparative anatomy, developmental morphology, pharmaceutical botany, and gross, micro-­, and neuroanatomy.126 This system enabled one department head to administer, co-­relate, and supervise all teaching of the various subjects within his field, thus economizing on space, teachers, and teaching aids. Even though the bulk of learning through lectures and laboratory work signified a more traditional return to prewar medical education norms, the NDMC emphasized the importance of hands-­on learning through requiring all students to undergo a year-­long rotating internship before graduation. A student recalled that the members of the NDMC grew “to appreciate more the value of internships” (shixi) in contrast to a mere textbook understanding of the biomedical sciences.127 He recalled spending half a year of internship undergoing apprenticeship ( jianxi) at two hospitals, where surgeons at the hospitals demonstrated their skills to NDMC students. These efforts at promoting hands-­on instruction, learning, and observation culminated in the construction of a teaching hospital at the NDMC in 1959. More critically, the wartime philosophy of mass medical education continued with the NDMC without the accompanying wartime characterization of the lack of rigor associated with mass medical training. From 1947 to 1962, the NDMC trained a total of 14,132 medical personnel, 13,946 of them in Taiwan. 128 This was comparable to the numbers trained by the EMSTS during the war, but at a significantly higher level of quality due to the longer periods of training and the availability of advanced laboratory and classroom equipment by the 1960s. The cost of training a student for a year in 1963 was around USD 834 (USD [2018] 6,839), a figure that was considered relatively modest at the time.129 For a universal health care system to cope with the demands of more patients who would be brought in, a critical mass of medical personnel was needed. This vision for a universal health care program in Taiwan brought to fruition parts of Robert Lim’s 1937 vision for state medicine in China, where every person would have access to health care paid for by the



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government.130 The post-­1995 Taiwanese health care system is a variation of a socialized health care system that incorporates medical choices with a requirement that all Taiwanese pay a modest monthly premium into a national insurance fund and, subsequently, a nominal fee when consulting a doctor or a dentist. This nominal fee prevents too many visits by patients while giving patients the choice of which physician or dentist they wish to visit. It has been critically lauded around the world for providing access to health care to most Taiwanese, even as it faces problems with funding today.131 The constant need for upgrading of the institution into the 1970s not only justified the relationship between ABMAC and NDMC but also provided for a strengthening of medical research as well as medical knowledge transfers from the United States to Taiwan. There was a significant increase in the number of exchanges between the United States and Taiwan, with many Chinese American and British Chinese professors and doctors visiting Taiwan in the 1970s to assist the doctors at the NDMC.132 In 1972, for example, three Overseas Chinese professors visited the NDMC: Prof. S. C. Wang of Columbia University, Prof. K. H. Lee from the University of California, and Dr. C. K. Wong from United Oxford Hospitals in England. Likewise, graduates of the NDMC were often given fellowships by ABMAC to study in the United States to develop their interests in more specialized medical fields. Some graduates returned to assist in the military hospitals and training schools in Taiwan,133 while others emigrated and worked in the United States and donated money for infrastructural projects of the NDMC. For example, Dr. Ying S. Mok, a 1962 medical graduate who was working in Evansville, Indiana, donated an unspecified amount of money to renovate the biophysics laboratory.134 NDMC doctors also wrote to consult their counterparts in the United States on challenging medical cases. In June 1972, the acting head of radiotherapy at NDMC wrote to his counterpart at the MD Anderson Hospital and Tumor Institute for medical advice on how best to treat a 68-­year-­old high-­ranking government official suffering from tuberculosis associated with a tumor mass in his body.135 Medicine at NDMC and, by extension, in Taiwan was global and diasporic by this period. By the 1970s, NDMC also saw a surge in research projects with the bolstering of facilities. With the help of ABMAC and the China Medical Board, the construction of the Alfred Kohlberg Laboratory in 1965, the

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construction of the Allergy Research Center, the Pharmaceutical Research Institute, and a new library in 1976 assisted this growth. In 1963, 26 projects were under way, many of them conducted at the new research laboratory.136 By 1973, more than 45 new research projects had been initiated, with almost 50 satisfactorily conducted by then.137 Finally, the NDMC elevated the status and role of nursing in Taiwan through the accreditation and professionalization of nurses. During the Second World War, Chou Mei-­yu led the nursing program at the EMSTS. Nurses trained by the program entered the Chinese military to assist wounded and sick soldiers on the battlefront. They did not enjoy a high status within the military or Chinese society, even though they were tasked with the challenging responsibility of taking care of the sick and wounded. They were sometimes disparaged by the local Chinese and American authorities. The Chinese authorities often suspected EMSTS nurses of being politically sympathetic to the Chinese Communists, and the American army officials based in China thought that Chou was too adamant about taking control of the food budget and improving the diet for sick patients.138 Robert Lim grew increasingly concerned about the treatment of Chou and her fellow nurses and felt that part of that disrespect came from their low ranks within the military. After the Second World War ended, Lim promoted Chou from major to colonel. In 1956, Chou was promoted to the rank of general, making her the first nurse in Chinese military history to have that position. With her newfound authority, Chou instituted reforms to boost nursing education, such as the directive to bestow bachelor’s degrees on nurses on the academic track, which meant that degree holders could become instructors at nursing schools and hospitals.139 They could become officers in the ROC military in Taiwan, elevating them from the noncommissioned ceiling in mainland China. Chou also introduced a master’s program in nursing. Many nurses from that program went on to America for further studies before returning to Taiwan to head nursing departments in hospitals across the island. From 1946 to 1954, the nursing school graduated 133 graduates, of whom 104 remained in Taiwan.140 Throughout the 1950s, Chou solicited money, books, and scientific journals for the nursing program at the NDMC from the United States. The Business and Professional Women’s Clubs (1952),141 the Hunter College Chinese Students Club (1954),142 the American Journal



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of Nursing Company (1955), 143 and the Los Angeles branch of ABMAC (1959)144 all raised modest amounts of cash and supplies for the center’s nursing program at the urging of Chou and her collaborators. During the Japanese colonial period in Taiwan, nurses were trained in an ad hoc manner by local hospitals rather than in a systematic fashion in a medical or nursing school.145 Moreover, the colonial authorities emphasized the ideal of the subordinate and submissive female nurse in the hospital. Chou sought to reform Taiwanese nursing practices, which she claimed were discriminatory towards nurses.146 She threatened to stop sending nursing interns to Taiwanese hospitals if the personnel compelled nurses to lie on tables instead of letting them rest on proper beds. In addition, Chou persuaded Taiwanese hospitals to install female toilets for nurses, rather than have them share restrooms with their male colleagues. Finally, she told leaders of Taiwanese hospitals that nurses were not meant to raise chickens or to wash clothes for patients. Nurses were meant to take care of patients in a scientific manner to alleviate their ailments, and were meant to assist doctors in medical duties. Her authority allegedly forced Taiwanese hospitals to change their practices, thereby elevating the status of nurses in hospitals. Chou argued that her reforms upgraded nurses from a purely vocational job to a viable professional career. The upgrading of nurses on the island reflected the NDMC’s overall importance in Taiwanese medical history, even though its significance unfolded over a long period of time. From 1949 to 1957, it was the main center that trained medical personnel. By the 1962, the NDMC had trained around 14,000 medical personnel. In contrast, the National Taiwan University College of Medicine trained fewer medical personnel, around 2,300 from 1949 to 1962.147 Yet, this process took a significantly longer time than a similar process during the Second World War, where the EMSTS and the CRCRMC were quickly established over a period of three to four years with assistance from the Overseas Chinese and their allies abroad. In contrast, the full-­fledged development of NDMC as a comprehensive medical training and treatment center developed over a period of 15 years. Such a comparative length highlights the importance of the Second World War as an unprecedented catalyst that mobilized resources around the world for the growth and development of wartime biomedicine. In contrast, the case of the NDMC illustrated the counterintuitive nature of medical reconstruction, which often took longer

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and sustained more setbacks than wartime development. The victory of Dwight D. Eisenhower, the general support by the Overseas Chinese and ABMAC, and the continual commitment of United States legislators and military officials to defending Taiwan provided the time and opportunity for NDMC leaders to reconstruct biomedicine in Taiwan.

Reconstructing Biomedicine across the Straits

The reconstruction of biomedicine in the ROC during the Civil War and Cold War period—in the form of strengthening quantitative analysis of medical phenomena, teaching combined sciences, consolidating existing medical institutions, enhancing veteran rehabilitation, expanding medical education, constructing infrastructures of medical research, and elevating the status of nursing—was a contingent historical process. The alliance between the United States and the ROC allowed Robert Lim to broaden the use of mobile medical units, appropriate Japanese resources to speed up the reconstruction process, and appeal to his supporters in the United States. Moreover, the postwar period allowed Lim to consider his wartime experiences in establishing the NDMC as well as the Chinese Army Medical Services. This was reflected in the continuity of key NDMC personnel from the prewar days of PUMC and the wartime EMSTS, the deepening of the relationship between the KMT and NDMC, the conception of a six-­year medical curriculum, and the emphasis on pyrogen and blood substitute research. However, the elusiveness of peace with the defeat of the KMT in mainland China meant the disruption of biomedical reconstruction on the mainland. That mission had to be taken to Taiwan. Of those who joined the NDMC in Taiwan, they faced a postwar Taiwan that struggled to cope with the huge influx of migrants from the mainland and a hostile international environment where support from the United States and the Overseas Chinese was rapidly declining. The US Central Intelligence Agency in 1949 gave the KMT in Taiwan no chance of survival against a possible attack on the island by Mao.148 Even if the ROC survived such an attack, the agency did not believe Taiwan could evolve beyond a middle-­income polity with basic medical services. The tenacity of Robert Lim, Loo Chih-­teh, and Chou Mei-­yu and the Eisenhower administration’s setting up of a friendly FOA, together with the strategic use of the Overseas Chinese by conservative American



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politicians, ABMAC, NDMC personnel, and Foreign Operations Administration personnel were crucial to the NDMC’s early institutionalization on the island. Rejecting the straightforward narrative of the United States inevitably aiding Cold War Taiwan because of the Communist threat in Asia allows us to understand the particularistic elements in the late 1940s and early 1950s. Conditions on both sides of the Taiwan Straits were volatile, and many people the world over had deep skepticism about Chiang Kai-­shek, which translated into lack of support for an NDMC with ties to the KMT military. The reconstruction of the NDMC throughout the 1950s also presented a viable solution to the long-­standing tensions in medical education in China between meeting the needs of a wider population and fulfilling the responsibilities of training competent medical doctors, nurses, and technicians. In providing a dual track of vocational and academic studies, NDMC could attract and train students for its longer medical program while deflecting potential charges of elitism that befuddled the PUMC. It is noteworthy that the six-­and-­a-­half-­year program at NDMC, which focused on combined sciences, was significantly shorter than the PUMC’s eight-­year Johns Hopkins University program, which allowed doctors to be trained more quickly without sacrificing rigor. The focus on upgrading the skills, rank, and credentials of nurses strengthened Taiwan’s health care services. The higher status of nurses in Taiwan contrasted with the lowering of the status of nurses in mainland China, where the PRC government discontinued the higher education of nurses in 1952 in favor of educating nurses as purely supportive personnel whose role was primarily a provider of injections and medications.149 After 1979, the PRC reversed course but struggled in training nurses after such a long hiatus. As a result of the postwar intervention, as well as 1990s reforms towards a universal health care system, Taiwan had the third-­highest level of physician-­to-­patient ratios as well as the third-­highest level of nurse-­ to-­patient ratios in Asia in 2018.150 The multiple threads of the Overseas Chinese were central to postwar reconstruction, broadening the range of the meanings of the Chinese diaspora to biomedicine in China and Taiwan. Being Overseas Chinese was critical in Robert Lim’s medical leadership. Lim’s language skills, medical expertise, military medical knowledge, and cross-­cultural administrative capabilities were part of his identity as an Overseas Chinese who grew up in Singapore,

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studied in Edinburgh, and worked in Britain, America, and China. In particular, Robert Lim’s native dialect Hokkien shared similarities with Taiwan’s own dialect, Taiyu. Lim’s prewar and wartime experiences endowed him with expertise and credibility, and his status as a Hokkien Chinese allowed local Taiwanese to see Lim as less of an outsider, as many saw those who came from mainland China as outsiders. Besides Lim’s leadership, the advent of the Cold War reframed the opportunities available for the NDMC to enlist the diaspora for the advancement of the NDMC. During the Chinese Civil War period, many Overseas Chinese were reluctant to support ABMAC and the NDMC. Yet, their temporary reduction of financial support from Nationalist China did not mean they became less important. Many Overseas Chinese studied at the NDMC in Taiwan and stayed on in Taiwan to become medical leaders on the island. More significant was how they became subjects of Cold War competition, whose vulnerability to Communism would be used to solicit long-­term US funding and support for the development of western medicine in Taiwan. The phenomenon of Overseas Chinese graduates staying in Taiwan to bolster its biomedical research augments Steven Phillips’s research on the ROC’s Overseas Chinese Affairs Commission’s active, but ultimately fairly unsuccessful, outreach to the ethnic Chinese community in Southeast Asia from the 1950s to 1970s.151 Even though the ROC failed to persuade a majority of Southeast Asian Chinese to back their agenda against Beijing publicly, the country’s commitment to Southeast Asia paved the way for Overseas Chinese medical talents to study and remain on the island. The Chinese diaspora remained important to biomedicine in Taiwan. The global history of biomedicine in China is a history of formulating institutions that sought on the one hand to adapt imported ideas, concepts, and materials to local conditions and, on the other hand, to maintain a rigor of medical curriculum that would solve the vast medical problems in the country. In Taiwan, the promise came to fruition as medical outcomes improved on the island with the dramatic increase in the number of doctors, nurses, and dental personnel, many of them trained at the NDMC. Collectively, it worked for Taiwan even as, for the individual institution of NDMC, there were ways that the enterprise was tremendously challenging, such as the inability to integrate more Taiwanese doctors and resources into the NDMC system, the limitations



B iomedicine across the T aiwan S traits 195

posed by the spartan conditions of 1950s Taiwan, the boom and bust of US official and unofficial assistance from 1945 to the 1960s, and the disruptive changes in medical personnel when the institution moved from Shanghai to Taipei. What was consistent then was the dedication of many ABMAC personnel to that endeavor of building up western medicine in China, as well as the unwavering commitment of Robert Lim and his Overseas Chinese colleagues to the cause of military medicine in China and Taiwan.

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CO N C LU S I O N

Legacies of Global Medicine

Af ter almost three decades fighting the plague and promoting quarantine methods in China as an Overseas Chinese medical expert, Wu Lien-­teh ended his career in private practice in Penang in 1937.1 In Penang, Wu turned his attention towards publishing his memoir, which he did in 1952.2 Wu’s legacy lives on in the response to Coronavirus Disease 2019 (COVID-­19) pandemic, which first appeared sometime in Wuhan, Hubei Province, China, in December 2019. The virus quickly spread across mainland China, infecting more than 84,000 people and causing more than 4,600 deaths as of June 15, 2020.3 This global pandemic has also spread to 227 countries and territories, infecting more than 7.9 million people, and killing more than 434,000 people. Wu’s directives that medical personnel wear masks, infected bodies be cremated, travel restrictions be implemented in affected regions, quarantine facilities rapidly constructed, and strict home-­quarantine be imposed were mirrored by the present Chinese government. Chinese authorities implemented several familiar measures, notably the rapid construction of a special care hospital, imposition of a broad range of travel restrictions over time, and the use of drones to ensure that residents not leave their homes unnecessarily and without a face mask.4 The Chinese government touted the measures as key to claims that it had successfully eradicated the spread of COVID-­19 within its borders as of March 18, 2020, even as limited community transmission reemerged in May and June of 2020.5

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Even though Chinese media explicitly invoked Wu in early 2020 as an inspiration for its exemplary pandemic control,6 the Chinese government shared little of Wu’s conviction that the successful control of the pandemic required international trust, awareness, and cooperation. In the 1911 International Plague Conference, Wu impressed upon participants from around the world the importance of open debate in developing scientific consensus on the etiology, diagnosis, prevention, and treatment of the plague. In the 1920s, Wu immediately reached out to the Russians, Americans, and Japanese for supplies and expertise when epidemics broke out in Manchuria and international support kept these diseases under control. In contrast, China saw the COVID-­19 fight in 2020 as a largely domestic affair. Wuhan officials suppressed the initial concerns of doctors in December 2019 because they were afraid of spreading panic. Physicians had called on the government to investigate the outbreak of an unknown virus that was similar to the Severe Acute Respiratory Syndrome coronavirus of 2003, which infected 8,096 people and killed 812 people around the world from February to June of that year.7 It was only on January 23, 2020, that China imposed a belated travel ban in Hubei after seeing the possibility of the virus spreading unabated throughout the country during the Lunar New Year holiday. Still, the 5 million who had departed from the province before the lockdown quickly spread COVID-­19 across China and the world.8 As the virus spread, the Chinese government refused to admit US Centers for Disease Control and Prevention personnel into the country in late January, making it difficult for outside experts to verify claims of China’s antipandemic efforts.9 It was only on February, 16, 2020, that 12 international experts (including two from the United States) could visit China for eight days as part of a World Health Organization (WHO) delegation.10 The visitors were initially denied access to Wuhan, the epicenter of the outbreak.11 China later relented and allowed three experts to visit the city but only for two days.12 The other nine experts stayed mostly in Beijing, Chengdu, and Guangdong, a contrast to Wu Lien-­teh’s insistence on holding the 1911 plague conference at the center of the outbreak in Manchuria.13 Based on their observations of China’s alleged successes, the WHO recommended that governments around the world reconsider their travel ban on China.14 Ironically, China would institute its own travel ban on foreigners a few weeks later.15

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China’s desire to keep a tight rein on international scrutiny of her claims of successful anti-­pandemic efforts might have contributed to the misplaced trust Spain, Czech Republic, and Britain’s had put in China’s test kits, which they imported in great numbers. Seventy percent of the COVID test-­kits imported into Spain, as well as all 3.5 million Chinese test kits to detect antibodies to COVID-­19 imported into Britain, were faulty.16 Leaders and journalists around the world cast doubt on Chinese claims of zero domestic infection rates as well as reports on death rates from the virus.17 Two National Public Radio (NPR) reporters, for example, visited Wuhan and revealed that the Chinese authorities were likely to be undercounting potential COVID-­19 cases by excluding asymptomatic cases.18 Two weeks later, NPR reported that Wuhan “made a huge upwards adjustment” by including another 1,290 deaths to its previous count in March to account for reporting delays and omissions.19 While a purely domestic approach culled infections within China, adopting Wu’s transparent and global approaches to pandemic control might have mitigated the spread of COVID-­19 around the world and improved international trust in the Chinese government’s claims of success.

Legacies of Wartime Medicine

Lim Boon Keng retired in 1937, to Singapore, after having established Xiamen University as a center for biology and the sciences in South China.20 American-­educated former blood bank publicity officer Adet Lin left China for the United States in 1946. She maintained her interests in international affairs and China as a prolific writer and employee of the Voice of America.21 Lin later spent some time in Taiwan working on a book introducing the National Palace Museum to a western audience.22 Robert Lim made his way to the United States in late 1949 and worked at the University of Illinois and Creighton University, before finishing his career at Miles Laboratories in Indiana. Robert Lim remained involved in the medical affairs of Taiwan as well as the NDMC. As shown in chapter 5, Lim actively contributed his views on NDMC’s funding and operations as a senior member of ABMAC in the United States. Moreover, Lim made multiple visits to Taiwan between 1950 and 1968. As seen in figure 6.1, Lim met with Chiang Kai-­shek in 1968 during a six-­month stay in which he sought to set up a neuro-­physiological laboratory.23 Meanwhile Stateside, Allen Lau of ABMAC relied on Lim’s

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Figure 6.1.  Robert Lim meeting with Chiang Kai-shek in Taiwan in 1968. Source: Academic Historica Archives, “Zongtong Jiangzhongzheng jiejian Linkesheng boshi,” May 3, 1968, File no. 002-050101-00070-045.

advice in such matters as problems with Taiwan’s army nutrition program.24 Similarly, Lim’s fellow Overseas Chinese doctor O. K. Khaw moved with Robert Lim from China to Taiwan to work at the NDMC after 1949. Khaw, who had headed the prewar Department of Parasitology at PUMC and the postwar Department of Parasitology at Taipei’s NDMC, constructed the first American-­style blood bank in Taiwan in 1954 and became its director.25 Recall in chapter 3 that Khaw went on to design other blood banks in Taiwan including the one at Keelung hospital, which opened in 1955. Upon his foundations, Taipei developed one of the most extensive outreach programs for blood donations anywhere in the world, and mobile units are ubiquitous throughout the city today. Yi Chien-­lung, the Canadian-­and American-­ trained director of the wartime blood bank, chose to stay on the mainland after the Communists defeated the Nationalists in 1949. Yi became the deputy director of the Hsiang-­Ya Medical College (formerly Hunan-­Yale Medical College) in 1949.26 In the first few years of the establishment of the PRC, Yi published six articles on physiology, nutrition, and blood types and transfusion in China.27 After 1956, Yi ceased active publication as overall

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biomedical research in China declined after this period. In contrast, Robert Lim and O. K. Khaw maintained an active research agenda in the United States and Taiwan. After 1949, Lim published twenty-­one articles, many on the neurophysiology of pain,28 and Khaw coauthored more than six publications on parasitology research across Taiwan.29

Development of Biomedicine in the PRC

As biomedicine was increasingly professionalized in Taiwan, it became increasingly politicized in mainland China. In Taiwan, medical research expanded with the help of the United States. Quality of medical services was assured by a centralized system of professionalization that required years of medical training for physicians, certification of doctors and nurses through formal training in medical institutions, and continual American endorsement of medical services and training. In contrast, Mao opposed such as a system as elitist and demanded that biomedical doctors, institutions, and practices serve the people rather than prioritize their own professional growth or engage with their Western counterparts. Serving the people meant serving the wishes of the CCP led by Mao Zedong, since the latter purportedly represented the Chinese masses. The CCP took four steps to nativize, discipline, and mobilize physicians between 1949 and 1980. Their strategies drew on the Overseas Chinese’s institutionalization of biomedicine in pre-­1949 China, even as they worked towards dismantling the global cooperation that underpinned their development. First, the CCP insisted in 1953 that biomedical doctors learn the tenets of classical Chinese medicine to fulfill the vision of an integrated Chinese and Western medicine in the country.30 Such a combination of Chinese and Western medicine shared philosophical similarities with the prewar efforts of the Overseas Chinese at promoting biomedicine through integrating the study of CCM treatment and pharmaceuticals, although the CCP’s desire at merging these two schools of medicine was much stronger and more comprehensive. The CCP compelled doctors to learn both Chinese and Western medicine. Their efforts were met with mixed success, as Volker Scheid argues that the number of biomedical doctors studying classical Chinese medicine gradually declined over time, with the last full-­time students enrolling in such a program in Shanghai in 1960.31 It appears that the efforts at unifying

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Western and Chinese medicine were aimed primarily at helping the newly enshrined Traditional Chinese Medicine (TCM) doctors secure access to medical resources previously held by the doctors of Western medicine.32 This process culminated during the Cultural Revolution, when Mao ordered the formation of a new group of physicians known as the “barefoot doctors” to head to the countryside in 1968. These predominately TCM doctors gained access and knowledge of biomedicine and deployed both systems of medicine in treating patients.33 They were required to provide basic medical care to patients across rural China, but not required to conduct any formal biomedical research at medical institutions. The “barefoot doctors” were emblematic of the desire of the state for physicians to serve the people rather than their own professional needs and interests. Second, the CCP targeted pre-­1949 biomedical institutions with foreign origins, especially the Rockefeller-­funded PUMC. In the 1950s, the government had criticized PUMC’s eight-­year medical curriculum as elitist and instructed the college to shorten its program. Its leaders refused, and the government dismissed the president of the PUMC in 1957 and shut down classes from 1954 to 1959 and again from 1966 to 1979.34 The institution that Robert Lim, O. K. Khaw, and many NDMC personnel had worked at and trained in for at least a decade fell under strict political control. The Communists also claimed that nurses trained by the EMSTS and the NDMC were politically unreliable, as the NDMC was seen to be a Nationalist-­sponsored institution. They were forced to write multiple confessions and tear up their pre-­1949 diplomas before they could practice nursing.35 These denunciations were part of the broader trends in the 1950s where professionals were sent to schools to learn the new Communist orthodoxy, and those with “suspect past” had to write confessions to admit all “their personal faults and mistakes.”36 Third, like Robert Lim’s efforts at militarizing medicine during the Second World War, the PRC embarked on a similar effort by ordering the PUMC to accept army personnel in addition to regular students in 1952.37 As a result, the number of students that year swelled to more than 100, in contrast to the slightly more than 300 students the college graduated from 1923 to 1943. This large number signified the ability of the PRC to force the PUMC to increase enrollment, superseding similar failed efforts by Robert Lim and his colleagues during World War II. More broadly, the PRC also

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developed military medical units during the Korean War to combat alleged “germ warfare” by the Americans.38 The impetus to militarize medicine was a catalyzation of the broader trends that began with Robert Lim and the CRCMRC during the Second World War, although the move was underpinned by an autocratic undermining of the globality of PUMC as an autonomous Sino-­American institution. Fourth, the CCP churned out doctors quickly in a new medical system that prioritized their deployment in the field, reminiscent of similar policies by Robert Lim during the Second World War. Scheid argues that the CCP increased the number of doctors in China from around 36,340 doctors in 1949 to 115,330 medical personnel in 1980.39 Most of these new doctors were trained in biomedicine, even though it was likely that many of them were trained in aspects of TCM. To bridge the gap between urban cities and rural communities’ access to medical care, the CCP sent many of these doctors to the countryside, particularly to fight schistosomiasis in China. Lasting from 1949 to 1979, the fight against schistosomiasis was the longest health campaign in the PRC against the disease and its host, snails.40 The state mobilized rural cadres and farmers to destroy snails in the fields and rivers.41 They also urged ordinary Chinese people to change their personal hygiene habits, as well as to seek out medical treatment if they contracted this disease. Patients seeking treatment met with doctors in white medical gowns who administered painful shots to them.42 Patients saw many of these doctors as incompetent, especially those who charged them exorbitant fees or rejected them if they had a late-­stage version of the disease for fear of ruining their treatment statistics. ­Patients also criticized doctors for wearing white, which denoted death in local culture, and more importantly, for forcing these injections and other painful interventions on people who rejected treatment. In retrospect, the CCP’s mass mobilization of doctors and other societal groups artificially fostered a sense of wartime urgency in the population, which expanded biomedicine and public health at the expense of professional growth of physicians and personal choices of patients. Similar to the conundrum faced by Lim and his colleagues during the Second World War (which was largely resolved in post-­1950s Taiwan), the PRC has struggled to maintain the integrity of biomedical research, training, and institutions in its attempt to disseminate biomedical practices to a large rural population in a wartime-­like environment.

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The Economics of Health Care

The global efforts at fundraising by the Overseas Chinese medical personnel in making biomedical endeavors work, as well as their incentivizing of Chinese people to donate blood, reveal the importance of considering the economics of medicine in twentieth-­century China. Finding enough money to provide medical care for all in the wartime period remained a significant challenge for China and Taiwan in the second half of the twentieth century. The Chinese government struggled to cope with the post-­1979 marketization of the health care system as well as the proliferation of chronic diseases that came with both a more urban and sedentary lifestyle and increased levels of air pollution wrought by rapid industrialization.43 Moreover, the reform-­era government struggled to match the expectations of a wealthier population as expectations of care rose. The marketization of health care brought corruption, long lines outside hospitals, and distrust between doctors and patients. In a state with neither the funding nor the will to pay medical personnel a living wage, hospitals and doctors routinely took kickbacks from pharmaceutical companies and bribes from patients.44 Workplace turnover among medical staff was high as distrustful patients committed acts of violence against doctors and nurses.45 In 1936, Robert Lim argued for the provision of curative and preventive care for all Chinese people, “irrespective of any necessary relationship to the conditions of individual payment.”46 Much of his vision came to fruition during the Second World War, where he expanded health care to a large number of Chinese soldiers and civilians with the support of the Overseas Chinese. Such a vision appears to have extended to the PRC’s effort at implementing a basic universal health care system in 2011. Average out-­of-­ pocket expenditures as a percentage of total health care costs fell from 60 percent in 2001 to around 29 percent in 2016 as a result of this reform. However, in 2015 more than 44 percent of underprivileged households remained impoverished because of illness.47 According to a 2017 survey, 44 percent of Chinese health care administrators believed that China had a long way to go to achieve universal health care, citing limited financial protection, health care inequity, poor portability, and ineffective supervision and administration of funds.48 In contrast, in 1995 the Republic of China in Taiwan created a universal health care system based on a national insurance model (Quanmin

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jiankang baoxian zhidu). Praised by scholars internationally,49 the system reduced out-­of-­pocket expenditures from 48 percent in 1993 to 26 percent in 2012,50 although roughly one-­fifth of households under the poverty line remained poor because of out-­of-­pocket health expenditures.51 In a 2019 survey, 89.7 percent of Taiwanese surveyed were satisfied with the National Health Insurance system, the highest rating ever since its inception.52 Taiwan’s philosophy of universal care can be partly traced to the wartime ethos of state medicine as expounded by Robert Lim. The continuing emphasis on physicians’ training, established in colonial Taiwan and wartime China, provided another foundation for Taiwan’s health care system, which today boasts more doctors per patient than mainland China.53 In addition, the importance of the medical profession as a marker of social and class status among Taiwanese elites during the Japanese colonial period from 1895 to 1945 laid a foundation on which to develop a comprehensive workforce that could sustain a universal health care system.54 In particular, this workforce was needed to meet the demand for medical consultations for the poorer Taiwanese, who traditionally had little access to the health care system. Most medical personnel in Taiwan were trained at the NDMC, National Taiwan University College of Medicine, and Kaohsiung Medical University. In 1997, the NDMC moved to a much larger campus. The training of medical personnel offered by these three institutions strengthened the viability of a universal health care system. The alternative would have been an overreliance on foreign medical personnel, a strategy undertaken by Singapore in the 2000s to correct its earlier policies of limiting medical school enrollments to a few hundred students a year.55 Even though large-­scale immigration of medical personnel has solved Singapore’s staffing problems, many patients have difficulty communicating with doctors and nurses who do not speak the same language.56 Taiwan has avoided this problem. This is not to say that universal health care has been without its challenges in Taiwan. Elected politicians’ reluctance to increase health insurance premiums led to an unsustainable deficit. It was only after 2010, when the KMT government raised the premium for the second time since its inception in 1995, that the National Health Insurance program could erase its deficit, which it did within two years.57 While the immediate postwar situation was more favorable for biomedicine in Taiwan, China eventually saw regrowth in university-­based

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biomedical research and training after the Cultural Revolution ended. After 1979, Xiamen University reemerged as the major center of life sciences, biomedicine, engineering, and natural sciences in South China.58 And in the 1990s, the Chinese government began strongly supporting biomedical research and medical education at PUMC, reviving what had been the institution’s two core strengths during the Republican period.59 PUMC has again become the preeminent institution of biomedicine in mainland China.

The Diaspora in the Global History of Chinese Biomedicine

Thus, those in the Chinese diaspora who sought to institutionalize biomedicine in twentieth-­century China set in motion a process that continues to evolve. Their ideas, institutions, and students have had a lasting impact on contemporary China and Taiwan. Efforts at expanding health care for all, which began during the Second World War, emerged as a cornerstone philosophy of both polities across the Taiwan Straits. Associated with military medicine, civilian medical systems in both postwar Taiwan and China were pressured to maximize the number of medical trainees and minimize treatment time for patients. Besides finding enough money to fund the health care system, finding enough people to staff a vision of universal health care remains a formidable task. As the relationship between China and Taiwan warmed in the 2000s, there emerged a new strand of diasporic involvement by Taiwanese managers, physicians, and nurses in helping to staff the Chinese medical system. Almost 200 Taiwanese doctors worked in mainland China from 2008 to 2018.60 In 2010, China and Taiwan signed a medical and health care cooperation agreement to promote cross-­straits medical exchange, providing the basis for both parties to share relevant information on epidemics and diseases in their respective polities.61 By 2014 Taiwanese companies had leveraged the strength of the island’s health care system to construct six hospitals and disseminate biomedical care in China.62 In the case of the COVID-­19 pandemic, these medical connections facilitated the visit of two Taiwanese doctors to Wuhan as early as January 13, 2020, a privilege denied to American visitors until more than a month later.63 Their visit convinced the Taiwanese doctors that there was human-­to-­human transmission of the virus, even though their hosts were

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reluctant to come to the same conclusion. Their findings spurred the Taiwanese authorities to begin screening anyone entering Taiwan for COVID-­19. Taiwan also established a central command center to direct antipandemic measures on January 20, 2020, as well as institute a ban on visitors from Wuhan.64 Together with the ramping up of surgical mask production and distribution, and the use of cell phone technology to ensure compliance with quarantine and stay-­at-­home orders, Taiwan emerged with very low relative rates of COVID-­19 infections (445 cases) as of June 15, 2020. 65 A globally competitive medical workforce, an exportable medical infrastructure, a carefully calibrated medical training curriculum, and a robust universal health care system which addresses chronic diseases have somewhat eluded the PRC since the end of the Chinese Civil War. If members of the diaspora from Taiwan and elsewhere help to construct these key components of a successful health care program on the mainland, they will add another chapter to the story of transpolitical medical assistance begun by their Overseas Chinese forebears during the Second World War.

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G L O S S A RY O F C H I N ES E C H A R AC T ER S

Adet Lin (Lin Fengru) 林鳳如 Allen Lau (Liu Kongle) 劉孔樂 Alfred Sze (Shi Zhaoji) 施肇基 Bencao gangmu 本草綱目 buzheng 不振 C. E. Lim (Lin Zongyang) 林宗揚 C. C. Chen (Chen Zhiqian) 陳志潛 C. T. Wang (Wang Zhengting) 王正廷 C. Y. Wu (Wu Zhangyao) 伍長耀 Chen Cheng 陳誠 Chen Jiageng kexue yuan 陳嘉庚科學院 Chiang Kai-­shek ( Jiang Jieshi) 蔣介石 Chinese Communist Party (Zhongguo Gongchandang, CCP) 中國共產黨 Chinese Nationalist Party (Chung-­Kuo Kuomintang, KMT) 中國國民黨 Chou Mei-­yu (Zhou Meiyu) 周美玉 Dai Jitao 戴季陶 Du Yuming杜聿明 danghua 黨化 Dongshansheng fangyi shiwu zongchu 東三省防疫事務總處 Eva Ho Tung (He Xianzi) 何嫻姿 fan guo 飯鍋 Fang yi 防疫

210

G lossary of C hinese C haracters

fen xiao 分校 Frank Co Tui (Xu Zhaodui) 許肇堆 Ganguyi 甘谷驛 geyou suochang 各有所長 gongchandang ba ren dang cheng gong ju 共產黨把人當成工具 guamian 掛麵 Guofang yixueyuan 國防醫學院 Hengyang Shi 衡陽市 Ho Ying-­chin (He Yingqin) 何應欽 Hongshi zihui jiuhu zongdui紅十字會救護總隊 Hu Shih (Hu Shi) 胡適 Hua Tuo 華佗 Huangdi neijing 黃帝內經 Huanjing weisheng 環境衛生 Huaren xueku 華人血庫 Hubing 護病 jianyao 簡要 ji gong hao yi 急公好義 jingji 經濟 Jinhua 金華 Junyi xuexiao軍醫學校 Junyishu xueku 軍醫署血庫 Junzhengbu junyi shu shuzhang 軍政部軍醫署署長 kangs (keng) 坑 Khaw Oo-­keh (O. K. Khaw, Xu Yujie) 許雨階 Lianhuan tu 連環圖 Li Gao 李杲 Li Shizhen 李時珍 Lim Boon Keng (Lin Wenqing) 林文慶 Lin Tsung-­yi (Lin Zongyi) 林宗義 Lin Yutang 林語堂 Liu Jui-­heng (Liu Ruiheng) 劉瑞恆 Liuzhou 柳洲 Loo Chih-­teh (Lu Zhide) 盧致德 Lu Xun 魯迅 Mao Zedong 毛澤東 Minnan 閩南



G lossary of C hinese C haracters 211

Nanning 南寧 Neike 內科 New Way-­Sung (Niu Huisheng) 牛惠生 Ningxue yinhang 貯血銀行 Piwei lun 脾胃論 P. Z. King ( Jin Baoshan) 金寶善 qi 氣 Quanmin jiankang baoxian zhidu 全民健康保險制度 Quo Tai-­chi (Guo Taiqi) 郭泰祺 Robert Lim (Lin Kesheng) 林可勝 renzao zilai xie 人造自來血 shibing yiyang rili 士兵營養日曆 shi jing elie 市景惡劣 Shen Tong 沈同 Shuxie yinhang 輸血銀行 Soong Ching-­ling (Song Qingling) 宋慶齡 Soong Mei-­ling (Song Meiling) 宋美齡 Sun Fo (Sun Ke) 孫科 Tan Kah Kee (Chen Jiageng) 陳嘉庚 Tang Erhe 湯爾和 Taiyu 台語 T. V. Soong (Song Ziwen) 宋子文 Taibei rongmin zong yiyuan 臺北榮民總醫院 Taiwan daxue yixue yuan 臺灣大學醫學院 tongyong 通用 Tseng Cheng-­Kui (Zeng Chengkui) 曾呈奎 Tu Tsung-­ming (Du Congming) 杜聰明 Waike 外科 Weisheng qinwu 衛生勤務 Wellington Koo (Gu Weijun) 顧維鈞 Wong Chi-­min (Wang Jimin) 王吉民 Wu Hsien (Wu Xian) 吳憲 Wu Lien-­teh (Wu Liande) 伍連德 Xiaguan 下關 Xiamen daxue (Xiada) 廈門大學 (廈大) xihaopin 嗜好品 Xifeng fukan 西風副刊

212

G lossary of C hinese C haracters

Xinan lianhe daxue (Lianda) 西南聯合大學 (聯大) xinyi 新醫 xueku 血庫 Yeh Shin-­Hwa (Ye Xinhua) 葉鑫華 Yen Fu-­ching (Yan Fuqing) 顏福慶 Ye Su 葉曙 Yi Chien-­lung (Yi Jianlong) 易見龍 yingyang jiuguo營養救國 yixing 易行 Yu Yan 余岩 ze zechuan erfeibei 則責傳而費倍 Zhongyi yiyao lianhehui 中醫醫藥聯合會 Zhang Jian 張建 Zhang Xianlin 張先林 Zhan shi weisheng xunlian zhongxin 戰時衛生訓練中心 Zhongguo xueku 中國血庫

N O T ES

Introduction

1.  Jean Chiang’s father was a professor of Chinese studies at McGill University in Canada. See Larry Hannant and Norman Bethune, The Politics of Passion: Norman Bethune’s Writing and Art (Toronto: University of Toronto, 2016), 205. 2.  Jean Chiang, “Report of the 29th Unit at Yenan (Fushin) (From Febuary to September 1938),” October 21, 1938, box 1, folder 6, in file “Chinese Red Cross 1938–40,” United China Relief records, Manuscripts and Archives Division, New York Public Library, Astor, Lenox, and Tilden Foundations (hereafter UCR Records). 3.  Robert Lim to Jimmie, December 20, 1948, Robert Lim Papers, Institute of Modern History Archives, Academia Sinica, Taipei, Taiwan (hereafter Lim’s Papers). 4.  For a history of scientific medicine (or biomedicine) in the nineteenth and early twentieth centuries, see Roy Porter, The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present (New York: W. W. Norton, 2009), 304–461. 5.  Bridie Andrews, The Making of Modern Chinese Medicine, 1850–1960 (Honolulu: University of Hawai‘i Press, 2015), 51–69. 6.  Ari Larissa Heinrich, The Afterlife of Images: Translating the Pathological Body between China and the West (Durham, NC: Duke University Press, 2009), 1–14. 7.  Ruth Rogaski, Hygienic Modernity: Meanings of Health and Disease in Treaty-­Port China (Berkeley: University of California Press, 2004), 165–92. 8.  See Mary Bullock, An American Transplant: The Rockefeller Foundation and Peking Union Medical College (Berkeley: University of California Press, 1981); and Mary Bullock, The Oil Prince’s Legacy: Rockefeller Philanthropy in China (Stanford: Stanford University Press, 2012). 9.  Liping Bu, Public Health and the Modernization of China, 1865–2015 (New York: Routledge, 2017), 1–27.

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10.  Sean Hsiang-­Lin Lei labels this phenomenon the prehistory of “pattern differentiation and treatment determination.” See Lei, Neither Donkey nor Horse: Medicine in the Struggle over China’s Modernity (Chicago: University of Chicago, 2016), 147–92. 11. See Sherman Cochran, Chinese Medicine Men: Consumer Culture in China and Southeast Asia (Cambridge, MA: Harvard University Press, 2006), 118–50; Adam M ­ cKeown, Chinese Migrant Networks and Cultural Change: Peru, Chicago, Hawaii, 1900– 1936 (Chicago: University of Chicago Press, 2001); and Philip Kuhn, Chinese among Others: Emigration in Modern Times (Lanham, MD: Rowman & Littlefield, 2008). 12.  Shelley Chan, “The Case for Diaspora: A Temporal Approach to the Chinese Experience,” Journal of Asian Studies 74, no. 1 (February 2015): 107–28. 13. Kuhn, Chinese among Others, 270. 14.  Mary Wright, China in Revolution: The First Phase, 1900–1913 (New Haven: Yale University Press, 1971), 30–40. 15.  For example, Karl Gerth and Klaus Mühlhahn downplayed the diasporic identity of Wu Tingfang (1842–1922), a main historical actor, in their research. Wu was a Singapore-­born and Hong Kong–trained lawyer who undertook constitutional reforms of criminal law and helped lead the boycott of Japanese products in China during the Republican period. He was an accomplished diplomat and served briefly as acting premier in 1917. See Gerth, China Made: Consumer Culture and the Creation of the Nation (Cambridge: Harvard University Press, 2003), 112–14; and Mühlhahn, Criminal Justice in China: A History (Cambridge: Harvard University Press, 2009), 60–61. 16.  Shelly Chan, Diaspora’s Homeland: Modern China in the Age of Global Migration (Durham, NC: Duke University Press, 2018). 17.  Karen Teoh, Schooling Diaspora: Women, Education, and the Overseas Chinese in British Malaya and Singapore, 1850s–1960s (Oxford: Oxford University Press, 2018), 121–45. 18.  Chan, “Case for Diaspora.” 19.  On the debate over such terms as Overseas Chinese, Chinese diaspora, and Sinophone, see Teoh, Schooling Diaspora, 5–6; Chan, Diaspora’s Homeland, 1–13; and Shu-­mei Shih, “Against Diaspora: The Sinophone as Places of Cultural Production,” in Sinophone Studies: A Critical Reader, ed. Brian Bernards, Shu-­mei Shih, and Chien-­hsin Tsai (New York: Columbia University Press, 2013), 25–42. On the debate over the varying types of Overseas Chinese (Huaqiao, Huayi, etc.), see Wang Gungwu, “Patterns of Chinese Migration in Historical Perspective,” in China and the Chinese Overseas (Singapore: Times Academic Press, 1992), 3–21. 20.  Chan, “Case for Diaspora”; Chan, Diaspora’s Homeland, 75–106. 21.  See Carol Benedict, Golden-­Silk Smoke: A History of Tobacco in China, 1550–2010 (Berkeley: University of California Press, 2011), 1–14, 110–254; Hilary A. Smith, Forgotten Disease: Illnesses Transformed in Chinese Medicine (Stanford, CA: Stanford University Press, 2017), 139–60; and Joan Judge, Republican Lens: Gender, Visuality, and Experience in the Early Chinese Periodical Press (Oakland: University of California Press, 2011), 115–48.



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22.  Rana Mitter and Helen Schneider, “Relief and Reconstruction in Wartime China,” European Journal of East Asian Studies 11, no. 2 (2012): 179–86. 23.  Lloyd Eastman, Seeds of Destruction: Nationalist China in War and Revolution, 1937–1949 (Stanford, CA: Stanford University Press, 1984), 130–57. 24.  See Stephen MacKinnon, “The Defense of the Central Yangtze,” in The Battle for China: Essays on the Military History of the Sino-­Japanese War of 1937–1945, ed. Mark R. Peattie, Edward J. Drea, and Hans J. Van de Ven (Stanford: Stanford University Press, 2001), 181–207. 25.  John Watt, Saving Lives in Wartime China: How Medical Reformers Built Modern Healthcare Systems amid War and Epidemics, 1928–1945 (Leiden: Brill, 2016), 13–14. 26.  Nicole Barnes, Intimate Communities: Wartime Healthcare and the Birth of Modern China, 1937–1945 (Oakland: University of California Press, 2018), 52–119. 27.  See Vivienne Lo and Michael Stanley-­Baker, “Chinese Medicine,” in A Global History of Medicine, ed. Mark Jackson (Oxford: Oxford University Press, 2018), 19–43. 28.  Randall Packard, A History of Global Health: Interventions into the Lives of Other Peoples (Baltimore: Johns Hopkins University Press, 2016), 217, 242, 249. 29.  Sönke Bauck and Thomas Maier, “Entangled History,” InterAmerican Wiki: Terms–Concepts–Critical Perspectives, 2015, www​.unibielefeld​.de​/cias​/wiki​/e​_Entangled​ _History​.html. 30. Packard, History of Global Health; Mark Jackson, “One World, One Health? Towards a Global History of Medicine,” in A Global History of Medicine, ed. Mark Jackson (Oxford: Oxford University Press, 2018), 1–18. 31.  For examples of the history of military medicine, rural medicine, and international organizations, see respectively Margaret Humphreys, Marrow of Tragedy: The Health Crisis of the American Civil War (Baltimore: Johns Hopkins University Press, 2017); Michael R. Grey, New Deal Medicine: The Rural Health Programs of the Farm Security Administration (Baltimore: Johns Hopkins University Press, 2002); and Marcos Cueto, Theodore M. Brown, and Elizabeth Fee, The World Health Organization: A History (Cambridge: Cambridge University Press, 2019). 32. Kuhn, Chinese among Others, 47–52, 372–80.

Chapter One

1.  Wu Lien-­teh, Plague Fighter: The Autobiography of a Modern Chinese Physician (Cambridge: Heffer, 1959), 375. Wu recounted that the plague had exacted a “toll of 60,000 lives and caused monetary losses estimated at 100 million dollars.” 2.  “Plague in China,” Times of India, April 19, 1911, 8. 3.  See Teoh, Schooling Diaspora, 21–22, for a brief history of the British Straits Settlements. Barbara W. Andaya and Leonard Y. Andaya, A History of Malaysia (Honolulu: University of Hawai‘i Press, 2001), 161–269. 4.  Swee-­Hock Saw, The Population of Singapore (Singapore: ISEAS, 2002), 29.

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5.  Saw, 29. 6.  Phyllis Ghim Lian Chew, Sociolinguistic History of Early Identities in Singapore: From Colonialism to Nationalism (Basingstoke: Palgrave Macmillan, 2013), 43–47. 7.  Ching-­Hwang Yen, The Chinese in Southeast Asia and Beyond: Socio-­Economic and Political Dimensions (Singapore: World Scientific, 2008), 63–65. 8.  Wu Lien-­teh and Ng Yok-­Hing, The Queen’s Scholarship of Malaya 1885–1948 (Penang: Penang Premier Press, 1949), 2. 9.  See “Second Examination for Medical and Surgical Degrees” for the years 1898 and 1899; see also “Third Examination for Medical and Surgical Degrees, Easter Term, 1901,” Cambridge University Archives. 10.  “Wu Lien-­teh,” in Howard L. Boorman, Richard C. Howard, and Joseph K. H. Cheng, Biographical Dictionary of Republican China (New York: Columbia University Press, 1967), 3:440–43. Ronald Ross was a close friend and star student of Patrick Manson’s, one of the first British doctors to investigate tropical medicine in China in the 1860s. Ross and Manson exchanged 173 letters between 1895 and 1899. Ross later, in 1912, had a falling out with his mentor. With the help of Manson, Ross won the Nobel Prize in 1902 for uncovering the role of mosquitoes in the transmission of malaria. See E. Chernin, “Sir Ronald Ross vs. Sir Patrick Manson: A Matter of Libel,” Journal of the History of Medicine and Allied Sciences 43, no. 3 (1988): 262–73. Élie Metchnikoff was a prominent Russian scientist who would win the Nobel Prize in 1908 for his research on the comparative pathology of inflammation. Clearly, Wu was working with scientists who were at the cutting edge of medical research on bacteriology, immunology, and tropical medicine. 11. Wu, Plague Fighter, 242–46. 12.  Wu, 242. It was allegedly required that a registered doctor apply for a license to dispense opium, even though it could be bought freely from any opium shop in British Malaya. The local courts fined Wu 100 Straits dollars. 13.  Wu and Ng, Queen’s Scholarship, 2. 14.  University of Edinburgh, “Graduation in Medicine and Surgery: Degrees and Diplomas in Medicine and Surgery, 1893–1894,” University of Edinburgh Student Records, University of Edinburgh Archives. 15.  C. F. Yong and R. B. McKenna, The Kuomintang Movement in British Malaya, 1912–1949 (Singapore: Singapore University Press, 1990), 12. 16.  “Neiwubu chengzhengting yu gesibanshi guize” [Regulations of the various departments in the Ministry of the Interior], quanzong [fonds] 001, juan [reel] 006, Second Historical Archives, Nanjing, PRC. 17.  R. K. S. Lim, PhD Thesis (comprised of a collection of his scientific publications), 1921, Center for Research Collections, Edinburgh University Library. 18.  Andrew Cunningham, “Transforming Plague: The Laboratory and the Identity of Infectious Disease,” in The Laboratory Revolution in Medicine, ed. Andrew



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Cunningham and Perry Williams (Cambridge: Cambridge University Press, 1992), 209–44. 19.  Sean Hsiang-­Lin Lei, “Sovereignty and Microscope,” in Health and Hygiene in Chinese East Asia: Policies and Publics in the Long Twentieth Century, ed. Liang Qizi and Charlotte Furth (Durham, NC: Duke University Press, 2010), 73–108. 20.  David Luesink, “The History of Chinese Medicine: Empire, Transnationalism, and Medicine in China, 1908–1937,” in Uneasy Encounters: The Politics of Medicine and Health in China, 1900–1937, ed. Iris Borowy (Frankfurt am Maim: Peter Lang, 2009), 149–76. 21.  Sean Hsiang-­Lin Lei, “Habituating Individuality: The Framing of Tuberculosis and Its Material Solutions in Republican China,” Bulletin of the History of Medicine 84 (2010): 248–79. 22.  William C. Summers, The Great Manchurian Plague of 1910–1911: The Geopolitics of an Epidemic Disease (New Haven: Yale University Press, 2012), 61–63. 23.  Carol Benedict, “Policing the Sick: Plague and the Origins of Chinese State Medicine,” Late Imperial China 14, no. 2 (December 1993): 60–77. 24. Lei, Neither Donkey nor Horse, 21–44. 25. Wu, Plague Fighter, 258. 26.  Wu, 272. 27.  Wu, 274. 28.  Wu Ting-­fang was a Singapore-­born and Hong Kong–trained lawyer who undertook constitutional reforms on criminal law and led the boycott of Japanese products in China. He was an accomplished diplomat and acted as premier briefly in 1917. See Gerth, China Made, 112–15, and Mühlhahn, Criminal Justice, 60–61. 29. Wu, Plague Fighter, 384. Wu recalled that, in June 2015, Tang had recommended Dr. Chen Winghan ( J. W. H. Chun), the son of a wealthy family in Shanghai. 30.  Residents born in the British Straits Settlements were British nationals by birth. Because Penang was part of the Straits Settlements, and Wu was born in Penang, Wu was a British national by birth. For an in-­depth discussion of British nationality laws in the various Malayan colonies over time, see Chua Ai Lin, “Imperial Subjects, Straits Citizens,” in Paths Not Taken: Political Pluralism in Post-­War Singapore, ed. ­Michael D. Barr and Carl A. Trocki (Singapore: National University of Singapore Press, 2008), 20–24. 31. Wu, Plague Fighter, 302. Wu described Sir Jordon as “genial, friendly, and helpful, especially during the early establishment of the [North] Manchurian Plague Prevention Service” and had “sought his co-­operation for the renewal of the annual appropriation which needed approval by the Foreign Diplomatic Corps after its sanction by the Chinese government.” 32.  Wu, 343. 33.  Wu, 384.

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34.  Cunningham, “Transforming Plague.” 35. Cunningham. 36. Wu, Plague Fighter, 276. In his autobiography, Wu recounted that “when the fierce pneumonic plague broke out in Manchuria in 1910 and I asked for volunteers to assist me, the two fourth-­year students who stepped forward were both Cantonese . . . both stuck to me for years afterwards in prosperity and adversity, wherever I was ordered by the Central government.” 37.  Richard P. Strong, G. F. Petrie, and Arthur Stanley, Report of the International Plague Conference Held at Mukden, April, 1911 (Manila: Bureau of Printing, 1912), vii–ix. 38.  “Problems of Plague,” Times of India, May 16, 1911, 7. 39.  “Plague Delegates at Peking,” Weekly Sun (Singapore), June 3, 1911, 4. 40.  For a history of increasingly negative representations by the Western and Japanese media on China in the first decades of the twentieth century, see James Hevia, “Desacralizing Qing Sovereignty, 1900–1901,” in English Lessons: The Pedagogy of Imperialism in Nineteenth-­Century China (Durham, NC: Duke University Press, 2003), 241–82; John Dower, “Throwing Off Asia II: Woodblock Prints of the Sino Japanese War (1894– 1985),” Visualizing Cultures, MIT, accessed August 27, 2019, https://​ocw​.mit​.edu​/ans7870​ /21f​/21f​.027​/throwing​_off​_asia​_02​/toa​_essay01​.html; and Benjamin Elman, “Naval Warfare and the Refraction of China’s Self-­Strengthening Reforms into Scientific and Technological Failure, 1869–1895,” Modern Asian Studies 38, no. 2 (2004): 283–326. 41.  “Dr. Kitasato Elected,” Japan Times, April 5, 1911, 5. 42.  Julia Yongue, “A Distinctive Nation: Vaccine Policy and Production in Japan,” in The Politics of Vaccination: A Global History, ed. Christine Holmberg, Stuart Blume, and Paul Greenough (Manchester, UK: Manchester University Press, 2017), 209–36. 43. Summers, Great Manchurian Plague, 99. 44.  Roger Greene to the Secretary of State, “Plague in North Manchuria,” January 26, 1911, Central Decimal Files, 1910–29, RG 59, Decimal File 158.931/65, National Archives at College Park (hereafter NACP). 45.  See Calhoun to the Secretary of State, “Jan 17, 1911,” RG 59, 158.931/58, NACP. Calhoun reported that “diplomatic corps urged stopping of all trains from Mukden but Chinese not disposed to do so but rely on quarantine.” He added that there were “reasonable expectations that plague will reach Peking.” 46.  Strong et al., Report of International Plague Conference, 40. Wu declared that it was his “pleasant duty to introduce Dr. Kitasato, who will take the chair during the discussion of bacteriology and pathology.” 47.  “China Welcomes Visiting Savants,” Chicago Daily Tribune, April 3, 1911, 5; “Plague Is Yielding,” New York Times, April 3, 1911, 4; “In Hope of Finding Plague Cure, Doctors Assemble in Mukden,” Los Angeles Times, April 3, 1911; “Doctors Rally to Check Plague,” San Francisco Chronicle, April 3, 1911, 3; “Doctors to Probe Plague Situation,” The Atlanta Constitution, April 3, 1911, 3. 48.  “China Welcomes Visiting Savants.”



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49.  “China Welcomes Visiting Savants.” 50.  “Kitasato hakase kōhyō” [Popular Professor Kitasato], Asahi Shimbun, April 18, 1911, 2; “Kitasato hakase no shinyō” [Professor Kitasato’s credibility], Asahi Shimbun, May 1, 1911, 2; “Pest Conference Ends: Japanese Views Embodied in Final Resolution,” Japan Times, April 30, 1911, 1. 51. Wu, Plague Fighter, 62–64. 52.  Wu, 62–64. 53.  “Dr. Kitasato on Pest Fight,” Japan Times, May 13, 1911, 1. 54.  “Dr. Kitasato on Pest Fight.” 55.  Strong et al., Report of International Plague Conference, 7. 56. Lei, Neither Donkey nor Horse, 26. 57.  Strong et al., Report of International Plague Conference, 260–61. 58.  See Wendy Orent, Plague: The Mysterious Past and Terrifying Future of the World’s Most Dangerous Disease (New York: Free Press, 2012), 194; Wu Yu-­lin, Memories of Dr Wu Lien-­Teh: Plague Fighter (Singapore: World Scientific, 1995), 37. Orent and Wu mention Wu’s heroic efforts in facing down opposition to the burning of corpses infected with plague through his appeals to the Qing court to allow cremation of such corpses, but in reality, he often compromised by allowing corpses to be buried deep within the ground to prevent the plague infection from spreading. This compromise represents the efforts at negotiating resistance rather than a biomedical take-­down of opposition. In the plague conference report, Wu mentioned that “in some places, however, the prejudices of the people outweighed their common sense.” He went on to describe how “at Mukden, the dead were buried in deep pits, after being promptly coffined with lime according to customary Chinese method.” See Strong et al., Report of International Plague Conference, 463–64. 59.  “The International Plague Conference,” The Scotsman, April 26, 1911, 13. 60.  Strong et al., Report of International Plague Conference, 283–303, 459–68. 61.  Strong et al., 462. 62.  Strong et al., 292. 63.  Strong et al., 294–95. 64.  Strong et al., 464–65. 65.  Strong et al., 461–62. 66.  Strong et al., 463. 67.  Strong et al., 461. 68.  Strong et al., 459–65. 69.  “World Menaced by the Black Death in China,” New York Times, February 19, 1911, SM2. 70.  “World Menaced by Black Death.” The reporter noted that “the Japanese had issued an ultimatum to China,” and will “take upon herself complete freedom of action if China does not come up to her sanitary standards.” 71.  “Find Plague Controllable: Delegates Say Their Investigations Will Benefit the World,” New York Times, May 1, 1911, 4.

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72.  “Plague Delegates Lack Harmony,” Austin Statesman, April 30, 1911, 2. 73.  “Where the Plague Began: Origin of the Terrible Epidemic in Manchuria,” Washington Post, May 21, 1911. 74.  “The International Plague Conference,” The Scotsman, April 26, 1911, 13. 75.  Eric W. Nye, “Pounds Sterling to Dollars: Historical Conversion of Currency,” accessed Wednesday, June 27, 2018, www​.uwyo​.edu​/numimage​/currency​.htm. 76. Wu, Plague Fighter, 377. 77.  Hans Van Der Van, Breaking with the Past: The Maritime Customs Service and the Global Origins of Modernity in China (New York: Columbia University Press, 2014), 1314. 78. Wu, Plague Fighter, 384. 79.  Wu, 384. 80.  For a brief history of the ebbs and flows of Russian influence in Manchuria, see Bruce A. Elleman and Stephen Kotkin, eds., Manchurian Railways and the Opening of China: An International History (London: Routledge, 2015), 37–102. For a history of the increasing encroachment of Japan in Manchuria, see Yoshihisa Tak Matsusaka, The Making of Japanese Manchuria, 1904–1932 (Cambridge, MA: Harvard University Asia Center, 2003). 81. Wu, Plague Fighter, 386. Chun and Pollitizer would later leave with Wu from Manchuria to Shanghai to aid the latter in his new position as the Director of the ­National Quarantine Services in 1931. 82.  Wu Lien-­teh, “Summary of the Second Annual General Report,” 105. 83.  “North Manchurian Plague Prevention Service: Summary of Third Report,” in Peking Daily News, October 1, 1915. 84. “The Manchurian Plague Bureau: Seventh Annual Report,” North China Herald, January 10, 1920, 73; “New Plague Hospital,” North China Herald, January 21, 1919, 754. 85.  “Campaign against Plague: How It Is Spread,” North China Herald, December 15, 1923, 750. 86.  “North Manchurian Plague Prevention Service,” North China Herald, November 6, 1926, 250. 87.  “Plague Prevention Service Issues Its Annual Report,” China Press, November 2, 1926, 2. 88.  “Campaign against Plague.” 89.  “North Manchurian Plague Prevention Service,” North China Herald, November 6, 1926, 250. 90.  “Manchurian Plague Service: Dr. Wu’s Report,” North China Herald, November 24, 1917, 454. 91.  “North Manchurian Plague Service: Dr. Wu Lien-­teh,” North China Herald, October 7, 1916, 54; “Manchurian Plague Service: Dr. Wu’s Report,” North China Herald, November 24, 1917, 454. Wu reported in 1917 that “he received last March lengthy



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communication from the Manager of the American Manchurian Development Company, thanking the service for the assistance we rendered him in having diagnosed and prevented anthrax among men and cattle in their newly opened farms.” 92.  “North Manchurian Plague Service,” October 7, 1916. A Dr. Hershberger was “able to prevent much distress and loss” of animals from infectious disease “by vaccinating both animals and man with serum, which has been kindly presented for this purpose by the Russian authorities of Blagovestchensk.” 93.  “Summary of Fifth Annual General Report,” October 26, 1917, in Wu Lien-­ teh, North Manchurian Plague Prevention Service (Reports 1914–1917) (Peking: Peking Gazette Press, 1917), 119. 94.  “The Second Manchurian Plague Epidemic: Appendix to Eighth Annual General Report,” North China Herald, September 3, 1921, 719. 95.  “The Manchurian Plague Bureau: Seventh Annual Report,” North China Herald, January 10, 1920, 73. 96.  “Manchurian Plague Bureau.” 97.  “Manchurian Plague Bureau.” 98.  See Summers, Great Manchurian Plague, 51–79, 130–52. 99.  Wu Lien-­teh, “2nd Plague Epidemic in Manchuria,” in Manchurian Plague Prevention Service Memorial Volume: 1912–1932 (Shanghai: National Quarantine Service, 1934), 66–68. 100.  “Fighting the Plague: Nineteenth Annual Report of the Manchurian Prevention Service,” North China Herald, January 5, 1932, 8. Wu lamented that “the sudden invasion of Manchuria by Japanese troops on September 18 and its aftermath has caused widespread suffering . . . and even our anti-­plague work in the Ssutao area was cut short by military movements.” 101.  Hollington Tong, “War and Plague Mock Japan’s Boast of Manchukuo Paradise,” China Press, October 29, 1933, 9. 102.  Tong, 9. 103.  See Wu Lien-­teh and Frederick Eberson, “Transmission of Pulmonary and Septicaemic Plague among Marmots,” Journal of Hygiene 16, no. 1 (1917): 1–11; Wu Lien-­ teh, J. W. H. Chun, and R. Pollitzer, “Plague Transmission through the Ectoparasites of the Tarabagan,” American Journal of Hygiene 5, no. 2 (1925); Wu Lien-­teh, “Investigations into the Relationship of the Tarbagan (Mongolian Marmot) to Plague,” The Lancet 182, no. 4695 (1913): 529–35; Wu Lien-­teh, “The Second Pneumonic Plague Epidemic in Manchuria, 1920–21. I. A General Survey of the Outbreak and Its Course,” Epidemiology & Infection 21, no. 3 (1923): 262–88. 104. Wu, Plague, 391–401. Wu Lien-­teh presented his research and experiences predominantly in the annual conference of the Far Eastern Association of Tropical Medicine, which rotated between different Asian nations in the prewar period. Japanese medical doctors also invited Wu to present his research in Korea and Japan.

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105.  Strong et al., Report of International Plague Conference, 260–61. 106.  Strong et al., 260–61. 107.  See Wu Lien-­teh and Wong Chimin, “The Struggle Between Old Forces and New Forces,” in History of Chinese Medicine: Being a Chronicle of Medical Happenings in China from Ancient Times to the Present Period (Tianjin: Tianjin Press, 1932), 159–68. 108.  Wu Lien-­teh and Wong Chimin, History of Chinese Medicine: Being a Chronicle of Medical Happenings in China from Ancient Times to the Present Period, 2nd ed. (Shanghai: National Quarantine Service, 1936), 159–68; David Luesink, “State Power, Governmentality, and the (Mis)Remembrance of Chinese Medicine,” in Historical Epistemology and the Making of Modern Chinese Medicine, ed. Howard Chiang (Manchester: Manchester University Press, 2015), 160–87; “Chinese Doctors Up in Arms: Native Practitioners Agitated Over Recent Decision,” North China Herald, March 16, 1929, 442; Lei, Neither Donkey nor Horse, 97–121. 109.  Lei, 118. 110.  “Yiyaolianhehui huanyin Wu Liande Buoshi Xiangqing” [Details of the welcoming of Dr. Wu Lien-­teh by the United Chinese Medical Organization], Yiyaoyuekan 2 (1930): 30–32. 111.  “China’s Doctors,” South China Morning Post, October 19, 1933. 112.  Luesink makes a similar observation. He argues that the History of Chinese Medicine was a “text that claims the prestige of a long, learned tradition of Chinese medicine, with the new grafted onto the old.” See David Luesink, “The History of Chinese Medicine: Empires, Transnationalism and Medicine in China, 1908–1937,” in Uneasy Encounters: The Politics of Medicine and Health in China, 1900–1937, ed. Iris Borowy (New York: Peter Lang Publishing Group, 2009), 160. 113.  Wu and Wong, History of Chinese Medicine, 2nd ed., 159–68. 114.  See the table of contents in Wu and Wong, History of Chinese Medicine, 2nd ed., xi–xii. 115.  Wu and Wong, xiii. 116.  Lim Boon Keng, “Infectious Diseases and the Public,” The Straits Chinese Magazine, 1, no. 7 (December 1897): 120–24. Lim wrote that if he “succeeds in convincing a few leaders of the various Asiatic communities in Malaya that epidemics are not caused by the displeasure of ill-­tempered deities, but are the results of insanitary conditions, especially accumulation of filth and overcrowding, then a couple of hours of writing snatched in the interval of a harassing occupation has not been spent in vain.” 117. “Lim Plans Novel School in Medicine,” China Press, April 14, 1936, 9. The newspaper reported, “All classes are conducted in Mandarin, but English is compulsory [at Xiamen University].” 118.  Luesink, “State Power.” Luesink argues on 165 that “Wu Liande (Wu Lien-­ teh), Yu Fengbin and Yan Fuqing—all educated in England or the United States—promoted a laissez-­faire view of medical transformation.” He goes on to observe that rather



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“than a complete revolution and abolition of Chinese medicine, for which Japanese-­ trained Tang Erhe and Yu Yunxiu aimed, the Anglo-­Americans adopted a more liberal approach that promoted the new medicine while sublimating, but preserving, the old.” 119.  Xiamen University (Xiamen daxue) was known as Amoy University in English until the Communist takeover of China in 1949. The short form for Xiamen University is Xiada. Present-­day Xiamen was known as Amoy before 1949. 120.  See Robert F. Dalzell, The Good Rich and What They Cost Us (New Haven: Yale University Press, 2013), 95. The Rockefellers were worth around 192 billion dollars by 1918. 121.  Based on exchange rates found in Yacob Shakila, The United States and the Malaysian Economy (London: Routledge, 2012), xix. From 1906 to 1920, 1 US dollar was roughly equal to 0.33 Straits dollars. In 1925, 1 US dollar was roughly worth 1.78 Straits dollars. 122.  C. F. Yong, Tan Kah-­Kee: The Making of an Overseas Chinese Legend (Hackensack, NJ: World Scientific, 2014), 50. In this chapter, all calculations of 2018 US dollars are drawn from US Inflation Calculator, www​.usinflationcalculator​.com/. 123. Dalzell, Good Rich, 80–81. 124. Yong, Tan Kah-­Kee, 87–89. 125.  William Schneider, introduction to Rockefeller Philanthropy and Modern Biomedicine: International Initiatives from World War I to the Cold War, ed. William Schneider (Bloomington: Indiana University Press, 2003), 1–6; Qiusha Ma, “The Peking Union Medical College and the Rockefeller Foundation’s Program in China,” in Rockefeller Philanthropy and Modern Biomedicine: International Initiatives from World War I to the Cold War, ed. William Schneider (Bloomington: Indiana University Press, 2003), 159–83. 126. Yong, Tan Kah-­Kee, 70. 127.  “The Chinese Rockefeller,” Straits Times, February 1, 1921, 12. 128.  “University of Amoy,” Singapore Free Press and Mercantile Advertiser, July 27, 1922, 11. 129.  See untitled article, Singapore Free Press and Mercantile Advertiser, May 20, 1925, 6. The newspaper report stated that “the eldest son of Dr. Lim Boon Keng, Dr. Robert K. Lim was appointed to the chair of physiology at the University of Amoy in 1923, but by request of the China Medical Board his services were transferred to the Peking Union Medical College, where at present he is teaching physiology as a visiting professor.” 130.  See “Xiamen Daxue Xin Qixiang” [New atmosphere at Xiada], Nanyang Siang Pau, August 13, 1926, 10. See also Zhang Yaqun, Ziqiangbuxi zhi yu zhi shan ( Jinan: Shandong jiaoyu chuban she, 2012), Location 2772, chapter 4, section 2 (Kindle version). 131.  Lim Boon Keng, “Xiamen Daxue Gongyiyuan mujuanqi” [Fundraising appeal for Xiamen University’s public hospital], Xiamen University Weekly no. 143 (1926): 1–2. 132.  “Xiamen Daxue Gongyiyuan mujuanqi.”

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133.  “Xiamen Daxue Gongyiyuan mujuanqi.” 134.  “Matters Chinese,” Singapore Free Press and Mercantile Advertiser, April 6, 1928, 16. 135.  “Matters Chinese.” The article noted that the “expenditure of the hospital and the dispensary was mostly financed by Mr. Wee Chu and the rest from the interest derived from contributions made in Singapore.” 136.  “Matters Chinese.” 137.  “The Man behind Amoy University,” Straits Times, January 2, 1930, 17. The Straits Times article stated: “The dispensary was opened before the establishment of the hospital, and the expenses in running it are met from the interest derived from the fund collected by Dr. Lim Boon Keng. The principle will be utilized in the building of the hospital, and as soon as the hospital is in full running, it is proposed to start a Medical faculty.” 138.  “Chen Jiageng xiansheng qianwan zai yihexuan yanshuo ci yilai wairen chuzi xingxue zuiwei ke chi” [Tan Kah Kee argued two nights ago that depending on outsiders for educational funding is most shameful], Nanyang Siang Pau, March 7, 1935, 5. Five years later, in 1935, Lim Boon Keng reportedly raised only 20,000 Straits dollars of the expected 40,000 Straits dollars from the Overseas Chinese community in Java and Luzon. 139.  “Chen Jiageng xiansheng.” 140.  By 1925, he had accumulated a significant debt of close to 3 million straits dollars (USD1 million), mainly to finance his education enterprise in China. Yong, Tan Kah-­Kee, 56. 141. Bullock, American Transplant, 63–65. Bullock argues that the “resounding stock market crash of 1929 and the Great Depression did not affect the CMB Inc. and RF securities until about 1933.” Bullock added that “the effort [of dealing with the decreasing grants from 1929 through 1933] was facilitated by a fluctuating exchange rate which increased the buying power of US dollars in China.” Bullock added that “Chinese silver dollars, per American dollar, increased from the rate of 2:1 to 4:1 by 1930.” 142. Yong, Tan Kah-­Kee, 71. Yong argues that “as Tan Kah-­kee borrowed more heavily, the size of repayments of interest snowballed and drained his much needed working capital.” 143.  Yong, 72–75. 144. Yong, 73. According to Yong, “Japanese rubber shoes were claimed to be cheaper and more competitive [than Tan’s rubber shoes] on the world markets.” In reporting on Tan’s bankruptcy, the South China Morning Post reported that a “complete story of why work had to stop [at Tan’s factories] has still to be told but undoubtedly the business depression, Japanese competition in foreign markets, tariff walls and the tightness of capital were important factors.” See also “Straits Bankrupt,” South China Morning Post, March 5, 1934, 19. 145.  Yong, 68. Yong argues that the high losses and debts meant that “the company’s capital of 2.5 million Straits dollars had been wiped out while the debentures were not covered.”



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146.  Yong, 68–69. 147.  The exchange rate of the Chinese dollar to the US dollar was 1:3 in 1935. See Jonathan Spence, The Search for Modern China (W. W. Norton & Company, New York, 1990), 426. 148.  “Higher schools given $720,000 aid by Nanking: Appropriation Made For Private Institutions Amoy Univ. Get Most,” China Press, August 8, 1934, 2; “Universities to get $720,000 from Nanking: Amoy School to Receive Biggest Appropriation From Government,” China Press, July 2, 1936, 15. 149.  “Difficulties of Amoy University,” North China Herald, June 24, 1936, 528. In reporting on the financial troubles of Xiamen University, the North China Herald reported that Tan Kah Kee was going to “spend a fortune on its buildings and equipment in the hope that the Central Government will ultimately take it over.” It added that “the University must either be taken over by either the central or provincial governments or it must definitely close.” 150.  “Amoy University: Dr. Lim Boon-­keng Will Resign His Post,” South China Morning Post, July 10, 1937, 14. The report noted that “following the change of Amoy University into a national college,” “the Central Government will make an annual appropriation of $290,000 for its regular maintenance, states the China Times.” 151.  “Amoy University”; “Action, Not Talk Is Wanted,” Malaya Tribune, September 22, 1937, 12. 152.  Pál Nyíri, “Reorientation: Notes on the Rise of the PRC and Chinese Identities in Southeast Asia,” Southeast Asian Journal of Social Science 25, no. 2 (1997): 161–82. The author noted that “Amoy University is on its way to becoming one of the few universities in China to have its own medical school, financed by an overseas Chinese donation.” The author of the article did not specify who the donor was. 153.  Lim Boon Keng, “Lin Wenqing Xiaozhang Baogao” [Report by President Lin Wenqing], in Xiamen daxue xiaoshi ziliao [The historical materials of Xiamen University], ed. Xiamen daxue xiaoshi bianweihui (Xiamen: Xiamen daxue chu ban she, 1987), 224–29. 154.  Light spent about two years (from 1922 to 1924) as the head of the Zoology Department at Xiamen University. See “Sol Felty Light, Zoölogy: Berkeley,” University of California: In Memoriam, 1947, Calisphere, accessed August 27, 2019, http://​texts​.cdlib​ .org​/view​?docId​=​hb1m3nb0fr​&​doc​.view​=​frames​&​chunk​.id​=​div00004​&​toc​.depth​=​1​&​ toc​.id=. 155.  “C. Ping,” in Lawrence R. Sullivan and Nancy Yang Liu, Historical Dictionary of Science and Technology in Modern China (Lanham, MD: Rowman & Littlefield, 2015), 46–47. 156.  For example, see C. Ping, “Zoological Note on Amoy and Its Vicinity,” Bulletin of the Fan Memorial Institute of Biology 1 (1930): 127–40; S. F. Light, “Amphioxus Fisheries near the University of Amoy, China,” Science no. 58 (1923), 67–70; and Tse-­Y in Chen, “The Effect of Oxygen Tension on the Oxygen Consumption of the Chinese Fresh Water Crab, Eriocheir Sinensis,” Chinese Journal of Physiology 6 (1932): 1–12.

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157.  Kerrie MacPherson, “The History of Marine Science in Hong Kong (1844– 1971),” in Perspectives on Marine Environmental Change in Hong Kong and Southern China, 1977–2001, ed. Brian Morton (Hong Kong: Hong Kong University Press, 2003), 17. 158.  Stephen Leroy Allgood, “Research into Biology: Conference Being Held in Amoy, Sea Life Study,” South China Morning Post, August 7, 1930, 10. 159.  “Biologists To Study at Amoy,” China Press, June 24, 1931, 4; Thomas Wayland Vaughan, International Aspects of Oceanography: Oceanographic Data and Provisions for Oceanographic Research (Washington, DC: National Academy of Sciences, 1969), 203. 160.  For more information on the origins of the China Foundation for the Promotion of Education, see James Reardon-­Anderson, The Study of Change: Chemistry in China, 1840–1949 (Cambridge: Cambridge University Press, 2002), 198–200. 161.  Allgood, “Research into Biology”; A. M. Boring, “Summer Institute for Biological Research at Amoy, China,” Science 72, no. 1869 (1930): 429–30. 162.  Boring, “Summer Institute.” Boring points out that the conference discussed several types of research, including “faunistics, experimental and cytological, concentrating on living amphioxus, but including also Teredo, Squilla, fishes, amphibia, insects, protozoa.” 163. Boring. 164.  Lim Boon Keng, On the Tenth Anniversary of the Founding of Amoy University (Unknown publisher, 1931). 165. Lim. 166.  “English Language in Malay Schools,” Straits Times, January 8, 1935, 12. 167.  Xiamen Shi difang zhi bian zuan weiyuan hui [Xiamen Gazetteer Committee], Xiamen shi zhi: Mingguo [Xiamen Gazetteer: Republican Period] (Beijing: Fangzhi chubanshe, 1999), 331 and 361–67. According to the gazetteer, a total of 2,013 students graduated from Xiamen University from 1921 to 1947. In 1947, there were around 300 teachers and 1,227 students at Xiamen University, with the majority of the students in the science, technical and law departments. 168.  Peter Neushul and Zuoyue Wang, “Between the Devil and the Deep Sea: CK Tseng, Mariculture, and the Politics of Science in Modern China,” Isis 91, no. 1 (2000): 59–88. 169.  “Science Is the Specialty of Amoy University,” China Press, July 23, 1931, 11. 170.  See Bullock, American Transplant; Bullock, Oil Prince’s Legacy; Andrews, Making of Modern Chinese Medicine, 2. 171.  For a breakdown of John Grant’s conceptualization and design of rural public health facilities near Beijing, see Bu, Public Health, 212–26; as well as Lei, Neither Donkey nor Horse, 55–58, 225–27. 172.  See Sigrid Schmalzer, The People’s Peking Man: Popular Science and Human Identity in Twentieth-­Century China (Chicago: University of Chicago Press, 2009), 37 and 42, for PUMC’s role in establishing the Cenzoic Research Laboratory for geological surveys as well as the role of PUMC’s Davidson Black in the Peking Men’s



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excavation. See also Daniel S. Asen, Death in Beijing: Murder and Forensic Science in Republican China (Cambridge: Cambridge University Press, 2016), 170–91 for the role of PUMC in developing biomedical methods for forensic investigations in China. 173. Lei, Neither Donkey nor Horse, 228–38. 174.  See Qiusha Ma, “From Religion to Science,” in Uneasy Encounters: The Politics of Medicine and Health in China, 1900–1937, ed. Iris Borowy (Frankfurt am Maim: Peter Lang, 2009), 29–62; and Zongyun Zi and Mary Bullock, “American Foundations in Twentieth-­Century China,” in Philanthropy for Health in China, ed. Jennifer Ryan, Lincoln C. Chen, Tony Saich, Peter Geithner, and Wang Zhenyao (Bloomington: Indiana University Press, 2014), 106. 175.  Laurence Schneider, Biology and Revolution in Twentieth-­Century China (Lanham, MD: Rowman & Littlefield, 2003), 26. 176. Bullock, Oil Prince’s Legacy, 52. 177.  Mary Augusta Brazelton, “Western Medical Education on Trial: The Endurance of Peking Union Medical College, 1949–1985,” Twentieth-­Century China 40, no. 2 (2015): 126–45. 178.  “Heads of Department” in “Publications—Yearbook, ‘The Unison,’ 1927,” box 132, folder 956, China Medical Board (CMB) Inc., Rockefeller Archive Center, Sleepy Hollow, NY (hereafter designated RAC). 179. Bullock, American Transplant, 22. 180. Bullock, Oil Prince’s Legacy, 52. 181.  John Z. Bowers, Western Medicine in a Chinese Palace: Peking Union Medical College, 1917–1951 (Philadelphia: Josiah Macy, Jr. Foundation, 1972), 102. Bowers argues that “some of the more conservative PUMC faculty members felt that Lim at the age of 27 was too young and untested for a senior appointment. He was therefore given a one-­year trial period under the critical eyes of Anton Julius (“Ajax”) Carlson at the University of Chicago . . . Before the year was over, Carlson reported to the CMB that Robert Lim was eminently qualified to hold a senior faculty position in any medical school, in the West or in China . . . Thus the program in physiology at PUMC received a great fillip with the arrival in 1924 of ‘Bobby Lim.’” 182.  Robert Lim to Roger Greene, October 7, 1922, in file “PUMC Physiology— Lim,” box 123, folder 890, CMB Inc., RAC. 183.  Schafer to Greene, October 20, 1922, in file “Physiology—Lim R.K.S.,” box 123, folder 890, CMB Inc., RAC. 184.  Roger Greene to Robert Lim, October 20, 1922, in file “PUMC Physiology— Lim,” box 123, folder 890, CMB Inc. RAC. Greene wrote, “I happened to see Dr. Alfred Sze, the Chinese Minister, yesterday before receiving your letter and he then referred very kindly to you.” 185.  Roger Greene to Robert Lim, November 27, 1922, in file “PUMC Physiology— Lim,” box 123, folder 890, CMB Inc., RAC.

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186.  Roger Greene to Sir Edward Albert Sharper-­Schafer, October 20, 1922, in file “PUMC Physiology—Lim,” box 123, folder 890, CMB Inc., RAC. 187.  Sir Edward Albert Sharper-­Schafer to Roger Greene, December 12, 1922, in file “PUMC Physiology—Lim,” box 123, folder 890, CMB Inc., RAC. Schafer wrote, “I have suggested to him [Robert Lim] in the first instance that he might go to Professor Carlson at the University of Chicago—especially if he should begin his work over there in August, as I understand that the University of Chicago encourages work during the vacation.” 188.  Richard Pearce to Roger Greene, February 25, 1923, in file “PUMC Physiology—Lim,” box 123, folder 890, CMB Inc., RAC. 189.  Pearce to Greene, February 25, 1923. 190.  Pearce to Greene, February 25, 1923. 191.  Pearce to Greene, February 25, 1923. 192.  Roger Greene to Richard Pearce, March 9, 1923, in file “PUMC Physiology— Lim,” box 123, folder 890, CMB Inc., RAC. 193.  Robert Lim to Roger Greene, May 30, 1923, in file “PUMC Physiology—Lim,” box 123, folder 890, CMB Inc., RAC. 194.  A. J. Carlson to Roger Greene, February 4, 1924, in file “PUMC Physiology— Lim,” box 123, folder 890, CMB Inc., RAC. In fact, the first sentence of A. J. Carlson’s letter suggested that Greene had reached out to Carlson for an official letter of recommendation only on February 2, 1924, two days earlier. Carlson began the letter with “Referring to yours of Feb. 2nd, I would like to say that Dr. Robert Lim has so far impressed me as a first-­class man, both in teaching and in research.” This meant that Greene seriously solicited the letter from Carlson only after Lim had received the offer from Xiamen University. 195.  Roger Greene to Robert Lim, February 7, 1924, in file “PUMC Physiology— Lim,” box 123, folder 890, CMB Inc., RAC. 196.  Robert Lim to Roger Greene, February 11, 1924, in file “PUMC Physiology— Lim,” box 123, folder 890, CMB Inc., RAC. 197.  Roger Greene to Robert Lim, February 14, 1924, in file “PUMC Physiology— Lim,” box 123, folder 890, CMB Inc., RAC. 198.  Henry Houghton to Roger Greene, February 19, 1925, in file “PUMC Physiology—Lim,” box 123, folder 890, CMB Inc., RAC. 199.  Henry Houghton to Mary Eggleston, April 23, 1925, in file “Physiology— Cruickshaw,” box 122, CMB Inc., RAC. 200.  Henry Houghton to Robert Lim, April 15, 1925, in file “PUMC Physiology— Lim,” box 123, folder 890, CMB Inc., RAC. 201.  Houghton to Lim, April 15, 1925. 202.  Henry Houghton to Robert Lim, March 3, 1927, in file “PUMC Physiology— Lim,” box 123, folder 891, CMB Inc., RAC. 203.  A. M. Dunlap to R. S. Greene, January 28, 1927, in file “PUMC Physiology— Lim,” box 123, folder 891, CMB Inc., RAC.



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204.  G.E.S., “Davidson Black. 1884–1934,” Obituary Notices of Fellows of the Royal Society 1, no. 3 (1934): 361–65. 205. “Guide to Bernard and Katherine Read Papers, Special Collections, Yale Divinity School Library,” accessed August 27, 2019, http://​drs​.library​.yale​.edu​ /HLTransformer​/HLTransServlet​?stylename​=​yul​.ead2002​.xhtml​.xsl​&​pid​=​divinity:​157​ &​query​=​&​clear​-s­­ tylesheet​-c­­ ache​=​yes​&​hlon​=​yes​&​big​=​&​adv​=​&​filter​=​&​hitPageStart​=​ &​sortFields​=​&​view​=​all; Bowers, Western Medicine, 103. Read was appointed a lecturer at PUMC after he had obtained a degree from the London College of Pharmacy. And after obtaining his doctorate from Yale University, he became the head of PUMC’s pharmacology department. 206. Bowers, Western Medicine, 105. 207.  Bowers, 132. 208.  Bowers, 142. 209.  “Wu Hsien,” in Boorman et al., Biographical Dictionary of Republican China, 3:402–3. 210.  Shuyong Liu, Yi zhi yi ye zong guan qing [Recollections of Hong Kong University alumni] (Xianggang: Xianggang da xue chu ban she, 1999), 30–34. 211.  Liu; Hong Kong Museum of Medical Sciences Society, Plague, SARS, and the Story of Medicine in Hong Kong (Hong Kong: Hong Kong University Press, 2006), 183. 212.  Margaret Anne Crowther and Marguerite Dupree, Medical Lives in the Age of Surgical Revolution (Cambridge: Cambridge University Press, 2010), 2–3. 213.  Peter J. Kuzink, Beyond the Laboratory: Scientists As Political Activists in 1930s America (Chicago: University of Chicago Press, 1987), 160. 214.  “Personal Information,” in file “Parasitology Staff—Khaw Oo Keh,” box 114, folder 826, CMB Inc., RAC. 215.  Robert Lim to Roger Greene, June 13, 1924, in file “Physiology—Lim R.K.S.,” box 123, folder 890, CMB Inc., RAC. 216.  “Interview with Dr. Cash,” March 4, 1927, in file “Parasitology Staff—Khaw Oo Keh,” box 114, folder 826, CMB Inc., RAC. Cash remarked that Dr. Khaw “expresses the fear that no great progress in the department of medical education in the University of Amoy is to be expected because of the irregular financial support afforded the medical side of the enterprise.” Cash added that Khaw “sees no particular future for himself under the circumstances, and while he does not say in so many words there is clear indication that he would consider favorably within the next year or two a call to return to PUMC.” 217.  Khaw Oo-­keh to Carl TenBroeck, April 14, 1927, in file “Parasitology—Staff, O. K. Khaw,” box 114, folder 826, CMB Inc., RAC. See also Wayne Soon, “Science, Medicine, and Confucianism in the Making of China and Southeast Asia—Lim Boon Keng and the Overseas Chinese, 1897 to 1937,” Twentieth-­Century China 39, no. 1 (2014): 24–43. 218.  “Roger Greene’s Interview with Dr. C. E. Lim,” November 30, 1927, in file “Parasitology—Staff, O. K. Khaw,” box 114, folder 826, CMB Inc., RAC. Dr. C. E. Lim

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remarked that it was “beginning to look as if Dr. Khaw might be free to accept position in Peking in six or seven months,” and added that it was “probable that President Lim will be leaving the University before very long.” 219.  Governing Committee, Educational Services Division, August 2, 1940, in file “Parasitology—Staff, O. K. Khaw,” box 114, folder 826, CMB Inc., RAC. 220.  Ernest Carroll Faust and Oo-­Keh Khaw, “Studies on Clonorchis Sinesis (Cobbold),” American Journal of Hygiene, 1927, in file “Publications 26–27 (Reprints),” box 172, CMB Inc., RAC. 221.  Roger Greene to Chang Hsi Chun, March 15, 1930, in file “Physiology Staff— Chang,” box 122, folder 887, CMB Inc., RAC. 222.  Roger Greene to Mary Eggleston, May 14, 1931, in file “Physiology Staff—Kosaka,” box 122, folder 889, CMB Inc., RAC. 223.  Horace W. Davenport, “Robert Kho-­seng Lim,” Biographical Memoirs of the National Academy of Sciences 51 (1980): 288. 224.  Davenport, 298–306. 225.  Wen Chao Ma, Robert Ko-­Sheng Lim, and An-­Chang Liu, “Changes in the Golgi Apparatus of the Gastric Gland Cells in Relation to Activity,” Chinese Journal of Physiology 1 no. 3 (1927): 305–30. The Golgi apparatus was uncovered in 1898 and is integral in modifying, sorting, and packing macromolecules for cell secretion or use within cells. 226.  Tsun-­Chee Shen, Chung-­Lien Hou, and R. K. S. Lim, “Observations on the Conduction of the Nerve Impulse in the Cooled Phrenic Nerve,” Chinese Journal of Physiology 2, no. 4 (1927): 307–80. 227.  Roger Greene to Mary Eggleston, November 8, 1928, in file “Hospital Staff Liu J H 1919–38,” box 70, folder 496, CMB Inc., RAC. 228.  “Liu Jui-­heng,” in Boorman et al., Biographical Dictionary of Republican China, 3:402–3. 229.  “China National Medical Association,” North China Herald, February 4, 1928, 176. Liu Jui-­heng argued that “we [biomedical doctors] need a more united front.” He added that “we should not have two medical associations.” 230.  Xiaoqun Xu, Chinese Professionals and the Republican State: The Rise of Professional Associations in Shanghai, 1912–1937 (Cambridge: Cambridge University Press, 2006), 133. 231.  “Roger Greene’s Interview with Robert Lim,” July 4, 1928, in file “Physiology— Lim R. K. S.,” box 123, folder 891, CMB Inc., RAC. Lim told Greene that the “prospect for uniting all medical associations is not so bright now.” Lim added that “there is still another group of German trained men from Germany and from German Schools in China.” This group presumably referred to the members of the China Medical and Pharmaceutical Association. See also “Roger Greene’s Interview with Robert Lim,” July 18, 1928, in file “Physiology—Lim R. K. S.,” box 123, folder 891, CMB Inc., RAC. Greene



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claimed Lim said that “plans for a comprehensive association cannot be carried out now.” He added that Lim wanted to propose his plan for “a federation of associations instead.” 232.  “Meeting of Chinese Medical Association,” South China Morning Post, September 30, 1932, 14. 233.  “W. S. New,” in Boorman et al., Biographical Dictionary of Republican China, 3:43–44. 234.  See “Greene’s Interview with Lim,” July 4, 1928. Greene recalled that Lim noted that “National Medical Journal will be moved to Peking this fall with C. E. Lim as editor.” See also “Editorial,” National Medical Journal of China 6, no. 1 (March 1920): 3; “The National Medical Journal of China,” National Medical Journal of China, 17, no. 5 (August–October 1931): 812. Also see Bu, Public Health, 53–56. From 1920 to 1931 at the journal, Wu Lien-­teh was the editor-­in-­chief and C. E. Lim was the head of publication services. O. K. Khaw was named an associate editor in 1931. 235. Robert Lim to Henry Houghton, July 18, 1928, in file “Physiology—Lim R. K. S.,” box 123, folder 891, CMB Inc., RAC. 236. “Notes by Dr. Robert McClure on Peking Union Medical College War-­ workers, August, 31, 1938,” in file “Criticism 1933–44,” box 35, folder 250, CMB Inc., RAC. 237.  “Chapter of the Acting Director for the Academic Year Ended June 30, 1944,” in file “Director—Peking Union Medical College (PUMC)—Annual Report 1933–41,” box 49, folder 341, CMB Inc., RAC. 238.  Robert Lim to Edwin Lobenstine, August 16, 1942, in file “Physiology—Lim R. K. S.,” box 123, folder 891, CMB Inc., RAC. 239.  See “The Chinese Physiological Journal” (Advertisement), in National Medical Journal of China 17, no. 6 (December 1931): 813. 240.  Robert Lim to Henry Houghton, September 22, 1936, in file “Physiology— Lim R. K. S.,” box 123, folder 891, CMB Inc., RAC. 241. Bullock, Oil Prince’s Legacy, 122. 242. Bowers, Western Medicine, 152. 243.  Henry Houghton to A.M. Pearce, September 24, 1939, in file “Physiology— Lim R. K. S.,” box 123, folder 891, CMB Inc., RAC. An excerpt from the letter is as follow: “HSH’s letter to ECL about Dr. Lim’s proposal that the PUMC set up a unit in Free China. HSH believes that if the College were to do this it would place the College and its Chinese Staff in extreme peril. HSH warns . . . the New York Office to be very circumspect in what they put into letters that are going to Peiping as the Japanese may censor the letter.” Also see Robert Lim to M. C. Balfour, June 18, 1941, in file “Physiology—Lim R. K. S.,” box 123, folder 891, CMB Inc., RAC. Lim wrote again in 1941 to the Rockefeller Foundation, imploring its directors to instruct PUMC to set up a branch school in Southwest China, but to no avail.

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Chapter Two

1.  “Field Work: From a Report by Dr. Wang I-­hsien, Medical Director of a Field Hospital, February 1939” in Foreign Auxiliary to the Red Cross Society of China, China Aid Council UCR, box 1, folder 6, in file “Chinese Red Cross 1938–40,” UCR Records. 2.  “Field Work.” 3.  By the middle of 1938, the Japanese and Chinese were fighting near central China’s tri-­city area of Wuhan, Changsha, and Hankou, located in Hubei Province and the northern part of Hunan Province. 4.  Figures are compiled from the seven reports of the CRCMRC located in Lim’s Papers. See also “7th Report of the Chinese Red Cross Medical Relief Corps,” Lim’s Papers, 49–57. 5.  The battle between the Chinese and the Japanese would pick up again in Changsha, a year after the battle of Wuhan. 6.  “4th Report of the Chinese Red Cross Medical Corps,” Lim’s Papers. 7.  “6th Report of the Chinese Red Cross Medical Relief Corps,” Lim’s Papers, 35. 8.  “Wounded Soldiers in China by ABMAC” (abstract of the 4th report of CRCMRC), China Aid Council UCR, box 1, folder 6, in file “Chinese Red Cross 1938-­40,” UCR Records. 9.  Until 1941, sulfur treatment was still endorsed by physicians as a tried and tested treatment, even though benzyl benzoate became increasingly popular during the Second World War in the West. See D. L. Carter, “Treatment of Scabies: Use of Sulphur Lather Tablets,” British Medical Journal 2, no. 4211 (1941): 401–3. After 1941, physicians increasingly proposed using a more curative method of benzyl benzoate to eliminate mites that caused the disease. Even so, they still emphasized disinfecting clothing to prevent the disease from spreading. See, for example, R. M. Gordon and D. R. Seaton, “Observations on the Treatment of Scabies,” British Medical Journal, June 6, 1942, 685–87. 10.  “7th Report,” 57. 11.  “5th Report of the Chinese Red Cross Medical Relief Corps,” Lim’s Papers, 36–38. 12.  See “5th Report,” and also “A Medical Service Training School and Hospital in Each War Area Is the Goal of Dr. Robert Lim,” Time, February 17, 1941, box 22, in file “National Red Cross Society of China,” American Bureau for Medical Aid to China Records, Rare Book and Manuscript Library, Columbia University (hereafter ABMAC Records). 13.  “4th Report of the Chinese Red Cross Medical Corps,” Lim’s Papers, 72; “3rd Report of the Chinese Red Cross Medical Corps,” Lim’s Papers, 42. In the third report, Lim argued that administering medicine was ineffective without “the aid of proper diet and nursing care.” 14. “4th Report,” 71. 15.  “Medical Service Training School.”



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16.  Evert Barger and Philip Wright, “Summary of Reports on a Survey of Red Cross Work in the Northwest,” July 1941, box 22, in file “National Red Cross Society of China,” ABMAC Records. 17.  Wu Hsien, “The Significance of Recent Advances in the Science of Nutrition,” China Medical Journal 27, no. 10 (October 1928): 737. 18.  See Kwok-­kan Tam and Terry Siu-­han Yip, Gender, Discourse and the Self in Literature: Issues in Mainland China, Taiwan and Hong Kong (Hong Kong: Chinese University Press, 2010), 674-­76; Brigid Vance, “Textualizing Late Ming Dreams: Acts of Translation in the Encyclopedia Forest of Dreams” (PhD diss., Princeton University, 2012); and Carla Nappi, The Monkey and the Inkpot: Natural History and Its Transformations in Early Modern China (Cambridge, MA: Harvard University Press, 2009), 174. For a brief study of food as medicine in classical Chinese medicine, see Rogaski, Hygienic Modernity, 31–37, and Bret Hinsch, Women in Early Imperial China (Lanham, MD: Rowman & Littlefield , 2011), 80. 19.  See Angela Leung, “Organized Medicine in Ming-­Qing China: State and Private Medical Institutions in the Lower Yangzi Region,” Late Imperial China 8, no. 1 ( June 1987), 134–66. 20.  See Ernest Koh, Diaspora at War: The Chinese of Singapore between Empire and Nation, 1937–1945 (Leiden: Brill, 2013), 73–74. 21.  “5th Report,” 181. 22.  “3rd Report of the Chinese Red Cross Medical Relief Corps,” Lim’s Papers, 2303001, 50. 23.  According to Hsing-­Tsung Huang, Gua mien originated in the Southern Song as “hung” noodles. See Huang and Joseph Needham, Fermentations and Food Science, Science and Civilization in China, vol. 6: Biology and Biological Technology (Cambridge, MA: Cambridge University Press, 2000), 484. 24.  “The Emergency Medical Services Training School,” Lim’s Papers, 2310001, 70. 25.  “4th Report,” 49. 26.  “6th Report,” 26. 27.  “4th Report,” 72–73. 28.  “4th Report,” 72–73. 29.  Barger and Wright, “Summary of Reports.” 30.  Shen Tong, “The Diet of Chinese Soldiers and College Students in Wartime China,” Science 98, no. 2544 (October 1, 1943): 302–3. 31.  Shen, 302–3. 32.  “6th Report,” 34. 33.  “6th Report,” 34. 34.  See “6th Report,” 29. 35.  “6th Report,” 31. Such a comparison only roughly indicates the disease rates as a percentage of detection rates because it assumes that the number of people deloused is equal to the number of people sampled for the disease.

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36.  “Red Cross Work: Twenty-­Eight Mobile Units on Battle Fronts,” South China Morning Post, February 4, 1938, 15. 37.  Agnes Smedley, “The Wounded in China,” Manchester Guardian, August 24, 1938. 38.  “Red Cross Relief: Work in China Reviewed by Dr. Robert Lim,” South China Morning Post, February 18, 1938, 14. 39.  “7th Report,” 49. 40.  “6th Report,” 11. 41.  “6th Report,” 11. 42.  “6th Report,” 135. 43.  “6th Report,” 31. 44.  “7th Report,” 194. 45.  “4th Report,” 44. 46.  See “Red Cross Aid for Guerillas,” North China Herald, March 1, 1939, 363. 47.  See Mark Selden, “Shensi Province: The Revolutionary Settings,” in China in Revolution: The Yan’an Way Revisited (Armonk, NY: M. E. Sharpe, 1995), 1–16. 48.  All 26 registered national medical schools in early wartime China were located in either Guizhou or Sichuan Provinces of Free China or in occupied coastal regions. See “Memorandum of Medical Education in China,” September 29, 1941, in P. Z. King to P. N. Cheng of ABMAC Chongqing (August 25, 1941), box 5, in file “Cheng Pao-­ nan,” ABMAC Records. 49.  China Defence League. In Guerilla China: Report of China Defence League (New York: China Aid Council, 1943), 16. 50.  Two missions to Yan’an in 1944 had a largely positive view of the base areas: the United States Army Observation Group and the group led by Overseas Chinese leader Tan Kah Kee. See David Barrett, Dixie Mission: The United States Army Observer Group in Yenan, 1944 (Berkeley: University of California, 1970), and Yong, Tan Kah-­Kee, 256–57, 285–86. 51.  Hannant and Bethune, Politics of Passion, 205. 52.  “Report of the 29th Unit at Yenan (Fushin),” UCR Records. 53.  “South Anhwei: Letter from Agnes Smedley, December 1938,” in Foreign Auxiliary to the Red Cross Society of China, China Aid Council UCR, box 1, folder 6, in file “Chinese Red Cross 1938–40,” UCR Records. 54.  “Field Work.” 55.  Chiang, “Report of the 29th Unit.” 56. Chiang. 57.  China Defense League, “A Brief Report of the New Fourth Army Medical Service, 1938-­1939,” box 2, folder 12, in file “Medical Aid to China, 1938–41,” UCR Records, NYPL. 58.  Chiang, “Report of the 29th Unit.”



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59.  China Defense League, “Field Reports: New Fourth Army Medical Service: Achievements and Needs,” in “China Defense League Newsletter,” April 1, 1939, box 5, in file “China Defense League,” ABMAC Records. 60.  “Jack Belden Speaks from the Front, January, 1939,” Foreign Auxiliary to the Red Cross Society of China, UCR Records. 61. China Defense League, “Brief Report of the New Fourth Army Medical Service.” 62.  China Defense League. 63.  For example, see Zhongyang dianshitai [China Central Television], Kang zhan: Ji nian Zhongguo ren min kang Ri zhan zheng ji shi jie fan Faxisi zhan zheng sheng li 60 zhou nian [Anti-­Japanese war: Sixtieth anniversary of the remembrance of the anti-­ Japanese and anti-­fascist war in China and the world] (Qingdao Shi: Qingdao renmin chubanshe, 2005), 242. 64.  See Diana Lary, The Chinese People at War: Human Suffering and Social Transformation, 1937–1945 (New York: Cambridge University Press, 2010), 198; and Mao Zedong, Serve the People; In Memory of Norman Bethune; The Foolish Old Man Who Removed the Mountains (Peking: Foreign Languages Press, 1967). 65.  Works on Norman Bethune include Adrienne Clarkson, Norman Bethune (Toronto: Penguin Canada, 2009); and Roderick Stewart and Sharon Stewart, Phoenix: The Life of Norman Bethune (Montréal: McGill-­Q ueen’s University Press, 2011). 66.  “Medical Work in the Northwest Border Region,” box 5, in file “China Defense League,” ABMAC Records. 67.  C. K. Chu, “Nationalization of Medicine in China,” 1940, box 2, folder 12, in file “Medical Aid to China, 1938-­41,” UCR Records, NYPL. 68.  See James Cook, “A Transnational Revolution: Sun Yat-­sen, the Overseas Chinese, and the Revolutionary Movement in Xiamen, 1900-­12,” in Sun Yat-­Sen, Nanyang, and the 1911 Revolution, ed. Lee Lai To and Lee Hock Guan (Singapore: Institute of Southeast Asian Studies, 2011), 170–99. 69. Yong, Tan Kah-­Kee, 188. A. See also “Shantung Relief Fund,” Straits Times, June 1, 1928, 11. 70.  Based on exchange rates found in Shakila, United States and Malaysian Economy, xix. In 1925, 1 US dollar was roughly worth 1.78 Straits dollars. 300,000 Straits dollars was roughly worth USD 168,539 in 1925. This amount is worth USD 2.42 million in 2018. All figures in this chapter for USD in 2018 terms are calculated from “US Inflation Calculator,” accessed November 17, 2018, www​.usinflationcalculator​.com/. 71.  See Yong Chen, “Understanding Chinese American Transnationalism During the Early Twentieth Century: An Economic Perspective,” in Chinese American Transnationalism: The Flow of People, Resources, and Ideas Between China and America During the Exclusion Era, ed. Suchen Chan (Philadelphia: Temple University Press, 2006), 156–73.

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72.  It is likely that the support of British Chinese for war-­torn China took the form largely of remittances, insofar as much of their postwar support for China took that form as well. See Gregor Benton and Edmund Terence Gomez, The Chinese in Britain, 1800-­Present: Economy, Transnationalism, Identity (Basingstoke: Palgrave Macmillan, 2008), 202–83. The involvement of British Chinese in twentieth-­century China arguably reached its height during the Second World War, when they donated money and supplies for medical relief there. 73.  See John Carroll, Edge of Empires: Chinese Elites and British Colonials in Hong Kong (Cambridge, MA: Harvard University Press, 2005), 64, 174, 190; and Takeshi Hamishita, Linda Grove, and Mark Selden, “China and Hong Kong in the British Empire in the Late Nineteenth and Early Twentieth Century,” in China, East Asia and the Global Economy: Regional and Historical Perspectives (Milton Park: Routledge, 2008), 145–66. Hong Kong emerged as one of the centers of remittance by Overseas Chinese in the early half of the twentieth century. 74.  See George Hicks, Overseas Chinese Remittances from Southeast Asia, 1910–1940 (Singapore: Select Books, 1993); and Cheun Hoe Yow, Guangdong and Chinese Diaspora: The Changing Landscape of Qiaoxiang (New York: Routledge, 2013), 28. From the 1930s to the 1940s, many ethnic Chinese in Indonesia, Thailand, and the Philippines remitted money to their hometowns in Guangdong Province. 75. “1st Report of the Chinese Red Cross Medical Relief Corps,” Lim’s Papers, 1. 76.  “Sons of Malaya,” Straits Times, October 2, 1940, 78. 77.  C. Y. Wu to Frank Co Tui, January 30, 1939, box 23, in file “National Red Cross Society of China (C. Y. Wu, 1938, 1939 & 40),” ABMAC Records. 78.  China Defense League, “Medical Work in the Northwest Border Region,” box 5, in file “China Defense League,” ABMAC Records. 79.  Ruth Price, The Lives of Agnes Smedley (Oxford: Oxford University Press, 2005), 341–42. Price describes briefly the close relationship between the China Aid Council and the China Defense League. The Aid Council was headed by Mildred Price, allegedly a secret ardent communist. See John Earl Haynes and Harvey Klehr, Venona: Decoding Soviet Espionage in America (New Haven: Yale University Press, 1999), 105. See also China Defence League, In Guerilla China. 80.  Based on exchange rates found in US Department of Commerce, Statistical Abstract of the United States, 1942 (Washington, DC: Government Printing Office, 1943), 332. 1 HKD was worth USD 0.2745 in 1939 and USD 0.2296 in 1940. 81.  Hilda Selwyn Clarke to Frank Co Tui, March 13, 1939, in file “Hilda Selwyn Clarke, 1939,” UCR Records; China Defense League Newsletter, October 1, 1939, 3, box 5, in file “China Defense League,” ABMAC Records. 82.  “Aid for War Orphans: China Defense League Recital,” South China Morning Post, October 26, 1940, 4.



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83.  “‘Pastor Hall’ Premiere Performance by China Defense League,” South China Morning Post, March 22, 2018, 4. 84.  University of Hong Kong, Growing with Hong Kong: The University and Its Graduates: The First 90 Years (Hong Kong: University of Hong Kong, 2002), 67. 85.  See Lindsay Ride, “The Test of War (Part 1),” in Dispersal and Renewal: Hong Kong University during the War Years, ed. Clifford Matthews and Oswald Cheung (Hong Kong: Hong Kong University Press, 1998), 9–24; and “Volunteer Doctors: Graduates from Hong Kong University Leaving Soon for Chinese Red Cross,” South China Morning Post, January 14, 1941, 7. Other Hongkongers who assisted Robert Lim included Dr. Sze Tsung Sing, who would become a professor of public health at Hong Kong University after the war, and Dr. Ho Hung Chiu, the son of Sir Robert Tung. 86.  James Bertram, “From Red Swastika to Red Cross: An Unknown Victory of the China War,” box 5, in file “China Defense League,” ABMAC Records. 87.  “China’s Medical Supplies,” Manchester Guardian, August 17, 1940, 9; see also “Red Cross Suffers: Humanitarian Appeal Made by Dr. Robert Lim,” South China Morning Post, August 27, 1940, 12. 88.  “China’s Agony,” The Scotsman, July 12, 1930, 13. 89.  “The Suffering Millions in China,” Manchester Guardian, July 11, 1939, 22; See also Price, Lives of Agnes Smedley, 331–32. 90.  Agnes Smedley, China Correspondent (London: Pandora Press, 1943), 167–69. 91.  Freda Utley, China at War (New York: John Day, 1939), 81–95. 92.  “China at War,” Straits Times, August 13, 1939, 16. According to the article, the ambulance she traveled in had been donated by a Singaporean millionaire. 93. Advertisement, Straits Times, September 18, 1937, 4. 94.  “’Chinese Venus Arrives at Batavia,” Straits Times, July 24, 1938, 5. 95.  Janet Chen describes similar efforts in Shanghai, where elites would raise funds for Subei refugees after the war by organizing beauty pageants and dance parties. Critics claimed that such efforts reflected the hedonistic lifestyle of the Shanghai elites, even though their fundraising appears to have been extraordinarily successful. See Janet Chen, Guilty of Indigence: The Urban Poor in China, 1900–1953 (Princeton, NJ: Princeton University Press, 2012), 189–90. 96.  Interview with Ng Gan Cheng, quoted in Koh, Diaspora at War, 78. 97.  See Ong Wei Meng, Nanqiao jigong: The Extraordinary Story of Nanyang Drivers and Mechanics Who Returned to China during the Sino-­Japanese War (Singapore: National Archives of Singapore, 2009), 102, and Hua qiao xiehui, Huaqiao yu kan ri zhanzheng lun wenji [Collected writings on the Overseas Chinese and the Sino-­Japanese War] (Taibei Shi: Hua qiao xie hui zong hui, 1999), 20. 98.  Chen, “Understanding Chinese American Transnationalism.” 99.  Major newspapers in the United States prior to the Second World War rarely used the term Chinese Americans to refer to American citizens whose racial or ethnic

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background was Chinese. Exceptions included newspaper reports that explicitly showed how the Chinese American community was boycotting Japanese goods in the United States after the First World War, when Japan took over German territories in China. See “Boycott upon Japan,” Washington Post, March 2, 1915, 1; and “Chinese-­Americans Show Patriotism,” Los Angeles Times, June 6, 1917, I3. 100.  “Japan Foes March Here: Chinese-­Americans Picket Consulate in Fifth Avenue,” New York Times, June 7, 1936. 101.  White Americans who lived and worked in China as well as ethnic Chinese in the United States made up the directors and members of ABMAC. Hu Shi, then China’s ambassador to America, was its patron. The president of ABMAC was Dr. Donald Van Slyke. Dr. Frank Co Tui was its vice president and was in charge of its everyday operations in America. Lin Yutang, an American-­based Chinese intellectual, was one of its writers and directors. 102.  “History of the American Bureau for Medical Aid to China,” box 11, in file “History of ABMAC (2),” ABMAC Records. 103.  See “Bowl of Rice Campaign,” South China Morning Post, July 30, 1941, 3; and “Bowl of Rice Fund,” South China Morning Post, August 23, 1941, 4. 104.  “Dinner Aids Chinese Funds,” New York Times, March 6, 1938, 28; “Sale to Aid the Chinese,” New York Times, November 4, 1938, 12; “Recital Here Wednesday For Chinese War Victims,” Baltimore Sun, January 18, 1939, M9; Thomas A. DeLong, Madame Chiang Kai-­Shek and Miss Emma Mills: China’s First Lady and Her American Friend ( Jefferson, NC: McFarland, 2007), 109. 105.  “Drive to Aid Chinese: Students to Seek $20,000 for a Ton of Quinine,” New York Times, April 14, 1938, 20. 106.  “5 Ambulances for China: Cost, $10,000, Subscribed by Laundrymen in New York,” New York Times, April 23, 1938, 7. 107.  “Relief Fund Sent to China,” Christian Science Monitor, January 5, 1938, 5. 108.  The statistics on funds received by the CRCMRC for this chapter were collated from seven CRCMRC reports located in Robert Lim’s personal papers at the Institute of Modern History archives at Academia Sinica. See Reports of the CRCMRC, Lim’s Papers. 109.  “Red Cross Workers Bring Modern Medicine Methods to China’s Interior,” China Weekly Review, April 19, 1941, 222–23. 110.  Collated from seven CRCMRC reports in Robert Lim’s Papers. 111.  According to Diana Lary, the exchange rate between the Chinese dollar and the US dollar dropped from 3.37 Chinese dollars for every US dollar (1 Chinese dollar to USD 0.2937) in July 1937 to 17.6 Chinese dollars for every US dollar (1 Chinese dollar to USD 0.0568) in December 1940. See Lary, Chinese People at War, 160. According to the US government, the exchange rate was 1 Chinese dollar for USD 0.2961 (1937), USD 0.2136 (1938), USD 0.1188 (1939), and USD 0.06 (1940). See US Department of Commerce,



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Statistical Abstract, 332. Since the data collected by the CRCMRC do not allow for the calculation of monthly sums relative to the exchange rate, I chose to use a conservative exchange rate of 1 Chinese dollar to USD 0.1 for the entire period between 1938 and 1940. 112.  “ABMAC Minutes Bulletin, 1939,” ABMAC Records. 113.  See Gloria Heyung Chun, Of Orphans and Warriors: Inventing Chinese American Culture and Identity (New Brunswick, NJ: Rutgers University Press, 2000), 43–45. 114.  The latter two operated in occupied China and were reluctant to be seen supporting Lim’s CRCMRC. 115.  “5th Report,” 99–101. The following list covers donors of vehicles, from the highest to the lowest number of vehicles donated: the Chinese Consolidated Benevolent Association of Los Angeles, the Chinese Patriotic Society of New England, Overseas Chinese from Java, the Hong Kong branch of the National Women’s Relief Association, and the Hong Kong Chinese Women’s Club. 116.  There were four main departments at the CRCMRC: General Administration, Medical Services, Transportation, and Supplies. Medical Services was the biggest component, with five submedical units: the Ambulance, Nursing, Curative, X-­ray, and Preventive Units. 117.  In contrast to Jean Chiang’s focus on the physical deprivations suffered by the mainstream CRCMRC medical units, Norman Bethune focused on deficiencies, such as the low standard of education among medical personnel. To remedy these deficiencies, Bethune argued for better “leadership and training” for the medical corps in guerilla base areas. See Norman Bethune to Dr. Yeh Ching San and Dr. Yu Sheng Hua, July 12, 1939, box 161, in folder “Bethune Materials (Indexed),” Indusco, Inc., Records, Rare Book and Manuscript Library, Columbia University Library. 118.  Robert Lim and C. C. Chen, “State Medicine,” Chinese Medical Journal 51, no. 78 ( June 1937): 781–96. 119.  “7th Report,” 49–56. 120.  Mackinnon argues that the Chinese Army comprising KMT, KMT-­affiliated, and CCP troops had roughly 1.7 to 2.2 million soldiers in 1937. Xiaobing Li states that CCP troops increased from 46,000 in 1937 to 500,000 in 1940. Li describes how the KMT expanded its military to encompass “246 frontline divisions and 70 divisions assigned to the rear areas, totaling 3.8 million troops” by 1941. Combining the numbers of CCP troops and KMT soldiers suggests that the Chinese Army had at least 4.3 million troops by 1941. See Mackinnon, “Defense of the Central Yangtze,” 184–85; Xiaobing Li, Introduction to China at War: An Encyclopedia (Santa Barbara, CA: ABC-­CLIO, 2012), xxix–xxx. 121.  Tina Phillips Johnson, Childbirth in Republican China: Delivering Modernity (Lanham, MD: Lexington Books, 2011), 144. 122.  “Red Cross Workers Bring Modern medicine Methods to China’s Interior,” China Weekly Review, April 19, 1941, 222–23.

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Chapter Three

1.  Yi Chien-­lung to Helen Stevens, April 10, 1945, box 4, in file “Blood Bank 1945” (hereafter 1945), ABMAC Records. 2.  Yi to Stevens, April 10, 1945. In the Western world from the late 1920s to 1940s, injecting liver extract was thought to increase the number of red blood cells in the body. Today, it is considered more of an alternative medical treatment and frowned on by those in the mainstream medical profession because liver extracts may contain germs harmful to the body. See George Minot, Edwin Cohn, William Murphy, and Herman Lawson, “Treatment of Pernicious Anemia with Liver Extract: Effects upon the Production of Immature and Mature Red Blood Cells,” American Journal of the Medical Sciences 175, no. 5 (1928): 599–621. 3.  These two comrades were Du Yuming and He Yingqin. General Du was the head of the Nationalist Fifth Army from 1942-­45. General He was sent by Chiang Kai-­ shek, in 1944, to Yunnan to train the Chinese Expeditionary Forces, after having led the Military Affairs Commission for a decade. 4.  Yi to Stevens, April 10, 1945. 5. Shigehisa Kuriyama, “Interpreting the History of Bloodletting,” Journal of the History of Medicine and Allied Sciences 50 ( January 1995): 11–46; Bridie Andrews, “Xuezheng yu zhongguoyi xueshi” [Blood disease and the history of blood in China], in Qingyilai de jibing, yiliao he weisheng: yishehui wenhua shiwei shijiao de tansuo [Investigating diseases, treatment, and hygiene from the Qing Dynasty from the social and cultural history angle], ed. Xinzhong Yu (Beijing: Xinzhi sanlian shudian, 2009), 159–88. 6. Cochran, Chinese Medicine Men, 71–73, 105. 7. Lei, Neither Donkey nor Horse, 5, 105–14; Andrews, Making of Modern Chinese Medicine, 137–39; Luesink, “State Power”; Bu, Public Health, 74, 144. 8. Lei, Neither Donkey nor Horse, 167–92. 9.  Frank Dikötter, Exotic Commodities: Modern Objects and Everyday Life in China (New York: Columbia University Press, 2006), 1-­22; and Wen-­hsin Yeh, “Corporate Space, Communal Time: Everyday Life in Shanghai’s Bank of China,” American Historical Review 100, no. 1 (1995): 97–122. 10.  See Lei,, Neither Donkey nor Horse, 268–73; Barnes, Intimate Communities, 5–7. 11.  Susan Lederer, Flesh and Blood: Organ Transplantation and Blood Transfusion in Twentieth-­Century America (Oxford: Oxford University Press, 2008), 55–105. 12.  Kara Swanson, Banking on the Body: The Market in Blood, Milk, and Sperm in Modern America (Cambridge, MA: Harvard University Press, 2014), 51–67. 13.  William Schneider, The History of Blood Transfusion in Sub-­Saharan Africa (Athens: Ohio University Press, 2013), 173–79. 14.  See Kevin Scott, Americans First: Chinese Americans and the Second World War. (Philadelphia: Temple University Press, 2008), 45–71; and Mark Lai, Chinese American Transnational Politics (Urbana: University of Illinois Press, 2010), 23–24. Scott reveals



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how more than 12,000 Chinese Americans joined the US military during World War II. Mark Lai shows the challenges faced by the Chinese American community in raising funds in the United States for the war effort in China. 15.  See John P. DiMoia, Reconstructing Bodies: Biomedicine, Health, and Nation-­ Building in South Korea since 1945 (Stanford, CA: Stanford University Press, 2013), 104; and Honghong Tinn, “From DIY Computers to Illegal Copies: The Controversy over Tinkering with Microcomputers in Taiwan, 1980–1984,” Annals of the History of Computing, IEEE 33, no. 2 (2011): 75–88. 16.  See Joel Howell, Technology in the Hospital: Transforming Patient Care in the Early Twentieth Century (Baltimore: Johns Hopkins University Press, 1996); and Malcolm Nicolson and John Fleming, Imaging and Imagining the Fetus: The Development of Obstetric Ultrasound (Baltimore: Johns Hopkins University Press, 2013). 17.  Early chronological history, box 11, in file “History of ABMAC (1) Chronology,” ABMAC Records; “China Prepares for Blood Plasma Bank,” ABMAC Bulletin 5, nos. 1–2 ( January–February 1943): 7. 18.  “China Prepares”; Douglas Starr, Blood: An Epic History of Medicine and Commerce (New York: Knopf, 1998), xii, xv, 101. Blood is comprised of red blood cells and the yellow liquid known as plasma, in which they are suspended. Plasma is prepared by spinning a tube of fresh blood containing an anticoagulant in a centrifuge until the blood cells fall to the bottom of the tube. The blood plasma is then filtered away. There were several purported benefits of using plasma: first, plasma was vital in abating the sudden loss of blood of soldiers shot in the battlefield. Post–World War I research showed that most soldiers died not of excessive blood loss when shot, but from the rapid loss of fluids from the body that dramatically lowered blood pressure. Thus, what was needed was a liquid that could quickly replenish this loss, and plasma was found to be most ideal. Second, plasma was highly portable and could survive for months in a frozen condition, unlike whole blood, which only lasted for a few days. Third, there was no need to type for plasma, because it usually did not cause incompatible reactions in recipients. When a donor gave incompatible whole blood to a patient (for example a blood type A donor to a blood type B recipient), the agglutinins in the recipient’s plasma attacked the incoming red cells, causing them to clump, resulting in deadly consequences for the recipient. When incompatible plasma was given, no obvious reaction happened because it contained such small agglutinins in relation to all the recipient’s red cells that it had little effect. Because of Scudder’s influence on Yi and Wong, the Chinese blood bank operated as a plasma bank. 19.  Helen Stevens to Walter White, July 22, 1943, in file “Chinese Blood Bank” (hereafter Blood), National Association for the Advancement of Colored People records, Library of Congress, Washington DC (hereafter NAACP records). 20.  Stevens to White, July 22, 1943. 21.  Stevens to White, July 22, 1943.

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22. “American Red Cross Blood Donation Policies, 1942–48,” Blood, NAACP records. 23.  Walter White to all New York branches, August 3, 1943, Blood, NAACP records. 24.  Walter White to Helen Stevens, August 3, 1943, Blood, NAACP records, August 3, 1943. 25. “NAACP Staff to Give to Chinese Blood Bank,” August 13, 1943, Blood, NAACP records; “To Aid Chinese Blood Bank,” New York Amsterdam News, August 21, 1943, 21. 26.  “US Japanese Give Blood,” New York Times, September 19, 1943, 11; “Japanese Blood Goes to the Aid of the Chinese,” New York Times, July 24, 1943, 18. 27.  Ellen Wu, The Color of Success: Asian Americans and the Origins of the Model Minority (Princeton, NJ: Princeton University Press, 2014), 82. 28.  “Chinese Blood Bank Opens in New York,” ABMAC Bulletin 5, nos. 6-­7 ( June– July 1943): 1. 29.  “Busy Day for the Blood Bank,” ABMAC Bulletin 6, nos. 1-­2 ( January–February 1944): 3. 30.  “Scope for War Fund Indicated by Tour,” New York Times, October 15, 1943, 21. 31. Swanson, Banking on the Body, 73–74. 32.  Swanson, 73–74. 33.  Kuriyama, “Interpreting the History of Bloodletting,” 44–46. This concept of “yin and yang” emerged during this time. 34. Kuriyama. 35. Lederer, Flesh and Blood, 35–36. 36.  Andrews, “Xuezheng yu zhongguoyi xueshi.” 37. Cochran, Chinese Medicine Men, 71–73, 105. 38.  “Feng Condition Now Critical,” China Press, June 23, 1931, 1. 39.  Peking Union Medical College, “Shuxueshu jianshuo” [A brief description of blood transfusion], Yixuezhoukanji [ Journal of Medical Studies] no. 4 (1931): 244–50. 40.  “Science of Blood Transfusion,” North China Herald, January 20, 1937. 41.  The magazine was founded in 1938 by Lin Yutang, Huang Jiayin (1913–61) and Huang Jiade to promote knowledge of American and British scientific trends to Chinese audiences. 42.  Milton Mackaye, “Jigong haoyide juanxuehui” [Selfless courage in doing good for society], trans. Hu Bei, Xifeng fukan [Western Wind Supplement], May 6, 1941 (originally in This Week Magazine, December 1940). 43.  Edith Roberts, “Juanxue kangzhan” [Donating blood to fight the war of resistance], trans. Ye Ha, Xifeng fukan [Western Wind Supplement], March 19, 1941 (originally in Hygenia, December 1940). 44.  Yi Chien-­lung to John Scudder and Co Tui, November 2, 1944, box 4, in file “Blood Bank (Correspondence to and from Blood Bank in China 1944)” (hereafter



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Correspondence), ABMAC Records. Xueku remains as the preferred word for most blood banks in China and Taiwan today. 45.  Robert Lim, “General Lim’s Speech at C. T. Loo’s Dinner Meeting for ABMAC Directors, May 16, 1944,” box 2, in file “Army Medical Administration: Directorate of Medical Service—Lim,” ABMAC Records. 46. Yi Chien-­lung to Helen Stevens, July 13, 1944, Correspondence, ABMAC Records. 47.  Adet Lin to Helen Stevens, September 16, 1944, Correspondence, ABMAC Records. 48.  Lin to Stevens, September 16, 1944. 49. Adet Lin to Helen Stevens, August 22, 1944, Correspondence, ABMAC Records. 50.  Lin to Stevens, September 16, 1944. The officer in charge had initially promised 1,000 soldiers in this camp, but only 400 showed up. The low turnout suggests that officers did not care enough to, or could not muster the authority to, command their troops to show up for inspection. 51.  Lin to Stevens, September 16, 1944. 52.  Lin to Stevens, September 16, 1944. 53.  Helena Wong, “Report from the Donor’s Clinic (September 1944),” November 14, 1944, Correspondence, ABMAC Records. 54. Wong. 55. Wong. 56.  Adet Lin, “Publicity Work during August 1944,” Correspondence, ABMAC Records. 57.  Adet Lin to ABMAC, August 1, 1944, Correspondence, ABMAC Records. 58.  Lin, “Publicity Work.” 59.  Adet Lin to Helen Stevens, August 22, 1944, Correspondence, ABMAC Records. 60.  Adet Lin to Helen Stevens, September 9, 1944, Correspondence, ABMAC Records. 61.  Robert Lim, “Summary of the Report of the Blood Bank, 1946,” Correspondence, ABMAC Records. 62.  Lin Youlan, “Xueku kaizai Kunming” [Blood bank in Kunming], Guang [Light] 4 (1945): 11–13. 63. “Qianfang jixu xuejiang” [The front needs blood plasma urgently], Yunnan Ribao [Yunnan Daily News], in Correspondence, ABMAC Records. 64.  For more on prewar Kunming’s economy and society, see Elizabeth Remick, “Police-­Run Brothels in Republican Kunming,” Modern China 33, no. 4 (October, 2007): 423–61; and Graham Hutchings, “Yunnan Province,” in Modern China: A Guide to a Century of Change (Cambridge, MA: Harvard University Press, 2001), 482–85.

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65.  Yi Chien-­lung to John Scudder and Co Tui, February 6, 1945, 1945, ABMAC Records. 66.  Yi Chien-­lung to Helen Stevens, July 13, 1944, Correspondence, ABMAC Records. The shipment left New York in January 1944 and arrived in May 1944. 67.  For a description of the physical nature of wartime Kunming and the Japanese bombing of the city, see John Israel, Lianda: A Chinese University in War and Revolution (Stanford, CA: Stanford University Press, 1998), 13, 21, 235, and 321. 68.  Yi to Stevens, April 10, 1945. 69.  Yi to Stevens, March 10, 1945, 1945, ABMAC Records. 70.  “Report on Mechanical Department, Feb 12, 1945,” 1945, ABMAC Records; Adet Lin to Helen Stevens, August 28, 1944, Correspondence, ABMAC Records. 71.  Lin to Stevens, August 28, 1944. 72.  Yi Chien-­lung to Robert Lim, November 12, 1944, Correspondence, ABMAC Records. 73.  Du is the hanyu pinyin transliteration of Tu. 74.  Yi Chien-­lung to John Scudder and Frank Co Tui, December 11, 1944, Correspondence, ABMAC Records. 75.  Yi to Scudder and Co Tui, December 11, 1944. 76.  “January 8, 1945, Special No. 2,” 1945, ABMAC Records. 77.  “7th Report,” 74, 194. 78.  Yi Chien-­lung to Helen Stevens, September 2, 1944, Correspondence, ABMAC Records. 79.  Lim, “Summary of Report of Blood Bank.” 80.  Mobile blood banks were used sparingly during the Second World War by other countries, such as England. See Starr, Blood, 183. 81. Captain Larrabee Albertson to Ms. Block, May 20, 1945, 1945, ABMAC Records. 82.  Yi Chien-­lung to Helen Stevens, July 17, 1945, 1945, ABMAC Records; Yi to John Scudder, November 9, 1944, Correspondence, ABMAC Records. Fott allegedly had damaged 24 bottles of plasma by not keeping the drying apparatus on for 24 hours. The demand that Fott keep such hours appeared unreasonable, however, and reflected the limits to which personnel were stretched by wartime circumstances. 83.  C. S. Fan to Donald Van Slyke and Frank Co Tui, October 4, 1944, Correspondence, ABMAC Records. 84.  Yi Chien-­lung to Helen Stevens, February 12, 1945, 1945, ABMAC Records. 85.  Betty Eng to Ruth Block, March 13, 1945, 1945, ABMAC Records. 86.  Ruth Deer to Helen Stevens, May 15, 1945, ABMAC Records. 87.  Deer to Stevens, May 15, 1945. 88.  Yi Chien Lung to John Scudder, August 20, 1944, Correspondence, ABMAC Records.



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89.  Adet Lin to Helen Stevens, November 29, 1944, Correspondence, ABMAC Records. 90.  Lin to Stevens, November 29, 1944. 91.  National Southwestern Associated University was formed from the merger of Beijing University, Qinghua University, and Nankai University after the fall of Beijing to the Japanese in 1937. The university migrated to Changsha before relocating to Kunming in 1938, where it stayed till the end of the war. 92. Israel, Lianda, 360–65. Students had remained supportive of the Chinese war effort even by 1944. 93.  Israel, 338–39. 94.  My calculations are based on the December 1944 rate of 570 Chinese dollars to 1 U.S. dollar. See Lary, Chinese People at War, 160. 95.  Robert Lim, “Summary of the Report of the Blood Bank, 1946,” 1945, ABMAC Records. 96. Adet Lin to Helen Stevens, October 23, 1944, Correspondence, ABMAC Records. 97.  I estimate that Lianda personnel donated around 125,749 cc of blood by dividing the total amount donated for October (260,310 cc) by the total number of donors that month (963) and then multiplying by the percentage who were Lianda personnel (48.3 percent). Israel, citing local newspapers, claimed that Lianda faculty and students donated a total of 150,000 cc of blood. See Israel, Lianda, 355. 98.  Adet Lin, “Trip to Tu Kuan Chun,” Correspondence, ABMAC Records. 99.  Adet Lin to Helen Stevens, November 21, 1944, Correspondence, ABMAC Records. 100.  Lin to Stevens, November 21, 1944. 101.  Report from the Donor’s Clinic, November 1944, Correspondence, ABMAC Records. 102.  Chang-­tai Hung, War and Popular Culture: Resistance in Modern China, 1937– 1945 (Berkeley: University of California Press, 1994), 244. Chang argues that the Communists first used comic strips to gain support for their causes during the Sino-­Japanese war. In this case, blood bank personnel also employed comic strips to reach out to Chinese civilians. 103.  Albertson to Block, May 20, 1945. 104.  “Guofang yixueyuan zhizao ganxuejiang” [National Defense Medical Center creates blood plasma], Shenbao, January 10, 1948. 105.  “Blood on the Market,” Chinese Weekly Review, November 28, 1946. 106.  “Shuxue yinhang yingfou qudi” [Should “blood banks” be cracked down?], Zhendanfalü jingjizazhi [Aurora University Law and Economic Journal] 3, no. 17 (1947): 139–40. 107.  Xiaoyun Huang, “Diwuci shuxue” [Fifth time donating blood], Jia [Home] no. 4 (1946): 35. My calculation draws on an estimated exchange rate of 3,000 Chinese

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dollars to 1 US dollar, based on the July 1945 exchange rate. See Lary, Chinese People at War, 160. 108. “Meianquan gongsu weishengzu tai sheli xueku” [Department of Health at the American Security Bureau sets up blood bank in Taiwan], October 1953, 028000000206A, NRC, AH. 109.  “Jilungshi xueku zuozhengshi chengli” [Keelung’s blood bank officially opens], Lianhebao [United News], July 20, 1955, 20. 110. “Taidayiyuan jueding jintian kaishi shishi bingrenqingyou quanxue bansu youxian kaidao” [Taida Hospital decides to prioritize surgery for those patients’ families and friends who can donate half their blood], Lianhebao [United Daily News], October 2, 1973. 111.  See “Benju guanyu guanli shuxue zhanshi banfa” [Regarding the temporary laws of the management of blood transfusion], February 1951, Beijing Municipal Archives, 135-­001-­00216; “Weishengju yu benju guanyu shuxue guanli gongzuo tongzhi” [Bureau of Public Health’s notice regarding management of transfusion work], 1964, Beijing Municipal Archives, 135-­001-­00833. The People’s Daily criticized the Taiwanese government for buying and selling blood. See “Jinri Taiwan” [Today’s Taiwan], Renmin Ribao [People’s Daily], February 24, 1957. 112.  Yang Meimei, “Beijing hemu jiayuan yiyuan jianli xiyou xueku” [Beijing United Healthcare Hospital sets up rare blood bank], People’s Daily, May 4, 2002; Song Xuechun and Sun Xiaoli, “Qingdao chengli daxuesheng liudong xueku” [Qingdao sets up university’s mobile bank unit], People’s Daily, April 28, 1999. 113.  Michael Dillion, Contemporary China: An Introduction (London: Routledge, 2009), 78–80. 114. “Gaizao ‘xueku’ yuanbi ‘zaoxue’ zhongyao” [Reforming “blood bank” more important than “creating blood”], August 29, 2011, Gongyi Shibao [China Philanthropy ­­ 8​-­­29​/111829311​.html; “Charity’s CredTimes], www​.gongyi​.sina​.com​.cn​/gyzx​/2011​-0 ibility,” China Daily, July 5, 2011, www​.chinadaily​.com​.cn​/bizchina​/2011​-­­07​/05​/content​ _12837565​.htm. These articles claim that only 3 percent of Chinese have donated blood or money to the Chinese Red Cross in recent years. Many Chinese oppose donating to the Red Cross because they are afraid the money will go to corrupt officials who extravagantly use donated blood to buy expensive cars and houses. 115.  Robert Lim, “Summary.” 116.  “Summary of Clinical Reports Administration of Plasma, October 17, 1945,” 1945, ABMAC Records. Only 2 out of 40 soldiers reportedly suffered from hypothermia and shock upon receiving plasma. 117.  “Office of Surgeon HQ IV Army Group Command Chinese Combat Command (P) October 9, 1945,” 1945, ABMAC Records. 118.  Adet Lin, “Trip to Tu Kuan Chun.” 119. Starr, Blood, 115–17.



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120.  Lin to Stevens, November 21, 1944. Adet Lin remarked to Helen Stevens then that, “Kunming is again in the middle of one of those minor scares, and there is talk of evacuation.” She added that there was “also quite a big scare two months ago,” even though it did not amount to anything. Her remarks were corroborated by a New York Times report a month later. See “Japanese Threat to Kunming Stands,” New York Times, December 5, 1944, 12.

Chapter Four

1.  Edward M Spiers, Chemical Warfare (Urbana: University of Illinois Press, 1986), 98. 2.  “Behind Battle Front: Foreign Doctor’s Experience of Gassed Chinese,” South China Morning Post, September 7, 1938, 17. 3.  “Behind Battle Front.” 4.  “Appalling Lack of Doctors in China Revealed,” China Press, February 14, 1937, 9. 5.  Michael Denham, “As We Once Were: The Wartime Emergency Medical Service and the Future NHS,” British Geriatric Society, November 8, 2015, www​.bgs​.org​.uk​ /resources​/as​-­­we​-­­once​-­­were​-­­the​-­­wartime​-­­emergency​-­­medical​-­­service​-­­and​-­­the​-­­future​ -­­nhs​-­­2. 6.  See Bullock, Oil Prince’s Legacy, 117–39; Brazelton, “Western Medical Education on Trial.” 7.  Daqing Zhang, “Medical Education in Contemporary Mainland China,” in Medical Education in East Asia: Past and Future, ed. Lincoln Chen, Michael Reich, and Jennifer Ryan (Bloomington: Indiana University Press, 2017), 61–84. 8.  The EMSTS trained a total of 15,931 personnel from May 1938 to March 1946, of whom 6,353 were trained from May 1938 to June 1943. The breakdown of the number of students trained for the specific periods is as follow: May to December 1938, 1,432 students; February 1939 to June 1942, 2,756 students; July 1942 to June 1943, 2165 students; June 1943 to March 1946, 9,578 students. See “The EMSTS First Report, June 1942–July 1943,” in file “ABMAC (EMSTS Report),” United Service to China Records, box 27, Seeley G. Mudd Manuscript Library, Princeton University (hereafter USC Records), 6,11; “The EMSTS Second Report, June 1942–July 1943,” in file “ABMAC (EMSTS Report),” USC Records, 26; “Report of Medical Field Service for August 1945–March 1946,” box 8, in file “Emergency Medical Services Training School 1942–46,” (hereafter cited as EMSTS 1942–1946), ABMAC Records, 18–20. 9.  William Kirby, “Continuity and Change in Modern China: Economic Planning on the Mainland and on Taiwan, 1943–1958,” Australian Journal of Chinese Affairs 24 (1990): 121–41; Julia Strauss, “Morality, Coercion and State Building by Campaign in Early PRC: Regime Consolidation and After, 1949–1956,” China Quarterly 118 (December 2006): 891–912; Chen, Guilty of Indigence, 9, 213–32; Morris Bian, The Making of the State Enterprise System in Modern China: The Dynamics of Institutional Change (Cambridge, MA: Harvard University Press, 2009).

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10. Bullock, American Transplant, 116–17. 11.  Ma, “From Religion to Science.” 12.  Weipin Tsai, Reading Shenbao: Nationalism, Consumerism and Individualism in China, 1919–37 (Basingstoke: Palgrave MacMillan, 2010), 161–62. 13.  “Emergency Medical Service Training School Announcement,” January 1941, Lim’s Papers, 1. 14.  “Emergency Medical Service Training School Announcement.” 15.  “Emergency Medical Service Training School Announcement.” 16.  “The Emergency Medical Services Training School, Dec. 30–Jan. 9, 1939,” in CRCMRC & EMSTS Memoranda and Reports, Lim’s Papers, 2310173. 17.  “Training Hospital: School Opened for Army Medical Personnel,” South China Morning Post, July 17, 1939, 18. 18.  “Training Hospital.” 19.  “The EMSTS First Report, June 1942–July 1943,” in file “ABMAC (EMSTS Report),” USC Records. 20. See “EMSTS First Report,” 24–25, and “The Emergency Medical Service Training School (Dec. 30 –Jan. 9, 1939),” in CRCMRC & EMSTS Memoranda and Reports, Lim’s Papers, 2309001, 1–3. 21.  “EMSTS First Report,” 13. As the report mentions, “the basic courses last exactly 13 weeks.” 22.  “Emergency Medical Service Training School Announcement,” 6–41. 23.  “EMSTS First Report,” 56. 24.  “EMSTS First Report,” 56. 25. “Junzheng bu zhan shi weisheng renyuan xunlian suo zengshe huangjingweisheng renyuan xunlian ban banfa” [Emergency Medical Services Training School’s addition of sanitary engineering classes act], Hunan jiaoyu 11 (1940): 65–66. EMSTS graduates would return to their units upon graduation. 26.  “EMSTS First Report,” 8. 27.  “EMSTS First Report,” 8. 28.  “Zhanshi weisheng renyuan xunliansuo gai kuang” [Survey of the EMSTS], Zhongguo hongshizihui huiwu tongxun 4 (1941): 4–5. 29.  Sweet, “Report on the Emergency Medical Service Training,” box 8, in file “EMSTS 1942–1946,” ABMAC Records. 30.  “EMSTS First Report,” 59–62. 31.  “EMSTS First Report,” 57–61. 32.  Five of these titles are Robert Lim, Zhan shi wei sheng gong zuo gui cheng: Di yibian, wei sheng qin wu [Regulations governing the work of wartime medical care: First manual, general health services] (Guiyang: EMSTS Press, 1941); Zhang Xianlin, ed., Zhan shi wei sheng gong zuo gui cheng: Di erbian, wai ke [Regulations governing the work of wartime medical care: Second manual, first aid and surgical services]



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(Guiyang: Chinese Red Cross Medical Relief Corps Press, 1940); Zhou Shou Kai, ed., Zhan shi wei sheng gong zuo gui cheng: Di sanbian, nei ke [Regulations governing the work of wartime medical care: Third manual, internal medicine] (Guiyang: EMSTS, 1940); Chou Mei-­yu, ed., Zhan shi wei sheng gong zuo gui cheng: Di sibian, hubing [Regulations governing the work of wartime medical care: Fourth manual, nursing services] (Guiyang: EMSTS, 1940);; Zhengxin Shi and Rong Qirong ed., Zhan shi wei sheng gong zuo gui cheng: Di wubian, fang yi [Regulations governing the work of wartime medical care: Fifth manual, prevention of communicable diseases] (Guiyang: EMSTS, 1940). As of 2013, five of the six manuals were located at the National Library of China. 33.  “EMSTS First Report,” 27–28. 34.  The adoption of western medicine as “new” had its precedents in Chinese history. In the Ming Dynasty, the Jesuits presented the Kangxi Emperor with a calendar that purported to be more accurate and able to predict the eclipses. The calendar, which was promulgated in 1645 as the official calendar, was called the Xiyang Lifa Xinshu (Calendar compendium following the new western method). See Joseph Dauben, foreword to Mr. Science and Chairman Mao’s Cultural Revolution: Science and Technology in Modern China, ed. Nancy Wei Chunjuan and Darryl E. Brock (Lanham, MD: Lexington Books, 2013), xi–xxviii. 35.  See Angela Leung, “The Yuan and Ming Periods,” in Chinese Medicine and Healing: An Illustrated History, ed. T. J. Hinrichs and Linda L. Barnes (Cambridge, MA: Belknap Press of Harvard University Press, 2013), 129–59. 36.  “EMSTS First Report,” 28. 37.  “Emergency Medical Service Training School Announcement,” 37–38. 38.  “Emergency Medical Service Training School Announcement,” 31. The CCP account of this incident can be seen in Zhonggong Hangzhoushi Xiaoshanqu dangshi yanjiushi [Committee on the official history of Chinese Communist Party at Xiao Mountain District of Hangzhou], Kangri zhanzheng zai xiaoshan: Ji nian kangri zhanzheng shengli liushi zhounian [The war of resistance at Xiao Mountains: Remembering the sixtieth year of the war of resistance] (Beijing: Zhong gong dang shi chu ban she, 2005), 124–25. Professional historians in the West are slightly more circumspect. See Keith Schoppa, “Bubonic Bombs,” in In a Sea of Bitterness: Refugees during the Sino-­ Japanese War (Cambridge, MA: Harvard University Press, 2011), 281–305. 39.  “EMSTS First Report,” 51. 40.  “EMSTS First Report,” 49. 41.  Details of experiments can be found in “EMSTS First Report,” 37–39. Robert Lim certainly knew about Marshall Bratton, H. J. White, and H. J. Kitchfield’s breakthrough in treating dysentery in the late 1930s. Drugs prior to their research were not effective in treating dysentery, and their discoveries resulted in an exponential growth of research on pharmaceutical treatment of dysentery in the early 1940s. Sulfaguandine

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and sulfapryridine were particularly well researched in this period. See E. K. Marshall Jr, A. C. Bratton, H. J. White, H. J. Litchfield, “Sulfanilylguanidine: A Chemotherapeutic Agent for Intestinal Infections,” Bulletin of the Johns Hopkins Hospital 67 (1940): 168–88; Lowell A. Rantz and William M. M. Kirby, “The Use of Sulfaguanidine in the Treatment of Dysentery Carriers,” Journal of the American Medical Association (hereafter JAMA) 118, no. 15 (1942): 1268–71; Perrin Long, “The Clinical Use of Sulfanilamide, Sulfapyridine, Sulfathiazole, Sulfaguanidine, and Sulfadiazine in the Prophylaxis and Treatment of Infections,” Canadian Medical Association Journal 44, no. 33 (March 1941): 217–27; and Lincoln Opper and Virginia Hale, “Sulfaguandine in Treatment of Dysentery (Bacterium Flexneri) Carriers, JAMA 119, no.18 (1942): 1489–91. 42.  The National Quarantine Bureau, led by Wu Lien-­teh from 1930 to 1936, treated Shanghai patients stricken with dysentery with saline solutions and bed rest. See Wu Lien-­teh, Cholera, a Manual for the Medical Profession in China (Shanghai: National Quarantine Service, 1934), 118–34. 43.  “EMSTS First Report,” 37. 44.  See Wen Chao Ma, Robert Ko-­Sheng Lim, An-­Chang Liu, “Changes in the Golgi Apparatus of the Gastric Gland Cells in Relation to Activity,” Chinese Journal of Physiology 1, no.3 (1927): 305–30. This experiment was conducted on eighteen dogs and seventeen rabbits in the mid 1920s at the PUMC by Robert Lim and his colleagues from the anatomy department. 45.  “EMSTS Second Report,” 37. 46.  See John Youmans, “Endemic Edema,” JAMA 99, no. 11 (1932): 883–87; Maria Maver, “Nutritional Edema and ‘War Dropsy,’” JAMA 74, no.14 (1920): 934–41. 47.  There were only experiments the other way around—whether improved diet for patients suffering from nutritional edema helped to improve the protein levels in blood plasma. See Russell L. Holman, Earle Mahoney, and George Whipple, “Blood Plasma Protein Regeneration Controlled by Diet I. Liver and Case in as potent diet factors,” Journal of Experimental Medicine 59 no. 3 (March 1, 1934): 251–67. 48.  “EMSTS First Report,” 27. 49.  Yeh Wen-­hsin, The Alienated Academy: Culture and Politics in Republican China, 1919–1937 (Cambridge, MA: Harvard University Press, 1990), 2, 176. 50. Lary, Chinese People at War, 90. 51.  A compelling account of the everyday challenges faced by students at Lianda can be found in Israel, Lianda. 52.  “Memorandum on the Emergency Medical Service Training Schools and the Orthopedic Center,” March 3, 1941, Robert Lim Papers, 2310001. 53.  “Memorandum on the Emergency Medical Service Training Schools.” 54.  “Wounded Soldiers in China,” in Chinese Red Cross 1938-­40, box 1, folder 6, United China Relief records. 55.  “Wounded Soldiers in China.”



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56.  “Wounded Soldiers in China.” 57.  “Aid for China Must Go On,” box 5, in file “China Defense League,” ABMAC Records. 58.  “First Report of EMSTS,” box 9, in file “Army Medical Administration (Directorate of Medical Service—Lim),” ABMAC Records. 59.  “Wounded Soldiers in China.” 60.  “EMSTS First Report.” 61.  “EMSTS First Report.” 62.  “Report of the EMSTS, September 18, 1942,” box 8, in file “EMSTS 1942–1946,” ABMAC Records. 63.  “Statistical Approach to Diagnosis and Cure,” ABMAC Bulletin 6, nos. 5–6 (May–June 1944): 3, 7. 64.  “Statistical Approach to Diagnosis and Cure.” 65.  “Statistical Approach to Diagnosis and Cure.” 66.  “EMSTS First Report,” 6, 25. 67.  “EMSTS First Report,” 25. 68.  Chou Mei-­yu, Pengyuan Zhang, and Jiurong Luo, Zhou Meiyu xian sheng fang wen ji lu [Records of interview with Chou Mei-­yu] (Zhonghua min guo Taibei Shi: Zhong yang yan jiu yuan jin dai shi yan jiu suo, 1993), 72. 69.  “The Emergency Medical Services Training School (Dec. 30–Jan. 9, 1939),” Lim’s Papers, 2310105, 3; “Junzheng bu zhan shi.” 70.  “Yue sheng fu juban zhan shi weisheng renyuan dengji” [Guangdong government organizes a recruitment drive of Emergency Medical Services Training School personnel], Shenbao, May 16, 1939. 71.  Chi-­ren Kuang and Yiu Lun Tsoi, Eastern Fortress: A Military History of Hong Kong, 1840–1970 (Hong Kong: Hong Kong University Press, 2014), 151. Kuang and Tsoi argue that “before the fall of Guangzhou in December 1938, 60 to 70 percent of goods imported by the Nationalists passed through Hong Kong.” 72.  “Dengji ren buguo bai ren” [Those who signed up did not exceed a hundred], Shenbao, May 25, 1939. 73.  “EMSTS Second Report,” 24. 74.  Robert Lim, “EMSTS Stage Training Program, Stage Medical Education,” Lim’s Papers, 23011001. 75. Bullock, American Transplant, 92. 76.  Lim, “EMSTS Stage Training Program.” 77.  Lim, 7. 78.  “Extract: Report of the Emergency Medical Services Training School,” 37–39, box 8, in file “EMSTS 1942–1946,” ABMAC Records. 79.  Alfred Kohlberg to Dwight Edwards, August 24, 1943, box 38, in file “Alfred Kohlberg Original Memos and Folders,” ABMAC Records.

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80.  Two scholars argue that KMT generals were jealous of Robert Lim’s fame, and saw him as a threat. These generals used the excuse of Lim’s alleged procommunist sympathies to remove him from his position as the head of EMSTS. See Barbara Tuchman, Stillwell and the American Experience in China, 1911–45 (New York: MacMillian, 1970), 265; Bullock, American Transplant, 201–2. 81.  “$5,000,000 Sought for China Relief; Seven Agencies Merged into New Group to Coordinate All Appeals for Aid China Relief,” New York Times, March 3, 1941. 82.  Other board members included Pearl Buck, William Bullitt, Robert Sproul, Wendell Willkie, John D. Rockefeller III, Theodore Roosevelt Jr., David O. Selznick, and Thomas Lamont. Henry Luce, the founder of Time, was one of the more active members on the board. 83.  Martha Lund Smalley, “Guide to Dwight W. Edwards Papers,” Special Collections, Yale Divinity School Library, accessed September 3, 2019, https://​archives​.yale​ .edu​/repositories​/4​/resources​/69. 84.  The Robert Lim incident suggests that ABMAC was willing to join UCR despite the obvious compromise to ABMAC’s autonomy because UCR was deemed to be a temporary organization that would be dissolved after achieving its fundraising aims, and Henry Luce would be a fair arbitrator of any differences between the organizations. On both counts, ABMAC would be disappointed. 85.  “Accepted Modus Operanti between UCR and the American Bureau for Medical Aid to China,” March 25, 1942, box 5, in file “January–May 1942 ABMAC Minutes,” ABMAC Records. 86.  All calculations of USD in 2018 terms for this chapter are drawn from US Inflation Calculator, last accessed September 3, 2019, www​.usinflationcalculator​.com/. 87.  “United China Relief Reports Rise in Aid: $8,612,155 Sent Overseas by the Organization in 1943,” New York Times, February 8, 1944, 4. 88.  In 1939, ABMAC raised around USD 200,000. In 1940, ABMAC disbursed a total of USD 160,000 to China. See “ABMAC Minutes 1938–1939,” and “History of ABMAC (1),” ABMAC Records. 89.  “History of ABMAC (1),” ABMAC Records. 90.  “Relief to China Grows: $40,655,711 Contributed in U.S. Since 1941,” New York Times, February 6, 1946, 4. 91.  B. A. Garside to Henry Luce, January 8, 1942, box 58, folder 6, in file “United China Relief Dispute with American Bureau of Medical Aid to China, 1943–1944” (hereafter cited as “Dispute”), Henry Robinson Luce Papers, 1917–69, Library of Congress Manuscript Division, Washington, DC (hereafter cited as Luce Papers). 92.  Douglas Auchincloss to Henry Luce, January 6, 1942, in file “Dispute,” Luce Papers. 93.  “The EMSTS Second Report, June 1942–July 1943,” 5, box 27, folder 7, in file “ABMAC (EMSTS Report),” USC Records. The exchange rate in December 1942 was



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49 Chinese dollars to 1 USD, and in December 1943 was 84 Chinese dollars to 1 USD. See Lary, Chinese People at War, 160. Since the EMSTS did not break down the receipt of funds from UCR and ABMAC into individual months, I use the exchange rate of 60 Chinese dollars to 1 USD to calculate the exchange rate during this period. 94.  This was similar to the conflict between Joseph Stillwell and Chiang Kai-­shek on the perceived long-­term needs of the Second World War. Stillwell wanted to commit American resources and Chinese troops to the immediate war effort by sending Chinese troops to Burma to fight the Japanese. Chiang was far more reluctant to do so, but eventually acquiesced under the pressures of President Roosevelt. See Maochun Yu, “An Army of One: Stillwell’s Chinese Vinegar,” in The Dragon’s War: Allied Operations and the Fate of China, 1937–1947 (Annapolis, MD: Naval Institute Press, 2006), 164–76. 95.  Bachman to United China Relief, March 22, 1943, box 27, folder 6, in file “ABMAC Jan.–April 1943,” USC Records. 96.  ABMAC to United China Relief treasurer, March 9, 1943, box 27, folder 6, in file “ABMAC Jan.–April 1943,” USC Records. 97.  Wes Bailey to Henry Luce, February 28, 1944, in file “Dispute,” Luce Papers. 98.  Dwight Edwards to ABMAC, April 7, 1943, box 27, folder 6, in file “ABMAC Jan.–April 1943,” USC Records. 99.  Donald Van Slyke and Alfred Kohlberg to Dwight Edwards, April 7, 1943, box 27, folder 6, in file “ABMAC Jan.–April 1943,” USC Records. 100.  Dwight Edwards Report, box 27, folder 5, in file “ABMAC, May–Sept. 1943,” USC Records. Although this report was not dated, the location of its placement in the folder, as well as the rebuttal by Donald Van Slyke on May 31, 1943, and Alfred Kohlberg on August 1943 suggest that this report was written sometime in May 1943. 101.  Dwight Edwards Report. 102.  Dwight Edwards Report. 103.  Dwight Edwards Report. 104. Notes by Donald Van Slyke, May 31, 1943, in file “EMSTS 1942–1946,” ABMAC Records. 105.  C. Y. Wu to Frank Co Tui, April 8, 1939, box 23, in file “National Red Cross Society of China (C. Y. Wu, 1938, 1939 & 40),” ABMAC Records. 106.  Wu to Co Tui, April 8, 1939. 107.  Lend-­Lease was a program introduced by President Roosevelt to assist Allies with fighting the Axis Powers during World War II, and represented official government aid. However, the Lend-­Lease aid to China was relatively modest compared to other Allied powers. Only 2.7 percent of all Lend-­Lease military aid was designated for China. See Yu, Dragon’s War, 88–103. 108.  Robert Lim to Donald Van Slyke, February 23, 1943, box 2, in file “Army Medical Administration,” ABMAC Records. 109.  Lim to Van Slyke, February 23, 1943.

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110.  Jane Thomson and John Dojka, “Guide to the Phillips F. and Ruth A. Greene Papers,” Yale University Archives, accessed January 13, 2019, https://​archives​.yale​.edu​ /repositories​/12​/resources​/3859. 111.  Philip Greene to Richard Allen, Vice Chairman of American Red Cross, February 3, 1943, box 38, in file “Alfred Kohlberg (Original Memo and Folders),” ABMAC Records. 112.  Greene to Allen, February 3, 1943. 113.  Greene to Allen, February 3, 1943. 114.  Alfred Kohlberg to Donald Van Slyke, November 5, 1943, in file “Dispute,” Luce Papers. 115.  Lin Yutang, Zhixue Liu, and Yanjie Bian, Lin Yutang zi zhuan [Autobiography of Lin Yutang] (Shijiazhuang Shi: Hebei renmin chuban she, 1991), 98. 116.  Lin Yutang to Alfred Kohlberg, January 23, 1944, box 38, in file “Alfred Kohlberg (2),” ABMAC Records. 117.  Lin to Kohlberg, January 23, 1944. 118.  See Donald Van Slyke to United China Relief—ABMAC Conference, December 7, 1943, and Edward Carter to Donald Van Slyke, December 20, 1943, box 27, folder 8, in file “October to December 1943,” USC records; Edward Carter to Alfred Kohlberg, January 8, 1944, Draft of Report of Special Committee (to investigate Alfred Kohlberg’s charges against United China Relief ), March 22, 1944, and Alfred Kohlberg to Paul Hoffman, Henry Luce, James Blaine, April 5, 1944, all three documents in box 38, file “Alfred Kohlberg (2),” ABMAC Records; Frank Co Tui to Henry Luce, January 26, 1944, Alfred Kohlberg to United China Relief, February 5, 1944, Alfred Kohlberg to Henry Luce, February 5, 1944, all three documents in file “Dispute,” Luce papers. 119.  Draft of Report of Special Committee, ABMAC Records. 120.  Van Slyke to Eugene Bartnett, October 6, 1943, box 27, folder 4, in file “United China Relief to ABMAC October–December 1943,” USC records. 121.  Chairman of Board to United China Relief, December 14, 1943, box 26, folder 4, in file “United China Relief to ABMAC October–December 1943,” USC records. 122.  Lennig Sweet, “Report on the Emergency Medical Service Training School, Kweiyang,” August 19, 1944, box 8, in file “EMSTS 1942–1946,” ABMAC Records. 123.  Chou et al, Zhou, 75. 124.  Based on personnel records held by the Chinese government, Robert Lim became the deputy surgeon general of the Chinese Army in March 1944 and the surgeon general of the Chinese Army on May 1945. See Junshiweiyuanhuizhang daishichu [Office of the Military Council], Linkesheng Renshi Dengjilu [Registration records of Lin Ko-­Sheng], in folder number 12800097997A, AH Archives. 125.  “Dr. Robert Lim’s Report #12,” March 12, 1945, box 2, in folder “Army Medical Administration, Reports 11–25,” ABMAC Records. 126.  “Report of the Army Medical Field Service School.”



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127. Bullock, Oil Prince’s Legacy, 122. 128.  “Memorandum of the EMSTS and the Orthopedic Center,” March 3, 1941, Lim Papers, 2310001.

Chapter Five

1.  Robert Lim to Jimmie, December 16, 1947, Lim’s Papers; Tsing Yi to Jimmie, October 20, 1948, Lim’s Papers. 2. Robert Lim, “National Defense Medical Center—Raison d’être (Report of Medical Services in 1946),” National Defense Medical Center 1 ( June 15, 1947): 1–15. 3.  Robert Lim wrote to Magnus Gregerson on March 3, 1948 stating that there were 1,604 students at the NDMC and that, by September of 1948, NDMC was expected to have around 3,000 students. Around 1,400 students moved with the NDMC from Shanghai to Taiwan in 1949, suggesting that there were at least 1,400 students by the end of 1949. Robert Lim to Magnus Gregersen, March 3, 1948, box 19, in file “National Defense Medical Center 1948–1954,” ABMAC Records. See also “NDMC Personnel and Dependents, June 20, 1949,” National Defense Medical Center 3 ( June 20, 1949). 4.  Guenter B. Risse, Mending Bodies, Saving Souls: A History of Hospitals (New York: Oxford University Press, 1999), 472–74. During the 1920s, the John Hopkins Hospital led the professionalization of medicine care and research in the United States. 5.  Lim, “National Defense Medical Center— Raison d’être.” Lim argued that the Japanese defeat did not mean that the job of providing medical care was done and that everything would be “rosy”; rather, it exposed the Chinese army’s weakness in education and the inability of China’s economy to pay for transportation and industry. This overall weakness in the economy and technical expertise had to be alleviated with greater participation by civilian technicians and business and academic elites responsible for providing medical aid. In addition, he urged civilians from the business and industrial sectors to provide medical aid and expertise. He urged the creation of a new council for Research and Development in China, similar to similar postwar endeavors in the United States and Great Britain. 6.  Drawing up the proposal for the center in late 1945, Lim obtained official approval for the National Defense Medical Center from Chiang Kai-­shek in January 1946. Construction of the center began soon after, and the center became fully operational by the fall of 1947. 7.  Lim, “National Defense Medical Center—Raison d’être.” 8.  Robert Lim to James Lim, June 1, 1947, Lim’s Papers. 9.  Robert Lim and Tsing Yi to James Lim, May 2, 1948, Lim’s Papers. 10.  Speech given by Dr. Robert Lim at the ABMAC Executive Committee meeting, February 13, 1957, Lim’s Papers. 11.  Lim, “National Defense Medical Center—Raison d’etre.” 12.  Robert Lim to James Lim, December 20, 1948, Lim’s Papers.

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13.  See K. Cheung (Dean of Army Medical College) to George Bachman, August 23, 1943, box 2, in file “Army Medical College,” ABMAC Records. 14.  Chen Cheng was a close confidant of Chiang Kai-­shek. He was made the minister of war in December 1944 and chief of general staff of the armed forces and commander in chief of the Chinese navy in 1945. He fought the Communists in North China during the height of the Civil War. He later underwent a successful stomach surgery at the NDMC in 1948. See Ramon Meyers, “Chen Cheng,” in Political Leaders of Modern China: A Biographical Dictionary, ed. Pak-­Wah Leung (Westport, CT: Greenwood Press, 2002), 13–14. 15.  Chou et al., Zhou, 77. 16.  Chou et al., 77. 17.  See Wang Gungwu, “China, Nationalist,” in Southeast Asia: A Historical Encyclopedia, from Angkor Wat to East Timor, ed. Keat Gin Ooi (Santa Barbara, CA: ABC-­ CLIO, 2004), 334–37. 18.  “Nanking Bid to Muzzle S’pore Press,” Singapore Free Press, July 18, 1947, 1; “Mr. Tans Ridiculed Gen. Li’s Appeal; No Support Likely,” Straits Times, March 14, 1950, 7. 19.  Steven Phillips, “Nationalist Legitimacy and Overseas Chinese Mobilization,” Journal of Modern Chinese History 7, no. 1 (2013): 64–86. 20. “Description of United Services to China Records,” Princeton University Library Finding Aids, accessed August 29, 2019, https://​findingaids​.princeton​.edu​ /collections​/MC135​#description. 21.  “Proposed Budget for the Year 1948 for the American Bureau for Medical Aid to China,” box 25, in file “Program (ABMAC), 1947–1948,” ABMAC Records. 22.  Robert Lim to Magnus Gregerson, March 3, 1948, box 19, in file “NDMC 1948– 1954,” ABMAC Records. 23.  Robert Lim to Allen Lau, March 18, 1948, box 19, in file “NDMC 1948–1954,” ABMAC Records. 24.  For a brief biography of Armstrong, see “George Armstrong,” US Army Medical Department: Office of Medical History website, accessed July 15, 2019, http://​history​ .amedd​.army​.mil​/surgeongenerals​/G​_Armstrong​.html. 25.  See “Statement of Receipt and Expenditure LADD CN$ 1945,” “Statement of Receipt and Expenditure LADD CN$ Jan 1 1946–Dec 31 1946,” box 19, in file “NDMC 1948–1954,” ABMAC Records. 26.  Based on an exchange rate of 35,000 Chinese dollars to 1 USD in June 1947. The Chinese dollar was greatly devalued from 1946 to 1949 due to the extremely high rate of inflation. See Diana Lary, China’s Civil War: A Social History, 1945–1949 (Cambridge: Cambridge University Press, 2015), 90. 27.  In the 1949 White Paper on China, the State Department claimed that the United States had given China USD 1.5 billion of aid from 1945–1949, arguing that the KMT failed in China despite massive US aid. However, it was clear that most of the aid



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was for repatriation of Japanese and Overseas Chinese nationals and the relocation of KMT troops and personnel from Southwest China to the rest of China through the Land-­Lease Act as well as the United Nations Relief and Rehabilitation Administration. Freda Utley, a long-­time China observer and journalist, questioned the White Paper’s aid figures in 1951 and argued that actual aid to the Chinese was closer to USD 100 million from 1945 through 1948. Together with the amount disbursed by the China Aid Act, she argues that the total amount of USD 220 million was “too little and too late” to help the KMT. Walter Trohan, the editor of the Chicago Daily Tribune, made a similar case in 1949. See US State Department, The China White Paper, August 1949 (Stanford, CA: Stanford University Press, 1967), 405; Freda Utley, “Too Little Too Late—The Facts about ‘Aid to China,’” in The China Story (Chicago: Regnery, 1951), 30–54; Walter Trohan, “Military Aid to China Held to Be Small: Far East Neglected, Records Show,” Chicago Daily Tribune, May 16, 1949, 12. 28.  The State Department promised USD 200 million of soft loans to the Chinese in 1947, which did not materialize. See Jay Taylor, The Generalissimo: Chiang Kai-­shek and the Struggle for Modern China (Cambridge, MA: Belknap Press of Harvard University Press, 2011), 375. 29.  Robert Lim, “NDMC May 9 1947 Robert Lim Speech to General Lucus, Officer of the AAG,” Lim’s Papers. 30.  See “Guofangyixeuyuan yakexi fazhan jihua shuominshu, Schemes in Building Up the Dental School of National Defense Medical Center,” National Resources Commission Files, Academia Historica, Taipei (hereafter NRC, AH), 003000007759A. The English translations of NDMC-­related National Resources Commission Files were provided by the National Resource Commission itself. 31.  See “Lianqinzongbu junyishu guofang yixueyuan yakeyuan ni chaiqian xuexiao ji gongchang jixie yunhuajianchang jihuabiao, A Plan of Transferring Japanese Machines to China Directorate of Medical Service Combined Service Forces,” NRC, AH, 003000007758A; “Guofangyixueyuan weisheng zhuangbei Shiyansuo Chongshi shuomingshu, Application of Medical Equipment Laboratory Required by National Defense Medical Center,” NRC, AH, 003000007760A; and “Guofangyixueyuan weisheng shiyanyuan shengwu pin gongchang chongshi jihua shuoming ji xijun yu xieqing xuexixiang risuo chang wujian biao, Plan for Equipping Vaccine Plant, Medical Laboratory, National Defense Medical Centre and List of Laboratory Supplies Requested by the Department and Serology, Medical Laboratory, National Defense Medical Centre,” NRC, AH, 003000007761A. 32.  See National Defense Medical Center, “National Defense Medical Center, Sites, Facilities and Installation, IV, February 28, 1947,” National Defense Medical Center 1 ( June 15, 1947); and Lim, “National Defense Medical Center—Raison d’etre.” 33.  National Defense Medical Center; Lim. 34.  National Defense Medical Center; Lim.

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35. Eastman, Seeds of Destruction, 301–11. 36.  Suzanne Pepper, “The Political Costs of Economic Mismanagement,” in Civil War in China: The Political Struggle, 1945–1949 (Berkeley: University of California Press, 1978), 95–131. 37. Eastman, Seeds of Destruction, 311–14. 38. Eastman, Seeds of Destruction, 311–14; Taylor, Chiang, 386–87. 39.  Tsing Yi to Jimmie, October 16, 1947, Lim’s Papers. 40.  Tsing Yi to Jimmie, March 4, 1947, Lim’s Papers. She had complained of the lack of buses in an earlier letter; see Tsing Yi to Jimmie, December 8, 1946, Lim’s Papers. 41.  Tsing Yi to Jimmie, October 20, 1948, Lim’s Papers. 42.  Robert Lim to Jimmie, December 16, 1947, Lim’s Papers. 43.  Robert Lim to Jimmie, June 1, 1947, Lim’s Papers. 44.  Lim, “National Defense Medical Center—Raison d’être.” 45. See National Defense Medical Center, no. 3 ( June 20, 1949), Lim’s Papers. 46.  Robert Lim to Magnus Gregersen, March 3, 1948, box 19, in folder “NDMC 1948–1954,” ABMAC Records; “NDMC Personnel and Dependents, June 20, 1949,” National Defense Medical Center 3 ( June 20, 1949). 47. “Planning for Peace, 1945–1949 (Part III),” 4–5, box 11, in file “History of ABMAC Chronology I,” ABMAC Records. 48.  “Planning for Peace, 1945–1949 (Part III),” 13. 49.  See “National Defense Medical Center 1948 Research Budget,” December 16, 1947, Lim’s Papers; “History of ABMAC Chronology (I),” 56, ABMAC Records. 50.  Lim, “National Defense Medical Center—Raison d’être.” 51.  More than 95 percent of those deloused were military personnel. See “Delousing Record of 1947 ( Jan.–Mar.),” Lim’s Papers. 52.  “7th Report”, Lim’s Papers. 53.  “Rates of Loss,” February 5, 1948, Lim’s Papers. 54.  See “Sick and Wounded Hospitalized (1937–1948),” “Sick and Wounded Hospitalized (Comparison with World Wars I & II Statistics),” “Anatomical Distribution of Wounds in Percent (Comparison with Other Wars’ Statistics),” “Wounds and Weapons Concerned,” “Pathological Distribution of Sick (Approximate),” “Rates of Loss,” “Distribution of Battle Losses for Armies (Corps) and Larger Units,” “Net Cost Per Inpatient Day Fiscal Year 1948 (Sept.),” Lim’s Papers. 55.  “Result of Hospitalization, 1937–1948,” Lim’s Papers. 56.  Tong Lam, A Passion for Facts: Social Surveys and the Construction of the Chinese Nation State, 1900–1949 (Berkeley: University of California Press, 2011). 57.  Shen Huaiyu and Lin Dongjing, “Wangxueshi xiansheng fangwenji” [Records of interview with Wang Xueshi], in Taibeirongminzongyiyuanbanshiji: Koushulishihuigu (Xiapian: gebu, ke, zhongxinzhurenyujiaoshou) [Half century of Taipei Veteran Hospital: Oral history (Second half: heads of departments and professors)], ed. You Jianming et al. (Taibei Shi : Zhongyan yuan jinshi suo, 2011), 1–50.



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58.  For details of the Battle of Xupeng or the Huaihai campaign, see Lary, China’s Civil War, 143–46; Odd Arne Westad, Decisive Encounters: The Chinese Civil War, 1946– 1950 (Stanford: Stanford University Press, 2004), 199–205. It was one of the fiercest battles fought between both sides, with more than 1.8 million soldiers involved. It ended in a major defeat for the KMT. The Communists killed, captured, and incorporated into their ranks more than half a million KMT troops. 59.  “Yidaiyixuezongshi Luzhideboshi” [The teacher of his times, Dr. Loo Chih-­ teh], Yuanyuan jikan 31 (2009): 12. 60.  Robert Lim to James Lim, December 20, 1948, Lim’s Papers. 61.  Robert Lim to Allen Lau, April 6, 1949, Lim’s Papers. 62.  Shen and Lin, “Wangxueshi.” 63.  Robert Lim to Allen Lau, April 6, 1949, Lim’s Papers. 64.  Robert Lim appears to have held the minister of health position briefly from December 1948 to January 1949. He was not sacked from the position, as the procommunist media suggested. Lim chose to resign from the position, as he preferred to focus on his endeavors at the NDMC as well as on a possible move to the United States. See Zhang Pengyuan and Huaiyu Shen, Guomin zhengfu zhiguan nianbiao, 1925–1949 [Annals of the official positions in the national government of the Republic of China, 1925–1949] (Zhonghua min guo Taibei Shi: Zhongyang yanjiu yuan jindai shi yanjiu suo, 1987), 221. 65.  Robert Lim to Jimmie, December 20, 1948, Lim’s Papers. 66.  Wang Daozhong, “Budong Zhongguohua de junyishuzhang—Lin Kesheng” [Robert Lim—The director of the military medical department who does not understand Chinese],” Xiuzhen Zazhi 2 (1949): 51–53; Geli, “Linkesheng diule weishengbuzhang [Robert Lim loses his minister of health’s position],” Qunyan 2 (1949): 8–9. 67.  Shen and Lin, “Wang Xueshi.” 68.  Tsing Yi and Robert Lim to Jimmie, March 8, 1949, Lim’s Papers. 69.  Tsing Yi and Lim to Jimmie, March 8, 1949. 70.  Shen and Lin, “Wang Xueshi.” 71.  See Dexian Hong, Chen Suzhen, and Zhou Weipeng, “Luo Guangrui xiansheng fangwen jilu” [Record of interviews with Mr. Luo Guangrui], in Taizhong rongmin zongyiyuan sanshizai: Koushu lishi huigu [Taichung Veteran Hospital: Oral histories], ed. Zhou Weipeng (Taibei shi: Zhongyang yanjiuyuan jindaishi yanjiusuo, 2012), 1–93; and Chou et al., Zhou Meiyu, 86. 72.  Hong, Chen, and Chou, “Luo Guangrui.” 73.  Allen Lau to Robert Lim, January 4, 1949, Lim’s Papers. All calculations of USD in 2018 terms for this chapter are drawn from US Inflation Calculator, accessed January 1, 2019, www​.usinflationcalculator​.com/. 74. Tom Christensen, Useful Adversaries: Grand Strategy, Domestic Mobilization, and Sino-­American Conflict, 1947–1958 (Princeton, NJ: Princeton University Press, 1996), 77–193; Warren Cohen, America’s Response to China: A History of Sino-­American Relations

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(New York: Columbia University Press, 2010), 203–5; and Nancy Tucker, Strait Talk: United States–Taiwan Relations and the Crisis with China (Cambridge, MA: Harvard University Press, 2009), 11–17. Tom Christensen delineates how the Truman administration became increasingly supportive of Chiang Kai-­shek because of the desire by some US leaders to consider the ROC as a counterweight to Communist China and North Korea with the outbreak of the Korean War. Scholars disagree, however, on the degree to which US policymakers supported Taiwan after the outbreak of the Korean War. Warren Cohen considers the support by Truman and Eisenhower for Taiwan as reluctant or “forced,” implicitly by the China Lobby, an amorphous US-­based pro-­ROC group. Nancy Tucker appears to consider such support, especially during the Eisenhower era, as a more straightforward realist response to the perceived threats of the Korean War to US interests. The case of NDMC suggests that any support during the Truman era remained in the realm of political rhetoric and military support rather than substantial economic and technical assistance akin to the US support for postwar Europe through the Marshall Plan. 75.  See Allen Lau to Robert Lim, March 11, 1949, Allen Lau to Robert Lim, March 24, 1949, and Allen Lau’s summaries of letters from January to March 1949, Lim’s Papers. 76.  Allen Lau to Robert Lim, March 15, 1949, Lim’s Papers. 77.  Julie Decker and Chris Chiei, Quonset Hut: Metal Living for a Modern Age (New York: Princeton Architectural Press, 2005), 24. 78.  Allen Lau to Robert Lim, April 7, 1949, Lim’s Papers. 79.  T. M . Peng, “A System of Medical and Allied Education at the National Defense Medical Center, Taipei, Taiwan, Republic of China,” Journal of Medical Education, 37 (May 1962): 463–72. 80.  Hong, Chen, and Chou, “Luo Guangrui.” 81.  See Zhang Xiurong, Taida yixueyuan [National Taiwan University College of Medicine, 1945–1950] (Taiwan: National Taiwan University Press, 2003), 66; and Tu Tsung-­ming, Huiyi lu Taiwan shouwei yixue boshi Du Congming [Recollections of the first professor of medicine, Tu Tsung-­ming] (Taibei: Long wen chu ban she, 2001), 191–92. 82.  This incident could not be mentioned publicly under the martial law period, and efforts to remember the event began in the 1990s as Taiwan democratized. See Steven Phillips, introduction to Between Assimilation and Independence: The Taiwanese Encounter with Nationalist China (Stanford, CA: Stanford University Press, 2003), 1–17; and Shelley Rigger, Why Taiwan Matters: Small Island, Global Powerhouse (Lanham, MD: Rowman & Littlefield, 2001), 25–26. 83.  Lung-­chu Chen, The U.S.-­Taiwan-­China Relationship in International Law and Policy (Oxford: Oxford University Press, 2016), 16–19. Chen claims that the KMT troops killed 20,000 people, many of whom were Taiwanese elites. Phillips claims a scholarly consensus of 10,000 Taiwanese killed, and 30,000 wounded. See Phillips, Between Assimilation and Independence, 83.



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84.  See Lan-­Hung Nora Chiang, “Different Voices: Identity Formation of Early Taiwanese Migrants in Canada,” in Immigrant Adaptation in Multi-­Ethnic Societies: Canada, Taiwan, and the United States, ed. Eric Fong, Lan-­hung Nora Chiang, and Nancy A. Denton (New York: Routledge, 2015), 255–85. 85.  See Zhang, Taida yixueyuan, 67, for the names of the NTUCM professors and students arrested during the February 28 incident. 86.  Tong-­hwa Lee, Guangfu chuqi Taida xiaoshi yanjiu: 1945–1950 [History of National Taiwan University in the early years of retrocession, 1945–1950] (Taibei Shi : Guoli Taiwan daxue chuban zhongxin, 2014), 229–30. 87.  See Loo Chih-­teh, “Medical Education and Service in Free China,” 1962, box 19, in file “NDMC 1962,” ABMAC Records. 88.  Hong, Chen, and Zhou, “Luo Guangrui,” 1–9. 89.  Hong, Chen, and Zhou, 1–9. 90.  Shen and Lin, “Wang Xueren.” 91.  Shen and Lin. 92.  Dwight D. Eisenhower, “Executive Order 10477—Authorizing the Director of the United States Information Agency to Exercise Certain Authority Available by Law to the Secretary of State and the Director of the Foreign Operations Administration,” August 1, 1953, American Presidency Project, accessed September 3, 2019, www​ .presidency​.ucsb​.edu​/documents​/executive​-­­order​-­­10477​-­­authorizing​-­­the​-­­director​-­­the​ -­­united​-­­states​-­­information​-­­agency. 93.  Dwight D. Eisenhower, “Special Message to the Congress on the Organization of the Executive Branch for the Conduct of Foreign Affairs,” June 1, 1953, American Presidency Project, accessed September 3, 2019, www​.presidency​.ucsb​.edu​/documents​/special​ -­­message​-­­the​-­­congress​-­­the​-­­organization​-­­the​-­­executive​-­­branch​-­­for​-­­the​-­­conduct​-­­foreign. 94.  Harold Stassen, Report to the President on the Foreign Operations Administration, January 1953–June 1955 (Washington: United States Government, 1955). 95.  Harry Urrows to Magnus Gregerson, “Washington Meeting on May 26,” box 36, in file “NDMC-­ABMAC Approach to Foreign Operations Administration Funds, 1954” (hereafter cited as FOA Funds), ABMAC Records. 96.  The reference to Cairo probably referred to the idea of Cairo as the center of Islamic Studies around the world in the late nineteenth and twentieth centuries. Holger Warnk, “Some Notes on the Malay-­Speaking Community in Cairo at the Turn of the Nineteenth Century,” in Insular Southeast Asia: Linguistic and Cultural Studies in Honour of Bernd Nothofer, ed. Fritz Schulze and Holger Warnk (Wiesbaden: Harrassowitz, 2006), 141–52. 97.  B. A. Garside, Robert Lim, Liu Jui-­heng, Loo Chih-­teh, and John Hanlon (Chief of U.S. Public Health Division) attended the second meeting to discuss in detail their proposal for the Foreign Operations Administration. 98.  “The National Defense Medical Center: A Focal Point of American Cooperation in Asia,” in file “FOA Funds.”

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99.  “Foreign Operations Administration—Aid to the National Defense Medical Center, July 17, 1954,” in file “FOA Funds.” 100.  Harry Urrows to Magnus Gregerson, “Washington Meeting on May 26,” in file “FOA Funds.” 101.  Harold Stassen to Walter Judd, July 29, 1954, in file “FOA Funds”; Stassen to Judd, October 29, 1954, in file “FOA Funds.” 102.  Loo to B. A. Garside, November 3, 1954, in file “FOA Funds.” 103.  Ting-­Hong Wong, “College Admissions, International Competition, and the Cold War in Asia: The Case of Overseas Chinese Students in Taiwan in the 1950s,” History of Education Quarterly 56, no. 2 (April 2016): 331–57. 104. The data was collated from Guofang yixueyuan yuanshibian zuan weiyuanhui [National Defense Medical Center Editorial Committee of the NDMC Official History], Guofang yixue yuan yuan shi [History of the NDMC] (Taipei: Guofang yixueyuan, 1995), 381–89. 105.  Lau to Loo Chih-­teh, January 18, 1955, box 19, in file “NDMC 1955–1959,” ABMAC Records. 106.  Loo Chih-­teh, “NDMC expansion program,” March 6, 1954, box 19, in file “NDMC 1955–1959,” ABMAC Records. 107.  “US Aid for Defense Medical Center,” July 29, 1954, in “NDMC Counterpart fund,” in file “Xingzhengyuanjinjijiansheweiyuanhui, ‘wenjianshiliaoyijiuwuqiniandu guofangyixeuyuanqicaian’” [‘The Documentary History of the Machines in the National Defense Medical Center’ in the files of the Economic Development Council of the Executive Yuan], 040000000258A, AH archives. 108.  Lau and the ABMAC did not follow up with this report, and all parties appear to have moved on from this issue. 109.  Zhang Shuqin and Lin Dongjin, “Yexinhua xiansheng fangwenjilu” [Records of interview with Yeh Shin-­Hwa], in Taibeirongminzongyiyuanbanshiji: Koushulishihuigu (Shangbian: lirenyuanzhang, fuyuanzhang) 2 [Half century of Taipei Veteran Hospital, oral histories (First half: former directors, and vice directors], ed. You Jianming et al. (Taipei: Institute of Modern History at Academia Sinica), 147–67. 110.  See “National Defense Medical Center, Supplementary Budget to Permit Development over a Period of Three Years,” in “NDMC Counterpart fund,” in file “Xingzhengyuan jinjijiansheweiyuanhui, ‘wenjianshiliaoyijiuwuqiniandu guofangyixeuyuanqicaian’” [‘The Documentary History of the Machines in the National Defense Medical Center’ in the files of the Economic Development Council of the Executive Yuan], 040000000258A, AH. 111.  “National Defense Medical Center, Supplementary Budget.” The Council was formed in 1948 to administer United States aid in the Republic of China. See Megan Greene, The Origins of the Developmental State in Taiwan: Science Policy and the Quest for Modernization (Cambridge, MA: Harvard University Press, 2008), 51.



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112.  Loo Chih-­teh to B. A. Garside, October 15, 1956, box 19, in file “National Defense Medical Center 1955–1959,” ABMAC Records. 113.  Loo Chih-­teh, “Medical Education and Service in Free China,” box 19, in file “National Defense Medical Center 1963,” ABMAC Records. 114.  Loo Chih-­teh, “General Loo’s Address at the Dedication of ABMAC Village for NDMC Faculty Families on 22 October 1960,” box 19, in file “National Defense Medical Center 1960–1961,” ABMAC Records. 115.  The National Federation of Business and Professional Womens’ Club in the United States donated a total of USD 14,565 to the NDMC Nursing Department from 1949 to 1951. See “Report of Nursing Department of National Defense Medical Center, Jan 1952,” box 19, in file “NDMC 1948–1952,” ABMAC Records. 116.  See Gertrude E. Hodman, “Report on Nursing in Taiwan,” box 2, in file “Army Nursing School, 1946–1957,” ABMAC Records; and Chou et al., Zhou Meiyu, 102–8. 117.  See Loo Chih-­teh, “NDMC Interim Report, April 1963,” and “Address on the Occasion of the Dedication of the Alfred Kohlberg Memorial Medical Research Laboratory, Nov, 11 1963,” box 19, in file “NDMC 1963,” ABMAC Records. The laboratory was a three-­story building with an area spanning 50 by 200 feet with a basement of 40 by 50 feet for housing mechanical equipment. 118.  See Greene, Origins of the Developmental State; Honghong Tinn, “Modeling Computers and Computer Models: Manufacturing Economic-­P lanning Projects in Cold War Taiwan, 1959–1968,” Technology and Culture 59, no. 4 (2018): S66–S99; James Lin, “Sowing Seeds and Knowledge: Agricultural Development in Taiwan and the World, 1925–1975,” East Asian Science, Technology and Society 9, no.2 (2015): 127–49. 119. Greene, Origins of the Developmental State, 90, 108. 120.  Lin, “Sowing Seeds and Knowledge.” 121.  See Pei-­Chia Lan, Global Cinderellas: Migrant Domestics and Newly Rich Employers in Taiwan (Durham, NC: Duke University Press, 2006). 122.  Gabriel Wu, “The Rejected Imagination of Poetry in Fang Ang, Fu Chengde and Chen Qianghua,” in Overcoming Passion for Race in Malaysia Cultural Studies, ed. David C. L. Lim (Leiden: Brill, 2008), 29–48. 123.  We-­Koh Keng, “Nation, Diaspora, and the World: Locating Namewee and Malaysian Popular Culture,” in Worlding Multiculturalisms: The Politics of Inter Asian Dwelling, ed. Daniel P. S. Goh (London: Routledge, 2017), 35–54. 124.  “The Need for the National Defense Medical Center,” Lim’s Papers, 02013024. 125.  Peng, “A System of Medical and Allied Education at the National Defense Medical Center.” 126. Peng. 127.  Cuihua Yang and Zhou Weipeng, “Junxiansheng fangwen jilu” [Oral history interview with Dr. Jun], in Taibeirongminzongyiyuanbanshiji: Koushulishihuigu (Shangbian: lirenyuanzhang, fuyuanzhang) [Half century of Taipei Veteran Hospital: Oral

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histories (First half: former directors and vice directors)], ed. You Jianming et al. (Taipei: Institute of Modern History at Academia Sinica, 2011), 205–40. Dr. Yu Jun would graduate to become a radiologist and, later, the president of the National Yang-­Ming University School of Medicine. 128.  “NDMC Interim Report, April 1963.” 129.  “NDMC Interim Report, April 1963.” 130.  Lim and Chen, “State Medicine.” 131.  See Uwe E. Reinhardt, “Humbled in Taiwan,” British Medical Journal 336, no. 7635 ( January 12, 2008): 72; and Karen Davis and Andrew Huang, “Learning from Taiwan: Experience with Universal Health Care,” Annals of Internal Medicine, 148, no.4 (February 19, 2008): 313–14. Taiwanese scholars are generally more critical of their health care system, but few, if any, want to go back to a pre–universal health care model. 132.  Loo to Friends, December 1972, Lim’s Papers. 133.  See “Dr. George Humphrey’s Address to the Executive Committee of the American Chamber of Commerce at the MAAG Officers Club, Taipei Taiwan, September 27, 1975, 7 a.m.,” in file “Dr. Humphrey’s Trip to Taiwan,” ABMAC Records. 134.  “Loo to Friends, Dec. 1974,” box 20, in file “National Defense Medical Center 1974,” ABMAC Records. 135.  Dr. Kuang Chen to Dr. Gilbert Fletcher, June 15, 1972, box 20, in file “National Defense Medical Center 1972,” ABMAC Records. 136.  “NDMC 1966: Season’s Greetings,” box 19, in file “National Defense Medical Center 1966,” ABMAC Records. 137.  “NDMC 1973: Season’s Greetings,” box 19, in file “National Defense Medical Center 1973,” ABMAC Records. 138.  Chou et al., Zhou Meiyu, 63–66. 139.  Chou, et al., 80. Chou claimed that the NDMC was the first school in China to institute a bachelor of science in nursing. She disputed the much-­cited claim that PUMC was giving out degrees for nurses in the first half of the twentieth century. She argued that these “degrees” were simply certifications for course work done at the college and that the PUMC graduates actually obtained degrees in non-­nursing-­related fields at partner universities. 140.  “The Training of Nurses for Free China at the National Defense Medical Center,” undated, circ. 1954, box 20, in file “National Defense Medical School—Nursing School” (hereafter cited as “NDMC Nursing”), ABMAC Records. 141.  Allen Lau to Chow Mei-­yu, July 1, 1952, in file “NDMC Nursing.” 142.  Allen Lau to Chow Mei-­yu, March 17, 1954, in file “NDMC Nursing.” 143.  Allen Lau to Chow Mei-­yu, June 29, 1955, in file “NDMC Nursing.” 144.  Jo Duvall to Chow Mei-­yu, April 3, 1959, in file “NDMC Nursing.” 145.  Shu-­ching Chang and Jane Lu, “Xingbie yu keyijiaohui de hulishi: Bentuanlian” [History of nursing in Taiwan at the intersection between gender and technology],



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in Dongya yiliaoshi: Zhiming, xingbie yu xiandaixing [A History of Healing in East Asia: Colonialism, Gender, and Modernity” See https://www.books.com.tw/products /0010760108], ed. Wen-­ji Wang et al. (Taipei: Lianjing, 2017), 223–39. The English translation of the edited volume was provided by the authors of the book. 146.  Chou, et al., Zhou Meiyu, 90–95. 147.  Taida yixueyuan bainian yuanshi bianji xiaozu. Taida yixue yuan bainian yuanshi (zhong) [One hundred years of National Taiwan University Medical College history: Middle volume] (Taibei shi: Guoli taiwan daxue yixue yuan, 1998), 29–30. The Department of Medicine at National Taiwan University admitted an average of 100 to 110 students per year from 1948–1984. The Department of Pharmacy admitted 40 to 60 students per year from 1953–1962. The Department of Dentistry accepted 25 to 35 students annually from 1955–1962. The Department of Nursing accepted 30 to 50 students annually from 1956–1962. In all, around 2,300 medical personnel were trained at the National Taiwan University Medical College from 1948–1962. 148.  Central Intelligence Agency, “Probable Developments in Taiwan,” March 14, 1949, National Archives Identifier: 6924334, HMS Entry Number: A1 22, NARA. 149.  Sonya Grypma and Cheng Zhen, “The Development of Modern Nursing in China,” in Medical Transitions in Twentieth-­Century China, ed. Bridie Andrews and Mary Bullock (Bloomington: Indiana University Press, 2014), 297–316. 150.  In 2018, Taiwan had 23.4 physicians (including TCM physicians) per 10,000 residents, as well as 71.2 nurses and midwives for every 10,000 residents. Only Japan (24.1) and Korea (23.7) have more physicians per 10,000 residents, and Japan (115.2) and Singapore (72.1) more nurses and midwives per 10,000 residents. See World Health Organization 2019 Statistics, accessed September 5, 2019, https://​apps​.who​.int​/iris​ /bitstream​/handle​/10665​/324835​/9789241565707​-­­eng​.pdf ​?ua​=​1; and “Jigou zhiye yishi renyuan shuji meiwanrenkou yi shiren yuanshu” [Statistics on the numbers of professional medical personnel as well as number of medical personnel per 10,000 residents], in National Statistics, Republic of China, accessed September 5, 2019, www​.stat​.gov​.tw​ /ct​.asp​?xItem​=​15428​&​CtNode​=​3638​&​mp​=​4. 151.  Phillips, “Nationalist Legitimacy.”

Conclusion

1.  Boorman et al., Biographical Dictionary, 440–42. 2.  Wu Lien-­teh, Plague Fighter: The Autobiography of a Modern Chinese Physician (Cambridge: Heffer, 1959). 3.  Johns Hopkins University, “COVID-­19 Case Tracker,” accessed June 15, 2020, www​.coronavirus​.jhu​.edu​/map​.html. 4.  See Kari Soo Lindberg and Colum Murphy, “Drones Take to China’s Skies to Fight Coronavirus Outbreak,” Bloomberg News, February 4, 2020, www​.bloomberg​ .com​/news​/articles​/2020​-­­02​-­­04​/drones​-­­take​-­­to​-­­china​-­­s​-­­skies​-­­to​-­­fight​-­­coronavirus​

266

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-­­outbreak; Amy Qin, “China Pledged to Build a New Hospital in 10 Days. It’s Close,” New York Times, February 3, 2020, www​.nytimes​.com​/2020​/02​/03​/world​/asia​ /coronavirus​-­­wuhan​-­­hospital​.html; and Grady McGregor, “China Scoffed at Being Subject to Early Coronavirus Travel Restrictions. Now It’s Enacting Its Own,” Fortune, March 3, 2020, www​.fortune​.com​/2020​/03​/04​/china​-­­coronavirus​-­­travel​-­­restrictions. 5.  As of June 15, 2020, China has seen limited community outbreak in Beijing, Wuhan, and Shulan City in Jilin province since March 18, 2020. See “Coronavirus: Wuhan in First Virus Cluster since End of Lockdown,” BBC News, May 11, 2020, https://​www​.bbc​.com​/news​/world​-asia​-china​-52613138; Chris Buckley, “Coronavirus Breaches Chinese Capital, Rattling Officials,” New York Times, June 15, 2020, www​ .nytimes​.com​/2020​/06​/15​/world​/asia​/beijing​-coronavirus​-outbreak​.html. 6. “Zhuixun zhanyi xianqu wuliande di beijing zuji” [In search of the anti– plague pandemic leader Wu Lien-­teh’s Beijing footsteps], Sina Finance, February 26, 2020, http://​finance​.sina​.com​.cn​/wm​/2020​-0 ­­ 2​-2­­ 6​/doc​-i­­ imxyqvz5834420​.shtml; “Wu Liande geidi xinxin” [The confidence given by Wu Lien-­teh], Jianshu, January 28, 2020, www​.jianshu​.com​/p​/cefe3508f3f0​?utm​_campaign​=​haruki; Xia Huashen, “Wu Liande Boshi 1910 nian Chuangjian de fangfa, renran shi duikang xinguangfeiyande zuiyouxiao fangfa” [Wu Lien-­teh’s established methods in 1910 are still the most effective measures against the novel coronavirus], Tencent News, April 4, 2020, www​. view​. inews​ . qq​ . com​ / w2​ / 20200402A03IIZ00​ ? tbkt​ = ​ G ​ & ​ s trategy​ = ​ & ​ o penid​ =​ o04IBAEosuBsHxyO4GStqVskOA9A​&​uid​=​&​refer​=​wx​_hot. 7.  Lily Kuo, “Coronavirus: Wuhan Doctor Speaks Out against Authorities,” The Guardian, March 11, 2020, www​.theguardian​.com​/world​/2020​/mar​/11​/coronavirus​ -­­wuhan​-­­doctor​-­­ai​-­­fen​-­­speaks​-­­out​-­­against​-­­authorities; “Asia Unites against SARS,” June 28, 2013, BBC News, www​.news​.bbc​.co​.uk​/2​/hi​/asia​-­­pacific​/3027994​.stm. 8.  Erika Kinetz, “Where Did They Go? Millions Left City before Quarantine,” Associated Press, February 9, 2020, www​.apnews​.com​/c42eabe1b1e1ba9fcb2ce201cd3abb72. 9.  Kate Sheehy, “China Has Yet to Allow CDC in Country to Help with Coronavirus,” New York Post, February 3, 2020, www​.nypost​.com​/2020​/02​/03​/china​-h ­­ as​-y­­ et​ -­­to​-­­allow​-­­cdc​-­­in​-­­country​-­­to​-­­help​-­­with​-­­coronavirus/; “C.D.C. and W.H.O. Offers to Help China Have Been Ignored for Weeks,” New York Times, February 7, 2020. 10.  World Health Organization, Report of the WHO-­China Joint Mission on Coronavirus Disease 2019 (COVID-­19), February 28, 2020, www​.who​.int​/docs​/default​-­­source​ /coronaviruse​/who​-­­china​-­­joint​-­­mission​-­­on​-­­covid​-­­19​-­­final​-­­report​.pdf. 11.  Wendy Wu and Sarah Zheng, “Coronavirus: Americans on WHO Team to Assess Crisis, China Says,” South China Morning Post, February 17, 2020, www​.scmp​.com​ /news​/china​/society​/article​/3051026​/americans​-­­who​-­­team​-­­assess​-­­coronavirus​-­­crisis​ -­­china​-­­says. 12.  World Health Organization, Report of the WHO-­China Joint Mission. 13.  World Health Organization; Wu and Zheng, “Coronavirus.”



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14.  World Health Organization, Report of the WHO-­China Joint Mission. The report argues that “as China works to resume a more normal level of societal and economic activity, it is essential that the world recognizes and reacts positively to the rapidly changing, and decreasing, risk of COVID-­19 in the country.” It goes on to ask governments around the world “to constantly reassess any restrictions on travel and/or trade to China that go beyond the recommendations of the IHR Emergency Committee on COVID-­19.” 15.  Keith Bradsher, “To Slow Virus, China Bars Entry by Almost All Foreigners,” New York Times, March 26, 2020, www​.nytimes​.com​/2020​/03​/26​/world​/asia​/china​-­­virus​ -­­travel​-­­ban​.html. 16. See Sam Jones, “Coronavirus Test Kits Withdrawn in Spain over Poor Accuracy Rate,” The Guardian, March 27, 2020, www​.theguardian​.com​/world​/2020​ /mar​/27​/coronavirus​-­­test​-­­kits​-­­withdrawn​-­­spain​-­­poor​-­­accuracy​-­­rate ; “80% of Rapid ­COVID-­19 Tests the Czech Republic Bought from China Are Wrong,” Prague Morning, March 26, 2020, www​.praguemorning​.cz​/80​-­­of​-­­rapid​-­­covid​-­­19​-­­tests​-­­the​-­­czech​ -­­republic​-­­bought​-­­from​-­­china​-­­are​-­­wrong/ ; “U.K. Says Millions of Coronavirus Test Kits Bought from China Are Unreliable for Most Patients,” Newsweek, April 7, 2020, www​.newsweek​.com​/uk​-­­says​-­­millions​-­­coronavirus​-­­test​-­­kits​-­­bought​-­­china​-­­unreliable​ -­­most​-­­patients​-­­1496506. 17.  “China Hits a Coronavirus Milestone: No New Local Infections,” New York Times, March 18, 2020, www​.nytimes​.com​/2020​/03​/18​/world​/asia​/china​-­­coronavirus​ -­­zero​-­­infections​.html; “Coronavirus: Why China’s Claims of Success Raise Eyebrows,” BBC News, April 7, 2020, www​.bbc​.com​/news​/world​-­­asia​-­­china​-­­52194356. 18.  Emily Feng and Amy Cheng, “Mystery in Wuhan: Recovered Coronavirus Patients Test Negative. . .Then Positive,” National Public Radio, March 27, 2020, www​ .npr​.org​/sections​/goatsandsoda​/2020​/03​/27​/822407626​/mystery​-­­in​-­­wuhan​-­­recovered​ -­­coronavirus​-­­patients​-­­test​-­­negative​-­­then​-­­positive. 19.  Scott Neumen, “China Raises Wuhan Death Stats by Half to Account for Reporting Delays and Omissions,” NPR, April 17, 2020, www​.npr​.org​/sections​/coronavirus​ -­­live​-­­updates​/2020​/04​ /17​ /836700806​ /china​ -­­r aises​ -­­w uhan​ -­­death​ -­­stats​-­­by​-­­half​-­­t o​ -­­account​-­­for​-­­reporting​-­­delays​-­­and​-­­omiss. 20. Wu, Plague Fighter, 386–87. 21.  Jean Amato, “Adet Lin (Also Tan Yun),” in Asian American Novelists: A Bio-­ Bibliographical Critical Sourcebook, ed. Emmanuel Nelson (Westport, CT: Greenwood Press, 2000), 204–6. 22.  Suoqiao Qian, Lin Yutang and China’s Search for Modern Rebirth (Singapore: Palgrave MacMillian), 396; Adet Lin, A Selection of Introductory Articles to the National Palace Museum (Taipei: Taiwan Chunghua shuju, 1972). Adet Lin’s book on the National Palace Museum was published posthumously in 1972, a year after she took her own life in Taipei.

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23.  In 1968, Robert Lim and his wife met with Chiang Kai-­shek in Taiwan. See “Zongtong Jiangzhongzheng Jiejian Linkesheng Boshi” [President Chiang Kai-­shek meets with Dr. Robert Lim], May 3, 1968, 002-­050101-­00070-­045, AH archives. See also Horace Davenport, Robert Kho-­Seng Lim (Washington DC: National Academy of Sciences, 1980), 292–93. Davenport notes that Lim “revisited the island several times to do research and to arrange for postgraduate training of Chinese physicians” in the United States. He adds that “the year before [Lim’s] death, he spent six months in Taiwan, setting up a neuro-­physiological laboratory.” 24.  Allen Lau to Robert Lim, September 14, 1955, Lim’s Papers. 25.  “Meianquan gongsu,” AH Archives. 26.  Xiaotian Wang, Wang Guoyu, and Mao Jian, “Yi Jianlong,” in Hunan Gujin Renwu Cidian [Biographical dictionary of Hunanese in the past and present] (Hunan: Hunan Renmin Chubanshe, 2017), ebook. 27.  Wang et al. 28.  Davenport, “Robert Lim,” 293–306. 29.  Examples of O. K. Khaw’s publications include R. Z. Liu, and O. K. Khaw, “The Shedding Cycle of Cercaria of Para Gonimus Westermani from Its Snail Host Semisulcospira Libertine,” Bulletin of the Institute of Zoology, Academia Sinica 4 (1965): 29–33; P. C. Fan and O. K. Khaw, “Paragonimus Westermani Infection in Crustacean Host, Eriocheir J­ aponicus, in Shen-­Keng District, Taipei County, Northern Taiwan,” Chinese Medical Journal 12, no. 4 (1965): 381–96; and Michael D. Clarke, O. K. Khaw, and J. H. Cross, “Clonorchiasis in Sun Moon Lake Area,” Chinese Journal of Microbiology 4, no. 1/2 (1971): 50–60. 30.  Kim Taylor, Chinese Medicine in Early Communist China, 1945–1963: A Medicine of Revolution (London: Routledge, 2004), 63–69. 31.  Volker Scheid, Chinese Medicine in Contemporary China: Plurality and Synthesis (Durham, NC: Duke University Press, 2005), 78. 32.  Marta Hanson, “Conceptual Blindspot, Medical Blindfolds: The Case of SARS and Traditional Chinese Medicine,” in Health and Hygiene in Chinese East Asia: Policies and Publics in the Long Twentieth Century, ed. Angela Leung and Charlotte Furth (Durham, NC: Duke University Press, 2010), 228–50. 33.  Xiaoping Fang, Barefoot Doctors and Western Medicine in China (Rochester, NY: University of Rochester Press, 2012), 58–61. 34. Bullock, Oil Prince’s Legacy, 132–39. 35.  See Chou Mei-­yu, “The Training of Nurses for Free China at the National Defense Medical Center 1954,” box 20, in file “NDMC Nursing School,” ABMAC Records. 36.  Frank Dikötter, The Tragedy of Liberation: A History of the Chinese Revolution, 1945–57 (London: Bloomsbury, 2017), 49. 37. Bullock, Oil Prince’s Legacy, 131. 38.  For a summary of the Chinese and North Korean allegations of bacteria warfare by the Americans during the Korean war and the Americans’ subsequent denials, see John Ellis Van Courtland Moon, “Biological Warfare Allegations: The Korean War



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Case,” Annals of the New York Academy of Sciences 666, no. 1 (1992): 53–83. For details on the efforts of PRC military doctors and nurses to develop blood drives during the Korean War, see Jing Jun, “From Commodity of Death to Gift of Life,” in Deep China: The Moral Life of the Person; What Anthropology and Psychiatry Tell Us About China Today, ed. Arthur Kleinman (Berkeley: University of California Press, 2011), 78–105. 39. Scheid, Chinese Medicine, 78. 40.  Miriam Gross, Farewell to the God of Plague: Chairman Mao’s Campaign to Deworm China (Oakland: University of California Press, 2016), 21. 41.  Gross, 115–44. 42.  Gross, 153–62. 43.  See Yangfeng Wu, “Major Challenges the Rural China Healthcare System Is Facing in the Epidemic of Chronic Diseases,” in Urbanization and Public Health in China (London: Imperial College Press, 2015), 181–96. Wu argues that “the ‘opening up’ policy and socio-­economic reforms initiated in 1978 have led to marked changes in socio-­economic, environmental, lifestyle, nutrition, and healthcare conditions and have also resulted in rising risks of non-­communicable diseases.” 44.  Jingqing Yang, Informal Payments and Regulations in China’s Healthcare System: Red Packets and Institutional Reform (Basingstoke: Palgrave Macmillan, 2016), 1–27. 45.  Shiying Chen, Shaowei Lin, Qishuang Ruan, Huangyuan Li, and Siying Wu, “Workplace Violence and Its Effect on Burnout and Turnover Attempt among Chinese Medical Staff,” Archives of Environmental & Occupational Health, 71, no. 6 (2016): 330–37. 46.  Lim and Chen, “State Medicine.” 47.  Wei Fu et al., “Research in Health Policy Making in China: Out-­of-­Pocket Payments in Healthy China 2030,” BMJ 360 (2018): k234. 48.  Linghan Shan et al., “Perceived Challenges to Achieving Universal Health Coverage: A Cross-­Sectional Survey of Social Health Insurance Managers/Administrators in China,” BMJ Open 7, no. 5 ( June 2017): e014425. 49.  See Reinhardt, “Humbled in Taiwan,” and Davis and Huang, “Learning from Taiwan.” 50.  Jui-­Fen Rachel Lu and William C. Hsiao, “Does Universal Health Insurance Make Health Care Unaffordable? Lessons from Taiwan,” Health Affairs 22, no. 3 (2003): 77–88; Jui-­fen Rachel Lu, “Universal Health Care Assessment: Taiwan,” Global Network for Health Equity, December 2014, accessed November 15, 2018, http://​gnhe​.org​ /blog​/wp​-­­content​/uploads​/2015​/05​/GNHE​-­­UHC​-­­assessment​_Taiwan​-­­1​.pdf. 51.  In “Universal Health Care Assessment,” Lu notes that about 13 percent of Taiwanese live below the poverty line, and that an extra 3 percent dropped into poverty as a result of paying out-­of-­pocket when accessing health services. This roughly translated to around 18.75 percent of underprivileged households becoming impoverished because of out-­of-­pocket expenditures. 52.  “Poll Finds Most Taiwanese Satisfied with NHI service,” Taipei Times, November 28, 2019, www​.taipeitimes​.com​/News​/taiwan​/archives​/2019​/11​/28​/2003726623.

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53.  Taiwan’s physicians-­to-­patients ratio (1.97 per 1,000 people, 2017) is higher than that of mainland China (1.812 per 1,000 people, 2015). World Health Organization, “Density of physicians (total number per 1000 population, latest available year),” accessed November 16, 2018, www​.who​.int​/gho​/health​_workforce/​ physicians_​ density/​ en/. 54.  For a discussion of medical training and the status of physicians in Taiwan during the Japanese colonial period, see Miriam Lo Ming-­cheng, Doctors within Borders: Profession, Ethnicity, and Modernity in Colonial Taiwan (Berkeley: University of California Press, 2002), 4–5. 55.  For a brief history of the Singapore government’s policy on the enrollment of medical students, see Paul Tambyah, “Selection of Medical Students in Singapore: A Historical Perspective,” Annals of the Academy of Medicine, Singapore, 34, no. 6 (August 2005): 147c–157c. Because historically too few doctors were trained in Singapore, the government introduced a policy of attracting foreign doctors to Singapore in the early 2000s. By 2010, 24 percent of all doctors registered to practice in Singapore were from abroad. As of 2012, 75 percent of auxiliary medical personnel (including nurses) in Singapore were foreigners. See Lim Meng Kin, “A New Approach to Solving Doctor Shortage,” Health Policy Monitor, April 2010; and “Foreigners a Must in Health-­Care Sector: How Reliant Are Singapore’s Essential Services on Foreign Labour?,” Straits Times, December 20, 2012. 56. See “China Docs Learn to Take Local Pulse: They Are Well-­Trained but Have to Adapt to Culture and Systems,” Straits Times, September 30, 2011. Periodic complaints from Singaporeans have emerged even in the traditionally progovernment media. See Flora Moo, letter to the Straits Times online forum,” May 14, 2013, www​ .straitstimes​.com​/premium​/forum​-­­letters​/story​/facebook​-­­20130514. Moo notes that “language barriers [exist] between foreign doctors and nursing aides, who speak only English, and elderly patients who understand only Mandarin or dialects.” 57.  Tsung-­Mei Cheng, “Reflections on the 20th Anniversary Of Taiwan’s Single-­ Payer National Health Insurance System,” Health Affairs, March 2015, www​.healthaffairs​ .org​/doi​/full​/10​.1377​/hlthaff​.2014​.1332. 58.  Xiamen University’s Departments of Life Sciences and Natural Sciences were ranked in the top 450 in the QS 2018 World University Ranking, and the Department of Engineering, Technology, and Computer Science was ranked in the top 200 out of 830 institutions by Shanghai Jiaotong University’s Academic Ranking of World Universities. QS University Ranking, “Xiamen University,” accessed November 11, 2018, www​ .topuniversities​.com​/node​/9400​/ranking​-­­details​/world​-­­university​-­­rankings/—2018; Shanghai Jiaotong University Ranking, “Xiamen University,” accessed November 11, 2018, www​.shanghairanking​.com​/World​-­­University​-­­Rankings​/Xiamen​-­­University​.html. 59. Bullock, Oil Prince’s Legacy, 131–40. 60.  Chen Qianye, “Dalu hui tai xizou taiwan yisheng? Chen Shizhong: Duozai jiceng meinian jin liushi 10 jiwei” [Benefits from Mainland China attracting Taiwanese



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doctors from Taiwan? Chen Shizhong: Mostly at the grassroots levels, and Taiwan only loses just over 10 doctors a year], March 16, 2018, https://​health​.ettoday​.net​/news​/1131893​ #ixzz5WlAR8gB2. 61.  “Mainland, TW Sign Agreement on Health Care Co-­op,” December 21, 2020, China Daily, http://​europe​.chinadaily​.com​.cn​/china​/2010​-­­12​/21​/content​_11738017​.htm. 62.  Huang Yongmei and Hongye Sun, Tu jie fu mao [Unpacking the ECFA treaty with images] (Taipei: Haoren chubanshe, 2014), 93–94. 63.  “‘They Wanted to Take Us Sightseeing. I Stayed in the Hotel,’ Says First Foreign Official to Enter Wuhan,” The Telegraph, May 6, 2020, www​.telegraph​.co​.uk​/global​ -­­health​/science​-­­and​-­­disease​/wanted​-­­take​-­­us​-­­sight​-­­seeing​-­­stayed​-­­hotel​-­­says​-­­first​ -­­foreign. 64.  Benjamin J. Cowling and Wey Wen Lim, “They’ve Contained the Coronavirus. Here’s How,” New York Times, March 13, 2020, www​.nytimes​.com​/2020​/03​/13​/opinion​ /coronavirus​-­­best​-­­response​.html. 65.  “Taiwan Is Beating the Coronavirus. Can the US Do the Same?,” WIRED, March 18, 2020, www​.wired​.com​/story​/taiwan​-­­is​-­­beating​-­­the​-­­coronavirus​-­­can​-­­the​-­­us​ -­­do​-­­the​-­­same; “Taiwan’s ‘Hidden Champions’ Help Coronavirus Fightback,” May 4, 2020, Financial Times, www​.ft​.com​/content​/2389c79e​-­­315c​-­­405a​-­­b039​-­­36422954b91a; John Hopkins University, “COVID-19 Case Tracker.”

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B I B LI O G R A P H Y

Archives and Libraries Consulted

Academia Historica, Taipei, Taiwan Academia Sinica, Institute of Modern History (IMH) Archives, Taipei, Taiwan Academia Sinica, Institute of Modern History (IMH) Library, Taipei, Taiwan Beijing Municipal Archives, People’s Republic of China (PRC) Capital Library of China, Beijing, PRC Cambridge University Archives, United Kingdom Columbia University, Rare Book and Manuscript Library, New York, NY Hoover Institution Library and Archives, Stanford University Kunming Library, PRC Kuomintang Party Archives, Taipei, Taiwan Library of Congress, Washington, DC National Archives at College Park, Maryland National Archives at Kew, London, United Kingdom National Central Library, Taipei, Taiwan National Library of China, Beijing, PRC National Library of Singapore National Taiwan University Library National University of Singapore Library New York Public Library, Manuscript and Archives Division, New York, NY Princeton University, Mudd Manuscript Library, Princeton, NJ Rockefeller Archives Center, New York, NY Second Historical Archives, Nanjing, PRC

274 B ibliography

University of Edinburgh Archives, Scotland University of Edinburgh Library, Scotland University of Hong Kong Library Xiamen University Archives, Xiamen, PRC Yan’an Library, PRC Newspapers, Bulletins, Social Media, and Popular Magazines

American Bureau for Medical Aid to China (ABMAC) Bulletin Asahi Shimbun ( Japan) Associated Press BBC News Bloomberg News Atlanta Constitution Austin Statesmen Chicago Daily Tribune China Daily (PRC) China Press China Philanthropic Times China Weekly Review Fortune Financial Times The Guardian (UK) Lianhebao (Taiwan) Jianshu (PRC) Japan Times Los Angeles Times Manchester Guardian Nanyang Siang Pau (Malaya) National Defense Medical Center National Public Radio (NPR) New York Amsterdam News New York Times New York Post North China Herald People’s Daily (PRC) Peking Daily News (PRC) Prague Morning San Francisco Chronicle The Scotsman Shenbao (China) South China Morning Post (Hong Kong)

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I N D EX

ABMAC. See American Bureau for Medical Aid to China (ABMAC) African American blood donors, 100– 102, 101fig, 102 AIDS/HIV, 120–121 Alfred Kohlberg Memorial Laboratory, 185, 189–190 Allergy Research Center, NDMC, 190 ambulances, 76, 84, 85 American Bureau for Medical Aid to China (ABMAC): blood banks, support for, 99–102, 101fig, 106, 115, 168–169; conflict with United China Relief, 127–128, 142–150, 252n84; Foreign Operations Administration (FOA) and support of Taiwan, 182, 185; funding for biomedicine, 7–8, 13, 84–85, 90, 137, 138–139, 144, 191–2; funding for NDMC in Taiwan, 176–177; fundraising post Second World War, 162–163; rehabilitation of Robert Lim, 150–152; relationship with NDMC over time, 189–190. See also specific ABMAC personnel’s names

American Committee for Chinese Industrial Cooperatives (Indusco, Inc.), 143 American Committee for Chinese War Orphans, 143 American Friends Service Committee, 143 American Journal of Nursing Company, 190–191 American Medical Association, 104–105 American Red Cross, 33, 69, 145, 148, 149; blood donation, 100–102, 101fig Amoy University. See Xiamen University An Chang Liu, 51 Andrews, Bridie, 96 Anti-­Epidemic Corps, 129 Anti-­Epidemic Curative Unit, 73 Anxi Province, 76 Armstrong, George, 151–152, 163 Army Field Medical Service School, 153–154 Army Medical Administration, 105, 141, 145, 149–150

296 I N D E X

Army Medical College ( Junyi xuexiao), 146, 147, 160–1, 174, 179 Army Medical Field Service School, 152, 160 artificial limbs, 133 Asian Vegetable and Research Development Center, 186 Associated Boards for Christian Colleges in China, 143 Atlanta Constitution, 26 Austin Statesman, 30 Bachman, George, 145, 148, 151, 160 Bai Chongxi, 178 Baoshan, Yunnan, 112 barefoot doctors, 202 Barnes, Nicole, 11, 97 Beijing: biomedicine, development of, 12–13; commodification of blood, 120–121; as Communist base area, 75; Japanese army occupation of, 59; tour by plague conference delegates, 28; Western medicine, promotion of, 4–5. See also Peking Union Medical College (PUMC) Beiyang Medical College, 24 beriberi, 66, 68–70 Bethune, Norman, 62, 77–78, 90, 239n117 Bian, Morris, 127 biomedicine: classical Chinese medicine (CCM), debates about, 34–37; in Communist base areas, 75–78; Coronavirus Disease 2019 (COVID­19), 197–199, 206–207; CRCMRC (Chinese Red Cross Medical Relief Corps) as transformer of Chinese medicine, 60–63; disruption of, in early Communist China, 192–195; economics of health care, 204–206; EMSTS training manuals, promotion of, 133–135, 134tab, 248–249n32; evolution of in China, 11–12; expansion of medical care during wartime, 72–74, 74map; financial support by Overseas

Chinese, 12–16, 31–33, 37–42, 127–128, 137–139, 144, 238–239n111, 252n86; introduction of, 3–5; Norman Bethune, 62, 77–78, 90, 239n117; Peking Union Medical College (PUMC), growth and development of, 44–52; in People’s Republic of China, 201–203; in postwar Shanghai, 166–169, 167fig, 168fig; postwar use of mobile medical units, 169–171, 172tab; pre-­Second World War promotion of in China, 18–20; prewar ideals and wartime adaptation, tensions within, 156–158; professionalization of, 50–52; transnational nature of, 11; transpolitical nature of, 11–12; universalizing care through military medicine, 88–93, 89tab; Western medicine, promotion of, 3–5, 18–20. See also blood banks; Chinese Red Cross Medical Relief Corps (CRCMRC); Emergency Medical Services Training School (EMSTS); military medical education Black, Davidson, 48 blood banks, 4, 9; Americans in China, 114–115; commodification of blood, 119–121; contamination of equipment, 112–113; data on donations, 102, 104, 107–108, 113, 116–117, 122; donations, civilian recruiting efforts, 109–114; donations, coercion of soldiers, 106–109, 106fig, 107fig; donations, incentives for, 14, 97–98, 107, 116–117; donations, opposition to, 14, 108–109; donations, rejection for, 107–108; donations, students and laborers, 116–118; establishment of, 93; history of, in U.S., 103; in Kunming, infrastructure challenges, 110–114; legacies of blood bank, 119–121; man-­made blood (Renzao zilai xie), 104; meanings of blood in China, 102–109, 106fig, 107fig, 121–124; mobile blood



I N D E X 297

banks, 113–114; nationalism and donations, 118–119; Overseas Chinese support for, 98–102, 101fig; plasma, 104–105, 241n18; in postwar Shanghai, 167–168; pyrogen contaminants, 167–168, 167fig, 168fig; risks and benefits, overview of, 95–99; in Second World War, 10–11, 13, 14; in Taiwan, 200 bloodletting, 103–104 blood plasma, 104–105, 136, 163, 167–168, 241n18 blood stasis, 103–104 blood transfusion banks (shuxie yinhang), 119–120. See also blood banks Blood Transfusion Betterment Association, 99 blood transfusions, history of practice, 103. See also blood banks Boring, A. M., 43 Boston Chinese Student Christian Association, 86 “Bowl of Rice” fundraising parties, 84 Boxer Indemnity Fund, 43, 138 branch schools (fenxiao), 54, 125–126, 129, 131–132, 131fig, 140, 145. Brazelton, Mary, 126 Britain. See Great Britain British Malaya (Malaya): British-­ controlled Straits Settlements, 20; Lim Boon Keng (Lin Wenqing 1869– 1957), life in, 21; medical supply routes, 7, 80, 83, 90; opium trade, 21, 216n12; Overseas Chinese funding from, 78–79, 80, 83, 137; repatriation from China, 83; Straits dollar currency, 38; University of Cambridge Queen’s Scholarship, 20, 21; Western medicine, promotion of, 7; Wu Lien-­teh (Wu Liande 1879–1960) life in, 20–21, 79, 146, 217n30 Bryn Mawr hospital, 99 Bullock, Mary, 126 Bureau for Health, 129

Bureau of Military Medicine, 137 Burma Road, 68, 80, 83 Burma Road Construction Bureau, 117–118, 123 Business and Professional Women’s Clubs, 185, 190 Canada, Overseas Chinese, 80 Cantonese, 20 Carlson, Anton J., 22, 46, 47, 49 Carter, Edward, 151 CCP. See Chinese Communist Party (CCP) Central Epidemic Control Bureau, 112 Central Field Health Station, 88 Chan, Shelly, 6, 8 Chang, H. C., 50 Changsha, 59, 60, 80, 125–126, 129 Chen, C. C. (Chen Zhiqian 1903–2000), 45, 51 Chen, Janet, 127 Chen, Lueatta, 99, 114 Chen Cheng (1897–1965), 2–3, 112, 161, 166, 173, 256n14 Chen Jiageng. See Tan Kah Kee (Chen Jiageng 1874–1961) Chen Sze-­Pang, 24, 31 Chen Zhiqian. See Chen, C. C. (Chen Zhiqian 1903–2000) Chiang, Jean, 1–2, 75–76, 90 Chiang Kai-­shek ( Jiang Jieshi) (1887– 1975), 200fig; appointment of Lim as surgeon general, 169; military strategy of, 10; Overseas Chinese skepticism of, 193; Overseas Chinese support for medical services, 81, 86, 137, 149–150; support for National Defense Medical Center (NDMC), 161; work with Robert Lim on wartime health care, 2, 60, 90 Chicago Daily Tribune, 26–27 China Aid Council, 80, 137, 143 China Defense League, 80, 82, 90, 137–138

298 I N D E X

China Emergency Relief Committee, 138, 143 China Foundation for the Promotion of Education, 43 China Medical Association, 52 China Medical Board, 44, 185, 189–190 China Press, 44 China Relief Committee, Singapore, 137 China War Relief Association, 85 Chinese, ethnic classification, 20, 186–187 Chinese Americans. See North America, Overseas Chinese in Chinese Army: blood donations by soldiers, 106–109, 106fig, 107fig; Chen Cheng, support for Robert Lim, 161; education and training of soldiers, 140; Robert Lim as Surgeon General, 169–174, 254n124; troop numbers, 91, 239n120 Chinese Army Medical Services, 82, 145, 172–173, 192 Chinese Canadians. See North America, Overseas Chinese in Chinese Civilian Relief Committee of New York, 80–81 Chinese Civil War: blood donations during, 119; disruption of medical expansion in China, 156–157, 159, 166, 192; hyperinflation, 165–166, 256n26; medical personnel decisions to move to Taiwan, 2–3, 157, 160; Overseas Chinese support, division of, 15, 161–162, 194; Robert Lim’s providing of medical care, 172–174 Chinese Communist Party (CCP): biomedicine in People’s Republic of China, 201–203; blood bank, legacies of, 119–121; China Defense League support for, 137–138; Chinese diaspora loyalties and, 15; CRCMRC (Chinese Red Cross Medical Relief Corps) and, 62, 75–78, 90; early history of, 2–3; economics of health care (1979–present), 204–206; expansion

of medical care during wartime, 72–74, 74map, 149–150; medical education, militarization of, 126–127; National Defense Medical Center, move to Taiwan, 155; Norman Bethune, promotion of, 77–78; Robert Lim’s concerns about communism, 158–160; war with Japan, 59 Chinese Cultural Theatre Group, 86 Chinese diaspora, use of term, 3–5, 6–13, 15, 19. See also Overseas Chinese; North America, Overseas Chinese in; Southeast Asian Chinese. Chinese Embassy Fund, 138 Chinese Exclusion Act, 85 Chinese Medical and Pharmaceutical Association, 51 Chinese Medical Organization (Zhongyi yiyao lianhehui), 35 Chinese Nationalist Party (Kuomintang) (KMT), 2–3; blood bank, legacies of, 119–121; blood donations by soldiers, 106–108, 106fig, 107fig; campus control, 136–137; Chinese diaspora loyalties and, 15; CRCMRC (Chinese Red Cross Medical Relief Corps) and, 62, 90; expansion of medical care during wartime, 72–74, 74map; February 28 (228 Incident), Taiwan, 178; funding for medical training, 131; global politics and shaping of medical education, 142, 149–150; medical care during Civil War, 172–174; medical supply routes, 80; move to Taiwan, 153–154; on moving National Defense Medical Center to Taiwan, 153–155; Overseas Chinese support for, 161–162; Peking Union Medical College (PUMC), military medicine, 52; Robert Lim’s alignment with, post Second World War, 158–160; war with Japan, 10, 59 Chinese Patriotic Association of New England, 138 Chinese Patriot League of Ontario, 80



I N D E X 299

Chinese Patriot League of Seattle, 86 Chinese People’s Blood Bank (Huaren xueku), 102 Chinese Red Cross, Hong Kong; C.Y. Wu (Wang Zhangyao), leadership of, 80, 146; C.T. Wang (Wang Zhengting (1882–1961), leadership of, 146–147. Chinese Red Cross Medical Relief Corps (CRCMRC), 2, 11, 13, 52, 54; on battlefield conditions, 59; in Communist base areas, 75–78; data on services provided, 60, 64, 66, 68, 69, 71, 71tab, 72, 87, 88, 89tab, 91; establishment of, 4; expansion of medical care during wartime, 72–74, 74map; medical personnel, shortages of, 125; medical supplies, procurement of, 67–68, 78–85, 86, 90; mobile medical units, 62, 63–65, 65fig; need for medical professionals, 129; Overseas Chinese funding for, 5, 62–63, 84–87, 87fig, 88fig, 238–239n111; prevention programs, limitations and innovations, 69–72, 71tab; as transformer of Chinese medicine, 60–63; Transportation and Supplies Department, 80; universalizing care through military medicine, 88–93, 89tab; vaccines, 138–139. See also military medical education; specific names of CRCMRC’s personnel Chinese Student Christian Association, Boston, 86 cholera: Manchuria (1920) outbreak, 32–33; in postwar Shanghai, 168; vaccines, 68, 138–139 Chongqing, 59, 73, 74map, 145, 169 Chou Mei-­yu (Zhou Meiyu, 1910–2006), 151–152, 163, 185, 190–191, 192 Chun, J. W., 24, 31 Chung, H. H., 42, 44 Chung-­Lien Hou, 51 Church Committee for China Relief, 143 citrinin, 168–169

classical Chinese medicine (CCM): biomedicine in People’s Republic of China, 201–202; Chinese Nationalist Party (KMT) stance against, 3; in Communist base areas, 77; food and beverage as medicinal, 67; Hua Tuo (140–208), 35–36; Lim Boon Keng and, 36–37; Manchuria, plague treatments, 34–35; meanings of blood in China, 103–109, 106fig, 107fig, 110; medical training in, 126; views on blood transfusions, 96–97; Western medicine, promotion of, 3–5; Wu Lien-­teh, response to, 34–37 Cold War: Communist China, disruption of biomedicine in, 192–195; Eisenhower and Truman administration support for Taiwan, 157–158, 260n74; Foreign Operations Administration (FOA), 180–187; Overseas Chinese, conflicted levels of support for Taiwan and mainland China, 193–195; Overseas Chinese support for biomedicine in Taiwan, 157–158 Columbia University, 84, 98, 99, 189 comic strips for blood donation, 110, 118, 119fig, 245n102 Cornell University, 61, 69, 84 Coronavirus Disease 2019 (COVID-­19), 197–199, 206–207 Council for United States Aid, 185, 186 Counterpart Fund Agreement, 185 CRCMRC. See Chinese Red Cross Medical Relief Corps (CRCMRC) Cultural Revolution, 186, 202, 206 Dai Jitao (1891–1949), 95–96 Daqing Zhang, 126 delousing efforts, 4, 10–11, 12, 13, 14, 65fig, 232n9; in Communist base areas, 76–77; CRCMRC (Chinese Red Cross Medical Relief Corps), 62; CRCMRC, data on services provided, 60, 64, 71tab, 88, 90tab, 91, 135;

300 I N D E X

delousing efforts (continued) expansion of medical care during wartime, 73, 74map; limitations and innovations, 70; mixed results of, 71, 71tab; postwar efforts, 169–170 Department of Health, Ministry of Internal Affairs, 21 Derr, Ruth, 99, 115, 123 diet and nutrition: beriberi, 66, 68–70; CRCMRC (Chinese Red Cross Medical Relief Corps), 60, 62; postwar efforts, 200; preventive medicine, CRCMRC privileging of, 65–69; preventive medicine, limitations and innovations, 69–72, 71tab; Special Diet Service, 67–69; of students at Lianda, 116–117; universalizing care through military medicine, 88–93, 89tab Dikötter, Frank, 97 disease: blood donation, rejections for, 107–108; CRCMRC, data on services provided, 60, 66; CRCMRC (Chinese Red Cross Medical Relief Corps), control of disease spread, 61–63; EMSTS medical training program, 135–136; mobile medical units, treatment by, 63–65, 65fig; postwar use of mobile medical units, 169–171, 172tab; preventive medicine, CRCMRC privileging of, 65–69; preventive medicine, limitations and innovations, 69–72, 71tab; rates in soldiers, 70; universalizing care through military medicine, 88–93, 89tab. See also specific disease names dressing stations, mobile medical care, 72 Du Yuming (1904–1981), 106, 112 dysentery, 66, 76, 134tab, 135–136, 249– 250n41, 250n42

Edwards, Dwight (1883–1967), 143, 145– 146, 148, 149–150 Eighth Route Army, 76–80 Eisenhower, Dwight D., 157–158, 180–187 electricity, shortages in, 111–112, 115 Emergency Medical Relief Committee for Honolulu, 138 Emergency Medical Service Training School (EMSTS): branch schools, 131–132, 131fig; characteristics of medical training, 128–130, 130fig; curriculum at, 129–130; financial management, questions about, 145–149; founding of, 125–126; global politics and, 142–154; history of, 14–15, 125–126; orthopedic services, 133; Overseas Chinese financial support for, 4, 9, 72, 127–128, 137–139, 252–253n93; promises and limits of, 132–137, 134tab; student demographics, 129; student recruitment challenges, 140–142; students trained at (1938–1946), 247n8; training manuals, 133–135, 134tab, 248–249n32; typical daily schedule, 136 emergency medicine, concept of, 125–126 EMSTS. See Emergency Medical Service Training School (EMSTS) Eng, Betty, 99 epidemics: Coronavirus Disease 2019 (COVID-­19), 197–199, 206–207; International Plague Conference (1911), 25–28, 27fig; Manchuria plague (1911), 17–18, 22–23, 28–31; during Second World War, 11. See also North Manchurian Plague Prevention Service (NMPPS) Eurasians, as ethnic group, 20

Eastman, Lloyd, 10 economics of health care, 204–206 education, medical. See medical education, military

Fan, C. F., 99, 114 Fang Xiaoping, 126 February 28 (228 Incident), 178 Feng Yi-­pei, 104



I N D E X 301

Fifth Infantry, 107 Foreign Operations Administration (FOA), 180–187, 192–193 Fott, Louis De, 99, 112, 114, 244n82 Fraenkel, Carl, 20–21 Fuchiatien, 29–30 Fudan University, 24 Fujian, 6, 20, 37, 40, 181 Ganguyi, 73, 74map Garside, B. A. (1894–1989), 143–144, 182 Gauss, Clarence (1887–1960), 137 gelatin, blood plasma substitute, 168–169 Grant, John, 44, 45, 51, 54 Great Britain: cholera outbreak, Manchuria (1920), 33; Coronavirus Disease 2019 (COVID-­19), 199; Emergency Medical Services, 125– 126; Overseas Chinese, support for China during Second World War, 78–85; Overseas Chinese, support for EMSTS, 137; professional training in, 3, 20, 21–22, 31, 46, 49; scholarship funds for Chinese students, 20; Wu Lien-­teh, British connections and citizenship, 23–24 Great Depression (1929–1939), 41 Greene, Phillips, 148 Greene, Roger, 46, 47, 49–50 Gregerson, Magnus, 162 Guangdong, 6, 18, 24, 20, 67, 74map, 141, 161, 174 Guangxi Province, 60, 67, 73, 74map Guilin, 74map, 129, 211 Guiyang, 59, 60, 74map, 80, 81, 129, 131–132, 131fig, 145, 169 Guizhou Province, 129, 132 Han Dynasty (25–220), 103 Hankou, 59, 60, 72, 74map, 80 Hankow. See Hankou Harvard Medical School, 48 Harvard University, 49, 51, 84, 181

Henan, 74map, 120 Hengyang City (Hengyang Shi), 73–74, 74map Himalayan Mountains, 68 HIV/AIDS, 120–121 Hodges, Paul, 48 Hodgman, Gertrude, 185 Hoeppli, Reinhard, 42 Ho, Eva Tung (He Xianzi 1862–1956), 81 Hokkien, 20, 194 Hong Kong: antiplague measures, 23; Chinese Red Cross Bureau in, 80; CRCMRC (Chinese Red Cross Medical Relief Corps), support for, 62–63; medical education, 49; medical supply routes, 67–68, 80; Overseas Chinese, support for China, 62, 78–85, 87, 90, 91, 146; recruitment of medical students, 141 hospitals: Coronavirus Disease 2019 (COVID-­19), 197, 200, 204–206; CRCMRC (Chinese Red Cross Medical Relief Corps), as transformer of Chinese medicine, 59, 60–63, 66; early history of, 2–3; North Manchurian Plague Prevention Service (NMPPS), 29, 32, 51, 52, 53, 56; Japanese hospitals in Shanghai, 164–165; treatment data, 170–174, 172tab; Xiamen University, unsuccessful efforts at building, 35, 39, 40. See also Veteran General Hospital, Taipei Houghton, Henry, 46–49 Ho Ying-­chin (He Yingqin 1890–1987), 149 Hsiang-­Ya Medical College, 200 Hua Tuo (140–208), 35–36 Hubei Province, 74map, 132, 197 Hunan Province, 60, 74map, 132, 155 Hunan-­Yale Medical College, 174, 200 Hunter College Chinese Students Club, 190 Hu Shih (Hu Shi 1891–1962), 137

302 I N D E X

hydrotherapy, 133 hyperinflation, effect on funding sources, 165–166, 256n26 Ida Kohlberg Kindergarten, 185 Imperial Medical College, Tianjin, 21, 24 Indianapolis China Committee, 86 Indusco, Inc. (American Committee for Chinese Industrial Cooperatives), 143 inflation, effect on funding sources, 87, 155, 165–166 inoculations. See vaccinations International Cooperation Administration, 185 International Plague Conference (1911), 13, 25–28, 27fig, 198 International Red Cross in China, 86 Japan: allegations of biowarfare, 135; bombing of Pearl Harbor, 103; Chinese Nationalist Party (KMT), war with, 10, 72, 78, 79; cholera outbreak, Manchuria (1920), 32–33; destruction of medical units, 74; destruction of blood banks, 123; facilities commandeered by NDMC, 164; Manchurian (1932), anti-­plague efforts, 33–34; Manchurian plague (1911), criticism of Chinese handling of, 25–28, 27fig; occupation of Chinese territory, 52, 53, 54, 59, 60, 67–68, 84, 132; Western medicine, promotion of, 3–5 Japanese American Committee for Democracy, 101 Japanese Americans, 101 Japan Mail, 25–26 Java, 24, 80 Jiang Jieshi. See Chiang Kai-­shek ( Jiang Jieshi) (1887–1975) Jiangxi Province, 74map, 132 Jinan, 74map, 79 Jin-­Cha-­Ji border region, 75, 76

Jiangsu, 74map, 6 Jinhua, 73, 74map Johns Hopkins University, 11, 49, 193 Johnston, Nelson, 137 Judd, Walter, 164, 165, 180–182 kangs, 2 Kaohsiung Medical University, 205 Kerr, Archibald Clark (1882–1951), 137 Khaw, O. K. See Oo-­Keh Khaw (O.K. Khaw, Xu Yujie 1883–1983) King, P. Z. ( Jin Baoshan 1893 –1984), 151 King, William, 122 Kirby, William, 127 Kitasato Shibasaburō, 25–28, 27fig, 55 KMT. See Chinese Nationalist Party (Kuomintang) (KMT) Kohlberg, Alfred, 151,185, 189–190 Kuomintang. See Chinese Nationalist Party (Kuomintang) (KMT) Kuhn, Philip, 6, 16 Kunming: blood bank, 7, 14, 9, 95, 98, 106, 122–123; civilian blood donation, recruiting efforts, 110–114; Lianda (National Southwestern Associated University), 116–117, 136–137; medical care provided in, 81; medical supply routes, 68, 80, 83 Kuriyama, Shigehisa, 96 Lau, Allan (Liu Kongle), 7, 162, 163, 176, 182–183, 199–200 “Lazy Susan” turntable, 23 Lederer, Susan, 97 Lee, K. H., 189 Lee Kong Chian, 41 Lee Teng Hui, 24 Lei, Sean, 45, 97 Lianda (National Southwestern Associated University, Xinan lianhe daxue), 116–117, 136–137 Liang Qichao, 21 lice. See delousing efforts



I N D E X 303

Li Gao (1180–1251), 67 Light, Sol Felty, 42 Lim, C. E. (Lin Zongyang 1891–1988), 49, 52, 79 Lim, Robert Ko-­Sheng (Lin Kesheng 1897–1969), 2–3, 5, 6, 7–8, 9, 12, 13; American Bureau for Medical Aid to China (ABMAC) and, 84; blood banks, establishment of, 93, 99–102, 101fig, 105–106, 123–124; civil war, fundraising challenges, 15; concerns about communism, 158–160; CRCMRC (Chinese Red Cross Medical Relief Corps), formation of, 60; efforts in Communist base areas, 75–78, 90; Emergency Medical Services Training School, leadership of, 14–15, 139–142; financial support for, 37; global politics and shaping of medical education, 142–154; on importance of diet and nutrition, 66; life and career of, 20, 21–22, 199–200, 200fig, 201; limits, legacies and promises, 53–57; medical care in Chinese Civil War, 172–174; on mosquito eradication, 66; move to United States, 181; National Defense Medical Center, move to Taiwan, 155–156; Peking Union Medical College, growth and development of, 19–20, 44–51, 56; preventive medicine, limitations and innovations, 69–72, 71tab; preventive medicine, privileging of, 65–69; rehabilitation of, 150–152; on skin diseases in soldiers, 64; Special Diet Service, 67–69; support from Overseas Chinese, 79–85, 138; on support of nurses, 190; as surgeon general of Chinese Army, 152, 169–171; universal care, goal of providing, 88–93, 89tab, 188–189, 204; vaccine production facility, establishment of, 138–139, 151. See also medical education, military; military

medicine; National Defense Medical Center (NDMC, Guofang yixueyuan), Taiwan Lim Boon Keng (Lin Wenqing 1869– 1957), 6–7, 13, 50, 53, 56, 79, 152; classical Chinese medicine (CCM) and, 36–37; fundraising efforts for medical school, 19, 37–40; life and career of, 20, 21, 79, 199; Xiamen University, growth of global sciences, 42–44. See also Xiamen University Lin, Adet (Lin Fengru 1923–1971): blood banks, establishment of, 7, 95–96; on blood donations from soldiers, 108, 109; civilian blood donor recruitment, 109–110, 114–115, 118, 121–123; life and career of, 99, 150, 199 Lin Tsung-­yi (Lin Zongyi 1920–2010), 179 Lin Wenqing. See Lim Boon Keng (Lin Wenqing 1869–1957) Lin Yutang, 150–151 Li Shizhen (1518–1593), 67 Liu, Jean, 98, 114 Liu Jui-­heng (Liu Ruiheng 1890–1961), 51, 52, 54, 56, 88, 89, 104 Liu Kongle. See Lau, Allen (Liu Kongle) Liu Shuqi, 42 Liuzhou, 73, 74map Liverpool School of Tropical Medicine, 20–21, 49 London Chinese National Relief Fund, 137 London College of Pharmacy, 48 Loo Chih-­teh (Lu Zhide 1901–1979): in China, 149–150, 151, 160, 161, 166, 173; in Taiwan, 179, 181–182, 192 Los Angeles Times, 26 Lucas, John, 165 Luce, Henry (1898–1967), 143, 145, 151 Luesink, David, 37 Lu Xun (1881–1936), 50, 156 MacKinnon, Stephen, 10 Madison Blood Donor’s Club, 104

304 I N D E X

malaria: blood donations, rejections for, 107–108; in Communist base areas, 76; mobile medical units, treatment by, 63–65, 65fig; preventive medicine, CRCMRC privileging of, 66, 92; quinine, 68, 85 Malaya. See British Malaya (Malaya). Malayan China Relief Committee for Funds, 137 Malays, as ethnic group, 20, 186 Malaysia, 20, 49, 83, 186. See also British Malaya (Malaya) malnutrition, 66, 70, 108. See also nutrition Manchester Guardian, 82 Manchuria, 9, 13; cholera outbreak (1920), 32–33; International Plague Conference (1911), 25–28, 27fig; plague (1911), response to, 17–18, 19, 21, 22–37, 55–56; Chinese Civil War period, 173, 175; resident resistance to plague-­fighting efforts, 33–34, 56 Mao Zedong (1893–1978), 2, 75, 77–78, 161, 201, 202 Maritime Customs, funding for antiplague efforts, 31, 37 Massachusetts Institute of Technology, 49 maternity services, 19, 32, 76 McClure, Robert, 52–53 MD Anderson Hospital and Tumor Institute, 189 medical education: disruption in early Communist China, 192–195; expansion in Taiwan, Overseas Chinese support for, 181–187, 183fig; historical overview, 3, 11, 13; NDMC in Taiwan, curriculum improvements, 187–192; nursing education, funding challenges, 162; nursing education, in People’s Republic of China, 202; nursing education, in Shanghai, 166– 169, 167fig, 168fig; nursing education, in Taiwan, 185, 190–191, 193; Peking

Union Medical College (PUMC), 32, 53–55, 206; in postwar Shanghai, 166–169, 167fig, 168fig; prewar ideals and wartime adaptation, tensions within, 156–158 medical education, military: branch schools, 131–132, 131fig; characteristics of, 128–130, 130fig; Chinese Communist Party (CCP) and, 126–127; curriculum for, 129–130; EMSTS training manuals, 133–135, 134tab, 248–249n32; global politics and, 142– 150; nursing training program, 151– 152; overview of, 125–128; promises and limits of, 132–137, 134tab; Robert Lim, efforts to create a six-­year program, 139–154; student demographics, 129; typical daily schedule, 136; women, medical training for, 129. See also military medicine medical supplies: for blood banks, 111; in Communist base areas, 76; dispute over ownership, 146; for NDMC in Taiwan, 176–177, 182; routes for obtaining supplies, 7, 9, 67–68, 90; support from Overseas Chinese, 78–85, 86 Metchnikoff, Élie, 21 military medicine: biomedicine in People’s Republic of China, 202–203; blood banks, 98–99, 105–109, 106fig, 107fig; in Communist base areas, 75–78; CRCMRC, data on services provided, 60, 64, 66, 68, 69, 71, 71tab, 72, 87, 88, 89tab, 91; expansion of medical care during wartime, 72–74, 74map; gender and wartime medicine, 1, 11; mobile medical units, 60–65, 65fig, 72–78, 74map, 88–93, 89tab; Overseas Chinese, support for, 55–57, 78–87, 87fig, 88fig; preventive medicine, CRCMRC privileging of, 65–69; preventive medicine, limitations and innovations, 69–72, 71tab;



I N D E X 305

Robert Lim, promotion of military medicine, 50–55; social meanings of blood in wartime China, 121–124; in Taiwan, 183–184; universalizing care through, 88–93, 89tab; wartime medicine, overview of, 10–11, 57, 59–63, 61fig; wartime medicine as priority, 13–14; Western medicine, promotion of, 3–5, 11–12. See also medical education, military; women Ministry of Internal Affairs, Department of Health, 21 mites. See delousing efforts Mitter, Rana, 10 mobile blood banks, 99, 113–114 mobile clinics, CRCMRC (Chinese Red Cross Medical Relief Corps): in Communist base areas, 75–78; expansion of medical care during wartime, 72–74, 74map; postwar, 169; as transformer of Chinese medicine, 60–63; universalizing care through military medicine, 88–93, 89tab mobile medical units, postwar, 169–171, 172tab mosquito eradication program, 66, 92, 185 Mukden, 26, 29 Nanchang General Hospital, 125 Nanjing, 4, 41, 59, 67, 80, 173, 191 Nanjing University, 114, 178 Nanning, 73, 74map National Association for the Advancement of Colored People (NAACP), 7, 100 National Defense Medical Center (NDMC, Guofang yixueyuan), Shanghai: biomedical promise in postwar Shanghai, 166–169, 167fig, 168fig; blood banks, 119, 167–168, 167fig, 168fig; hyperinflation, funding challenges, 165–166, 256n26; Japanese hospitals, use by NDMC, 164–165; medical care during Civil War,

172–174; move to Taiwan, 119, 153–156; Robert Lim’s leadership, 2, 7, 8 National Defense Medical Center (NDMC, Guofang yixueyuan), Taiwan: Army Medical College, merger with, 160–161; curriculum improvements, 187–192; early fundraising challenges, 161–165, 176; Foreign Operations Administration (FOA), support from, 180–187, 192–193; Loo Chih-­teh, leadership of, 181–187; mergers, exchanges, and politics in Taiwan, 177–180; move from Shanghai, 119, 153–156, 160, 173–177; nursing training programs, 190–191; Overseas Chinese support for, over time, 189–190, 193–195; present day medical training, 205; reconstruction of institution, 192–193; reluctance of personnel to transfer, 174–175; Robert Lim, leadership of, 8, 15; student and faculty exchanges with other countries, 189–190; survival and adaptation (1949–1952), 175–177 National Federation of the Business and Professional Women’s Clubs, 185, 190 National Health Administration, 67, 79, 125–126 National Health Administration School Health Program, 88, 89tab nationalism: blood donation and, 118–119. See also Chinese Nationalist Party (Kuomintang) (KMT) National Medical Association of China (NMAC), 51 National Medical Journal of China, 52 National Professional Women’s Club, 151–152 National Quarantine Bureau, 34, 88 National Quarantine Service, 43, 89tab National Southwestern Associated University (Xinan lianhe daxue or Lianda), 116–117, 136, 178, 245n91

306 I N D E X

National Taiwan University, 175 National Taiwan University College of Medicine (NTUCM, Taiwan daxue yixue yuan), 177–179, 191, 205. See also Tu Tsung-­ming New Fourth Army, 77, 78, 80 New Way-­Sung (Niu Huisheng, 1892– 1937), 51–52 New York: China Aid Council, 80; Chinese American community, 84–85; Chinese blood banks, early origins, 99–100, 103, 104, 111–115, 123; Chinese Civilian Relief Committee, 80–81; global politics and shaping of medical education, 145, 163, 179; rehabilitation of Robert Lim, 150–152. See also American Bureau for Medical Aid to China (ABMAC); United China Relief (UCR) New York Chinese Hand Laundry Alliance, 85 New York Times, 26, 30, 84, 102–103 New York University, 84, 185 Ninth War Area, 135 Niu Huisheng. See New Way-­Sung (Niu Huisheng, 1892–1937) North America, Overseas Chinese in: CRCMRC (Chinese Red Cross Medical Relief Corps), support for, 62–63, 80, 84, 85, 86, 93; blood bank, support for, 6, 7, 14, 98–102, 114–115, 120, 122, 123, 138; National Defense Medical Center (NDMC Guofangyixueyuan), support for, 185, 189; support for China during Second World War, 78–85. See also United States North Manchurian Plague Prevention Service (NMPPS), 18, 31–33, 37, 40, 79; resident resistance to, 33–34 nursing training program, 151–152; biomedicine in People’s Republic of China, 202; in Communist China, 193; funding challenges, post Second World War, 162; in postwar

Shanghai, 166–169, 167fig, 168fig; in Taiwan, 185, 190–191, 193 nutrition: beriberi, 68; CRCMRC (Chinese Red Cross Medical Relief Corps), 62; CRCMRC, data on services provided, 60; instruction on, 141; preventive medicine, CRCMRC privileging of, 65–69; preventive medicine, limitations and innovations, 65, 69–72, 71tab; research on, 46, 51, 200; Special Diet Service, 67–69; for students at Lianda, 116–117; universalizing care through military medicine, 88–93, 89tab nutritional edema, 66, 70, 136, 250n47 obstetrical services, 1, 76 Oo-­Keh Khaw (O.K. Khaw, Xu Yujie 1883–1983), 7, 39, 49–50, 79, 120, 200, 201 opium, 21, 216n12 orthopedic medical care, 133, 151 Osaka Dental Manufacturing Cooperation, 164 Overseas Chinese: blood banks, support for, 98, 121–124; Chinese biomedicine, influence on, 4–9, 10–16, 55–57; Chinese biomedicine, legacy of, 206–207; Cold War tensions and, 193–195; CRCMRC (Chinese Red Cross Medical Relief Corps), support for, 62–63, 84–87, 87fig, 88fig; creating image of vulnerability, Cold War, 180–187; divided support during Chinese Civil War, 161–162; financial support for NDMC in Taiwan, 176– 177; financial support of biomedicine in China, 31–33, 37–42, 127–128, 137– 139, 144, 238–239n111, 252n86; global politics and shaping of medical education, 142–154; medical education, support for, 127, 137–139, 181–187, 183fig, 189–190; skepticism of Chiang Kai-­shek, 193; support of health care,



I N D E X 307

in wartime China, 78–85; use of term, 8–9; Western medicine, promotion of, 2, 4–5, 18–20; Wu Lien-­teh, internationalizing of biomedicine by, 23–24. See also North America, Overseas Chinese in; Southeast Asian Chinese Pan, C., 148 Paocheng, 132 Pasteur Institute, 21 Pearce, Richard, 46–47 Peking Union Medical College (PUMC): biomedicine in People’s Republic of China, 202, 206; Chinese Communist Party (CCP) takeover of, 126–127; early history of, 4, 19–20; growth and development of, 44–51; Lim, Robert Ko-­Sheng, career of, 7, 13, 22; PUMC Medical Corps, 53; Robert Lim, head of Physiology Department, 66–67; Robert Lim, limits, legacies, and promises of, 53–55; Robert Lim’s leadership of, 14–15, 19–20, 56; Robert Lim’s promotion of military medicine, 50–55; student enrollment requirements, 128. See also specific PUMC physicians’ names Penang, 6, 7, 18, 20–21, 24, 39, 49, 79, 120, 181, 193, 197 Peng, T. M., 183 People’s Republic of China (PRC): biomedicine in (1949–1980), 201–203; Coronavirus Disease 2019 (COVID­19), 197–199, 206–207; economics of health care, 204–206; Overseas Chinese, lasting impact on biomedicine, 206–207 Pharmaceuticals, 20, 37, 68, 92, 104, 134tab, 135–136, 161, 179, 201; production of, 67, 163; students of, 183. See also Renzao zilai xue (man-­made blood) Pharmaceutical Research Institute, NDMC, 190

physiotherapy, 133 Ping, C., 42 plague: classical Chinese medicine (CCM) and, 34–35; Coronavirus Disease 2019 (COVID-­19), legacy of Wu Lien-­teh, 197–199; International Plague Conference (1911), 25–28, 27fig; Manchuria (1911), 17–18, 22–37, 55–56; Manchuria (1911), antiplague measures, 28–31; Manchuria (1911), resistance to public health efforts, 33–34, 56, 219n58; medical training fieldwork, 135; monitoring of outbreaks, 21, 135; vaccines for, 138–139 plasma. See blood plasma. pneumonia, 66 Pollitzer, Robert, 31 preventive care: in Communist base areas, 75–77; CRCMRC, data on services provided, 60, 68, 69, 70, 71, 71tab, 87, 88, 89tab, 91; CRCMRC (Chinese Red Cross Medical Relief Corps) and, 60–63; CRCMRC privileging of, 65–69; EMSTS training fieldwork, 135, 142; EMSTS training manuals, 133–135, 134tab, 248–249n32; in People’s Republic of China (PRC), 204–206; universalizing care through military medicine, 88–93, 89tab Princeton University, 84 protein intake, disease and, 66, 70–71, 136 public health: EMSTS Public Health Training Institute, 137; John Grant, influence of, 44–45; Manchuria plague, prevention measures, 18, 22, 28–31; Overseas Chinese support for, 19, 55, 137; Peking Union Medical College (PUMC), Dept. of Public Health, 50; in People’s Republic of China (PRC), 203; Western medicine, promotion of, 3, 4, 18–20, 44–45. See also Lim, Robert Ko-­Sheng (Lin Kesheng); Wu Lien-­teh (Wu Liande 1879–1960)

308 I N D E X

PUMC. See Peking Union Medical College (PUMC) qi (vital energy), 103–104, 105 Qing China (1644–1911): Chinese migration from, 5–6; Western medicine, rise of, 3–4; Wu Lien-­teh (Wu Liande 1879–1960), 21, 23, 31 Qingdao, 43, 120 Qinghua University, 69, 178 Qiyang, 60 Queen’s Scholarship, 20–22 quinine, 66, 68, 85 Quo Tai-­chi (Guo Taiqi 1888–1952), 137 Rangoon, 68, 83 Read, Bernard, 48 Reader’s Digest, 84 Red Cross. See American Red Cross; Chinese Red Cross, Hong Kong; Chinese Red Cross Medical Relief Corps (CRCMRC); International Red Cross in China relapsing fever, 10, 63, 64, 71, 71tab, 73–74 Renzao zilai xie (man-­made blood), 104 respiratory disease: in Communist base areas, 76; mobile medical units, treatment by, 63–65, 65fig; preventive medicine, CRCMRC privileging of, 66. See also Coronavirus Disease 2019 (COVID-­19) Reynolds, F. E., 31 Rockefeller, John D. Jr., 45 Rockefeller Foundation, 4, 22, 37, 38, 43, 44–50, 84, 128, 180–181 Ross, Ronald, 20 Russia: cholera outbreak, Manchuria (1920), 33, 198 Russian Railway, 33 Salmonella infection, 135 San Francisco, China War Relief Association, 85 San Francisco Chronicle, 26

scabies, 10, 63–65, 65fig, 71, 71tab, 92, 169–170, 232n9 Schafer, Edward, 46, 47 Scheid, Volker, 201, 203 schistosomiasis, 203 Schneider, Helen, 10 Schneider, William, 97 Scotsman, 29, 30, 82 Scottish Rite Masons of Virginia, 138 Scudder, John, 99, 114 Second World War, 2; Japanese army occupation of Chinese territory, 59, 60; Overseas Chinese, role in resistance to Japan, 10–11; Robert Lim, increasing enrollment for medical students, 54; wartime medicine as priority, 13–14. See also Chinese Red Cross Medical Relief Corps (CRCMRC); military medicine Severe Acute Respiratory Syndrome (2003), 198 Seymour, Horace (1885–1978), 137 Shaan-­Gan-­Ning border region, 75 Shaanxi-­Gansu-­Ningxia border region, 75 Shaanxi Province, 73, 74map, 75, 132 Shandong Province, 10, 74map, 76, 77 Shanghai, 31, 32, 52, 73, 80, 86, 88; blood bank personnel, praise of, 114–115; early medical services in, 2–3; Japanese army occupation of, 59; medicine, promotion of, 4, 55. See also National Defense Medical Center (NDMC, Guofang yixueyuan), Shanghai Shantung Relief Fund, 79 Shi Zhaoji. See Sze, Alfred (Shi Zhaoji 1877–1956) shuxie yinhang (blood transfusion banks), 119–120 Sichuan Province, 73, 74map, 132 Singapore, 6, 7, 13, 34, 193, 205; British-­ controlled Straits Settlements, 20; immigration from China, data on,



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20; Lim, Robert, background of, 20–22, 36, 79, 193–194; Lim Boon Keng, background of, 20–22, 79, 199; Overseas Chinese support for China during Second World War, 82–83, 137; Overseas Chinese students from, 183; postwar medical education, 205; support for Chinese Communist Party, 161; Tan Kah Kee (Chen Jiageng 1874–1961), 38, 40, 41, 137; Wu Lien-­teh, background of, 20–24, 79 Singapore Free Press and Mercantile Advertiser, 83 Sino-­American Joint Commission on Rural Reconstruction ( JCRR), 186 Sino-­American Liaison Committee, 182 smallpox, 76, 77, 138–139 Smedley, Agnes, 82 socioeconomic incentives, blood donation, 97 Soong, T. V. (Song Ziwen 1891–1971), 150 Soong Ching-­ling (Song Qingling 1893–1981), 80 Soong Mei-­ling (Song Meiling 1898– 2003), 86, 137, 165 Southeast Asia, Overseas Chinese 2, 5–8, 11, 13, 15, 161–162; CRCMRC (Chinese Red Cross Medical Relief Corps), support for, 62–63, 82–83, 85, 87fig, 90; Cold War, conflicted levels of support for Taiwan and Mainland China, 161–162, 181, 186, 194; in Taiwan, 184. See also British Malaya; Overseas Chinese; Singapore. South Manchuria Medical College, 51 Special Diet Service,12, 13, 62, 67–69, 70, 74, 90, 92, 105 St. Andrew’s Hospital Sanatorium, 83 Stanford University, 184 Stassen, Harold, 180, 181–182 Stevens, Helen, 100, 110, 112 Straits dollars, 38, 39, 41, 79, 83, 235n70 Straits Settlements Legislative Council, 21

Straits Times, 82 Strauss, Julia, 127 Stuart, Leighton, 165 Studebaker motor vehicles, donation of, 80, 87 sulfaguandine, 135, 249–250n41 sulfapyridine, 135, 250n41 Sun Fo (Sun Ke 1891–1973), 175 Sun Yat-­sen, 21, 80, 84 Swanson, Kara, 97 Swarthmore College, 84 Sze, Alfred (Shi Zhaoji 1877–1956), 6, 28, 46 Taipei, 173, 175–178, 181, 200 Taiwan: blood banks, 120; Coronavirus Disease 2019 (COVID-­19), 206–207; discrimination against ethnic groups, 186; February 28 (228 Incident), 178; Overseas Chinese, lasting impact on biomedicine, 206–207; Overseas Chinese in, 8–9; postwar medical services, 2–3, 8–9, 15–16, 153–154; United States support, solicitation of, 181–187; universal health care system, 188–189, 204–206. See also National Defense Medical Center (NDMC, Guofang yixueyuan), Taiwan; Taipei Takao Kosaka, 50 Talbot, H., 125 Tang Erhe (1877–1940), 37 Tang Shaoyi, 24 Tan Kah Kee (Chen Jiageng 1874–1961), 6, 37–42, 79, 137, 161–162 Taylor, Adrian, 48 Taylor, Kim, 126 TenBroeck, Carl, 48 Teoh, Karen, 6 tetanus toxoid, 138–139 Tianjin, 4, 21, 59, 75 ticks. See delousing efforts Time magazine, 66, 145 Tokyo College of Dentistry, 164

310 I N D E X

Toller, Ernst, 81 Traditional Chinese Medicine (TCM), 202. See also classical Chinese medicine (CCM) transfusions. See blood banks transnational politics: global politics and shaping of medical education, 142–154; military medical education, 14–15. See also Cold War; Overseas Chinese Tseng Cheng-­Kui (Zeng Chengkui 1909–2005), 44 Tse-­Ying Chen, 42 Tsing Yi, 165 tuberculosis, 66 Tui, Frank Co (Xu Zhaodui 1897–1983), 7, 84, 162, 238n101 Tung, Robert Ho, 81 Tu Tsung-­ming (Du Congming 1893– 1986), 177–179 228 Incident (February 28), 178 typhus fever, 71, 71tab, 76, 135; vaccine for, 73 typhoid vaccine, 138–139 United China Relief (UCR): component members, 142; conflict with ABMAC, 9, 14–15, 142–150, 160; medical education and, 127–128; rehabilitation of Robert Lim, 150–152 United Family Hospital, 120 United Kingdom. See Great Britain United Nations Technical Assistance Program, 180 United Oxford Hospitals, 189 United Services to China (USC), 162 United States: blood donations, incentives for, 97; Chinese Americans in Chinese blood banks, 114–115; cholera outbreak, Manchuria (1920), 32–33; Coronavirus Disease 2019 (COVID-­19), 198; Counterpart Fund Agreement, 185; discrimination in,

100–102, 101fig; Foreign Operations Administration (FOA), 180–187, 256– 257n27; Lend-­Lease program, 148, 253n109, 257n27; Manchurian plague (1911), criticism of Chinese handling of, 25–28, 27fig; nursing training programs, support for, 151–152; Overseas Chinese, blood bank support from, 98–102, 101fig; Overseas Chinese, support for EMSTS, 137–138; Overseas Chinese organizations, 80–81, 84–85, 86; support for Taiwan, 157– 158, 176–177; United Family Hospital joint venture, 120; Western medicine, promotion of, 3–4, 7–8. See also Cold War; North America, Overseas Chinese in; specific organization names United States Army: support for National Defense Medical Center, 162–165, 164fig universal health care, 204–206 University of California, 181, 189 University of Cambridge, 20, 21, 31, 39, 49 University of Chicago, 22, 46, 49 University of Edinburgh, 21–22, 31, 46, 49, 120, 194 University of Hong Kong, 49, 81 University of Michigan, 86 University of Minnesota, 181 University of Toronto, 48 University of Virginia Medical School, 48 University of Wisconsin, 48, 99 Upjohn Company, 185 US Public Service, 180–181 Utley, Freda, 82 vaccinations: for cholera, 68; in Africa, 97; in Communist base areas, 76–77; CRCMRC (Chinese Red Cross Medical Relief Corps), 12, 60, 62, 87, 88; North Manchurian Plague Prevention Services (NMPPS), 32; Overseas Chinese fundraising for,



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138–139; for typhus, 76; universalizing care through military medicine, 88–93, 89tab; vaccine production facility, 127, 132, 138–139, 151 Van Slyke, Donald, 84, 101–102, 146–148, 238n101 Veteran General Hospital, Taipei, 184, 185 veterinary medicine, plague prevention, 32 Vincent, George, 84 vitamins. See nutrition Walter Reed Medical Center, 163 Wang, C. T. (Wang Zhengting 1882– 1961), 146–147, 148 Wang, S. C., 189 Wang Gungwu, 161 Wang Jimin. See Wong Chimin (Wang Jimin 1889–1972) War of Resistance. See Second World War Washington Post, 30 Washington University in St. Louis, 48 water supplies, 70; for blood banks, 111–112; chlorination programs, 135; testing of, 32 Watt, John, 11 Wellington Koo (Gu Weijun 1887–1985), 137 Wen Chao Ma, 51 Wen-­Hsin Yeh, 97, 136 Western medicine. See biomedicine; blood banks Western Wind Supplement (Xifeng fukan), 104–105 White, Walter, 100–101 White Terror period, 178 William, Maurice, 84 wine vats, as delousing stations, 10, 70, 92 women: medical care provided by, 11, 81; medical care provided to, 1, 76; medical training for, 129; Overseas Chinese support from, 6, 9, 80, 85, 86, 101fig, 107fig, 137, 151, 165, 185, 190. See also Chiang, Jean; Chou

Mei-­yu (Zhou Meiyu, 1910–2006); Derr, Ruth; Lin, Adet (Lin Fengru 1923–1971); Liu, Jean; Wong, Helena; nursing training program; specific women’s names Wong, C. K., 189 Wong, Helena, 99, 107fig, 108–109, 122–123 Wong Chimin (Wang Jimin 1889–1972), 35–36 World Health Organization (WHO), 31, 198 World War II. See Second World War Wu, C. Y. (Wu Zhangyao), 67–68, 79–80, 146–147 Wuhan, 59, 60, 72, 74map; Coronavirus Disease 2019 (COVID-­19), 197–199, 206–207 Wu Hsien (Wu Xian 1893–1959), 49, 66–67 Wu Liande. See Wu Lien-­teh (Wu Liande 1879–1960) Wu Lien-­teh (Wu Liande 1879–1960): classical Chinese medicine (CCM) and, 34–37; fundraising efforts, 31, 37; hygienic practices, interventions in, 23; international funding for plague prevention, 13, 31–33; International Plague Conference (1911), 25–28, 27fig; legacy of, Coronavirus Disease 2019 (COVID-­19), 197–199; life and career of, 6, 13, 20–21, 23–24, 34, 46, 49, 52, 55, 56, 79, 88, 89; Manchurian resident resistance to anti-­plague efforts, 33–34; Manchuria plague (1911), response to, 18, 19, 22–37; military medicine, 52; North Manchurian Plague Prevention Service (NMPPS), 31–33 Wu Ting-­fang (1842–1922), 24, 214n15, 217n28 Wuxi, 104 Wu Xian. See Wu Hsien (Wu Xian 1893–1959)

312 I N D E X

Xiaguan, 73, 74map Xiamen University: Amoy University, use of name, 223n119; biomedicine, development of, 12–13; early history of, 19–20; fundraising efforts for medical college, 19, 37–42, 56, 79,; global science, growth of, 42–44; Lim Boon Keng (Lin Wenqing 1869–1957), as president, 6–7, 21, 50, 55; in People’s Republic of China, 206; Robert Lim, recruitment of, 47 Xian, 169 Xu Yujie. See Oo-­Keh Khaw (O.K. Khaw, Xu Yujie 1883–1983) Xu Zhaodui. See Tui, Frank Co (Xu Zhaodui 1897–1983) Xuzhou, 10, 173 Yale-­China Medical College, 79 Yale University, 48 Yan’an, 2–3, 75, 76–77, 78, 90. See also Chinese Communist Party (CCP) Yang Shau King, 83

Yangtze River, 135 Yeh Shin-­Hwa (Ye Xinhua, 1928–2017), 184 Yellow Emperor’s Inner Canon (Huangdi neijing), 103 Yen Fu-­ching (Yan Fuqing 1882–1970), 79 Ye Su, 179 Yi Chien-­lung (Yi Jianlong 1904–1983), 7, 95, 99, 106, 112–113, 114, 115, 123–124, 200–201 Yi Jianlong. See Yi Chien-­lung (Yi Jianlong 1904–1983) Ying S. Mok, 189 Young Men’s Christian Association, 110, 143 Yuan Shikai, 21, 46 Yunnan Province, 73, 74map Yu Yan (1879–1924), 35, 37 Zhang Jian (1902–1996), 160–161, 174 Zhang Xianlin (1902–1969), 173, 174 Zhejiang Province, 73, 74map Zhiyang, 129