1. Introduction
The Rockefeller Foundation (RF) was a charitable organization, established in 1913 by an American oil magnate John D. Rockefeller Sr., with its mission being “to promote the well-being of mankind throughout the world.” His son, John D. Rockefeller Jr., officially served as the Foundation’s first president.1) In the early years of the Foundation, charitable activities primarily centered around churches and education. Subsequently, under the influence of Frederick T. Gates, the advancement of modern medicine became a top priority for the Foundation. Frederick T. Gates, a former Baptist clergyman and educator, served as the principal advisor on business and philanthropic matters to the oil magnate Rockefeller, Sr. He managed the Rockefeller family’s charitable endeavors from 1891 until his resignation in 1923, and believed that the Foundation should play a crucial role in the development of “Scientific Medicine.”
China was deemed an ideal place to realize the aspiration of advancing modern medicine. Transforming China’s medical system with a focus on modern medicine could demonstrate the superiority of Western civilization. Additionally, expanding charitable opportunities in China could prove advantageous, especially given the unfavorable public opinion toward the RF in the United States at that time (Ma, 2013; JO, 2022).
Part of the reason for this focus on medicine was the experience of failure in 1908. That year, the Oriental Education Commission, supported by the Rockefeller philanthropies, considered establishing a secular, science-oriented research university in China. However, according to previous studies, the initiative was abandoned due to concerns that such an institution would provoke demands for Chinese control, compounded by a prevailing perception of “Chinese dishonesty and incompetence” that rendered the idea “out of the question” (Ninkovich, 1984: 801). Most decisively, the plan was blocked by strong resistance from missionary organizations that were deeply hostile to secular education (Ma, 2013: 145-146). Rockefeller Jr., like Frederick T. Gates, endorsed the focus on medicine emphasizing that it was “a non partisan work and one which would interest all of the people regardless of the government changes” and thus promise of long-term continuity (Ninkovich, 1984: 801–802).
To assess medical conditions in China, the RF dispatched the First China Medical Commission in 1914. The Commission pointed out in its report that despite people in China witnessing unsanitary conditions and the widespread prevalence of diseases, the Chinese government had not been able to “take comprehensive measures for public health” thus far (China Medical Commission, 1914: 3-4). It also argued that addressing these problems required a fundamental solution rather than temporary relief and that this solution lay in training highly qualified Chinese physicians.
However, given the political instability in China at the time and the fact that the was recognized by the Chinese government as a missionary organization,2) it would have been difficult to pursue institutional solutions in cooperation with the Chinese authorities. Moreover, since many missionary-established medical schools and hospitals were already operating in China, the most practical and effective approach was to focus on medical education in collaboration with these existing institutions.
Such circumstances led to the establishment of the China Medical Board (CMB) in 1914, with the RF creating it as a division of the Foundation for the purpose of developing modern medicine in China. In 1915, the CMB took over the management and operation of the Peking Union Medical College (北京協和醫學院, PUMC), which symbolized the RF’s medical education efforts in China. As a subordinate body of the RF, the CMB—best known for operating the PUMC—remained under the oversight of the Foundation, with its operations and decisions requiring RF approval. The PUMC, which began admitting students in 1917, adopted English as the language of instruction and aimed to train elite physicians and public health experts of the highest quality. Notably, until the RF’s reorganization in 1928, its support for China focused entirely on medical assistance through the CMB, and most of the funds were used for the construction and operation of PUMC.3) Accordingly, most previous research on the RF’s involvement in Chinese medical education has focused on PUMC (Bowers, 1972; Brown, 1979; Bullock, 1980; Ma, 1995; King, 1996; GE, 2010; 2019; 2021; JO, 2020b; 2022).
After investigating the medical situation in China, the First China Medical Commission published a report titled Medicine in China, which advocated the establishment of medical education centers in Beijing (北京) and Shanghai (上海). Consequently, the CMB first acquired a missionary medical school in Beijing—the PUMC—in 1915. In Shanghai, the plan was to integrate the existing St. John’s University–Pennsylvania Medical School (聖約翰大學-賓夕法尼亞醫學院)4) and the Harvard Medical School of China (HMSC), both in Shanghai, with the Jinling University Medical School (金陵大學醫學院) in Nanjing (南京)5) into a single institution named “Shanghai Medical School” (New and Cheung, 1982: 1209). Among these, St. John’s University–Pennsylvania Medical School and Jinling University Medical School were American missionary medical schools. The HMSC, an institution modeled after the American system of medical education, was established by Harvard alumni with the goal of “Scientific Medicine Education,”6) which aligned with the RF’s mission and paved the way for the Foundation to conduct elite education in China. However, the school closed in 1916 due to financial difficulties. The reason for its closure was that the elite education it advocated did not align with local conditions in China, and it failed to mobilize local funding (Xia and Zhang, 2010; Xia, 2014).
The CMB’s initiative aimed at merging these schools to establish “Shanghai Medical School” floundered for over five years and was ultimately abandoned in 1920. Studies regarding medical education and the activities of the RF in China briefly mention that a plan to establish a medical school in Shanghai had been abandoned owing to the outbreak of World War I and the enormous costs involved in constructing PUMC (Ma, 2013; Zhang, 2009; Xia, 2014). Prior research on the CMB and PUMC also offers the same explanation. However, it also points out that the cancellation of the “Shanghai Medical School” plan brought certain benefits to other institutions. St. John’s University–Pennsylvania Medical School, for instance, became the only English-instruction medical school in Shanghai. The decision likewise benefited PUMC, as high-level personnel and financial resources were concentrated there rather than being divided between institutions. In addition, the National Shanghai Medical College (國立上海醫學院) received the land previously purchased by the RF, which greatly contributed to the school’s development (Ferguson, 1970: 36).
To date, there has been little detailed or systematic research on “Shanghai Medical School” itself, likely because the plan remained conceptual and was never implemented, thus receiving limited scholarly attention. However, since the plan aimed to integrate American and missionary medical schools in Shanghai into a single high-level institution and make Shanghai the center of medical education in South China, it is an important topic for understanding the state of medical education in Shanghai at the time. It is also crucial for understanding the RF’s vision of medical education in China, since the CMB sustained its efforts to establish “Shanghai Medical School” until the very end, engaging in various developmental activities throughout the process.
Moreover, the realization of this plan required close collaboration with existing missionary medical institutions, highlighting the practical interdependence between the two sides in advancing medical education in Shanghai. Previous studies have highlighted the opposition between the missionary societies representing Christianity and the RF advocating scientific medicine. More recent research, however, highlights how the two groups ultimately formed a cooperative relationship, focusing on their positive interactions and mutual dependence (Jo, 2022). Understanding this cooperative dynamic is also essential for explaining why the RF was so deeply committed to the operation of PUMC and how PUMC came to occupy a leading position in elite education in China.
While previous studies have only briefly mentioned the cancellation of the “Shanghai Medical School” plan to explain why the CMB’s support was concentrated on PUMC, this paper is significant in that it offers a detailed examination of the entire trajectory—from the background of the RF’s proposal to the process leading to the cancellation to the developments that followed. It also explores the state of medical education in Shanghai at the time, why the three schools in question were selected for the proposed merger, and why medical missionaries accepted the Foundation’s proposal. Furthermore, it investigates how medical education in Shanghai and the RF’s activities changed following the cancellation of the plan. This study primarily utilizes materials collected from the Rockefeller Archive Center (RAC).
2. The State of Medical Education in Shanghai and the Entry of the Rockefeller Foundation
As is well known, Western medicine was first introduced in China by medical missionaries, and Shanghai was no exception. On December 23, 1843, the British medical missionary William Lockhart established Renji Hospital (仁濟醫院), the first Western-style hospital in Shanghai and the second in all of China (Jo, 2020a: 130). Considering that Western medical education in China initially began as small-scale classes to train hospital assistants (Jo, 2015: 239–241), it is possible that such informal medical education took place at Renji Hospital as well. A notable example is Huang Chun-pu (黃春圃) who received training at Renji Hospital and learned vaccination techniques while working as an assistant to a medical missionary, and became well known for spreading the use of vaccines in China. However, this was merely a means of assisting medical missionaries in their work, and a formally accredited medical school was not officially established at Renji Hospital.
In 1880, medical missionary Henry William Boone established a Medical Department at St. Luke’s Hospital (同仁醫院) in Hongkou (虹口) District. This department later became the origin of the St. John’s University School of Medicine. St. John’s University is a missionary university established in Shanghai in 1879 by the Episcopal Church in the United States, reorganized the medical department as a formal unit in 1896 with Boone as its director. The program initially spanned four years, but in 1906—when the institution was registered in the United States as St. John’s University—it was extended to seven years, and graduates were awarded a doctoral degree in medicine. In 1914, the school merged with Guangzhou (廣州) Medical College of Pennsylvania,7) resulting in the formation of St. John’s University–Pennsylvania Medical School. By 1915, many of its graduates had studied in the United States and gone on to become leading medical professionals in China (The South Manchuria Railway Company, 1915: 52).
In addition, 1912 saw the establishment of the HMSC, an American-affiliated English-language instruction institution. The idea of establishing this school was first discussed in 1908 and was rooted in the Student Volunteer Movement for Foreign Missions in the United States. Medical students inspired by the zeal of missionaries actively spread their faith across various regions in China, and students at Harvard Medical School also considered ways to serve humanity. As a result, on April 29, 1908, a proposal was submitted to President Charles William Eliot to establish a medical school in China. In 1909, Dr. Martin Edwards, a Harvard Medical School graduate, spent seven months in China and selected Shanghai as the school site. In 1911, Edwards became the dean of the HMSC, and the school officially opened on March 4, 1912. Twelve students who had completed their first and second years at St. John’s University were formally admitted as third-year students at the HMSC (New and Cheung, 1982: 1208). Initially, the school had a cooperative relationship with St. John’s University and conducted clinical teaching at St. Luke’s Hospital. However, when the HMSC claimed that St. Luke’s Hospital was not sufficiently aseptic and demanded control of the hospital, friction arose between the two schools. As a result, the partnership with St. John’s University ended in 1913.
Subsequently, the HMSC entered into an agreement with the Chinese Red Cross to operate the Red Cross Hospital and the Red Cross Medical School for five years, as the Chinese Red Cross faced financial difficulties at the time (China Medical Commission, 1914: 29; Xia, 2014: 37). The HMSC initially embarked on the ambitious goal of providing medical education that surpassed the standards of missionary schools. All lectures were conducted in English, and the faculty strove to maintain high academic standards. However, students struggled significantly to meet the academic standards pursued by the school (New and Cheung, 1982: 1208). In addition, securing funding was a major challenge. President Eliot requested financial support from the RF, and in 1911, Rockefeller promised to provide the HMSC with $5,000 annually for five years, totaling $25,000 by 1915. The HMSC also sent annual letters to Mr. Rockefeller, reporting on the school’s activities and reminding him of his funding promise, thereby securing the funds.8) The support, although limited to five years, appears to have enabled the continued operation of the school. In 1915, the school had 13 faculty members and approximately 25 students (The South Manchuria Railway Company, 1915: 54).
In addition to the two American-style medical schools mentioned above, German and French medical schools also existed in Shanghai. The Shanghai German Medicine School (同濟德文醫學堂) was a German medical school founded in 1907 by German physician Erich Paulun. It naturally followed the German system, and the language of instruction was German. The German government hoped that this school would become a center for spreading German culture in China, and by 1916, the number of students had reached approximately 200 (Wu and Zhang, 1999: 10). In 1903, Aurora University (震旦大學) was established with the support of French Jesuits. After the departure of its first president, Father Ma Xiangbo (馬相伯), in early 1905, the university was operated by the French Jesuit order, with French as the language of instruction. In 1911, it established a Preparatory School of Medicine as a foundation for formal medical training. In 1915, it officially opened the Medical School.
Since the goal of the RF was to train elite physicians through American-style medical education with English as the language of instruction, medical schools affiliated with Germany and France were naturally excluded from consideration as potential partners in establishing a new medical school in Shanghai. It was evident that they would not accept the Foundation’s proposal to collaborate in establishing a new medical school in Shanghai, and there was a significant risk of provoking hostility. For example, the First China Medical Commission attempted to visit the Shanghai German Medicine School but was denied on the grounds that it was “examination time.” Notably, one of the school’s professors admitted that the institution was not as well equipped as the HMSC (China Medical Commission, 1914: 39).
At the time of the RF’s entry into China, the situation of medical schools in Shanghai was described above. In this context, the First China Medical Commission asserted that the initial medical institution should be linked to PUMC, and that the second major medical institution should be established in Shanghai. The CMB, which was established to implement the commission’s recommendations, fundamentally aimed to cultivate highly trained physicians and public health experts capable of implementing sanitary administration, which required a high-level medical school. The school that drew the attention of the CMB for this purpose was PUMC. Following the commission’s recommendation, the CMB took over PUMC in 1915. The school originally operated through a union of six missionary societies. After the acquisition of PUMC, CMB appointed 7 of the 13 board members, while each of the six missionary societies appointed one member (Jo, 2020b: 237).
The commission believed that instead of establishing separate educational institutions in both Shanghai and Nanjing, a single high-quality medical college in the Lower Yangtze Valley would be sufficient, and that concentrating resources in Shanghai would allow for more efficient support. The choice of Shanghai was based on various factors: its large population and urban scale, its geographical importance, the presence of foreign concessions, its strong economic capacity, the diversity of educational institutions, and a high level of English education (China Medical Commission, 1914: 50-51, 92-93).
Against this background, a plan was pursued to merge St. John’s University–Pennsylvania Medical School and the HMSC in Shanghai with the Jinling University Medical School in Nanjing to form a single high-quality medical college, thereby concentrating the Foundation’s support in one institution. Jinling University, a missionary university, was established in Nanking in 1888 by the Methodist Episcopal Church in America. The Medical School was established through a union of the Board of Foreign Missions of the Methodist Episcopal Church, the Foreign Christian Missionary Society, and the Board of Foreign Missions of the Presbyterian Church of the United States of America (China Medical Commission, 1914: 22-23).
3. The Proposal and Purpose of Establishing “Shanghai Medical School”
On November 4, 1915, representatives from the three medical schools—St. John’s University–Pennsylvania Medical School, the HMSC, and the Jinling University Medical School—held a meeting to discuss the establishment of “Shanghai Medical School.” Subsequently, on November 5, Dr. Robert C. Beebe (Secretary of the China Medical Missionary Association) informed Wallace Buttrick that Bishop Graves (American Episcopal Church) and Acting President Walker of St. John’s University, Dr. Henry S. Houghton and his colleagues from the HMSC, and Arthur J. Bowen (President of Jinling University) and his colleagues agreed to merge the medical schools and establish “Shanghai Medical School.”9) Since St. John’s University–Pennsylvania Medical School, the HMSC, and the Jinling University Medical School were American-affiliated institutions and had maintained close relations under a cooperative agreement since 1911 (China Medical Commission, 1914: 28), there was likely not much opposition to the idea of a merger.
Since the RF’s support ended in 1915, the HMSC was scheduled to close in 1916 in line with the plan to establish “Shanghai Medical School.” The school had long struggled with persistent problems, namely, inadequate financial resources and a shortage of students proficient in English. Facing closure, the HMSC could only hope that a new medical school would carry forward its ideals. The Chinese Red Cross Hospital and its affiliated laboratory, which had been operated by the HMSC since 1913, were to be managed by the CMB for two years so that they could be used by the new school. Thus, effective July 1, 1916, the CMB engaged Houghton to assume responsibility for the Chinese Red Cross Hospital and, in collaboration with Roger S. Greene, to oversee the Board's activities in China.10) Additionally, the CMB arranged for the seven most promising students through placements in the United States and arranged alternative education opportunities for the remaining students in China.11)
It was planned that St. John’s University–Pennsylvania Medical School would cease operations once “Shanghai Medical School” opened.12) However, as the establishment of “Shanghai Medical School” was postponed, St. John’s University–Pennsylvania Medical School continued its operations. By the fall of 1918, the Pennsylvania St. John's Medical School admitted a new class of fourteen first-year students, all of whom had previously completed their sophomore year in college.13) Jinling University also agreed to the CMB’s proposal for the establishment of “Shanghai Medical School” and decided to close its medical department. However, because the hospital could provide essential facilities for training interns and nurses, the CMB promised to support the hospital by providing funding, one additional doctor, and three nurses.14)
On April 6, 1916, the CMB resolved to establish “Shanghai Medical School,” and the RF approved this action on April 11. Sufficient funds were allocated to provide facilities and maintain the school. The institution, named the “Shanghai Medical School of the Rockefeller Foundation,” was founded with the following main objectives. It aimed to train Chinese practitioners of medicine to the standards of the highest-level U.S. medical schools and foster a high-caliber indigenous profession. Ultimately, the goal was to transfer this education to Chinese hands, with qualified women admitted on the same terms as men.15) In addition, by merging the three existing medical schools, it concentrated human and material resources in a single medical school. Finally, by incorporating the missionary medical schools of St. John’s University and Jinling University into the new school, it could serve as a symbol of friendly cooperation with missionary societies. As Starr J. Murphy of the Executive Committee of the Rockefeller Foundation explained, the CMB intended to establish a new school “which should work in cordial and sympathetic cooperation with missionary societies, and in which it desired to merge existing medical schools.”16) Subsequently, on April 12, 1917, the board of directors of the “Shanghai Medical School” obtained a provisional charter17) from the University of the State of New York under the corporate name “Shanghai Medical School of the Rockefeller Foundation” and also adopted its by-laws.18)
4. Framework for Cooperation with Missionary Medical Schools
1) Significance of the Board Composition
On April 11, 1916, at a meeting of the RF, the following individuals were selected as trustees of the “Shanghai Medical School of the Rockefeller Foundation”: Fletcher S. Brockman, Starr J. Murphy, Wallace Buttrick, Francis W. Peabody, M.D., Walter B. Cannon, M.D., Robert E. Speer, Simon Flexner, M.D., George E. Vincent, Frederick L. Gates, M.D., William H. Welch, M.D., and John W. Wood.19) Most of the trustees were distinguished figures in the fields of medical education and philanthropic activities associated with the RF. They included Murphy, Rockefeller Sr.’s lawyer and a participant in his philanthropic activities; Buttrick, Director of the CMB and Secretary of the General Education Board; Peabody, a member of the China Medical Commission; Flexner, Director of the Laboratories of the Rockefeller Institute for Medical Research; Vincent, the third President of the University of Minnesota; Frederick L. Gates, a physician and bacteriologist who conducted influential research at the Rockefeller Institute for Medical Research; and Welch, Dean of Johns Hopkins Medical School and a renowned pathologist. Speer, a missionary and the secretary of the Presbyterian Board of Foreign Missions, was also closely connected to the RF. He was one of the Rockefeller Trustees and participated in the first China Conference of the RF held on January 19 and 20, 1914 (Bullock, 1980: 36). Other trustees included Brockman, a highly respected missionary and the head of the Y.M.C.A. in China; Wood, a missionary of the Protestant Episcopal Church; and Cannon, a professor and the chairman of the Department of Physiology at Harvard Medical School.
On July 21, 1916, Murphy informed Frederick L. Gates that the appointment of trustees and the incorporation of “Shanghai Medical School” would be discussed by a special committee to be appointed by the chair, and that the members of this committee would be himself, Buttrick, and Frederick L. Gates. This appears to have been a form of vetting the proposed members.
In this message, Murphy cited the November 5, 1915, letter to Buttrick from Beebe. In that letter, Beebe conveyed to Buttrick that the representatives of St. John’s University, the University of Pennsylvania Medical School, Jinling University, and the HMSC had requested “which shall be conducted by a board of trustees upon which would be represented the governing bodies of the cooperating schools.”20)
In response to this request, Buttrick and Murphy proposed granting St. John’s University and Jinling University the right to appoint representatives to the board for a period of at least five to ten years. Since the HMSC had closed, they believed it would be sufficient to grant that right only for the first year. He went on to argue that “their representation would be so small that it could not seriously interfere with anything that we [CMB] would want to do, and the granting of the right might tend to preserve the cordial relations which are so desirable.”21)
On the 26th of the same month, Frederick L. Gates responded and expressed his views. He pointed out that since the medical schools in question were to be closed following CMB’s entry into Shanghai, representation should be granted not to the medical schools themselves but to their respective universities. He identified St. John’s University and Jinling University as relevant institutions and believed that Harvard University and the University of Pennsylvania should be excluded. According to him, the University of Pennsylvania had no material assets, valuable reputation, or goodwill in Shanghai, and therefore should not be granted any representation. Concurrently, he believed that St. John’s University and Jinling University also offered little in terms of material contribution. He maintained a skeptical stance, stating, “in reality our relations with them cannot do much more for us than to assure us of their courteous good will, and their influence in support of the school.” He believed that missionary societies should trust the CMB’s goodwill and willingness to cooperate with them for the benefit of China, and should not claim authority over the new “Shanghai Medical School” for which they bore no responsibility. Therefore, his view was that there was no need to grant rights to these universities, and that all authorities to appoint the Board of Trustees should rest with the CMB. However, he stated that, as a gesture of courtesy, Buttrick could informally offer St. John’s University and Jinling University the opportunity to propose candidates for the first Board of Trustees. He also agreed, as an exception, with the proposal to appoint Cannon as a representative of Harvard University for the first year only.22) The son of Frederick T. Gates, he similarly emphasized “scientific medicine” and sought to minimize religious influence within the RF, just as his father had.
Murphy and Buttrick agreed with Frederick L. Gates’s view that since the medical schools were to be closed, representation should be granted to the universities—St. John’s University and Jinling University—rather than to the medical schools themselves. However, they repeatedly emphasized the importance of maintaining friendly relations with these institutions during the initial stages and proposed the following compromise: instead of specifying a defined period for representation or granting representative rights through a formal agreement, each year, the universities would be invited to nominate candidates when the board of the new “Shanghai Medical School” was being formed. One of these nominees could be selected to serve a three-year term as a trustee. They also proposed that trustees be eligible for reappointment after three years, provided there are reasonable grounds.23)
It was ultimately decided to recommend Speer as the representative of Jinling University, Wood as the representative of St. John’s University, and Cannon as the representative of the HMSC. This meant that the board members determined in April remained unchanged. Despite opposition from Frederick L. Gates—who envisioned a “Shanghai Medical School” led entirely by the CMB and free from missionary influence—the views of Buttrick and Murphy, who emphasized the importance of cooperation with missionary schools in establishing the institution, gained a certain degree of traction. Compared to PUMC, where six missionary organizations still held significant influence on the board, “Shanghai Medical School” had a structure in which the CMB could exert more control than missionary groups. Among the total of 11 board members, only three could be classified as affiliated with mission groups. One of them, Speer, was already closely tied to the RF. Moreover, the names of all 11 founders were identical to those on the Board of Trustees.
At noon on May 18, 1917, at the New York office of the CMB, the meeting of the Board of Trustees of “Shanghai Medical School” was held to introduce the provisional charter and the medical school by-laws.24) The provisional charter included regulations concerning the board of trustees and stated that if the necessary resources and facilities were established and the institution was maintained following the charter’s objectives within five years, it would be converted into an absolute charter, allowing the school to confer medical degrees. Additionally, the “By-laws of the Shanghai Medical School of the Rockefeller Foundation” outlined regulations concerning members and trustees, officers, chairman and vice chairman, secretary, meetings, quorum, executive committee, and amendments. It was specified that an annual board meeting would be held each year on the third Saturday of February.
The Chairman of the Board was Vincent, President of the Rockefeller Foundation. Wood was appointed Vice Chairman, and Buttrick was appointed Secretary, and Houghton was appointed acting dean of the “Shanghai Medical School.” The appointment of Wood and Houghton was noteworthy; Wood was a prominent figure in the missionary community, and Houghton had been the president of the HMSC (1915–1916). By appointing Wood as vice chairman, the board allowed for some representation of the missionary perspective, while through Houghton, it aimed to uphold the spirit of “scientific medicine” jointly pursued by the HMSC and the RF. Additionally, in accordance with the proposal by Murphy and Buttrick, board member terms ranged from one to three years. Cannon was appointed for a one-year term, while Speer and Wood were given three-year terms.
The boards of trustees elected according to the regulations are shown in Figure 1. There were no Chinese members. Figure 2 lists the PUMC boards of trustees. The 1917 Annual Report of the Rockefeller Foundation featured the board lists of both schools.25) The PUMC board list includes the names of six missionary organizations and their representatives who collaborated with the CMB to operate the school. Notably, there were no Chinese members on the board at PUMC either. Chinese individuals were included much later. A comparison of the two lists reveals that several individuals played significant roles in both schools, indicating overlapping influence and leadership, with Vincent, Buttrick, and Flexner being key figures in both institutions.
Vincent served as the chairman of the board of “Shanghai Medical School” and the Executive Committee chair of PUMC. Buttrick was the secretary and a member of the Executive Committee at both schools. Flexner was also a member of the Executive Committee of both institutions. Thus, had “Shanghai Medical School” operated as planned, it would have been significantly influenced by the operational model of PUMC, potentially resembling the Shanghai branch of PUMC.
As per the by-laws introduced at the first board meeting, annual board meetings were held in New York on the third Saturday of February, with the second meeting held on February 20, 1918, the third on February 19, 1919, and the fourth on February 18, 1920. At the second meeting, Edwin R. Embree, the secretary of the CMB, was appointed as secretary of “Shanghai Medical School,” and at the third meeting, Brockman replaced Murphy as the Executive Committee member.26) Despite these developments, there were no significant changes to the overall board composition, likely due to the slow progress in establishing the school.
2) Missionary Reactions and Support for Surrounding Schools
With the opening of modern Shanghai as a port city, Western culture and technology were introduced. The RF designated it as a center for scientific medical education alongside Beijing, indicating that the city had a substantial foundation for promoting medical education. Owing to the city’s population, wealth, the convenience of its location, and the operation of several missionary schools, it was expected that finding talented individuals who could speak English would be relatively easy. So, how did the missionaries practicing modern medical education in Shanghai respond to the RF’s proposal to establish medical schools in the city?
The China Medical Missionary Association (博醫會), an organization composed of Protestant medical missionaries across China and based in Shanghai, served as a central hub for the exchange of information and coordination of medical missionary activities. To ensure the uniformity of medical education, the Council on Medical Education was established under its authority, and missionary medical schools were required to follow the principles set forth by the council in order to receive its accreditation (Jo, 2020a: 132–133). In other words, the China Medical Missionary Association exerted significant influence over missionary medical education.
Therefore, it can be considered that the opinion of Beebe in 1916, represented the views held by the majority of medical missionaries.27) He viewed the RF’s establishment of a medical school in Shanghai and its support for various mission schools positively, stating, “While these schools are purely educational institutions and not a part of religious propaganda, it is designed that the men connected with them shall all be in sympathy with missionary work and that the schools shall be ‘a distinctive contribution to missionary endeavor.’” In this context, “these schools” refers to the new “Shanghai Medical School” and the Yale Mission’s medical school in Hunan (湘雅醫學院).
The key issue was not merely the establishment of the medical school in Shanghai itself, but rather “how to secure in these high-grade schools the greatest Christian influence” and “what shall be done in its own distinctively missionary effort at medical education.” Beebe argued that to secure the Christian influence, it is necessary to train excellent teachers with a missionary spirit to work at the medical schools of the CMB. Since the CMB sets very high standards for teacher selection, it would not be easy to find teachers who meet these criteria. However, if teachers possessed a missionary spirit, they could impart it to students at the CMB’s medical schools.
Furthermore, Beebe emphasized that missionary medical schools should continue to operate. He expressed optimism about cooperation with the CMB, stating that “if medical education is continued as distinctive missionary work, the China Medical Board will have done good service in making it.” He also noted, “There is no reason for antagonism but every reason for hearty cooperation between the missionary body and the China Medical Board.”
Certainly, some medical missionaries expressed concerns about the entry of the CMB into China. However, at the time, missionary medical schools suffered chronic shortages of personnel and funding, making it difficult to forgo support from the RF. It seemed more practical to strive to achieve the goal of “evangelism through medicine” while receiving financial support from the Foundation. As a result, they were generally more receptive to the RF’s proposal and tended to view the establishment of “Shanghai Medical School” in a favorable light. They also believed that their role did not necessarily conflict with that of the RF and that through cooperation, both parties could achieve better outcomes in advancing medical education and missionary objectives (Jo, 2022). This approach could likely allow missionary medical schools to continue their missions and expand their impact through the additional resources provided.
Meanwhile, it is evident that Chinese doctors were also interested in the establishment of “Shanghai Medical School,” as the plans for its establishment and the process were consistently featured in The National Medical Journal, the official publication of the National Medical Association of China (中華醫學會), which was founded in 1915 primarily by Chinese doctors.28) These Chinese doctors, who had been educated at missionary medical schools in China or had pursued further studies in the United Kingdom or the United States—thus belonging to the so-called “Anglo-American faction” (英美派)—were fundamentally elite physicians whose backgrounds brought them closer to endorsing the RF’s plans (JO, 2016). In a letter sent to Rockefeller Jr. in August 1919, Vincent reported, “The Medical Profession and especially the medical missionaries are looking forward with interest to the establishment of the Shanghai school.”29)
The RF could not ignore medical missionaries who had been practicing medicine and medical education in Shanghai for a long time when establishing medical schools. Cooperation with surrounding schools was crucial for the establishment of “Shanghai Medical School.” To facilitate cooperation with preparatory schools, hospitals, medical missionaries, and modern trained native physicians, the CMB prioritized financial support. Map 1 illustrates the medical education sites in China supported or assisted by the CMB.30) In addition, records show that in 1917, the CMB donated approximately $50,000 to hospitals in 12 regions in northern and central China.31)
Unlike PUMC, the decision not to establish a preparatory school for medical school admission was made to foster cooperation with surrounding schools. If “Shanghai Medical School” were to establish its preparatory school, it might lead to conflicts of interest with nearby schools that already offered similar courses. Therefore, it was decided to collaborate with nearby universities with high educational standards to teach science and premedical courses.32) In practical terms, the RF judged it more effective to have students who had already studied English and basic sciences at missionary schools enter “Shanghai Medical School” rather than operating educational institutions from primary schools through medical colleges on its own.
St. John’s University was the ideal partner in this regard as students who received their foundational education could continue into medical school.33) In 1918, the RF decided to provide up to $80,000 over five years to St. John’s University. The university was thus able to construct a new Science Laboratory, purchase new equipment, and send science teachers to the United States for training.34) Additionally, Fujian Christian University (福建協和大學) in Fuzhou (福州) was assured of various forms of support for both the expansion and maintenance of its Science Department, including the provision of faculty members and the payment of their salaries.35) Although the university is geographically distant from Shanghai, the availability of ferry transportation between Shanghai and Fuzhou made it feasible to maintain ongoing collaboration.
This strategy of collaborating with mission-affiliated institutions likely helped alleviate the concerns of the missionaries who feared that the Christian spirit of the medical school might be weakened under the influence of the RF’s strong emphasis on scientific medicine. Simultaneously, by providing funding to mission-affiliated schools and improving their educational standards, the CMB would be able to secure students with the qualifications necessary to enter its new medical school.
5. Ongoing Efforts
The gradual progress toward the establishment of “Shanghai Medical School” was inevitably delayed due to the aftermath of World War I. The 1917 Annual Report of the Rockefeller Foundation stated: “The war has made necessary the postponement of this building project. The difficulty of securing a staff, the high cost of building materials, the unfavorable condition of foreign exchange, all forbid a present beginning.”36)
Despite these challenging circumstances, the plan to establish a medical school and hospital in Shanghai could not be easily abandoned. In Map 1, regions with medical schools supported by CMB are marked with stars, squares, and circles. Among these, only Beijing and Shanghai are marked with stars.37) As evidenced by the separate explanation attached to the map— “Stars indicate the location of the Medical Schools being built and maintained by the Board” —it is evident that the CMB already considered the establishment of a medical school and hospital in Shanghai to be a given fact. Without “Shanghai Medical School,” the CMB’s direct sphere of influence, as depicted on the map, would have been limited to Beijing, resulting in a northern concentration. “Shanghai Medical School” was intended to play a crucial role in the CMB’s plan for medical education in China, making it an initiative that could not be easily abandoned.
However, in 1918, the CMB decided not to commence the construction of the school until the new PUMC buildings were completed. This decision was attributed to the very unfavorable rates of exchange and the increased cost of building materials due to the war, which significantly increased the construction costs of PUMC. Since the construction was expected to take another year and a half to complete, it was deemed unlikely that the school’s construction would begin within the next three to four years.38)
Ultimately, the construction of “Shanghai Medical School” could not begin for at least another five years, and the actual opening would occur even later. In this context, the board contemplated the role they should play in Shanghai’s medical education and saw the potential to expand their support for St. John’s University and Fujian Christian University until the new school opened.39) The 1919 Annual Report of the Rockefeller Foundation also mentioned that the establishment of the school was delayed due to “difficulties in securing material, the export embargoes, the high prices and unfavorable exchange, as well as the uncertainty concerning all future enterprises” during the war.40)
Despite these delays, the “Shanghai Medical School” board continued to meet in 1919 and maintained its commitment to establishing the school. A substantial portion of the groundwork for the school had already been completed. Specifically, CMB purchased 20 acres of land for approximately $250,000, secured a provisional charter, and appointed the board of trustees. In light of these developments, during the CMB meeting on December 2, 1919, it was decided to conduct a special study to assess whether it would be possible to maintain a satisfactory level of medical education in Shanghai at a minimal cost.41) In the same meeting, plans were made to investigate land and housing near the “Shanghai Medical School” site to provide accommodation for faculty members. It was anticipated that the faculty would likely prefer residential areas slightly removed from the school, so it was decided to purchase three existing houses at a total cost not exceeding $105,000. The records also noted that, given the steadily rising land prices in Shanghai, it would be advantageous to make these purchases quickly.42) Subsequently, the construction of the school buildings was assigned to Harry Hussey, who was also the architect of PUMC.43)
On February 18, 1920, during a board meeting, Roger S. Greene, Houghton, and Vincent, who played significant roles in the establishment of “Shanghai Medical School,” submitted a recommendation advocating its establishment.44) They were concerned that indefinitely postponing the establishment of the school, which had already become an official commitment, would diminish the CMB’s authority. They emphasized that Shanghai was a central location that could gain great advantages in public health and hospital social services. With the use of steamships, schools could take responsibility for medical education not only in Shanghai but also in a broader region. Given Chinese customs, traveling long distances for education is considered unremarkable. This attitude, combined with the accessibility of ferry transportation, made it easy and affordable for students from various regions to reach Shanghai.45) They also argued that by collaborating with the Shanghai community, public health professionals could be trained effectively. Furthermore, the Rockefeller Institute for Medical Research could partner with Shanghai hospitals to conduct studies on tropical diseases. They asserted that cost issues could be addressed by utilizing practical and inexpensive buildings.
6. A Vanished Dream: The Abandonment of the Proposal and Its Aftermath
Despite continuous efforts to establish “Shanghai Medical School,” the RF ultimately decided to abandon the proposal. This decision was made during a special meeting held on April 28 and 29, 1920 in Hot Springs, Virginia.46) On May 26, 1920, the RF announced that “owing to changes in the world situation growing out of war,” it felt it was necessary to abandon the goal of establishing a medical college in Shanghai.47)
Maintaining existing projects has become critical for the Foundation. Changing global circumstances, high exchange rates, and rising costs of building material and equipment had led to unexpectedly increased expenses for all operations in China. An examination of the Annual Report of the Rockefeller Foundation reveals that the cost of establishing medical schools in Beijing and Shanghai experienced substantial annual escalation, becoming a substantial financial burden. In 1917, the amount spent by the CMB on the development of medical schools in Beijing and Shanghai was $263,989.26. Additionally, assistance to unaffiliated medical schools amounted to $107,079.10; support for hospitals to $48,968.75; fellowships and scholarships to $44,515.39; and miscellaneous expenses to $36,869.22. Consequently, half of the total expenditure of $501,421.72 incurred in 1917 by the CMB was used for the development of medical schools in Beijing and Shanghai.48) In 1918, the expenditure on the development of medical schools in Beijing and Shanghai amounted to $1,850,344, accounting for approximately 87% of the total CMB expenditure of $2,131,588 incurred in 1918. Although the CMB received $5,500 in support from the HMSC, it was not of significant help, considering the total amount required for the development of medical education.49) The costs of the PUMC site and buildings, along with its operating expenses, amounted to $2,808,624 and $3,255,246 in 1919 and 1920, respectively. These figures constituted approximately 88.5% of the total amount ($3,171,854) in 1919 and approximately 89% of the total amount ($3,641,595) in 1920, as shown in Table 1.50)
Despite a substantial investment of $6 million for construction and maintenance, PUMC, which commenced operations in the fall of 1919, enrolled only seven students in its initial season.51) Given this context of PUMC’s inability to achieve optimal enrollment capacity, continuing to pursue the establishment of “Shanghai Medical School” was impractical. Moreover, schools across the globe were struggling because of the increased cost of living abroad and the depreciation in the effective value of their endowment values. There was also a judgment that it would be better to support medical schools in the United States and Europe, which already had well-prepared students but lacked funding and adequate teachers.
Ultimately, the RF decided to abandon the establishment of “Shanghai Medical School” and concentrated all its support on PUMC. There seemed to be some contemplation whether it might be better to postpone the proposal rather than discard it entirely. However, the RF ultimately chose complete abandonment because indefinitely postponing establishment could confuse those trying to secure personnel and funding for medical schools. This decision did not indicate the CMB’s decreased interest in medical education in China. Instead, it emphasized that it would make every effort to accelerate PUMC’s growth and advance medical development in China through other means.52)
In early 1921, the board members of “Shanghai Medical School” received a letter announcing the annual meeting to be held on Monday, February 16, 1921, along with the RF’s statement on its withdrawal from the proposed project in Shanghai. Although the proposal to establish the school was abandoned, the tasks of settling the board’s affairs and returning the provisional charter to the State of New York remained.53) That day, the school trustees assembled for their fifth and final annual meeting (Ferguson, 1970: 36).
Despite strong protests from Dean Eliot, the affiliates of the HMSC who supported the establishment of “Shanghai Medical School,” and some missionaries who had been anticipating the new institution, the decision could not be reversed. The HMSC was already closed, and its property was transferred to the “Shanghai Medical School.” The Secretary of the Executive Committee of the HMSC asked whether the land or proceeds from its sale could be returned. Greene was responsible for facilitating the transfer to the HMSC or its associates.54)
However, unlike the HMSC, the decision was not entirely unfavorable from the perspective of the St. John’s University–Pennsylvania Medical School. After five years of uncertainty, this school decided to move forward with its plans to become the “Orient’s foremost training place for physicians and surgeons.”55) The school then held the title of the only English-instruction medical college in Shanghai. It was also expected that the financial support it had been receiving from the RF would continue.
Despite the abandonment of the “Shanghai Medical School” proposal, the CMB chose not to relinquish its land holdings in Shanghai, anticipating that future opportunities for medical school development might still arise. For example, on December 23, 1919, the CMB’s Executive Committee spent $115,000 to purchase land and houses for the staff of “Shanghai Medical School” and acquired land in the French Concession for $14,893.12. The CMB decided to retain large plots intended for medical laboratories or hospitals for future medical school projects that it might sponsor. This decision was made because of the rapid development and increasing value of prime locations in Shanghai, which made it difficult to find suitable sites for new schools. Some portions of the land were to be sold either within the French Concession or to the owners of adjacent properties.56) The decision to retain some of the land indicates that although the proposal for “Shanghai Medical School” was abandoned, the possibility of supporting the establishment of a new medical school in the future remained. However, the CMB never established a medical school directly operated by them in Shanghai.
7. Conclusion
In 1915, the RF sought to establish medical schools in Beijing and Shanghai as pivotal centers for the dissemination of American-style medical education. Beijing, the capital of China, held symbolic significance and geographically represented North China, while Shanghai, as a leading modern city, was positioned as a hub for medical education in South China. In Beijing, the CMB took over the management and operation of PUMC. In Shanghai, the plan was to integrate the existing St. John’s University–Pennsylvania Medical School, Jinling University Medical School, and HMSC into a single institution named “Shanghai Medical School.” However, this ambitious initiative ultimately proved unsustainable. The RF encountered insurmountable challenges precipitated by post-war global circumstances, including unprecedented exchange rates, escalating costs of building material and equipment, and critical human resource constraints. Additionally, medical schools in the United States and Europe required support from the RF. Consequently, the RF, through its CMB, elected to terminate the “Shanghai Medical School” initiative and consolidate its efforts in China exclusively on PUMC in Beijing.
The cancellation of the initiative was a step backward for the RF but also a strategic retreat to enable future progress. It allowed the Foundation to expand its educational support beyond China to other countries. Until 1919, most of the RF’s support for medical education was channeled through the CMB. For example, in 1919, the Foundation’s total expenditure on “Medical Education and Research” was $3,248,547, of which $3,171,845—approximately 98%—was allocated to the CMB.57) However, starting in 1920, the range of recipients of educational support began to diversify, and several European countries started to receive funding. In 1920, the total expenditure on medical education was $4,482,964, of which the CMB used $3,641,595—primarily for the operation and development of PUMC—reducing the CMB’s share to approximately 81%.58) In 1921, the total expenditure on medical education was $4,119,261. This reduced the CMB’s share to approximately 47%, a significant decrease from the previous year’s 81%.59) This was partly because construction of PUMC reached a certain level of completion, significantly reducing the related building expenses. Concurrently, the Foundation expanded its educational support to various regions, including London, Canada, Central Europe, and Brazil, thereby extending its influence globally.
Although the establishment of “Shanghai Medical School” failed, the process from proposal to abandonment yielded significant insights for studying the history of modern medical education in China. It provides a novel perspective on the relationship between the RF and missionary societies, which played a major role in medical education in China at the time. The CMB, well aware that establishing the medical school would be difficult without the cooperation of missionary groups, sought to strike a balance between its pursuit of “elite scientific medicine” and the maintenance of amicable relations with the missionary community. For example, the CMB provided generous financial support to missionary schools around Shanghai and included missionary figures on the board of “Shanghai Medical School.” It also demonstrated its willingness to reflect missionary interests by appointing Wood, a prominent missionary figure, as its vice chairman. Additionally, the appointment of Houghton, the former president of the HMSC, as the president of “Shanghai Medical School” reflected a commitment to continue the “scientific medicine” ideals shared by the HMSC and the RF. Compared to PUMC, where six out of thirteen board members were representatives of missionary societies, the “Shanghai Medical School” had a governance structure in which the influence of the CMB surpassed that of the missions. Had the school been established, the CMB might have exercised relatively greater autonomy and initiative in its operation than it did in Beijing.
Furthermore, this study helps clarify the developmental trajectory of modern medical education in Shanghai, demonstrating that missionary and Chinese institutions—rather than the CMB—eventually came to play a central role in shaping this field. With the cancellation of the RF’s plan to establish “Shanghai Medical School,” missionary medical schools naturally assumed a central role in medical education in Shanghai. Unable to establish a base in Shanghai, the Foundation turned to St. John’s University as an alternative. The cooperative relationship between St. John’s University and PUMC deepened, and many of the former’s graduates went on to pursue graduate studies at PUMC (Ferguson, 1970: 36).
Subsequently, this outcome could be seen as a turning point that encouraged Chinese medical elites to pursue an independent education system. The establishment of the Medical College of the Fourth Zhongshan University (國立第四中山大學醫學院) in 1927 marked the beginning of Chinese-led development in medical education (GE, 2010: 61). This school was the first national medical college founded by the Chinese, with the renowned medical practitioner and educator Dr. Yan Fuqing (颜福庆) serving as its first president. Dr. Yan was a graduate of missionary schools and received American-style medical education. Being part of the so-called Anglo-American faction, he maintained close ties with both missionary organizations and the RF. Thus, although the leadership of medical education had shifted to Chinese hands, the commitment to adopting modern Western medical principles likely persisted. The Medical College of the Fourth Zhongshan University became independent in 1932 as the National Shanghai Medical College, which is now known as the Shanghai Medical College of Fudan University (復旦大學上海醫學院).
Interestingly, the RF’s abandonment of its own plan became a stepping stone for the National Shanghai Medical College to emerge as one of the most prestigious medical schools in China. In accordance with a resolution passed at the Board of Trustees meeting on April 11, 1934, the RF transferred the land it had purchased for the planned “Shanghai Medical School” to the Board of Directors of the Shanghai Medical Center. The Shanghai Medical Center was an institutional hub established in the early 1930s with the aim of integrating public health services and professional medical education, and was closely affiliated with the National Shanghai Medical College and Zhongshan (中 山) Hospital. The land was later utilized by the National Shanghai Medical College and Zhongshan Hospital for their campus and medical facilities. The RF also provided $3,374.64 to support the maintenance of the National Shanghai Medical College. Over the course of more than a decade, the land had appreciated significantly in value, reaching $298,331.95 as of December 31, 1933.60) This funding must have greatly contributed to the operation of the National Shanghai Medical College.
Third, the cancellation of the “Shanghai Medical School” plan enabled PUMC to sustain its elite education model through the concentrated support it received from the CMB. In fact, following the cancellation, several faculty members who originally intended to serve at “Shanghai Medical School” instead joined PUMC, where they were able to deliver high-quality instruction to students. These members included Houghton, who became the Acting Director of PUMC; Albert M. Dunlap, Head of Otolaryngology; Adrian S. Taylor, Head of Surgery; Paul C. Hodges, Head of Radiology; Andrew H. Woods, Professor of Neuropsychiatry; and Harvey J. Howard, Head of Ophthalmology (Ferguson, 1970: 36). Most of these individuals had been affiliated with the HMSC and had pursued high-level American-style medical education since that time. Talented students from various regions were likely drawn to PUMC owing to its outstanding faculty, well-equipped educational facilities, abundant research funding, and generous scholarships. As previously mentioned, the fact that many graduates of St. John’s University went on to pursue graduate studies at PUMC after the “Shanghai Medical School” plan was canceled further illustrates this trend.
Given the absence of other CMB-operated medical schools outside Beijing, the Foundation’s influence was limited to the indirect financial support of institutions operated by missionary societies, the Chinese government, or foreign entities. This geographical constraint resulted in diminished influence on medical education beyond Beijing. To secure a competitive advantage over other regions, it was imperative for PUMC to maintain its original emphasis on elite education. Indeed, even before the “Shanghai Medical School” plan was canceled, PUMC had already been the central focus of the RF’s medical education policy in China, receiving sustained investment that firmly established it as the centerpiece of its elite training strategy. Paradoxically, the failure in Shanghai also reduced friction between the missionary community and the RF, enabling each to concentrate its efforts—missionary institutions in Shanghai and the Foundation in Beijing—without direct rivalry. As the cornerstone of the RF’s elite medical education in China, PUMC produced graduates who exerted substantial influence on the advancement of medicine in China and East Asia. Although the cancellation of the plan was not the starting point of this focus, it nevertheless reinforced it by enabling the CMB to concentrate its resources more fully on PUMC, thereby helping the institution cement its reputation as the “Johns Hopkins of Asia.”
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