Medicine in China
The China Medical Board (CMB) was created in 1914 as one of the first operating divisions of the Rockefeller Foundation (RF). Provided with a $12 million endowment and separately incorporated as CMB, Inc. when the Foundation was reorganized in 1928, the Board's aim was to modernize medical education and to improve the practice of medicine in China.
China was a long-standing interest of both John D. Rockefeller, Sr. (JDR Sr.), and his son. For decades they and their fellow Baptists had supported missionary work in Asia. Beginning in the early 1900s, Frederick Gates encouraged them to devote even more attention to that region. In 1908, five years before the Foundation was created, the Rockefellers funded a commission headed by Edward D. Burton, a University of Chicago professor of theology. He and other educators traveled to China to explore the potential for philanthropic work there.
In its final report the Burton Commission argued that a Western-sponsored educational program in science and medicine for elite Chinese students could succeed, despite a difficult political climate. One of the first actions of the newly created RF was to organize a conference about China in New York in early 1914. The Foundation later dispatched two additional survey groups, the China Medical Commissions of 1914 and 1915, to gather more information about how such an educational program could operate.
Following the model established by Abraham Flexner’s survey of U.S. medical education, the 1914 Commission set out to appraise medical education in both missionary and Chinese schools. It found appallingly low standards throughout the country. The report concluded that “the country is so vast, and the resources available for dealing with the problem are so limited as yet, that the need of outside assistance is still very great.” The CMB was formed to meet those challenges, and Wallace Buttrick was named its first director.
The Foundation’s approach to Chinese medical education would inevitably follow the general patterns for reforming U.S. medical education advocated in the 1910 Flexner report and most fully embodied in the Johns Hopkins University School of Medicine. Medical education in China would be scientifically rigorous and adhere to Western standards. And, in a decision with long-term consequences, instruction would occur in English. Consequently, the school could reach only a small, elite percentage of the population. Yet in a country of 400 million people then served by fewer than 500 well-trained doctors, such an approach stood to be criticized. Nevertheless, the CMB set out to build a medical school in China that it hoped to make the equal of Johns Hopkins.
Building for the Future
The RF entered China with an ambitious goal: to build modern medical schools in both Peking and Shanghai. By purchasing the Union Medical College from the London Missionary Society in 1915, the Foundation took its first steps toward that goal. Over the next six years the Foundation assembled a faculty of fifty professors and upgraded and enlarged the facilities of what was soon called the Peking Union Medical College (PUMC). Particular attention was paid to the school’s architecture and campus plan. According to the RF’s 1917 Annual Report, “While the buildings will embody all the approved features of a modern medical center, the external forms have been planned in harmony with the best tradition of Chinese architecture. Thus they symbolize the purpose to make the College not something foreign to China’s best ideals and aspirations, but an organism which will become part of a developing Chinese civilization.”
PUMC opened its doors in 1919, under the de facto directorship of Roger S. Greene, resident director of CMB. The 70-acre campus would ultimately encompass more than 50 buildings, including a hospital, classrooms, laboratories, and residences. But in New York Rockefeller officials grew concerned about the mounting costs of PUMC and were soon forced to scrap their plans for Shanghai. From an initial construction estimate of $1 million in 1915, expenses ballooned to $8 million in capital expenditures by 1921. The operating budget more than doubled between its first year of operation and 1921. Nevertheless, the medical school and its new campus were deemed worth celebrating. John D. Rockefeller, Jr. (JDR Jr.) led an impressive delegation to China for the 1921 dedication ceremonies.
PUMC’s initial contributions toward the improvement of medicine in China, though consequential, were inevitably limited in scale. Its graduating classes were small, in part because its standards remained high and its curriculum at the outset was exclusively in English. Between 1924 and 1943, PUMC produced only 313 doctors, more than half of whom would continue their studies abroad through CMB fellowships. Upon their return many of these doctors ultimately became leaders in medical administration, teaching and scientific research both before and after the Chinese Revolution.
PUMC also transformed the nursing profession in China. When PUMC opened, there were fewer than 300 trained nurses in the country, many of them affiliated with various missionary organizations and most of them male. Because the Chinese had never considered nursing to be an appropriate profession for women, the task of PUMC was both to train qualified women nurses and to elevate the status of the profession. Those responsibilities fell to a twenty-eight-year-old nurse from Johns Hopkins, Anna D. Wolf. She arrived in 1919 to create a training program for nurses and to organize the hospital’s nursing staff. Recruiting her initial faculty from the best U.S. nursing schools, she devised pre-nursing and nursing curricula. Within five years she established a school capable of meeting U.S. accrediting standards.
The RF’s Annual Report had been clear from the beginning about the CMB’s ambitions for PUMC: “It is the purpose and hope of the China Medical Board to co-operate with the various existing agencies in the gradual and orderly development of a system of scientific medicine in China.” But some staff members at PUMC believed the school’s primary task was the more urgent health needs of the Chinese people.
John Grant, a professor of public health at PUMC from 1921 to 1934, sought to offer medical services beyond the campus walls. He collaborated with the city’s police in 1925 to create a public health station serving the 100,000 people living in Peking’s first ward, the neighborhood surrounding PUMC. As Grant knew, the station also provided learning opportunities for students at the university. He persuaded his faculty colleagues that PUMC students should spend a four-week rotation there.
Grant's interest in pursuing broader public health work in rural areas found responsive allies in New York. Selskar Gunn, who had worked with the International Health Division in Eastern Europe before joining RF's Division of the Social Sciences, traveled to China in 1931 to assess the Foundation's work. While there he met Yan Yangchu (known to his American associates as Jimmy Yen), a pioneer in mass education and leader of the Rural Reconstruction Movement, with which Grant was already working. After several trips to China, Gunn produced a report that envisioned a coordinated program of basic education, health, and economic development.
Gunn was critical of PUMC and of RF's and CMB's disproportionate investment in it. By 1933 almost $37 million had been spent on an institution that would never solve China’s most pressing health problem: the severe shortage of trained medical personnel. A 1931 League of Nations Health Organization survey had concluded that China would need 50,000 physicians in order to have just one doctor per 8,000 people.
Few as they were, the cadre of professionals produced by PUMC would play important roles in shaping China’s health system. In 1946 an observer wrote to Raymond Fosdick, commenting on the small number of PUMC graduates. “Both doctors and nurses are in positions of leadership and many of them are effective in leadership…we found plenty of evidence that this small group had had an influence quite out of proportion to its size.”
But many in China had expected more. A Chinese Ministry of Education assessment of PUMC in the mid-1930s urged not only that enrollment be increased but also that more classroom instruction be in Chinese. Other recommendations soon followed: increase the courses in public health, parasitology, and bacteriology; teach Chinese medical terminology; and publish papers in both Chinese and English so that they would reach a larger audience.
Henry Houghton, who had directed PUMC during its formative years in the 1920s, returned in 1934 to address these criticisms. But by the mid-1930s relations with some departments of the Chinese government had soured. Tensions between the New York office and PUMC had led to the firing of Roger Greene, and there were continuing difficulties in transforming PUMC into a more fully Chinese institution. By 1937 Houghton and his colleagues were making substantial moves toward bilingual instruction, reducing the numbers of Western faculty, and placing Chinese professors in positions of departmental leadership. Plans for a graduate medical school were also under discussion with the Ministry of Education, but the Japanese invasion in 1937 interrupted this work.
Surviving War and Revolution
A 1938 memorandum summarized the devastating impact of the war on medical training. “The effect of the war on Medical Education is almost incomprehensible. Only 5 of the 33 medical, pharmacy and dental colleges existing before the war continue unaffected. The remainder have either been suspended destroyed or forced to remove, in instances thousands of miles. This is an almost complete national disruption.”
At PUMC limited teaching continued for a time even though some prominent faculty and staff fled in 1937 to southwest China to assist with war-related training and rural health programs. The school closed completely only after the U.S. declaration of war on Japan in December 1941. The Japanese occupied the grounds of PUMC, imprisoning Houghton for the war’s duration. Heroically, the nurses moved their school in its entirety to Chengdu and reopened there in 1942.
PUMC resumed limited operations in 1947, but RF staff debated the Foundation’s role as nationalist and Communists factions fought for supremacy. Could they stay above the fray and continue their work? What was the Foundation’s role likely to be as a new political order took shape? Alan Gregg saw that Communism, which in the U.S. represented a challenge to capitalism, meant something else to the Chinese. Communism in China battled a feudal order. He concluded that this “puts American aid in combating Chinese Communism into some odd attitudes and curious commitments.”
In 1947, amid the uncertainty about PUMC's future, the Foundation made a terminal grant of $10 million to the CMB. But in 1951 the People’s Republic of China nationalized PUMC and severed ties with the RF and CMB, Inc.
Between 1915 and 1951, the RF and CMB, Inc. spent well over $50 million on medical initiatives in China, nearly $45 million of it to establish PUMC. Other missionary hospitals benefited from smaller Foundation contributions. Fellowships helped doctors and nurses to travel abroad for advanced training. Medical texts were translated, and medical libraries were built. But the greatest RF legacy was PUMC and the enduring contributions its graduates have made to China's health system. PUMC's buildings, dedicated in 1921, still stand in the center of Beijing. A bust of JDR Sr. greets visitors to PUMC’s auditorium. The hospital still ranks as one of China’s most advanced. Today, the Chinese Academy of Medicine operates from the campus.