Intimate Communities is a cogently argued, substantially documented and excellently illustrated account of health services during China's War of Resistance. It focuses on the interactions of trained women health providers with illiterate people vulnerable to atrocities not all committed by Japanese invaders. The author's central thesis is that volunteers and low-paid medical workers (almost all women) approached the common people with empathy and life-saving care. In the process they created bonds that “changed the shape of the Chinese state and the nature of the national community” (p. 12).
This gendered analysis is one of many published in recent years that throw light on the backward conditions of early 20th-century China and the determination of trained women to do something about it. At that time, warlord regimes exploited poor people mercilessly. But the Japanese military introduced far worse methods of destruction. This onslaught, coupled with lethal outbreaks of infectious diseases, accumulations of garbage, bomb damage and “hospitals” staffed with incompetent and ill-equipped personnel, formed the challenge facing China's medical and public health workers.
The author discusses this context in five chapters. Chapter one, “Policing the public in the new capital,” describes the extent to which the government, led by Chiang Kai-shek, relied on police and local control systems to enforce public health orders. This “masculinist” system attempted to keep Chongqing clean but with very limited results. Chapter two addresses large elements of the health system populated by women nurses, that dealt with caring aspects of health service, such as street level inoculations, public health-care classes, household visits, refugee relief, and hospital and battlefield service. It features the work of the distinguished PUMC-trained nurse Zhou Meiyu in training nurses for public health work in pre-war Dingxian county.
Chapter three, “Healing to kill the true internal enemy,” deals with military nursing. In this arena three big problems surfaced. Infectious diseases spread more rapidly in military than in civilian contexts. Military medical personnel were enrolled at the divisional level with few if any medical qualifications, so that army invalids were often very badly served. The Red Cross Medical Relief Corps and its training schools mitigated the work of Army medical units but fell foul of internal struggles between Nationalist and Communist forces and their leaders. Meanwhile the shortage of trained army medical personnel remained unresolved despite Zhou Meiyu's initiation of a nursing school for the Medical Relief Corps. These problems deserve further elucidation. But the author produces significant evidence that dedicated women nurses were able to persuade healed soldiers to return to frontline service.
Chapter four, “Authority in the halls of science,” discusses how nurses were able to gain rapidly in professional recognition as health service workers, and also the glass ceiling that kept them from rising to the top. Scientific knowledge provided the recognition; physician management of medical service held them back. The worst example of the latter was the China Medical Board's abuse of Dean Nieh Yuchan, the director of the PUMC's nursing school, which had migrated to Chengdu along with a few medical students. The author discusses this matter in some detail without going into its full ramifications. She also discusses the exacting curricula of a leading nursing school and the ways in which wartime conditions gave women the space in which to create a new definition of women's work as nurses.
Chapter five, “Mothers for the nation,” focuses on wartime treatment of children and the vexed question of alternative systems of child birthing. Under the heading “Childhood under siege,” the author reports bad things that happened to various children; but the topic is so broad that it would require a nationwide study to get to the bottom of children's experiences of wartime epidemics, floods, droughts, military campaigns, refugee flight, and loss of parents and neighbourhoods. A longer section on “Delivering the new nation: maternal and child health in wartime,” discusses this complex topic with particular reference to the work and writings of Dr. Yang Chongrui, Nationalist China's most celebrated obgyn specialist and woman physician. At that time the great majority of births were delivered by traditional midwives whose procedures were far from aseptic but who enjoyed social status in village communities. Introduction of young midwives trained in aseptic procedures tended to be resisted in rural areas because they lacked social standing or familiarity.
The author concludes that a gendered history of health care during the exhausting eight-year war “narrates the making of modern China.” This view is supported by substantial citation of work reports in Chinese archives as well as of American archival materials and photographs and many recent scholarly studies. As such, it adds a significant perspective to this critical subject.
