The Intergenerational Transmission of Medical Knowledge

Barefoot Doctors and Modern

Medicine in Rural China

Fang Xiaoping

Social Science Academic Press (China)

May 2024

89.00 (CNY)

This book reconstructs the collective memory of medical professionals and patients during the unique historical period through oral interviews and written archives， providing a more comprehensive narrative of the history of China’s medical system.

Fang Xiaoping

Fang Xiaoping is an associate professor at the School of Literature， Monash University， Australia. His primary research interests include the history of medicine， health， and epidemics in China， as well as contemporary Chinese social and political history. He has published numerous papers in various journals.

The selection process for barefoot doctors publicly declared that medicine was no longer a personal or family affair， and such policy gradually increased the number of recipients of medical knowledge. In response to the changes in candidate selection methods， knowledge transmission also showed a general trend: Western medicine was gradually introduced into rural China and increasingly integrated into the knowledge base of rural medical practitioners through intergenerational transmission. This book’s discussion on the group of healers in Jiang Village begins with Chen Hongting， one of the founders of the Jiang Village United Clinic， and continues until the emergence of a new batch of barefoot doctors in 1968--1969. These rural medical practitioners can be divided into four generations. Chen Hongting (including his father， Chen Changfu) and the other four clinic founders learned traditional Chinese medicine through conventional means and began practicing before 1949. As the first generation of healers in Jiang Village， they incorporated Western medical knowledge into their daily practices after 1950. Chen Zhicheng， who became the director of the United Clinic after 1968， studied medicine under his mentor Zheng Buying from 1959. Chen Hongting’s brother-in-law， Zhu Shouhua， began his apprenticeship in Chinese medicine in 1962， with Chen Hongting as his mentor. Although Chinese medicine knowledge was passed down within the clinic through the traditional master-apprentice model， the training received by Chen Zhicheng and Zhu Shouhua differed from their mentors because Western medicine also became a compulsory subject. As previously mentioned， anatomy was a core course for Chen Zhicheng， while Zhu Shouhua learned to dispense Western medicine tablets in the pharmacy. In this sense， Chen Zhicheng and Zhu Shouhua can be considered the second generation of healers.

As noted earlier， when classroom training replaced traditional master-apprentice knowledge transmission， the Jiang Village United Clinic conducted systematic training for health workers for the first time in 1965. These health workers became the third generation of rural medical practitioners in Jiang Village. They learned Western medicine from Chinese medicine practitioners like director Chen Hongting， who， though being a practitioner of Chinese medicine， had already mastered Western medicine. Chen Hongting lectured these healers on topics such as preventive medicine， and the prevention and treatment of endemic diseases， schistosomiasis， and malaria. Later， the sources of their medical knowledge became more diversified. As the best students among the sixteen or seventeen health workers trained in 1965， Luo Zhengfu and two other classmates were selected for a two-year Western medicine course at the “Yuhang County Rural Doctor Training Class” briefly in 1966. In 1967， these three students interned at the First Hospital of Hangzhou for a year. There， they were required to familiarize themselves with various departments. The significance of this training process lies in the fact that it was the first time medical practitioners from Jiang Village went outside their local community to learn medical knowledge in a modern hospital. More importantly， they studied Western medicine rather than Chinese medicine. After completing the courses and internships， the three returned to the commune clinic， with Luo Zhengfu working in surgery while his classmates worked in internal medicine and obstetrics and gynecology， respectively. Luo Zhengfu recalled that their mission was to improve the medical standards of the commune clinic.

Due to the inability of the aforementioned first batch of health workers to meet local needs， some young commune members were selected to join the ranks of barefoot doctors in 1968 and 1969. These barefoot doctors became the fourth generation of medical practitioners in Jiang Village. There was a significant change in the sources， types， and transmission modes of their medical knowledge. Zhou Yonggan became a barefoot doctor in 1968 and still works at the Jiang Village Health Clinic today. He recalled， “Our training consisted of two parts: one part was with the People’s Liberation Army unit stationed near Liuxia Town， and the other part was at Chen Zhicheng’s commune clinic. Military doctors and health workers taught us， responding to call to ‘shift the focus of medical and health care to rural areas.’ At the commune clinic， Chen Zhicheng and Luo Zhengfu taught us.” Xu Shuilin， who studied medicine under Zhou Yonggan， said， “We first learned basic theoretical knowledge and then followed military doctors to treat soldiers. We learned medicine through a combination of theory and practice. Initially， we underwent military training， followed by one to two weeks of medical study， including rural health knowledge and Western medicine knowledge.” He still remembers how Chen Zhicheng used white radishes to teach them acupuncture at the commune clinic. Shen Guanyong became a barefoot doctor later than Zhou Yonggan and Xu Shuilin. Unlike their experiences， Shen initially studied medicine mainly in Jiang Village. As mentioned earlier， he studied for three months under Dr. Qi’s guidance when Qi and Luo Zhengfu had just returned to the commune clinic from Hangzhou.

Until 1970， barefoot doctors in Jiang Village primarily learned medical skills through intergenerational transmission， even though their teachers at the commune clinic had begun to venture out to absorb Western medical knowledge. However， after 1970， medical education was no longer confined to the local community. Initially， three barefoot doctors were selected to study for six months at Yuhang County People’s Hospital. Among them， Zhou Yonggan was assigned to study surgery， while the other two studied ophthalmology and internal medicine， respectively. Before they returned to the commune， the brigade arranged for others to fill their vacant positions. In the following years， new barefoot doctors continued to fill these vacancies， and all of them were able to continue their studies at Yuhang County Health School or Yuhang County People’s Hospital. According to Luo Zhengfu， they all studied Western medicine.

In the early 1970s， various methods were employed for barefoot doctor training classes at the county level in the Hangzhou region. However， by the mid-1970s， these training classes became increasingly formalized and standardized. According to the training syllabus， there were mainly three types of classes， lasting 3 months， 6 months， and 12 months.

Compared to the introduction of Western medical knowledge into rural areas， the transmission of folk medical expertise continued to follow traditional models. As mentioned earlier， after the major adjustment of the rural medical system in China， folk healers were granted a certain degree of legitimacy and were incorporated into cooperative medical stations. In the Jiang Village commune， Shen Jinrong， a folk healer skilled in Gua Sha and bone setting， became the barefoot doctor in his village. He was the only folk healer among Jiang Village’s barefoot doctors. As a barefoot doctor， he used his unique medical techniques to treat fellow villagers but did not share this knowledge with his peers， even though the revolutionary discourse of the time encouraged barefoot doctors to share knowledge. However， he did pass on his knowledge in a different way. In the Wulian Production Brigade， a young barefoot doctor named Hong Jinglin， who had studied medicine with Luo Zhengfu at the Jiang Village United Clinic under Chen Hongting in 1965， was taught by Shen Jinrong. In 1970， Hong Jinglin was just in his early twenties， while Shen Jinrong was over forty. Shen Jinrong’s wife recalled that her husband regarded Hong Jinglin as an honest， diligent， and reliable person， so he married his daughter to Hong Jinglin. During their daily medical practice， Shen Jinrong unreservedly taught Hong Jinglin the unique medical skills of the Shen family， including Gua Sha， bone setting， bloodletting， and treatments for bruises and injuries. Despite the old saying， “Teach the son but not the daughter， teach the wife but not the brother，” Shen Jinrong still passed on his unique medical knowledge to an outsider because the latter had “changed families” and become part of his family. This conservative mode of transmission was in stark contrast to the large-scale introduction of Western medical knowledge into rural China through school training and medical textbooks.