Global Medicine in China: A Diasporic History

By Wayne Soon

In 1938, one year into the Second Sino-Japanese War, the Chinese military found itself in dire medical straits. Soldiers were suffering from deadly illnesses, and were unable to receive blood transfusions for their wounds. The urgent need for medical assistance prompted an unprecedented flowering of scientific knowledge in China and Taiwan throughout the twentieth century. Wayne Soon draws on archives from three continents to argue that Overseas Chinese were key to this development, utilizing their global connections and diasporic links to procure much-needed money, supplies, and medical expertise. The remarkable expansion of care and education that they spurred saved more than four million lives and trained more than fifteen thousand medical personnel. Moreover, the introduction of military medicine shifted biomedicine out of elite, urban civilian institutions and laboratories and transformed it into an adaptive field-based practice for all. Universal care, practical medical education, and mobile medicine are all lasting legacies of this effort.

• Language: English
• Publisher: Stanford University Press
• Release date: Oct 20, 2020
• ISBN: 9781503614017

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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

CONTENTS

Acknowledgments

List of Abbreviations

Note on Romanization

Introduction: Diasporic Medicine

1. Prewar International Strategies

2. Wartime Military Medicine

3. Making Blood Banking Work

4. Transnational Politics of Military Medical Education

5. Reconstructing Biomedicine across the Taiwan Straits

Conclusion: Legacies of Global Medicine

Glossary of Chinese Characters

Notes

Bibliography

Index

ACKNOWLEDGMENTS

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.

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 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.

ABBREVIATIONS

NOTE ON ROMANIZATION

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.

INTRODUCTION

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.

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 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 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 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 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, 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 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 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.

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 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 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 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