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Gunn’s First Years in China – his new home

Gunn Establishes his Office in Shanghai

Greene, with whom Gunn spent his first few weeks on his return to China, informed Gregg in a personal and confidential letter that Gunn seemed to be enjoying himself but was “a little impatient of having to pick up the threads of the office management and attend to minor matters like fellowships.”

There still seemed to be some doubt concerning where his permanent office should be although both Greene and Gunn were inclined towards Shanghai. For the immediate, Gunn’s address was Lockhart Hall, one of the buildings of the PUMC. Before leaving Peking, Gunn informed Mason that he would keep a record of his important interviews, which he hoped would become “more significant as time goes on and I meet a much wider group of people.” Rather than send these or even a “full statement concerning my activities and the way in which I am thinking” to Mason (who he must have known by now did not like to read long reports), he proposed “to write you every so often … .” Several months later, Mason replied that he had found Gunn’s individual memoranda “highly illuminating” but would not “acknowledge them in detail.”

Mason took this occasion to bring Gunn up to date concerning issues facing the Foundation of potential importance in determining Gunn’s future. He announced that a general meeting would be held “before long” where the Directors would present histories of past programs, and the Trustees would “have their day at court on what the Foundation should be doing in this changing world. The “advance of knowledge” program adopted in 1928 required review as well. Mason seemed to imply that such a review was required to “avoid the large amount of dissipation in small ways … [as] it is certainly better for the Foundation to fire a few large caliber shells than to dissipate its energies in bird shot.” He advised Gunn to take his time “and soak in the situation” as he was “strongly convinced that we have not had enough of this in the past, and should much prefer that a long time elapse before you settle on desirabilities. A field as vast as the East cannot be covered in a short time.”

Within several weeks Gunn did decide to establish his office in Shanghai, which he did in February, and which Mason judged wise for him to have done but with regret as Shanghai “as a center could not be as attractive personally for you as Peiping.” On his way to Shanghai, Gunn stopped off for a day in Nanking (now Nanjing) where he made his first contact with the newly created National Economic Council (NEC). There, he learned that the “people in Nanking are anticipating war in the North … but that the Chinese are in no condition to present a serious resistance to the highly organized Japanese army.” He took this occasion to recommend that Mason and the Directors read Tawney’s Land and Labour in China, which Gunn believed to be “the best thing that I have read concerning contemporary China.”

Concerning the Japanese threat, Gunn noted that Greene was not especially worried. Even if Peking were occupied by the Japanese, Gunn doubted if there would be any serious disturbance at the PUMC – “retreating Chinese armies, however, probably more dangerous than advancing Japanese armies.”
Another expert that impressed Gunn was Dr Carlo Dragoni, former Secretary-General of the International Institute of Agriculture, who was on loan by the League of Nations to the NEC. Gunn, who had stopped making entries in his diaries in March 1931, wrote 2 pages to describe what he had learned from Dragoni, who he judged to be “a man of considerable ability and acute observation.”

Dragoni identified three “outstanding immediate problems in the agricultural field in China: (1) a thorough-going study of land tenure; (2) development of crop statistics; and (3) the establishment of a central agricultural experimentation station. He was particularly impressed with the work being done under the direction of Professor Buck at Nanking and Professor Franklin Ho at Nankai (District in Tianjin Southeast of Peking). He also thought well of the efforts at Yenching University in rural sociology.

Dragoni believed that Chinese peasants were not bound up with tradition and that they were always willing to adopt new methods or grow new crops if they could be shown the benefits. He informed Gunn that there were a large number of “so-called” official agricultural experiment stations but that they were very poor and were doing work of little or no account. Dragoni was “much impressed” with the development of cooperative in some places in China and in the advance in rural credit organizations. He believed that “there was an opportunity for a school to train a staff of men capable of going around organizing cooperative and rural credit associations.”

Farmers were paying at least 3% per month, and with high taxes and poor facilities for marketing their products, were unable to pay the interest on their loans, with the result that many owner-farmers have had to sell their land and become tenant farmers under adverse conditions. He also observed:

Where you have owner-farmers, as is particularly true in the north, you have practically no communism, but in the central regions of China, and in large sections of the south, where the land is owned by the so-called gentry and rented out under various conditions to the peasants, communism and banditry are rife.

Gunn, who no doubt thought that he was free of all other responsibilities than those concerned with China, was clearly disturbed at being asked by Sydnor Walker (Associate Director for the Social Sciences Division in New York) for his recommendations concerning the University of Hawaii, which Gunn had visited several months earlier. Gunn had written a report following his visit and had expressed his hopes that Day would visit Honolulu to make his own judgment. He added in a rather peevish manner: In order that the matter may be in order I am writing a letter to Mr Mason and enclosing it herewith on this subject, as according to my instructions I am supposed to write directly to the President.

Mason’s Reform Efforts

Meanwhile, in New York, Gregg in his capacity as a member of the CMB (but who would not visit China again until after WWII) learned that Mason “would emphasize [to the CMB, Inc.] the desirability of making facilities of the PUMC available to Chinese if pressure develops for this”. Gregg did not record his own opinion on this occasion. Unfortunately, when Mason first took over as President he indicated to Gregg his disapproval of long diary entries, which led to Gregg’s entries losing much of the intimacy and depth that he had invested in them earlier, or, as in this case, to record nothing.

A short time later, Mason indicated that an “expansion policy for PUMC [was] dubious at present time,” a point noted in Gregg’s diary. The depression was cutting into Foundation funds; as Gregg informed Gunn: our affairs are not what the French call ‘brilliant’. We are minus about a million of expected income and the margin for new undertakings is pretty largely swallowed up by existing commitments, actual and implied”. In any case, meeting with Mason and Vincent, Gregg learned that there would not be any “abrupt reduction” to the PUMC from the Foundation.

The special meeting that Mason had announced earlier to Gunn took place in early April 1933. Mason introduced his statement concerning future operations by recognizing that the Foundation enjoyed “the confidence of the world at large… The Foundation has a rich and unique inheritance of experience in procedures, and of world-wide contacts with scholars and situations. Future operations within the general field of past interests are thus endowed at their outset with high factors for their success”.

Mason continued using dramatic and evocative language before reaching his concluding points:

Being convinced of the wisdom of increased concentration, it remained to select fields of critical importance; fields in which the procedures could capitalize the rich heritage of the Foundation’s long experience, and in which the progress secured would be of enduring significance since the attack would be upon basic causes. The salient of concentration, as they are to be proposed here, are directed to the general problem of human behavior, with the aim of controlling through understanding. The Social Sciences, for example, will concern themselves with the rationalization of social control; the Medical and Natural Sciences propose a closely coordinated study of the sciences which underlie personal understanding and personal control. Many procedures will be explicitly cooperative between divisions. The Social Sciences and the International Health Division, for example, may have common interest in the expansion of health control units into the broader service of community centers. The Medical and Natural Sciences will, through psychiatry and psychobiology, have a strong common interest in the problems of mental disease.

This is a more explicit explanation of what was meant by ‘social control’, i.e. using education to alter behavior via a better understanding of whatever concerns those in charge had.

The proposed program was approved “in principle”.

The immediate loser in the program that was adopted was the IHD, which was to have its budget reduced. For the moment, it would seem the efforts made by Vincent, and now Mason, to control the so-called Medical Barons was bearing fruit.

What drove Mason to seek new directions of the kind announced is not at all obvious. He was trained as a mathematician, and even taught mathematics at MIT while Gunn was there, although there is no evidence that they met at that time. From MIT he moved to Yale and then Wisconsin-Madison, where he became a professor of Physics. In 1925 he became President of the University of Chicago, a position he left in 1928 to join the Foundation as Director of the Natural Sciences Division, with the understanding that he would take over as President on Vincent’s retirement.

It was Mason who brought Weaver into the Natural Sciences Division in 1931. Weaver had studied under Mason, who he considered to be a “truly great teacher”, as well as a close friend. They even wrote a book together The Electromagnetic Field, which was published in 1929! At the same time, Weaver believed that “Max was not a great administrator”, and “should have continued to be a teacher and a scientist”. His “mercurial brilliance was such that systematic preparation for meetings and sustained study of proposals submitted to him were simply not congenial to him”.

Weaver’s arrival coincided with the restructuring of the Foundation’s program that led to shifting the emphasis from long-term commitments to institutions to short-term grants for research on more fundamental scientific problems. With the “conviction that physics and chemistry were ripe for a fruitful union with biology,” it was natural that he almost immediately stepped on the toes of some of his medical colleagues, in particular Gregg, who felt that biology belonged to them rather than to the natural sciences. Gregg was so sure of this that he ventured to predict, when Fosdick took over from Mason as President of the Foundation in 1936, that the Medical Sciences and Natural Sciences Divisions would be merged, and that Weaver would possibly depart “on the basis of lack of knowledge of this field,” which turned out to be wishful thinking on his part. Weaver stayed on in that capacity until 1955, and is now credited as being a pioneer in such diverse fields as molecular biology and machine translation.

Gunn Continues his Rounds in China

Gunn spent three days in Hangchow to visit educational institutions and to get some general information concerning the Province of Chekiang which interested him very much as a possible area with which to cooperate at some future date. He went to Peking for a week to spend some time examining Yen’s rural demonstration work at Tinghsien. He made a short trip to Foochow, before going up the Yangtze to visit the educational institutions at Hankow and Wuhan.

On his way to Peking he met with René Charron, an envoy of the Finance and Economic Research Centre in the League of Nations, who brought Gunn up-to-date on the Leagues activities in China, about which Charron was extremely critical. High on his list of problems faced by the League was the fact that Rajchman, who was present in China at the time, “has many enemies” in China. Then there was the problem that experts stayed for too short a time and little or no good arose from their visits. Visiting professorships at the National Central University were “a complete failure”, mostly it would seem due to the attitude of the students which he found “intolerable”, as they insisted on setting the hours for lecture and then did not show up. All three professors currently teaching agreed that their “work has been useless”.

While in Peking, Gunn met with Hsu, professor of sociology at Yenching University. Hsu, who received his graduate training at the University of Iowa, was successful in developing the Yenching School of Social Work and Social Research with a grant of US$140,000 in 1928 covering a period of five years from the Laura Spelman Rockefeller Memorial. He was also awarded a Rockefeller fellowship for a year-long study tour in the major academic centers in the US, London, Paris, Geneva, and Moscow. His attempts, however, to develop a Chicago-Yenching project failed when the Foundation rejected his proposal, which was judged “weak” and “without a genuine research focus”. Whether Gunn knew of this proposal is not clear but as they met to discuss on-going rural reconstruction activities in China he no doubt learned of Hsu’s interest in studying four aspects of the Chinese society: family, village, social economy and politics, as well as the Universities sociological laboratory in Qinghe, which was located in the province of Hebei.

Gunn learned of Hsu’s plans to convene a meeting of representatives of the leading institutions and rural demonstration units currently interested in the problem of rural reconstruction. It was hoped that a National Union would be created which would, inter alia, create facilities in colleges for the training of men and women for work in rural regions; develop a central publication for all types of rural work; experimentation such as already going on in Tinghsien and Ching Ho; and provide technical advice to government and private agencies.

Responding to Gunn’s request as to whether the NEC had been invited, Hsu said that “it would probably be ill-advised to have too close a relationship to governmental agencies at this time, as it was almost certain to lead to complications”. To his question concerning whether or not it was desirable to have Yenching University, a mission college, act as hosts, which might jeopardize at least part of the success of the movement, Hsu agreed and indicated that the meeting might better be held on strictly Chinese territory.

Hsu “hinted that aid from the Foundation in connection with the development of the program might be necessary” to which Gunn replied that it was altogether too soon to raise a question of this kind. Gunn concluded his diary entry with the belief that it was “obvious that this whole development is resulting from the criticism which [he] and others have directed against the workers in Rural Reconstruction in China, who although preaching cooperation in many forms to be the country people have similarly shown little cooperation amongst themselves and in fact have generally and frequently unfairly criticized each other”.

Hsu was not the only one pushing to bring together rival rural construction programs under their wing or to create new programs in the hope of attracting the large sums of monies that it was believed Gunn was in a position to provide. Yen’s program in Tinghsien, which became in time central to Gunn’s program, was actively being courted by the Nanking government to establish similar programs in other areas of China.

William Johnson, superintendent of the Nanchang Academy and close friend of Madame Chiang Kai-shek, claimed that he had learned from Gunn of the Foundation’s interest “to back the Provincial and Central Governments’ plans and to stimulate them to undertake an adequate program for this kind of work”. As the only record of this meeting seems to be Johnson’s letter, it is not clear exactly what kind of work they discussed or to what degree Johnson’s apparent belief that he had impressed Gunn with his ideas, was in fact true, especially as there is no further reference to Johnson or to any of the institutions that he was involved with in Gunn’s reports. How many such discussions took place is anyone’s guess. Gunn simply reported to Mason: I do not believe that I have ever been busier than I have been here in China during the last six months. The number of people who come to see me is ever increasing, and I can fairly say that I have already been able to win the confidence of a large number of important people, both Chinese and foreigners. Did Gunn not imagine that much of this ‘confidence’ was due to the apparent largesse the Foundation was bringing to China?

By the end of May, Gunn was in a position to report to Mason “the barest skeleton of [his] thinking at present”, after first expressing his appreciation that he was not being pushed and, contrary to earlier indications that he might be ready to present his program at the December 1933 meeting, he was now inclined to believe that “this would rush things, and I am now looking forward to presenting the program for China at the April meeting”.

He expressed his belief that the Foundation was going to be able to undertake:

… some important work in China in the next decade. Reasonable security of life and property of course must be assured. There is no doubt that one of the major problems in China has to do with the raising of the economic level of the rural population. No government, certainly no foreign agency, is capable of giving the Chinese people the minimum of the public services to which they are entitled unless the general economic level is raised. This involves what is broadly called a program of rural reconstruction, and it may be that in this field we shall have our real opportunity in China…

A program in Rural Reconstruction might well interest all of the Divisions of the Foundation. It would certainly demand our interest in certain selected institutions of higher education, and would bring us into close contact with agricultural and engineering activities, in addition to those concerned with the Natural Sciences, Public Health and Medicine. Even Humanities might well be included…

Any program would necessarily be a long-time one, not necessarily a very expensive one. China is surely too large for us to have any general nation-wide program, and it would be necessary to select certain parts of the country where we could concentrate our efforts.

Mason agreed with the direction that Gunn was “gravitating toward[s]”, as well as with his plan to present his program in April 1934.

Gunn’s Program Takes Shape But is delayed

Gunn’s report largely avoided presenting specific projects, as its aim was to outline a “new policy for China,” one that was based on China’s pressing needs. The main objective of the new policy was “rural reconstruction”; with few exceptions, all the suggestions made were with special reference to rural problems. Gunn expressed the belief that the existing program in China, i.e. the PUMC, was “no longer in touch with the times or the best we could find,” while also expressing his conviction that “the opportunities in China are vastly more significant than those presented in any of the many countries where I have worked for the Foundation in Europe”. The PUMC program was seen to belong to the missionary movement”.

He had spent the past year fostering cordial relations with Chinese officials and with important people connected with purely Chinese institutions. He recommended that indigenous institutions be used instead of sending Chinese students abroad for study, as the majority of returned students had “lost a good deal of their Chinese point of view and background and have picked up something of Western life but insufficient to make them really Western in their outlook”. An annual expenditure of 300,000US$ was envisaged.

Most of the report concerned issues closely related to the social sciences and rural reconstruction; the part that dealt with medicine and public health was largely written by Grant. In the introductory part of that section, which it would seem was written by Gunn, the question was asked if the results that had been obtained by investing over 33 million US$ in the PUMC were “commensurate with the effort”? Despite the fact that he credited the PUMC for its graduates occupying important and strategic positions in the medical and public health fields of China, his answer was no. The huge investments to the PUMC had not been warranted in terms of accomplishment in China. Furthermore, the PUMC was as an example of one of the “stereotyped educational institutions which are based essentially on Western forms” that were beginning to show their limitations in the training of men and women for work in China. Given the needs in other directions in China Gunn had no difficulty in concluding that it would be “highly dubious” to make any further large grants to the PUMC.

Turning to public health, it was clear that not much had been accomplished in China. Nor did it seem that the IHD was contemplating any marked development of its Chinese program. The attitude of the Medical Sciences Division was “negative”. Given this state of affairs Gunn had become convinced that the program in both medicine and public health needed to be restudied and developed on new lines. At this point he gave over the section to Grant, with his “general endorsement”.

Grant proposed two ways for viewing a future medical policy for China. One was as a contribution to a program of national reconstruction of which a unified national policy would be a part, the other as a method for assuring the continued value and significance of the large investment already made in the field of medical education in China. An effective national medical policy should include medical education, public health, and medical relief. Such a policy, however, was so dependent upon the progress in other fields of community activity that it should be closely coordinated with a program of national planning. The minimum essential components of such a medical program were an administrative infrastructure of four types (national, provincial, urban and rural), facilities for training several categories of necessary personnel, a medical consciousness in the population served, and commensurate progress in economic, educational, transit and similar fields.

With regards to ensuring that the PUMC was capable of assisting in the attainment of the objective of a new social order, something Grant believed possible “provided some direction is given”, the PUMC should start producing the medical personnel needed for a series of specific projects, some of which were ready for consideration. These included the experimental medical school at Nanking; public health activities of the MEM at Tinghsien; sanitary engineering; health education; provincial medical and health organization at Changsha, and possibly Tsinan; a fellowship program; and funds for research and development in medicine and public health. The time was past when medicine and its application in public health should be considered as separate entities. That Grant and Gunn were thinking exactly along the same lines is clear.

The PUMC could provide the engine for bringing about the linking of these hitherto separate programs, but exactly how the program of the PUMC was to be altered in order to become a constructive element was not made clear, especially in light of the fact that they were advocating nor further large grants.

The technical personnel needed to run this new program were:

  1. A Vice-President, who would be the responsible head and who would also handle social sciences,
  2. A scientist, who would take care of both natural and applied sciences, and
  3. A physician, who would be in charge of medicine and public health.

This group would work as a team. The different Directors in New York “would have the opportunity of studying all major projects and voicing their opinion before any action was taken”. They, along with the President, were encouraged visit China “at the earliest opportunity,” as were the Trustees.

Gunn prepared a more detailed “skeleton” in early December. It contained 13 points:

  1. The Foundation should continue to have a Chinese program.
  2. The program which was related to pre-medical activities in the past would not have pre-medical subjects as its major interest in the future.
  3. Cooperation with educational institutions would remain our major interest. This program would be more and more with purely Chinese institutions rather than with Mission colleges.
  4. The problems in connection with Rural Reconstruction would be amongst the Foundation’s paramount interests in China.
  5. Our science program would include both the Natural and Applied Sciences… Agriculture and engineering education and research would be definitely a part of our program as would be medical education, with particular reference to public health.
  6. Aid to Rural Reconstruction demonstrations … would be included.
  7. Opportunities in connection with primary and secondary education might be anticipated in the future … along the lines of vocational education.
  8. Funds will be needed for research and development aid along the general lines of the new program.
  9. The fellowship program would undergo considerable modification. Emphasis would be on local fellowships, although foreign fellowships would not be ruled out.

10. The staff of the Shanghai office … would include a man who could take care of the work in both Natural and Applied Sciences, a man who could take care of our program in the Medical and Public Health Sciences, and a man who would direct the activities of the office and take care of the Social Sciences. This small group would work as a unit … responsible to the Vice-President in Shanghai rather than to the individual directors in the New York Office.

11. The total amount of money needed, exclusive of overhead, should not be more than US$300,000 at the beginning, but might readily increase as the work developed.

12. The program … would be concentrated in relatively few places and would be for a long term.

13. There are undoubtedly opportunities for work in the Humanities in China, but a study of this situation should be made by a competent authority before the Foundation launches into such a program.

Gunn had a question mark next to the 300,000 figure no doubt due to the fact the rate of exchange between the dollar and Shanghai dollars had dropped from 5 to 3.1 in the 10 months that he had been in China and some people believed that it would continue to decline. Gunn confirmed his plan to leave, with his wife, for New York the coming February, where he planned to prepare for the April meeting.

Having moved to China, Gunn was no longer listed as having any responsibility with the Social Sciences Division, nor was he listed as having any responsibility in China. He was in limbo, a limbo that would last as long as no decision was taken concerning his program in China.

What happened in New York on Gunn’s arrival in early 1934 was best captured in a handwritten letter written by Gregg to Greene of which Gregg “kept no copy”. Gregg wrote of how the lack of coordination in January and February had if anything “increased”. Nothing definitive could be written as “impermanence of decisions” surrounded items of most importance. There was “recognizable friction” between Mason and JDRjr. A Committee of Review was voted which would look into the activities of the Foundation and report to the Board at the April meeting.

Now into such a turmoil comes SM Gunn. Mason having made during the past 15 months no mention to the Trustees of the fact that Gunn and a possible program in China may require attention and provision someday, has given Mike but little time to explain his views … I wish Gunn were not in so exposed a position. Without some fairly radical changes here he is going to have difficulty in convincing Fosdick and the other Trustees that it is a good time to begin agricultural reform in China. And only to begin! I was interested that he said to us in conference that it would take a long time to evaluate such a program – that things in China take a long time to evaluate – that it might not be in our life time … ‘Well’, I said, ‘ how can you reconcile that point of view with the statement in your report regarding the PUMC that it is fair to ask ourselves whether the results are commensurate with the expenditure?’ He was decent and suggested later that he wanted to qualify the statements of opinion regarding the PUMC in his report. Wise for him to do so, as I should think, since he can hardly hope to induce interest in his program at the expense of older interests, without introducing a principle that would in turn endanger his own understanding when its day of judgment arrives. At the moment I wouldn’t bet much on his going back to Shanghai”. After discussing some of the problems facing the CMB, Gregg concluded by indicating that the PUMC and CMB “show more promise than they have for a year”.

This long quote is revealing on several accounts. Nowhere in his report did Gunn use the terms “agricultural reform”. In more radical circles at the time, ‘reform’ meant freeing peasants from inordinately heavy taxes and providing them access to ownership of the land that they worked. Was Gunn conveying this image to his colleagues in New York, or had Gregg used ‘reform’ as a synonym for ‘reconstruction’? Either way, it is clear, given the fact that this letter was to Greene, that Gregg at the time seemed not to be concerned with to how Gunn’s program might affect the future of the PUMC. Further supporting this view is the fact that Greene agreed in early 1934 to Grant being transferred to Shanghai where Gunn was stationed, as at this point Grant was “mainly preoccupied with national health matters”.

Much to Gregg’s surprise, Gunn’s program in rural reconstruction was received “with more sympathy and interest than might have been expected”. But given the absence of the review committee – JDRjr (off on a cruise), Angell (on vacation) and Fosdick (laid up with a cold) – the matter “was in effect tabled”. While still indicating that any prediction “would be hazardous,” Gregg now felt that “something will be done”.

Conflicting Views on the Role of the PUMC in Gunn’s Program

The meeting held in 1931 concerning Faber’s report did not lead to any immediate action as the Chinese government had to face a series of natural disasters on unprecedented scales. A new development was the appearance of Štampar who, like a bull in a China Shop, did not hesitate to make his opinions known, especially concerning medical education. He noted how the practical experience given to the students of many schools was far from satisfactory and how the situation was further complicated by the existence of schools of either the ‘Anglo-American’ or the ‘German’ pattern, the graduates of which find it difficult to cooperate with each other. He saved his greatest criticism for the PUMC!

Although it did not seem to be part of his remit, Štampar took the time to study in detail reports prepared by the PUMC, from which he learned that only 78 physicians had graduated since its opening, and that the average of 10 per year would not change over the coming five years. Using the reports of the Rockefeller Foundation Quarterly Bulletin, he calculated that each diploma cost about US$ 118,000, not counting overhead costs, which would make the sum still much larger. Not counted as well were the costs of the hospital. As the Chinese schools that he visited cost so much less, it led Štampar to think about the question of the costs of a good medical school. While he did not attempt to answer this question, he volunteered the conclusion that if the PUMC were to reduce its expenses a greater number of students could be trained in a school truly corresponding to the national conditions for the whole Chinese nation and not for such a limited circle. This also called for the PUMC to adapts its objective to national needs which it had “not yet done and could do without sacrifice of scientific standard”.

Gregg, who received a copy of Štampar’s report, indicated that it would not be wise on his part to comment on a medical education policy for a country he had not yet visited, but it was his impression that the PUMC was “now and will be in the future the best place to train adequately the teachers… [whose supply] will be of the greatest importance in producing in other schools a large number of practitioners”. This, of course, was the safest and easiest position to take, as it totally avoided Štampar’s criticisms.

WS Collins, an RF staff member in the Far East, also learned from his brief meeting with Štampar felt that the “Chinese have made a great error in attempting to graft western civilization upon the culture of the orient”. Štampar’s contention “is that methods applicable in the west are not necessarily applicable in the orient and yet the educated Chinese who are at present leaders in China do not seem to realize that western life cannot be transplanted successfully to the East”.

It’s not obvious if Štampar’s views were ever made public or were discussed with the Chinese authorities. In any case, the Faber Report, according to Grant in 1935, still continued to be the point of departure for national policy; however, progress had been slow due to the difficulty in coordinating in one location the three conditions for an experimental school could be developed – personnel, funds and field practice facilities. While concrete proposals for the Nanking school had been drawn up by Robert Lim in 1933 it was shelved due to lack of funds.

In the meantime, Gregg continued his campaign against Grant “dragging” the PUMC into Gunn’s program. Gregg wrote explicitly to Houghton, who had taken over from Greene in the fall of 1934, to express his concerns. Again Gregg spelled out the “special significance” of the PUMC. It was the “inductive method of thought” that was the essence and germ of most of what the Western World had to offer to the East. The PUMC was where “the West puts its best foot forward,” and where a “point of view in the interpretation of natural phenomena and a certain discipline of mind” is given. The success of such an institution, “nearer the university in atmosphere than anything the west has placed in China,” should not be judged by the numbers of doctors trained, the kind of doctors trained, or whether they were selfish or public spirited. In the long run, the contribution of the PUMC would be the “persistent and jealous fostering of a kind of thought unknown by the Chinese…” Such a heritage was more important than medicine; it was a gift “that cannot be relinquished or withdrawn without grievous loss to the recipient and the stultification of the donor”.

Gregg also wrote to Greene who at the time (early 1935) was somewhat in a state of administrative limbo; having been replaced by Houghton after having been fired in mid-1934, the PUMC Trustees “rebuked New York and voted unanimously to retain Greene”! With Greene still potentially playing an important role in the future of the PUMC, Gregg wrote him that he did not believe that it was “incumbent on Doctor Grant to take the initiative of tying up the PUMC with the National medical program for China. I should think the initiative belongs to Mr. Gunn, and it would be certainly wise to have Houghton as well as the Acting Director of the PUMC approached directly in such matters”. Gregg added that it did “not seem to me wise for him [Grant] to assume that the Shanghai office is expected by us to tell the PUMC what to do or how to act”. Furthermore, “Dr Grant is not a representative of the MS [Medical Sciences] in China. Mr Mason has given us to understand that programs submitted by the Shanghai office go straight to him and he will refer them to the divisional directors for their informal opinions when these are desired. There is no MS representative in China nor any MS program there”. Gregg’s frustrations are clear; aside from preserving the preciousness of the PUMC, it is not clear if he ever addressed the question of what the Chinese authorities should be doing to meet immediate pressing needs.

Gunn referred to “the PUMC muddle” soon after his return to China, but this had nothing to do with conflicting views concerning the place of the PUMC in China but rather the uncertainty surrounding Greene’s role, i.e., was he in or out.  He noted that the “relation of the RF China program to the PUMC depends to a considerable extent upon who is in charge of that institution. Personally, I am hoping that some really competent Chinese will be appointed, but apparently the chief opposition to the Chinese is coming from YT Tsur and other prominent Chinese trustees”. Tsur was the Chairman of the PUMC Trustees. Gunn may have not fully appreciated the fact that the PUMC Trustees were outraged that the CMB had unilaterally fired Greene, this being in their eyes in conflict with what they thought their responsibilities were. In any case, Greene resigned in April 1935, and Houghton replaced him first as CMB Resident Director and then, at the time of the Japanese occupation in 1937, as Acting Director of the PUMC. Gunn wishing for a Chinese director might be viewed as support to Grant’s beliefs as surely any Chinese appointed would be a close ally of Grant.

It is around this time that Gunn wrote a letter in which he mentioned his wife. In a letter to Gregg, dated 5 December 1935, he wrote that they were both pleased with the picture that Gregg had sent of his son Michael and his dog, and wrote about how William Allan White, who had dined with the Gunn’s along with his wife, had so many good things to say about Gregg. White was a Foundation Trustee between 1923 and 1935. Gunn was made Michael’s God Father. Despite their close friendship (or maybe because) their letters rarely touched on work-related subjects. To what degree Gunn was aware of Gregg’s worries is not clear as the next series of events seems to demonstrate.

Grant visited New York in October 1934, which gave him an opportunity to discuss his ideas directly with Gregg; the only record of this meeting is an undated one-page memo in which Grant indicated that the program of the PUMC “should fit” with the coordinating objective of Gunn’s program, which Gunn saw on 6 September while Gregg did not get to see it until 26 December!

Grant also met with Mason while in New York, who wrote to Gunn that Russell expressed “cordial appreciation of Grant’s ability”. Russell had been fearful that Grant was “far more interested in quantity production of doctors… in the PUMC, than in maintaining a high quality of work,” but he no longer believed that Grant held this view.  Grant also had lunch with Fosdick, during which time he stressed the opportunity for an “international demonstration in China,” which he claimed interested him.

By analogy with the physical sciences Grant believed that what Gunn was doing was allowing economists, sociologists and others to control “their own experimental community fields,” something that could take place in China “long before” it could occur in America “due to the absence of vested traditional interests in the former”. He added: Of course, a planned society resting upon university investigations … is something now undreamed of but that may be obtainable in China”. He also noted that Fosdick hoped to visit China in the spring of the following year. Fosdick did visit China but his charge was to smooth over the resentment on the part of the PUMC Trustees over Greene’s forced resignation, a resignation that was due to his unwillingness to incorporate religious studies in the PUMC curriculum, something that JDRjr insisted on.

Following Grant’s visit, Gregg wrote a letter to Greene, which was mostly dedicated to how unprepared New York was concerning the protest in China over Greene being asked to resign. In it, however, Gregg indicated that he had taken Grant into his confidence. Grant had hoped “to be commissioned as in informal go-between” Gunn’s project and the PUMC, something that Gregg thought unnecessary and probably unwise as he was reluctant to have Grant interpret the attitude of the CMB, when, as he told him “the CMB couldn’t state its attitude toward the right policy of the College to save its life”!

Gregg had contemplated resigning from the CMB, but had been advised by Greene not to. He was now glad that he had not as “there would have been an even larger measure of heedless ignorance and incredible stupidity and vanity” if he had resigned. One also learned that Gregg was deeply upset with Fosdick’s “lighthearted superficiality and elusive” attitude towards China. None of this could have made Grant feel any happier at having been moved onto Gunn’s project before the project had even officially begun!

Gregg, who still had not seen Grant’s one-page memo, took the time to write to Houghton to make it clear to him “the special significance” he attached to the PUMC. It was the “inductive method of thought” that was the essence and germ of most of what the Western World had to offer to the East. The PUMC was where “the West puts its best foot forward”. It is where a “point of view in the interpretation of natural phenomena and a certain discipline of mind” is given. The success of such an institution, “nearer the university in atmosphere than anything the west has place in China,” cannot be judged by the numbers of doctors trained, the kind of doctors trained, or whether they are selfish or public spirited. In the long run, the contribution of the PUMC will be the “persistent and jealous fostering of a kind of thought unknown by the Chinese”. Such a heritage was more important than medicine; it was a gift “that cannot be relinquished or withdrawn without grievous loss to the recipient and the stultification of the donor”.

When Gregg finally did see Grant’s memo, he wrote to Greene, with a copy to Gunn, Grant and Houghton, to make clear what he believed to be “the desirable relationships” between “Gunn’s program in China” and the PUMC. His very first point was that it was “not incumbent on Doctor Grant to take the initiative of tying up the PUMC with the National medical program for China.” That he thought belonged to Gunn, who would be “wise to have Houghton as well as the Acting Director of the PUMC [Greene] approached directly in such matters”. Dr Grant’s opinion “is important … but not essential for the decisions of the RF regarding the PUMC”. It was not wise for Grant “to assume that the Shanghai office is expected by us to tell the PUMC what to do or how to act”. On the other hand, Grant should be consulted, and the PUMC should be familiar with his work and needs.

Gregg made “one further point” – Dr Grant is not a representative of the MS in China. Mr Mason has given us to understand that programs submitted by the Shanghai office go straight to him and he will refer them to divisional directors for their informal opinions when these are desired. There is no MS representative in China, nor any MS program there”. Gregg recognized that Grant was “handicapped by being out of the best place for a foreigner to find and train public health personnel in China, and therefore his concern with the PUMC must be heeded as well as excused. The PUMC faculty is handicapped by the battle of quantity vs. quality which rages around them and by having other tasks they must attend to”.

To Grant, Gregg wrote an “unofficial and pretty informal” reply, in which he advised him to “present your own point of view, or after consultation with Gunn, your combined opinions, to Houghton and Fosdick with the intent of getting them to see as clearly as possible what you think the objectives of the PUMC should be”. Concerning Grant’s vision that the “normal medical school” for China (i.e. the PUMC) should meet university standards “but adapted to the specific needs of the country,” Gregg expressed some concern with the ‘but’. To Gregg’s mind, university standards “are the specific need of the country,” it was up to the other medical colleges to do the adaptation. He added some more words similar to those he had written Houghton a month earlier concerning the role of the PUMC as a place “where the best of western thought was offered to the east”. Furthermore, “knowledge is so likely to outlive national ends and is so far more easily defined and so much more consistent than national ones, that the criticism of high standards as not serving national ends can be a boomerang”.

Greene responded to Gregg’s letter with assurances that the PUMC was disposed “to consult Dr Grant on all matters in respect to our department of public health and shall value his advice on other matters also”. Greene voiced a “great respect for Dr Grant’s achievements in the promotion of public health in China as well as his ability to stimulate his students and assistants”. Greene noted the “informal character” of Gregg’s “relationship to work that may be undertaken in the medical field by Mr Gunn”. Greene also indicated that he was keeping “in close touch with Dr Houghton” seeking his advice on “all our more important and troublesome problems”.

While all of these letters were making their way to China and to New York, Grant on his return to China made “a swing around the country” that included Nanking, the Kaingsi Province, Changsha, Tinghsien, Peking and Cheeloo. On his return to Shanghai he wrote a four-page letter to Gregg in which he expressed the wish that he “might have two hours conversation with you instead of being forced to use the quite unsatisfactory medium of writing”.

In it he devoted his last paragraph to making his “only comment” concerning the PUMC, which he asked Gregg’s comments on:

The majority of the medical schools in China have not sent staff to the PUMC for training that undoubtedly they are greatly in need of and which the PUMC could supply. How to rectify: the Ministry of Education and the National Health Administration have a joint Commission on Medical Education, the resolutions of which are satisfactorily pigeon-holed. The chief defect is the absence of a full-time competent secretary, whose need is acknowledged by the Minister of Education, but who feels unable to set the precedent of allocating funds to one technical field that might lead to the necessity for each of the others. I feel that were the right individual available, who could visit particularly the poor institutions to become acquainted if not friends with the best men in each, and if he were able to assist either through fellowships to the PUMC, or to provide essential equipment in developing these men, that in the course of ten to twenty years there would be a revolution in the status of medical education, together with a de facto utilization of the PUMC as a source of technical inspiration.

Gregg noted ‘good’ alongside the last sentence!

Meanwhile, Grant pursued his role of pushing the government to move in directions he favored. He questioned whether the effort to train teachers for a new curriculum was advisable if there were not schools ready in which they could teach. Two developments were needed – that the Provincial Administration progress to the point where organization would be available to receive medical personnel trained specifically to meet the economic-medical needs of today, and gaining of sufficient experience to allow the formulation of principles for the training of personnel specifically for state medicine. He expressed these views directly to Liu in early 1935.

Grant sent Greene a copy of his letter to Liu, and asked for his comments. Greene’s reply, copied to Gregg, listed 12 objections as to why he continued “to hold the opinion that if such an effort is ever advisable the time is not ripe for it”!  While in “hearty sympathy” with a system of state medicine, the first step was the production of medical practitioners of a relatively high type to undertake the planning and direction of such a system. Such physicians are in a minority in China and they are threatened from low-grade practitioners who are jealous of those better trained. Increasing the number of the latter might strengthen the opposition of the unenlightened element!

There was no evidence that the lower standard would produce satisfactory solutions. Countries that seemed to have been able successfully to adopt two types of physicians had “strong and enlightened political control,” something not yet present in China. He did not provide any such examples, although he may have had Russia in mind. Why should the lower level physician accept low-paid positions in rural areas when they could secure better income in the cities? Even if such an experiment could be carried out in one school, there was little prospect for providing staff for more than two or three others in the near future. If, instead, efforts were concentrated on well trained men, then if there were still a need for lower grade workers, special schools for producing them could be established in short order.

In the meantime rural state medicine on a small scale could be developed in areas contiguous to large cities as part of a natural process for extension of cultural development from the urban areas outwards. What was lacking in China was not money but doctors who would know how to use it wisely – when money is not available it is usually because there are not enough high-grade men to educate the public. Men such as Liu and Chen produced highly creditable work due to their “intellectual endowment and superior training and to the fact that they can deliver professional goods of high quality”. More of them were needed.

Greene also wondered if sufficient thought had been given to the possibility that measures for the raising of the economic level of the people through development of transportation, for instance, might have a far more beneficial influence on the general welfare of the people, including their health, than a system of state medicine prematurely extended and entrusted to a personnel of inevitably inferior quality?

This last paragraph illustrates why Grant said of Greene: although he was a layman, knew medicine – or rather, he knew social medicine better than anybody on the faculty of the medical school … he was a farseeing individual and could translate the implications of our efforts in public health, outside the PUMC, in a manner in which the professional heads of the school could not begin to. That might have been the case, but one can also see that Greene had given considerable thought to how to maintain the high standards that the PUMC had been designed to demonstrate.

As clear from these exchanges and earlier statements, the question of State Medicine did not seem to divide the public health community at the time. Hume wrote we are all agreed that China is working towards a system of State Medicine.  Even Hans Zinsser, a strong critic of state socialism, wrote in 1939: At the present time (1939), there is a strong popular movement for the socialization of medical practice, and an effort, essentially praiseworthy, to bring the benefits of discovery and of improved care within the reach of the population as a whole, irrespective of ability to pay. This is as it should be.

During Gunn’s absence from China during the early months of 1934, Grant seemed to have had second thoughts about the prospects of the experimental school at Nanking and as a consequence, according to Greene, was dubious about throwing in his lot with Gunn. Greene thought this was not Grant’s permanent state of mind, and remained unchanged in his belief that Grant should move to Shanghai. Grant seemed to be going through a particularly difficult time partly due to personal problems. Several years earlier Rajchman, who had offered Grant several new career prospects that Grant turned down, suggested to Heiser that Grant “be withdrawn for a period of about a year” due to his having “worn himself into an extremely nervous condition over the many difficult situations he has had to meet”. RF headquarters began receiving complaints concerning Grant’s interfering in national affairs. Mason consulted with Gunn and advised Gunn to make sure that Grant was fully aware of “the traditional careful attitude of the Foundation against exerting pressure and becoming arbiters of the institutions we assist”. In his reply, Gunn referred to Grant as having “a mind of considerable brilliance” and that most of the criticism could be discarded.

Adding to Grant’s difficulties was the abandonment of the experimental school program, and his transfer to Shanghai which according to Greene “appears to have been something of a shock” to Grant! It was left to Greene to explain how all involved had considered it impossible for Grant to continue the job of teaching at the PUMC while being on Gunn’s staff at the same time. Grant had cut his links with the PUMC, although Greene hoped that Grant could be made available to take part in the public health teaching in the third trimester of the current academic year (1934-1935).

Tight budgets all around meant that each staff position that was not clearly linked with an ongoing project was open to renegotiation. And, as Gunn had not yet had his project approved, he obtained the services of Grant on a loan from the IHD through the end of 1935. At the same time Gunn indicated to Mason that he was counting considerably on cooperation and counsel of the staff of the IHD in connection with the development of the new program. No mention was made of any role for Gregg’s Medical Sciences Division in Gunn’s project.

A new possibility for developing an experimental school soon arose in a proposed reorganization of Hsiang-Ya Medical College, Changsha, Hunan Province. An informal conference was held in April 1935 to advise the college on how to proceed. The importance of this one day meeting can be seen by the names of those present – Chen, CK Chu, Grant, Houghton, EH Hume, Robert Lim, Liu, and Štampar. Chu was a 1929 PUMC graduate and a “leading proponent of drastically modifying China’s medical education” and the department of health’s representative in the Ministry of Education’s Commission on Medical Education. Hume was the founder of the ‘Yale in China’ school in 1914. It is interesting to note that in 1921 he spoke to the need for the PUMC curriculum to be adapted to the “exigencies of China”.

Chen opened the meeting with his ideas concerning a curriculum suitable for the education of doctors who were expected to serve rural communities. The individual “requires a thorough training, but not too extensive training. He does not require too many facts and details, but consideration should be given to acquiring methods of approaching problems”. Technical training needed to be long enough to train the student in such habits. Actual treatments can be quickly learned, but habits of using instruments, treating cases, etc., must be developed in the school. Chen concluded that a period of seven years was required for such training.

As China cannot afford too many types of health workers, Chen envisaged only two types – one- “the responsible individual, whom we have regarded as absolutely necessary, and secondly, another type who would assist the responsible individual in carrying on the duties according to the demand of such a responsible individual”.

Štampar indicated his surprise at the length of time but once he realized that the first few years would be devoted to a “senior high school education” he understood the necessity for such a long period of training. He added that from his experience in Yugoslavia, doctors “must be educated not only in medicine, but also in social economics, otherwise they were unable to appreciate their position in the social status”.

Robert Lim “was agreeably surprised at the unanimity of opinion now reached about the type of doctor required”, while adding that it “was essential to establish the institution and personnel on a State basis in order that the students would have the example to follow, for, not only in the lecture room but also in the field, they would have the lead of officers who were living the mode of life the students would ultimately have to lead themselves”.

Liu felt that market for such students had been established. It was now necessary to determine “the way to meet the demand”. If enough doctors were produced their salaries would fall, as had many other aspects of modern life, taxi fares, cost of sending a telegram, and even the staffing of a rural hospital. Nevertheless, he found it difficult to visualize that graduates would be willing to work for “say $60.00 a month”. Štampar indicated that it took a long time for economic situations to change appreciably. And in America, where salaries of $500 to $600 per month were the norm not so very long ago, people were now willing to work for $100.

Hume, who had not participated in any earlier discussions and who was quite stimulated by the discussion, took the opportunity to stress the importance of doctors being trained in both preventive and curative medicine as “preventive medicine alone would not win the confidence of the people”. As basic as this point is, it is quite remarkable how little time seems to have been given to its importance, especially in light of the Foundation’s policy to keep public health and medical care separate.

Chen, responding to Hume, indicated that curative medicine had not been neglected. There might in fact be too much emphasis on clinical training. The curriculum had to be one that met the demands of the population, which included the curative. He suggested that the question of whether China needed two types of doctors “should not be made a point of discussion at the present time.” With the scheme outlined, most students after finishing their pre-medical course “would be so trained that even presuming they did not proceed with their studies, they could be utilized as medical assistants”.

Houghton, who was also new to these proceedings but who had long experience in China and close relations with both Grant and Greene, expressed being “surprised and troubled that no more emphasis had been laid on the inferior and superior group”. By training both types, wasn’t it too much to expect that the inferior group “would say to the world in general that as they were an inferior product, that they were willing to work for lower remuneration”. It was more likely, he continued, “that they would consider themselves as good as anyone else, and see no reason why they should be expected to drift off to the country and work for low wages”. He and Greene no doubt had occasion to share their similar views on this.

Grant felt that “Dr Houghton had put his finger on an essential point”. There seemed to be consensus indicating that the “present minimum curriculum is unsuitable for China”. If this were the case then the group should propose an alternative. For the moment, comparing the situation to the army, there were “training centers only for Generals and Colonels, but no training centers for Lieutenants”.

Despite this agreement, Štampar interceded to note that in Europe there were “definitely two grades, those trained in basic medicine, and those more highly trained”. Many public health officers required special post-graduate medical training after having received a basic medical education. The time spent in such basic medical education “varied according to the requirements of the country concerned. The question was what should be the basic type in China”. By adding that “the product turned out depended upon the material, as it is possible to turn out a good doctor in four to five years, and bad doctors after nine and ten years”, Štampar clearly was beginning to be exasperated with the lack of progress being made.

It was unanimously resolved that “the Ministry of Education be requested to approve, for experimentation, a curriculum for provincial medical schools designed to adapt training in medicine … more fully to existing economic and social conditions”. It was further recommended that the curriculum and the choice of area should be designated by the Commission on Medical Education (CME) with due to consideration of the adequacy of health and other reconstructive organizations and the medical school to be utilized”. The CME recommended its’ execution to the Ministry of Education the following day.

More importantly, according to Grant, the meeting in Nanking resulted in a “reorganization of the Commission on Medical Education”. Chu was transferred from the Department of Health to the Ministry of Education to be the full-time secretary of the Commission. Grant, writing to Russell indicated that it was expected with the new funds provided that “he will gradually raise the standards of the present inferior provincial schools through strengthening competent individuals, either by additional equipment or further training. The training will be through fellowships in the PUMC accorded by the Commission on Medical Education”.

Following this meeting, Grant wrote to Russell, who he had not contacted since his return to China some 4 months earlier. He reminded Russell that one responsibility of Gunn’s project “was to tie up the medical phase of our program with the already large investment in the PUMC”. This, he continued, could be “summarized as ‘marketing’ responsibility for the ‘production’ represented by the PUMC”. It is not clear from the records available if Russell was able to interpret such a cryptic summary. It is only through more extensive correspondence with Gregg, when Grant was describing his vision of Gunn’s program that his reference to ‘marketing’ becomes clearer, as discussed below.

Grant described a number of other developments to Russell including Chen’s proposed curriculum, and the resulting reorganization of the Commission on Medical Education, for which Chu had been made full-time secretary, with the expectation that he would “gradually raise the standards of the present inferior provincial schools”. Grant wrote at the same time to Gregg, but instead of summarizing developments in a 3 page letter, as he had done for Russell, he attached a 5 page letter that he had sent to Borčić which itself had a 7 page attachment entitled National Health Programme! As Gregg only got around to reading this material several months later, Gregg’s reactions are discussed a little bit later below.

Almost buried within the various exchanges that took place between April and July 1935, perhaps the most revealing was Gregg’s reaction to Chen’s article on State Medicine and Medical Education, which had been published in February 1935, then translated into English and sent by Gunn to Gregg with the invitation: Dr Grant and I believe this will be interesting for you to pursue.

Chen’s piece was a telling critique of the current status of medicine in China. Referring to the 10 medical schools in China, he noted that they were all “in the hands” of students who has studied abroad and that due to their “lack of actual experience, they have only been able to ‘preach’ scientific medicine, and have been unable to teach scientific medicine”. Scientific medicine, in the hands of private practitioners, on the other hand, has been “a tool for swindling the people”, which has resulted in its discrediting. Hospitals were run by and large by graduates of ordinary medical schools; their training was “certainly most unsatisfactory, while their equipment is extremely poor”. This has resulted in the average man getting a “headache at the mention of ‘western doctor’”.

During the past few decades, Chen argued, China had been “following blindly the system of medical practice in Europe and America, without regards for the social and economic conditions of this country”. As Štampar had noted earlier, medical doctors, whether as directors of hospitals or universities, followed what they had learned abroad.

State medicine was “the one and only hopeful medium for spreading scientific medicine in China”. It is the Government that is responsible for the protection of life and property of the people. It should be responsible for the protection of their health as well. The health system of Tinghsien was based on this idea. If the system of private practice were employed, it would be impossible to have obtained the results thus far achieved.

Turning more specifically to medical education, Chen judged existing curricula of not having a fixed standard, not meeting the requirements of the masses, and not taking into consideration the career of its graduates. Instead, medical education in China has imitated Europe and America, as well as Japan, and as a consequence was “a great blunder”.

To “rectify the blunders of the past, and to open a new road for the future”, Chen proposed the following course:

  1. Recognize the fact that scientific medicine could only be brought about through state medicine.
  2. Under state medicine, physicians, teachers, and engineers should occupy the same position; they must be able to meet the needs of the community.
  3. Adopt the methods of studying and solving problems of scientific medicine, so as to have a basis for the training of personnel, and not to copy in toto the curricula of eastern and western medical schools.
  4. There must be a uniform standard for the training of all the medical personnel throughout the country.

Following a description of the different languages currently in use in medical schools (all foreign), Chen added one further point, namely that “Chinese should be used uniformly throughout the country”.

Only in the next-to-last page of his 14 page article did Chen turn his attention to the PUMC. Chen, having come to understand that the PUMC was originally conceived as a center for the training of teaching personnel, “regretted” that the College was “not operated on such a basis at present”. He hoped for a change in policy which would make the PUMC suitable for the training of teaching personnel, and the study of special health problems by the Government. For this, “the sum of $2,000,000 or 3,000,000 spent every year would be utilized in realizing the original purpose for which the College was founded by Mr Rockefeller”.

Gregg’s response is worth recording in some detail as it helps clarify the major concerns that he had at the time:

I have read the article by CC Chen … To judge from the record of the PUMC graduates one would assume that the PUMC is a Normal College and that the difficulty which it faces is that at a time when the PUMC is attempting to recruit personnel for its own staff, it is being subjected to imperative request from all parts of China for leaders as well as workers, and in self-protection is somewhat reluctant to attempt to meet the demands.

It seems to me that the central task before the PUMC is to determine as carefully and considerably as possible on what scale it can wisely meet a very heavy demand for personnel and then to be perfectly explicit about its plans in that particular.

I would seem to be extremely valuable for most, if not every, member of the staff at the PUMC visit from time to time the varied conditions for which some at least of their pupils are being trained. I am dubious as to whether the ‘market’ for PUMC graduates can wisely be catered to in a fashion satisfactory to the market without sacrificing something that no other school in China is as yet qualified to give and which is an extremely valuable nucleus of further growth. Another way of saying much the same thing is to say that if the PUMC were to meet the demands of the leaders in Chinese medicine today, it would run a serious risk of becoming a school whose level would make it necessary for the ablest Chinese again to resort to English, German and American schools for what they cannot get from China.

With most of Chen’s paper one could hardly have any disagreement, and in any case it is interesting and informative reading. I don’t, however, agree with the suggestion that ‘the government might invite the College to participate in the movement towards state medicine by using a small portion of the funds of the College for the reorganization of one provincial medical school to carry on experiments in various methods of medical education’. It seems to me that the extension and application of what the PUMC stands for might best be accepted directly and with earnestness by the government as exactly what it is, namely its own problem.

Your sincerely, Alan Gregg.

Gregg did not reply to Chen’s criticism that the PUMC had moved away from its original objectives. In any case, it was much too late to do anything about it.

Returning to Grant’s earlier letter plus attachments to Gregg, which Gregg read only after he had digested Chen’s paper. It in that short letter that Grant attached a 4+ page letter from Grant to Borčić and a 7 page official memorandum describing the national health program, which Grant described as our “sailing orders”.

Several new points were included in Grant’s letter to Borčić, such as the expectation that Houghton was “drawing up principles for the reorganization of the institution [PUMC] in a manner which we trust will assure greater national utilization”, and the hope that Štampar would be commissioned to make a progress report on Kiangsi, since the attempt there to develop the four “fundamental factors” – funds, personnel, organization, and methods – had been a “failure”. Grant believed that there was still an opportunity to make progress there provided there was “a sufficiently strong progress report at this time”.

The paper describing the national health program was an accounting of what the Ministry of Health had so far accomplished and a plan describing the health organization at the different levels that were expected to be put in place. It ended with six “immediate steps to be taken”, which included “to adapt the PUMC to serve as the normal medical university”.

Gregg’s reaction was almost violent in tone; this time he wrote to Gunn directly: Either I didn’t understand Grant at all or else I completely agree with him and know nothing about the PUMC. You can show him this letter if you want to, and I must say in conversation we did not seem as far apart as some of the statements in his memorandum make me think we may be.

Gregg’s first critical observation was that the “security of the PUMC’s future is not going to be enhanced by Government control such as involves standards of minimum facilities and the presence of a secretary of the government committee on education as a PUMC trustee[Chu]. He did not believe that it was the PUMC’s “most promising function to be a para-governmental institution, nor even that the fullest national utilization of the PUMC should be the objective of the College nor the peculiar role that it could best play”. He did not believe that “Grant’s study of or experience with the educational institutions is wide enough to make him realize the danger of forsaking standards of excellence for the standard of fullest national utilization”. And just in case Gunn and Grant had not gotten the message, he added that he would prefer “insistence on quality at the PUMC to a ‘left-handed’ attachment of the PUMC to Grant’s conception of ‘The Chinese Program’”. The best way to combat that was to “see that the faculty get into contact with conditions which most of the graduates will meet”.

The objective of the PUMC, according to Gregg, was “to give the best possible education to the best Chinese it could find and when an institution has done that it can leave the fate of those graduates to conditions over which it should not attempt to exert control unless it is prepared to risk having its eye blacked for its political ambitions.” Gregg concluded, “If I were a Chinese I should resent the affiliation of a foreign institution with a struggle for political power, and I think it unwise solicitude for the PUMC to concern itself primarily with such ambitions”.

Gunn showed Grant the letter he had received from Gregg. Grant did not attempt any explanations, as there were “no divergencies of opinion to explain”! He had written his memo “in support of the grant from the China program to the Commission on Medical Education”, which was a perspective that viewed the PUMC “in terms of its greatest possible utilization in terms of national needs and ideally how in a planned society such an outstanding institution would be called upon”. Grant was not easily cowered.

There is another side to this history which is somewhat disturbing, namely that Grant managed to ‘shape’ words to suit his purpose, or as Gunn, in a confidential report, put it: His memory is not always to be depended on… it may be necessary to check up with me some of the statements which he may make …”. A possible instance of this is to be seen in the contents of a letter that Houghton wrote Gregg on 31 December, 1935. In it, he referred to the plan to develop graduate training of senior health officers, something that he had discussed with Grant in September of that year. He learned from Grant that it was his understanding that Gregg was “contemplating a recommendation to the Foundation for a grant to promote a center of graduate training in public health within the College”. Grant felt the time was ripe now for such a development. However, having discussed this matter with Gregg several days before, Houghton now put on record that Gregg did “not feel that the DME [sic] can properly recommend a major appropriation of the sort referred to by Dr Grant as long as the College is dependent upon the Rockefeller Foundation for a part of its operating expense”. Gregg did not deny Grant’s interpretation of what they had discussed earlier; he simply informed Houghton that it all depended upon the “expectation that the College would shortly become entirely independent of the Foundation’s aid”, which did not happen.

Grant seems to have been torn between his own more limited goal of developing a graduate center in public health at the PUMC (somewhat like a school of public health) and the much broader agenda of involving the whole of the PUMC in China’s medical education plans, which he may also have sincerely wished or which he may have had to go along with to appease those Chinese leaders who believed this to be necessary.

Whatever the truth in the matter might have been, it is clear the Foundation did not have the funds for either. Gunn’s highly restrictive budget was nowhere near what was necessary to subsidize the PUMC to play such a role, but if the Chinese that he visited did not believe that to be the case, it may be that no one understood just how deeply the financial crisis had greatly limited what the Foundation could do. Perhaps for these reasons, Gunn held out for many years before he entered this discussion.

Gunn Finally Enters the Medical Education Discussion

There seems to have been a lull that lasted during the latter part of 1935 and early part of 1936 concerning the disputes surrounding the question of what the role of the PUMC might be in China’s program. Nevertheless, it seems that Greene attempted to keep Grant away from the PUMC by suggesting to Gunn that he take on the “North China business” himself in order to free Grant to “nurse along the important medical and public health ventures in Shanghai and Nanking”, adding if Grant “could take an active part in the teaching at Nanking, it would I suspect be an enormous contribution”. Gunn, on the other hand, envisaged that Grant would need to spend more time in the North, “including frequent and rather long visits to Tinghsien”, which would put him in the proximity of the PUMC.

In any case it seemed in New York that matters were moving so slowly in China that serious thought was given to promoting Grant to a position of regional director for the IHD in the Orient, something along the lines of what Heiser’s earlier responsibility. It was Sawyer, who had taken over from Russell in 1936, who proposed this to Gunn. At the same time as indicating the need for “a much higher degree of supervision from the home office than heretofore”!

That matters were not as settled as it might seem is suggested by the fact that Gunn felt it necessary to put on paper his thoughts concerning “the question of the PUMC and its present status”. This was towards the end of 1936 in a letter to Gregg. One can imagine that he had remained silent up to this point due to his views were similar to those of Grant and he had hoped that Grant would prevail without having to enter the fray.

Gunn recognized that there were some who wished the PUMC to remain outside the national program that Grant had helped create. His response was that, if the College did not “enter into the national medical picture more definitively,” it would rapidly lose whatever influence it had on developments in China. He sided with the active men who wished “to broaden the PUMC’s outlook and vitalize it as a leading institution”. The government’s Commission on Medical Education had become a “very live organization”. Chu, who headed the Commission, was “loyal to the PUMC,” but he felt a growing resistance or indifference on the part of Chinese authorities to the PUMC. This was based on the belief that the PUMC was “so much interested in medical science … and its own affairs,” that it was not concerned in taking an active part in the planning and development of medical and public health education in general. In an earlier letter to Mason Gunn had described Chu as “a very excellent man”.

Clearly contradicting Gregg’s reasoning, Gunn stressed that this was not time for the PUMC “to be an institution where scholars devote themselves only to their science and have little or scant interest in the huge developments that are going on in social medicine throughout this country”.

Liu, who was still the nominal head of the School, was “unfavorably” disposed to it. On the other hand, Robert Lim had developed a powerful position and was becoming one of the “leading exponents and thinkers in connection with the development of state medicine and all it implies”. If the PUMC did not fall in line with this policy, Gunn was fearful that Lim would quit. New personnel were needed to “stir things up”. Concluding, Gunn stressed that this was not the time for the PUMC “to be an institution where scholars devote themselves only to their science and have little or scant interest in the huge developments that are going on in social medicine throughout this country”.

Fosdick, through whom the letter had been sent, was “particularly delighted” to have seen it, as “we all felt that you hit the nail right on the head”. Houghton, who was included in that “we”, also responded with enthusiasm. But there were members of the CMB, wrote Houghton, “notably Dr Cohn [Albert Cohn was a cardiologist who had been a visiting Professor at the PUMC in 1925],” who were inclined to be conservative and who feel “that the College should concern itself with the very long-time ahead”. Also, as Houghton had explained to the CMB, additional funds from “one source or another” would have to be sought for any advanced training. Houghton was certain, however, that Gregg, who was away in Europe at the time, would be “glad to give his support” to any reasonable plan concerning this aspect of the program. It is not clear if Houghton was referring to Gregg in his capacity as a member of the CMB or as Director of the DMS Division. Gunn, on the other hand, had clearly written Gregg in his capacity as a CMB member, no doubt aware of the opposition by some members to the PUMC-related aspects of his program. There is NO record that Gregg ever responded! As a member of the CMB, he must have been aware of the continuing criticism being voiced by its conservative wing, and from his earlier comments to Grant and Greene, was most likely sympathetic to many of their concerns. This alone would account for his silence.

Gunn’s letter might have satisfied Fosdick and Houghton but Greene remained in opposition. In a long (9 page) personal letter to KY Wang, Minister of Education and who had chaired the April meeting on medical education, Greene identified the National Medical College of Shanghai as being in the “best position to serve as the first center” in which promising young men could “serve as apprenticeship as a result of which those who are found useful may be given further opportunities abroad”. He then went on to provide guidance on all aspects of medical education, including “experimental biology” to be conducted by “men able to use and to improve chemical and physical methods of study”.

As desirable it was to “hasten the day when medicine may be taught wholly in the national language”, Greene believed that it would be “wise to let each faculty decide this question for itself … The number of competent teachers who can teach in Chinese is so small that excessive emphasis on the language [was] likely to result in inferior teaching and consequently delay the time when a first-rate medical education can be given in the Chinese language”. There was no mention of the PUMC!

Wang was no fool. In his short but respectful reply, Wang expressed the hope that “the PUMC will not continue to find its own requirements in deviation from the requirements prescribed in the Government Regulations”. Given Wang’s clear position, Greene took on a different tack, one operating within the Foundation’s complex. In early 1937 he informed Cohn of the degrading situation concerning the teaching of medicine (shorter period of training and encouraging the use of Chinese instead of English), which he blamed on “Dr Grant’s activities”. Not only had “Grant encouraged Dr Liu to make demands on the College for help of various kinds, but he brought about the organization of the Commission on Medical Education of the Ministry of Education and secured funds for it from the Rockefeller Foundation”. Chu, “was under” Grant’s  influence; furthermore, “Chu was ignorant of the field of medical education”, and “we [to be read the PUMC] are not organized and staffed for systematic graduate teaching, and least of all when the budget and the staff are being reduced”. According to Greene, “the fundamental trouble is that Dr Grant is not under the control of the competent officers in New York, that is, Gregg in matters of medical education, and Sawyer in public health. We therefore have the absurd situation of different officers of the same organization working at cross-purposes”.

Greene proposed that Gunn’s program lose its independence so that all of its projects would have to be cleared by New York officers. If this were not possible, then Gregg “might be moved to secure instructions to Gunn from Fosdick that Grant has to use his influence” to get the Chinese authorities “to leave the College alone as much as possible”. That Gregg did no such thing can be seen by the fact that by the end of the year Greene blamed Gregg for adhering to a policy “of keeping hands off”. How that part of the Foundation that had direct responsibility with medical education could remain “aloof” was beyond Greene’s comprehension. Having learned from Gregg that it was Sawyer who wanted Grant to retain his connection with the PUMC, in other words, the part of the Foundation having to do “only with public health, which is not a fundamental part of medical education, interferes not only as to health teaching but in very fundamental matters.”

Grant and Chu, who Greene portrayed as “the gang”, had been appointed as advisers to the planning committee responsible for maintaining liaison with the government and the PUMC. This “gang” was making sure that those PUMC staff members (especially foreigners), who Greene felt should be involved in this planning activity, were excluded. Instead, the “contribution of the experienced foreign staff” was being totally ignored.

Grant being asked to prepare a program for the IHD was part of efforts on the part of Sawyer to bring Grant back into the IHD fold, something he probably had reasons to fear. On his next visit to New York, during which time Gunn gave the Sedgwick Lecture at MIT in April 1937, Gunn and Sawyer discussed the real possibility of Grant being made the regional director of the IHD; Sawyer expressing at the same time the “opinion that it might prove advantageous to have another IHD staff member assigned to China for some specific public health activities to help offset the tendency toward diverting attention toward the dominance of the medical care program from the public health activities, especially in the proposed field demonstrations”. These ideas were discussed with Fosdick at which time it was also proposed that Grant visit the US and Europe for “5 or 6 months”. Instead, Grant moved to India where he played a key role in the Bhore Committee which developed a far-seeing plan for India’s health system.

Gunn, no doubt ‘protected’ by his position as a Vice President of the Foundation, seems to have avoided (on paper at least) such open confrontation with his colleagues. In all of his reports, he fully supported Grant, giving him full credit for laying out the basic principles of the program, thus possibly helping Grant overcome whatever doubts that might have arisen from the questioning attitude of others. In turn, Mason fully supported both Grant and Gunn, so whatever disagreements there may have been lurking ‘in-house’ did not surface openly. As long as Gunn’s program seemed to be progressing well, there was no reason for Mason to focus on the doubts that Gregg, Russell and others were raising. In any case, it is not even obvious how much Mason was aware of these doubts or even if he understood how deeply his officers, especially Gregg, felt about the direction that Gunn and Grant had taken.