Drawing upon his long experience in the American Bureau of Medical Advancement to China, John Watt offers readers a wide-ranging and intimate view of health care in 20th-century wartime China. Watt takes the complicated and intertwined histories of the Nationalists and the Chinese Communist Party and attempts to tease out the complexities of health care, priorities and policies, tying it all together with detailed biography of key players. Combining political, institutional and military history, the common theme of public health is interwoven throughout to show that even in wartime, different actors formulated and implemented efforts to improve the health of the Chinese people. These initiatives went beyond that of necessary wartime military medicine, but also extended to the health of the overall population with a focus on hygiene and sanitation. Thousands of formerly marginalized rural folk were trained in basic health care, sometimes to support the military and at other times to improve general public health. Watt examines the intellectual shifts necessary for these medical advances to occur and laments the strenuous and complicated political and social vagaries that limited their effect. Even at this level of intricacy, Watt provides a good context of the development of public health ideas and systems globally, and of China's place within the creation of new institutions and scientific discoveries in the name of state building.
The book is roughly chronological and divided into eight chapters and an introduction, with attention to important institutions (National Health Administration, Red Army, Chinese Red Cross Medical Relief Corps) and location (Nanjing, Yan'an, Chongqing). Like the history that gets messy as Japan enters China's civil war, the later chapters are more complicated as public health officials from different factions attempted to continue or implement health improvement projects while dealing with political chaos.
Chapters one and two detail conflicting ideas about the roles of public health and state medicine in the new China, and lay out the structure and policies of the new Nationalist Ministry of Health during the Nanjing decade. In chapter three, Watt takes us to the Chinese Communist base area in Jiangxi where the Red Army encountered epidemics, poor sanitation and hygiene, and lack of health care personnel. Watt convincingly argues that because of their small numbers, Red Army leaders had to be more concerned with preserving lives and thus learned effective triage and service delivery using mobile systems. Chapters four and five introduce us to Dr. Lin Kesheng, director of the Chinese Red Cross Medical Relief Corps, and his Emergency Medical Service Training Schools during the War of Resistance against Japan. Using Lin as an example, Watt argues that the Nationalists ultimately withered under “bad leadership, indifference to human values, and blindness to real dangers and real resources,” preventing reformers like Lin Kesheng from achieving public health goals (p. 203). The last three chapters assess health outcomes during wartime, for example successful foundational data collection systems and preventive health care programmes, and reemphasize the importance of the public health foundation laid during wartime.
Archival data from ABMAC, the Rockefeller Foundation Archives, and provincial and municipal archives in China, among others, provides a comprehensive background for this study. Utilizing extensive correspondence and biographical information, throughout the book Watt makes this history personal by delving into the thinking and decision-making processes of the key health reformers like Li Ting'an, Liu Ruiheng and Lin Kesheng. However, numerous references to questionable online sources should be used judiciously and with a more critical eye. There is also the slightest touch of unevenness towards traditional Chinese medicine, and Watt does not always seem to consider that, aside from the question of efficacy, traditional healers served community and social purposes and therefore should not be dismissed outright. Some readers may take offence at terms like “quack” medicine.
This volume contributes to our knowledge of both the history of public health in wartime China as well as to the health-related policies and political machinations of the Nationalist and the Communist administrations. Scholars interested in public health and 20th-century Chinese history will find this book invaluable. With a deep understanding from personal experience combined with extensive research, Watt gives us considerable details of military situations and health-related military activities, and in so doing makes military history even more interesting by overlaying it with the theme of public health.
