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China at the time of Gunn’s Visit


Rockefeller activity in China had its origin in JD Rockefeller Junior’s interest in the work of the missionary societies in the Far East. He financed a study of conditions in China in 1909 with the idea of establishing a great Western-style university there. This idea was soon replaced with that of a medical college. The China Medical Board (CMB), which was an internal division of the Rockefeller Foundation, was established to oversee the construction and administration of what would soon become the Peking Union Medical College (PUMC).

The Peking Union Medical College (PUMC)

It was perhaps inevitable that the medical commission sent to China in 1915, given its composition (members included Welch and Flexner), proposed a ‘Johns Hopkins for China’.

The Johns Hopkins University Medical School was one in which the Medical School was a graduate institution affiliated with a major university, and its hospital, an integral part of the teaching facilities. Its design was heavily influenced by what William Welch, its first dean, had seen in Germany. The German model included higher entrance standards, more emphasis on laboratories and demonstration techniques than on lecturing, and a faculty whose full-time commitment was to the University.

A Johns Hopkins for China meant the best that money could buy. The highest standards were aimed for and, for that, it was thought necessary that all teaching take place in English and that only students of the highest caliber should be accepted. As Welch noted in his diary: the essential thing is to raise Chinese to be first class medical men, and every proposition must be considered from that point of view. The ultimate aim was to train Chinese as medical teachers and leaders who would eventually take over the work.

Fosdick, some 30 years later, echoed the same sentiment: From the very start, the school did not aim to turn out numerous doctors and nurses – Chinese institutions had to assume that task – but to train leaders in medicine and nursing who would serve as teachers and investigators in Chinese medical schools, hospitals, and health organizations.

The ground and buildings of the Peking Union College were purchased in 1915 and renamed the PUMC. Instruction began in 1919; construction continued until 1921 when the school celebrated its dedication ceremonies.

At the dedication ceremonies Dr Edward Hume, dean of the Yale-in-China Medical College in Hunan, cited the fact that in China there was only one modern-trained doctor per 120,000 persons, contrasted to one per 720 in America. Despite the impossibility of the medical colleges in China ever being able to produce enough doctors to close this gap in the near future, he urged that the stress on high standards being set by PUMC be extended to medical institutions throughout China. Rockefeller Junior, on this same occasion, indicated that all that Western civilization could do would be to point the way towards the establishment of modern scientific medical education, while noting that for the PUMC to serve as a suitable model it was essential that the current cost of operating should always be kept on the conservative level, something that he nor his staff were ever able to accomplish.

When completed, the PUMC comprised 59 buildings spread out over 25 acres of land. The project included a hospital with 225 teaching beds and provision for 30 private rooms, a nurses’ training school and quarters for resident physicians and interns. The college began with a student enrollment of 140, and a teaching staff of 67, of whom 17 were instructors in the pre-medical school.

The key administrative personalities during the early years of the PUMC were Henry Houghton, who was its director from 1921 to 1928, and Roger Greene who at the beginning was the Resident Director in China for the CMB, whose headquarters was in New York City, and subsequently de facto Director of the PUMC when Houghton left. Houghton was a medical doctor, while Greene was a graduate of Harvard with no medical background.

From its inception, the PUMC cost far more than the Foundation had envisaged. Its Trustees, in 1914, had estimated that by 1920 its annual budget would rise to somewhere between $150,000 and $200,000. Instead, by 1916 it was already $225,000 and growing; by 1927, it had reached $900,000. The reorganization undertaken by Fosdick starting in 1927 had as one of its aims to separate the PUMC and CMB from the Foundation. However, for this to be financially viable, an endowment of $18 million was judged necessary.  The CMB was incorporated with the idea that it would take over the full responsibility of the PUMC, However, when only $12 million was provided the Foundation was still required to grant funds to the PUMC. With the onset of the global depression, this financial obligation seeded much discontent among the other programs of the Foundation whose budgets were being cut.

John B Grant, who became Gunn’s partner in the 1930s, joined the PUMC in 1921 where his task was to ascertain whether it was possible to initiate public health activities in China that would aid in the quicker establishment of a national public health movement. In addition, he was to develop a curriculum in what was shortly to be called preventive medicine, and to establish an intramural College Health Service, which would meet a local need and serve as a basis and model for other schools to follow in China. This job description was shaped at an informal meeting attended by the Vincent, Welch, Victor Heiser, Pearce, Houghton, and Grant. Heiser was the IHB’s Director of the East.

Grant spoke Chinese fluently as his parents were Canadian missionaries who were sent in 1888 to the treaty port of Ningpo by the Baptist Foreign Mission Society where Grant was born in 1890. He left China for Nova Scotia to attend Acadia College; upon graduation he returned to Ningpo for a year, before moving to the United States to study medicine at the medical school at the University of Michigan, from where he received his MD in 1917. He was engaged by the IHB later that year. Like practically all professionals engaged by the IHB at the time, Grant’s career began with his learning about hookworm and how to organize a campaign to fight this disease. This took him to China for several months, Puerto Rico to oversee a hookworm and malaria survey, and to North Carolina, where his immediate supervisor attested to his being the best man who had come to the State for training during the past year, being “energetic, well trained, and tactful; and able to mix with and interest all classes of rural people”. Grant’s stay in Puerto Rico convinced him that “you couldn’t secure implementation unless you had a technical health consciousness among the consumers”, i.e. a public educated in matters of health.

Following his field training, Grant was sent to the newly established Johns Hopkins School of Hygiene and Public Health where “tall, gaunt and so severely nearsighted that he used to wear eyeglasses while swimming”, he made “a strong impression”. After he obtained his MPH, Welch reported to the IHB that Grant “has ability, enthusiasm, and industry”, but added that Sir Arthur Newsholme thought him “a little too cock-sure in his judgments”. But it was Newsholme who helped Grant see disease not simply in terms of pathogens but also as indicators of social and economic disorder.

Very early on Grant realized that he had to educate political leaders to the importance of health as well as enticing medical students to engage public health as a career. For the latter purpose he developed an urban demonstration health center to be able to provide practical training in public health. By February 1922 he had completed a health survey of Peking and had outlined the basic functions of such a center. Grant soon turned to introducing preventive medicine courses into the PUMC curriculum. Training public health specialists offered an opportunity that he judged to be “unique in medical history”. He was convinced that by combining curative and preventive medicine a community approach to health care could be taught. As well, it would be a step towards developing a national public health movement, as his mandate called for.

Grant soon extended his courses to include graduate physicians who had not had the advantage of modern courses. However, Greene, now associate director of the PUMC, expressed the hope that Grant’s “natural desire to forward public health work” would not lead him to do anything which might “interfere with the fundamental training of doctors and nurses”. Realizing that Grant’s demands might draw staff away from their normal training duties in the school, Greene thought it best that Grant wait until the school prepare ordinary doctors and nurses from whom public health workers must eventually be selected. That Grant was running faster than those around him thought possible or desirable was (almost) a constant theme throughout his stay in China.

In 1928, by which time the center (Health Station) was fully staffed and operating, Grant described the project as follows: A good sample community of from 40,000-60,000 population is to a department of public health…what a 250-bed hospital …is to the departments of medicine, surgery, and obstetrics. The Department of Hygiene of the Peking Union Medical College is acquiring a teaching community comparable to its teaching hospital. He was to use this comparison on many occasions during his life.

The early success of the Grant’s Health Station encouraged him to think more widely of government involvement in public health, both for the urban and rural populations of China. In an address to the National Medical Association of China in January 1928 he advocated a system of state-supervised medicine for China, including the development of social machinery to ensure standards of living adequate for the maintenance of health. To his supervisors in New York he wrote euphorically about the general situation of China. The period 1925-30, he wrote, in all probability, would prove the most significant of any five years when the future medical history comes to be written….; the real birth of Public Health in China is now occurring.

He submitted some suggestions for a “systematic” Foundation policy in China with regard to public health. This was a moment in history that “comes only once in each cycle of civilization”. The IHB had probably “never before been confronted with any better opportunity to assist during the formative period in ensuring adequate architectural plans from which a future health edifice” was to be erected. The key building blocks that Grant identified at this point was one ‘quality’ school and 3 ‘quantity’ schools, and three regional health demonstrations along the lines of the Health Unit that was in the process of being developed in Peking in association with the PUMC.

In 1929 Grant invited James (Jimmy) YC Yen to lecture at the PUMC. Yen was educated at Yale University, and, while in Paris during WWI, had developed a teaching method for the illiterate Chinese population based on the use of around 1000 characters of the alphabet. On his return to China, he first experimented with this approach to literacy in several major cities, beginning with Peking. This led in 1923 to the creation of the National Association of Mass Education Movements (MEM). When he started working in rural areas, however, he realized that literacy alone was not enough. Literacy isn’t education – it is only a tool for education, a means to the whole end. The people had to get an education which involved the whole of their life.

When Yen moved to Tinghsien (a rural district and town of the same name, less than 100 miles from Peking) to establish a rural base, and to expand his literacy program to include health, Grant helped him develop a department of rural health.

The Tinghsien project was an innovative, new approach to the provision of health care, one that later gained fame for its village-based ‘barefoot doctors’. It demonstrated how state medicine could develop in China and was central to Gunn’s China Program. The eventual success of this project was largely due to CC Chen, who was one of the exceptionally bright and alert students that Grant had lured into public health.

In 1930/1 Chen completed a year’s graduate work at the Harvard University School of Public Health and work at Das Reichshaus für Hygienische Volksbelehrung in Dresden. While the analytical and theoretical material that he was exposed to at Harvard “exerted an important influence on my thinking as a public health specialist,” he was disappointed in the field training. It consisted of “superficial observation, without much student participation, a decided contrast to the highly motivating, hands-on exposure to the health problems of ordinary people we had at the Peking First Health Station”. On his return to China, in 1932, Chen, who was still on the faculty of the PUMC, was offered the position of Director of the Department of Rural Health of the Yen’s MEM, which he accepted.

Under Chen’s leadership a program evolved which in time covered more than 150 villages, and involved three levels of health care. Village health workers (prototype bare-foot doctors) selected by villagers, carried out simple health measures. Over them were sub-district health stations where a health officer, one or more public health nurses and an attendant, were present. Maintaining technical competency of these stations was the responsibility of the health center, which was located in the town of the county, and which comprised a hospital of 45 beds, a diagnostic laboratory, a central supply room and a health education section.

Grant believed that it was Chen’s experience in Tinghsien which successfully seemed to indicate that individual villages could support a medical worker, providing the educational movement had prepared the population for community reconstruction and that such a medical worker could collect statistics, give vaccination, [and] give first aid, under supervision.

Štampar had visited Tinghsien earlier, before Chen had a chance to carry out his reforms. He found the whole organization being conducted according to American methods and views and by means of American money. From his own work in Yugoslavia, he had learned “that not everything that one had learned outside of his own country can be applied when he returns to it. It is a great art to find the right way. Sometimes one must pay dearly for this experience. To find good and well proven methods adapted to national conditions is one of the hardest problems of the work to be found in Tinghsien”. There is no doubt that Štampar’s criticism contributed further to Chen engaging himself in reforming the program to bring it into line with the typical conditions of the Chinese countryside.

Štampar was accompanied by Grant on his visit to Tinghsien. His time there led him to indicate he was “very much impressed with the capability and the knowledge of Dr Grant, who, he seemed to consider, one of the outstanding men in the field. He felt that Grant was doing a very great work and that his field activities in particular were well planned.

In 1935 Chen visited Yugoslavia for 3 months, where he saw for himself the rural health care facilities in the Croatian region of the country which Štampar and Borislav Borčić, a colleague of Štampar, had developed. He also visited the RF supported institute of hygiene in Zagreb, whose integrated approach to the solution of rural problems, he found to be “broader than ours,” involving sanitary engineers, agronomists and specialists in veterinary medicine in addition to medical personnel. This institute was “quite unlike the institutes of hygiene and schools of public health that I knew of elsewhere at the time”. Those in America “seemed to be concerned more with theoretical knowledge and scientific research than with the practical application of scientific knowledge for the benefit of the general population”. The trip to Yugoslavia reinforced Chen’s belief that “we were on the right path… I returned to work with heightened enthusiasm”.

According to Chen, it was Grant who had enticed him into the field of community health. Chen described Grant’s approach as follows:

Realizing that local communities had to have their own permanent health agencies if health improvement was to be sustained, Grant applied himself particularly to developing pioneer public health careers in as many students as possible and never lost sight of those he considered the best and the brightest…

A major component of his teaching philosophy was his insistence on experience outside the classroom. As an initial step, he established a course requirement that each student organize and conduct a complete health survey in a locality of that student’s own choosing. More importantly, after several years in China, Grant sought the cooperation of Beijing municipal police authorities and established an urban health station, where PUMC medical and nursing students were provided with an opportunity to practice what they learned in the classroom.

Chen also credited Robert Lim for having “demonstrated an important principle of medical education, specifically, that it is entirely possible to correlate instruction in public health and clinical medicine in a meaningful way”. Robert Lim enters our story later.

Rajchman’s and the LNHO’s interest in China

The LNHO’s interest in China was first linked with its’ epidemiological intelligence and opium programs. Rajchman visited China in 1925 where he was appalled by the inadequacy of quarantine regulations, noting that “incredible as its sounds, China with her fifty odd Treaty ports and her 5,400 miles of sea coast has no quarantine Service”. Plans were made to carry out a detailed survey, but these were interrupted by the civil war that broke out following the death of Sun Yat-sen in March that year.

With the establishment of the new Nationalist Government in 1928 and the League of Nation’s desire to not have China abandon the league, Joseph Avanol, the League’s Deputy Director, was sent to China to suggest projects that might help keep the country attracted to the League.

Grant was a close friend of J Heng Liu, who was Vice-Minister of the newly established Ministry of Health. Aware that a strictly American-based support to China would encounter considerable political obstacles, Grant recommended the involvement of the League of Nations. It was this recommendation that led Rajchman to be invited to visit China in October 1929. Prior to that visit, Gunn had noted that Rajchman “had no preconceived ideas – certainly seems in doubt as to whether or not anything effective could now be accomplished through the League”.

Liu was a Harvard-trained physician (BS in 1908 and ME cum laude in 1913). He joined the staff of the PUMC as an associate in surgery and continued his training at the Rockefeller Institute and John Hopkins before returning to China where he became Director of the PUMC, a position that he maintained while working for the Ministry of Health. The reality of the situation was that Greene was still in charge; the appointment of Liu was part of an ongoing effort (resisted by Greene and many others) to appoint Chinese to senior positions.

Following Rajchman’s visit, Grant wrote to Liu:

You will recall my views as to why the League could become the chief stabilizing factor, especially if it possessed an integral interest in the more strategic activities. If the League had a representative in the country, no matter how complete the political change, this individual would felicitate the new group and as a matter of course get them to carry on with the same personnel.

He proposed a detail program in a number of fields that included:

  1. The conceptualization and establishment of a central field station as a nucleus of a future national field service.
  2. The establishment of a National Hospital to offer under- and post-graduate studies.
  3. The organization of a provincial health administration, with Chekiang to serve as a model for other provinces later.
  4. The Creation of a medical education system, for which the assistance of the competent LNHO Commission was sought.

Grant advised Rajchman to obtain the services of Borčić, who he described as a “very broad gauge medical statesman” to be associated with the Central Field Health Station at Nanking. At the time he was Director of the Zagreb National School of Hygiene. Borčić arrived in May 1930 and stayed in China until 1938. Whether Grant’s self-proclaimed importance in the relationship between the LNHO and China is historically correct is not of great importance, as it is obvious that he played a central role, even if it was Rajchman who was in charge of the LNHO work.

Rajchman, who had developed an “obsession for China”, took a year’s leave from his post in Geneva from 1 August 1933 to 31 July 1934 to serve as a technical agent to the Ministry of Health. Rajchman’s major role was to attract international health experts to come to China for an extended period of time. One such expert was Štampar, who undertook prolonged visits to China between early 1932 and the summer of 1936, especially to the Shenxi, Kansu and Kiangsi regions where he took stock of existing medical facilities and lent his advice to the budding regional public health system.

In early 1935 Grant reported that Kiangsi was the one province where “embryonic developments” were best seen in health as well as in other social fields. This was due to the attention given to it by the Nationalist Government following a civil war between the Communists and the Government forces. A commission was created in which Štampar participated to recommend a program for reconstruction.

As reported by Štampar, “the chief cause of unrest in the province was the tenancy system”, which led the Commission to recommend that the right to own landed property should be restricted; that owners with land in excess of a given amount should be expropriated, compensation being given in the form of Government bonds; and that, except in special circumstances, no person should be allowed to own land who did not also cultivate it. The proposals were never put into practice; as Štampar was to put it later: I told them that social and economic questions could not be solved with cannons and guns, they showed no particular pleasure with my views. The Government did, however, accept proposals that called for one innovative approach, one that called for integrating various welfare activities such as health, education, cooperatives and agriculture.

The Japanese government was not pleased with the attention that the LNHO and particularly Rajchman were giving to China. Avenol, who had taken over the LNHO during Rajchman’s absence, was not willing to curtail the ongoing program in China but did warn Rajchman that any extension of his contract with the Chinese government would mean the loss of his job as Director of the LNHO.

In the meantime, LNHO activities in China continued. In 1934, for example, more than 500 students attended various courses of the Central Field Station, including medical officers, sanitary inspectors, nurses, school teachers, pharmacists and midwives. However, as Gunn “confidentially” reported to Mason in early 1935 Štampar was “having a row with Rajchman, and has sent in his written resignation. I think he feels that he has been personally slighted by the officials of the League, and in addition, feels that the League of Nations should either get in or get out of China. The present program, which is of very small dimensions, is, in his opinion, practically useless”.

What may have provoked Štampar was the fact that Rajchman had engaged Borčić for another six months “without his opinion being asked”, as reported to Gregg by Gunn, who went on to write that Štampar had “made some interesting surveys and recommendations in connection with public health work in various parts of the country, but he is more dogmatic than ever and has become rather impossible and tiring at times”. If Grant were to meet him in the US on this way back to Europe, Gunn advised that Gregg “take a lot of his statements with a grain of salt”.

Štampar’s critical comments clearly stemmed from the fact that he had firmly come to the conclusion that the key problem of China was the exploitation of the peasantry and unless land reform was carried out there could be no real progress in health. Not being able to return to his home country, he must have been extremely frustrated, even to the point of feeling that he was wasting his time.

Knud Faber’s Study of Medical Education

Knud Faber, professor of Medicine from the University of Copenhagen, Denmark, was chosen by the LNHO to carry out the study of medical education in China. On his arrival in Nanking on the 12th of October 1930, Faber received a letter from Liu, who was now Minister of Health, which set out the questions he was to study. In addition to being asked to provide an account of the present status of  medical schools in China, he was asked to outline “future policies” that would permit medical education to “develop along modern lines”; to indicate whether “there should be only one or more than one standard for medical schools in China”; what should be the “minimum standard for a medical school in China in regard to entrance requirements, pre-medical training and instruction in the pre-clinical and clinical sciences; and what would be the “minimal hospital facilities required to enable a medical school to teach clinical medicine adequately”.

Faber knew that a Committee for Medical Education (CME) had been established and that it already had suggested a plan that provided for two types of medical schools, (a) the medical college, to produce high grade physicians, and (b) the special medical school, to train practitioners of medicine. The course envisaged for high grade physicians would last 6 years, while the training of practitioners would require only 4 years of study.

According to Faber, the role of medical doctors was to “provide medical relief for the people”. This could be done by private and public practitioners and by hospitals and dispensaries, but preferably by both methods, especially owing to the growing belief that “the best medical treatment is hospital treatment and that there is a need for large numbers of doctors for this purpose”. Faber travelled extensively in China over a period of several months and talked with many of the leaders in medical education.  His major conclusions were:

  1. There should be two kinds of institutions for medical education as proposed by the CME.
  2. Immediate improvement of existing National Medical Colleges and instead of establishing more such colleges the “Government should concentrate on the development of special medical schools [as] they represent the basic training necessary for all types of physicians. After the fourth year, further specialization could be carried out.”
  3. The standard of a medical college should be: secondary education in senior middle school or entrance examination of a similar standard; two years pre-medical work in the department of science in a university or in the college itself; and four years medical training in the college plus one year as intern in the college hospital or other accredited hospital.
  4. A modern teaching hospital of about 300-400 beds with an out-patient clinic, both attached to the college.

In the course of his visit Faber met with Greene who reported on this visit to Mason, using his 8-page letter to outline how he saw the options available to the Chinese government and the potential role that the PUMC might play. At the same time, he clearly wished to impress Mason with the importance to the PUMC of this new opportunity, hoping thereby to obtain more direct support from the home office, in particular the visit of Alan Gregg, now Director of the Foundation’s Medical Sciences division.

Greene described how the first step to be taken would be the creation of an experimental school which would attempt “to break away from conventional ideas as to how medicine should be taught, etc., and to devise an intelligent system based on the real requirements of the profession as it exists today, and on the demands and economic possibilities of China at the present time”. Greene saw this project as being of “unique significance not merely for China but for the rest of the world”:

Everywhere we hear from the more thoughtful minority of expression of dissatisfaction with the medical curriculum of today. The way in which the whole field is divided, the time assigned to different subjects, and the teaching methods, are largely determined by the varying traditions of each of the leading countries, rather than by dispassionate consideration of the needs of the profession for which the students are being prepared, and of the content of knowledge, and the habits of thought and work which the graduate should carry with him from the school. Each country sees weaknesses in the other’s system, but the teaching profession in any given country seems relatively complacent as to its own methods. An experimental school that would be interested in trying new combinations and new methods, especially one conducted under the auspices of an international group like ours, might conceivably make a contribution of great value to medical education in the rest of the world.

If the PUMC was to play an important role in China’s efforts to improve the education of its doctors, however, it needed to have some of its “deficiencies … made good”. While the PUMC was in a “good position to give good graduate training on a small scale in practically all of the principle branches of medicine”, the department of hygiene and public health, which was run by Grant, “does not possess the staff or facilities for really professional instruction in the special branches of public health, such as epidemiology and vital statistics, physiological hygiene, industrial and child health work”. The amount of money required for making good these deficiencies “would not be large compared with the rest of the budget of the College”. His choice of words here are somewhat amusing as he well knew that “the rest of the budget” was much too high for the CMB and RF to support!

Mason seems not to have had any interest in encouraging Greene’s hopes. Despite Greene “earnestly hop[ing] that Dr Gregg may be able to rearrange his plans, and accompany you to China in the spring of 1931, in order to go into these plans”, Mason never visited China, and Gregg did not visit until 1932.  According to Grant, Greene “felt that New York was unconscious of the part the PUMC could play nationally, rather than just locally”.

Rajchman invited many concerned individuals to comment on Faber’s report. Not surprisingly, Greene was disappointed by the manner in which Faber referred to the PUMC. References to the PUMC were so “casual” that most readers might not even appreciate their significance. And as Faber had spoken “quite kindly of other institutions”, which were much less fortunately situated, this might suggest that the adjectives used with reference to the PUMC might “also not to be taken too seriously”. This ‘logic’ was consistent with his earlier comment that too many less-qualified doctors might jeopardize the place of the more highly qualified physicians.

Robert Lim, PUMC professor of physiology, used his comments to outline the educational policies he believed China needed to follow. It was clear to him that the future medical doctor needed to be trained along three lines:

  • Disease prevention routine: the ‘policing of disease’.
  • Environmental ‘engineering’ to deal with fundamental causes of disease, be they biologic, economic, or social.
  • Detection and repair of casualties caused by disease.

He outlined a “minimum curriculum for the preclinical school” to be taught by “competent teachers, to furnish “a good foundation for medicine”. In total it called for 1716 hours of courses spread over two years, which was some 200 hours less than Faber’s model. It included the teaching of “old Chinese medicine” to provide doctors the knowledge needed to “conquer old prejudices”, something which Faber ignored. Instead of seeking to train large numbers of less qualified doctors quickly, he placed emphasis on inaugurating “a minimum attainable standard”, the provision of a “definite mechanism of training medical teachers,” followed by the setting up of a “model school, partly for the benefit of the teachers in training and partly to offer a pattern to future schools”. He believed his scheme could handle 100 students per year per school.

Gregg, in a post-Faber visit assessment, did not believe that Faber’s experience had made him “adequately appreciate the ill efforts to be observed in larger universities like Paris, London or Vienna upon the students coming from smaller or less advanced countries for their medical training”. Furthermore, added Gregg, it seemed to him that there “should be one school in China of first rate quality so that the Chinese need never feel that for real good medical training they must go to other countries”. He doubted that Faber attached the “right importance to the fact that increasing number of students at Peking would mean only a small increase in medical practitioners in China relative to the need but would mean a serious loss in standards in the school”.

Rajchman and some 15 MOH and other PUMC staff, participated in one day meeting chaired by Liu in March 1931 to discuss Faber’s report. Whether or not two types of schools were really necessary seemed to hinge on just how different it was imagined that they would be. If it was a matter of “only one or two year there was no necessity of having two types of medical schools”, but if it was 4 or 5 years as some had proposed, then “it would be worthwhile to discuss this problem and to try to find a solution”.

CE Lim, PUMC Professor of bacteriology, used the occasion to voice his opposition to the introduction of “the lower type of medical school”, as there were already existing relatively low standard medical schools crowded with students. It would be better to improve their standards and make them more attractive by “giving students free lodging and board or tuition”.

Despite the opposition of CE Lim and others to the idea of two schools, Rajchman intervened to indicate “that in general everybody had agreed to the adoption of two types of school, i.e. the higher normal school and the medical school”. Robert Lim, PUMC Professor of physiology, agreed with Rajchman that “there was need for the higher normal medical college and the ordinary medical college”. He called for the creation of a “permanent body” that would be responsible for supervising an experimental school, for which the Army Medical College in Nanking could be used. When Gregg later (1932) met Robert Lim, who was still promoting this idea, he told him that he had “a good many doubts and reservations on this” but he didn’t feel that he knew enough yet about the Chinese situation to be sure. He was, however, “surprised that Lim had become convinced of the importance and value of creating two standards or types of medical schools in China”.

After a wide-ranging discussion it was unanimously accepted to fix the curriculum of the experimental school “at four years, including one year internship”. Robert Lim’s proposed curriculum was discussed and it was agreed that it would be attached to Faber’s report as an annex. He agreed to be acting dean if funds and staff could be found.

Grant indicated that the PUMC “might serve as a normal medical school until the other schools reached the desired high standard”, and that it “might provide teachers for the experimental school, or if some
teachers from other medical schools were taken, the PUMC might provide personnel to fill the vacancies thus left in the other medical schools”. The PUMC, however, would need strengthening before it could fulfill these roles. All others who spoke supported Grant’s proposal. Within a short period of time, however, Grant’s enthusiastic efforts to involve the PUMC ran into opposition from those who feared that it would degrade the efforts of the school to prepare medical doctors of the highest caliber, as discussed in Chapter 11.