A Doctor in Red China

Born in the United States, DR. WILDER PENFIELD studied at Princeton, Johns Hopkins, and Oxford universities, and began his scientific and clinical career at Columbia and at the Presbyterian Hospital of New York City. He has been a citizen of Canada since 1934 and was the director of the Montreal Neurological Institute for twenty-five years. In the autumn of 1962 he and his wife spent a month on the mainland of China as the guests of the Chinese Medical Association. Here are his impressions.

by Wilder Penfield, M.D.

IT WAS the play we saw in Shanghai one Sunday evening in September, 1962, that helped us to understand what has happened to the families in the People’s Republic of China. Some customs have vanished. Some characteristics remain unaltered and unalterable.

Our Chinese hosts called for us at the Peace Hotel, and we motored along the waterfront of this vast smoky metropolis. The sun had set, but out on the river, junks and sampans could still be seen moving like shadows among the lighted ferries and ships. Leaving the harbor esplanade, with its din of traffic whistles, shouts, and steamboat blasts, we entered Nanking Road and came to quiet streets, dimly lit, crowded with men and women hurrying somewhere on foot, bicycle, or tricycle.

It began to rain as we approached the theater along a dark, shining pavement, but a crowd had gathered under a single light at the entrance. As our cars came to the curb, the doors were opened for us, but no tips were expected or given. Our principal host for the evening was the dean of the First Shanghai Medical College. The others in our party were also physicians, with the exception of the interpreter and a man and a woman from the local government office. We filed into a large undecorated auditorium, and taking our places, watched the people enter and fill the seats around us. In the first ten rows, some women wore long black dresses of Chinese style and the men were in business suits. Behind us, many were in their working clothes and some women wore blue jeans and simple shirts like the men’s. On the whole, people were better dressed here than at the opera in Peking, and definitely better dressed than the people in Canton.

The play was Candles of Dragon and Phoenix by Hung Fung — an old story set in the late Ch’ing period. Our interpreter, Mr. Woo, explained that “candles” referred to the nuptial ceremonies, “dragon” to the man, and “phoenix” to the woman. There were illuminated panels on either side of the stage to provide a running commentary. “Before liberation,” Mr. Woo translated, “nine marriages out of ten were unhappy ones.” By “liberation” they mean escape from their own serfdom under Chinese landlords and freedom from foreign dictation. The date given for “liberation” is October 1, 1949, when the Communist government declared the Chinese mainland to be a republic.

As the curtain rose, we entered a different world, the romantic colorful China of yesterday, with men of wealth and splendid dignity, idle women, respectful servants, cunning hangers-on, and corruptible messengers from the emperor. The play was well staged and beautifully costumed. It showed the evils of marriage as planned by the father and the matchmaker. There was a tyrannical father, a cruel stepmother, an ailing bridegroom, and a bride of lower social standing.

The actors sang their parts, for this was Chinese Opera. The sound comes to resemble the intoning chant heard in some Christian churches, but it rises at times to high falsetto, where a man’s voice can hardly be distinguished from a woman’s, while the orchestra, composed of old-style Chinese stringed instruments and drums, follows the dramatic mood — sad or gay, soft or deafening. The acting was excellent, the comedy obvious, and the spectators were spellbound.

At the intermission we made our way through the crowded, smoke-filled corridor and up a flight of stairs to a room reserved for us. We sat around a table covered with a clean white cloth while a woman in blue jeans and black felt slippers filled our glasses with boiling water from a large kettle. This is the drink that has protected China from dysentery for many years. In a home or an institution, tea leaves would have been added, and on trains packets of tea leaves can be bought.

Our companions were dressed much as we were, except that one of them (he was closer to the Communist Party than the others) wore a gray-blue jacket with a high round collar, like that of an officer in the French Army. One of the physicians was an old friend of ours. After graduating from the Peking Union Medical College, he had gone to Montreal in 1937 and stayed until 1939 on a Rockefeller fellowship doing graduate work in neurosurgery. All six of the Chinese physicians were men of long experience, and a good physician knows as much about families as he does about diseases. Here was an opportunity.

“Ask them,” I said to Mr. Woo, our interpreter, “to tell us what has happened to the family in China during these recent years.”

The dean smiled: “Our mothers came to the bridegroom’s house, veiled and carried in a red palanquin just like the one you saw on the stage. There have been many changes.”

Someone else spoke up. “Men used to remain where they were born. Now the sons are scattered.”

“Since liberation,” a third said, “the laws have been changed. It is now against the law to have more than one wife or to have any concubines. Married sons and daughters no longer continue to live under the same roof with their parents. That was possible for the wealthy. That was a part of Chinese capitalism. That has gone.”

Our companions were all entering the discussion now, and I was taking notes: “Young people arrange their own marriages today. At first, in the early days after liberation, our children went too far in their independence, and they made mistakes. Now, I think they are beginning to ask their parents’ advice.”

“They have their own home even if it is no more than a room or two in a commune or a factory area.”

“What about divorce?” I asked.

“Divorce is possible if both partners agree, but the judge makes an effort to persuade them to carry on. The husband must pay separation allowance to the wife unless she has a good job.”

“Do opium addiction and alcoholism contribute to family difficulties?”

“Opium is finished. It is no longer a problem in China. Alcoholism never was much of a problem here,” said the vice president of the Chinese Medical Association. “It has practically disappeared now as a cause of admission to mental institutions.”

“What about the population increase and the question of birth control?”

The vice president answered again. “The population has been increasing at the rate of two percent annually. But the present policy of the government is to limit the birth rate. Physicians carry out this policy as well as they can, especially the obstetricians. They organize family-planning clinics in all hospitals, and elsewhere in areas where there are no hospitals. They give advice in regard to contraception when asked.”

“How do they persuade people to follow the policy?” I asked.

“The people are urged to delay marriage at least until twenty-five for women and twenty-seven for men. When they do marry, we recommend that they postpone having children for several years, if possible. The argument is that small families are best for the mother’s health and that parents can provide better education for their children if they do not have too many. The average now is two children to each family.”

“The fact is,” one of the younger neurosurgeons interrupted, “that improvement in medical care is steadily lowering the death rate. That defeats our whole attempt to limit the population growth.”

“Yes,” I agreed, “medical advance is responsible for the population explosion in other countries, too.” I asked about surgical abortion, and was told that it is strictly illegal unless a committee of the local hospital recommends it on the grounds of the mother’s health, or because there are already too many children in the family. It is also forbidden to unmarried mothers except when health requires it.

We returned to our seats for the last act, and Mr. Woo resumed his running translation. At the end of the play many of the audience surged down the aisles, coming as close to the stage as they could, to clap and watch the actors take their bows.

OUTSIDE, the automobiles waiting for us were the only cars in sight. We drove off, my wife in the second car with several doctors and the woman “administrator.” Passenger automobiles, in general, belong to the government and are usually of English or German manufacture. China makes its own trucks and large passenger buses. We saw many of them throughout the country. The first car suitable for private use, the Phoenix, had just made its appearance. We were told about it, but we saw only one example.

China has no professional prostitutes, I was told as we were passing an imposing building at the confiuence of three streets. In the old days, that building was a world-famous brothel. Now it is used for reading rooms, public meetings, and table tennis— a sort of mammoth Y.M.C.A. for both sexes, without the C for Christian. We heard the chimes from the great clock in the customhouse, followed by the deep-toned striking of the hour, a stubborn Western voice in China’s largest city.

“Do people go to Christian churches?” I asked.

“Yes,” the dean replied, “if they want to. A church is kept open in each district of Shanghai.”

“What happened to the prostitutes for which Shanghai was so famous?”

“After liberation, they were rounded up and treated medically. Then they were taught useful trades and put to work.”

“Were there no backsliders?” I asked.

“Yes, but not many. They were arrested, and when possible, trained again and put to work. A few were sent away to hard labor. But most of them married. Some have done very well indeed.” My companions exchanged smiles. “More than one of these women,” someone explained, “has been elected to the People’s Assembly in Peking.”

We had reached the drive along the harbor now. Mr. Woo pointed to a building and remarked bitterly, “That is where the British Concession used to be. They put up a notice at the entrance of that compound. ‘ No admittance to Dogs and Chinese.’ ”

“I’m sure all British people would regret the insult today,” I said.

“Oh, it was not the people,” the dean said. “It was the imperialist government.”

The car stopped at our hotel. It is an old-fashioned structure rising high above the waterfront. Mr. Woo entered with us, and I asked him who had built the Peace Hotel.

“It used to be called the Sassoon Hotel,” he said. “It was built by Sassoon, who made money in China selling opium to the Chinese.” I looked at Mr. Woo. His face betrayed no emotion, but for the second time that night, there was bitterness in his voice.

My WIFE and I had come to mainland China as Canadian guests of the Chinese Medical Association, at the invitation of the president of the association in Peking. He had suggested visits to hospitals and colleges and places of interest, and lectures in different medical centers. That was their purpose.

Mine was to learn all that the doctors and educators could teach me behind the great wall of isolation. But our purpose went beyond that. We both believe that the way to peace in a warring world is through friendship and understanding on every level in each profession and occupation. When you meet your opposite number, it is easy to get his point of view and to see his world through his eyes.

Our experience at the play that night had been revealing. We had seen portrayed a well-to-do family of the empire, and the talk at intermission had told us much about the recent social changes. Were we getting the truth? A writer on Communist affairs had laughed at us before we started on our journey. “You will see what they want you to see,” he said, “and believe what they want you to believe.” What he had forgotten, perhaps, is that the way to the truth about men and women is through friendly contacts at first hand, rather than through analysis of data derived at a distance from spies and expatriots.

In general, when I enter an operating theater or a hospital ward and hear a medical discussion, I see the actual medical situation. When I talk to physicians, I get at the truth as they see it. When we wander through parks, we catch revealing glimpses that tell the truth of life in a thousand families. There can be no preparation, no putting; the best foot forward. When we traveled forty-nine hours by train from the south to the north across that vast country, we looked into innumerable passing homes and farms. We walked with the people on the platforms. Before reaching Shanghai, we had entered two-room homes, selected on our own initiative in towns and cities, and had visited a rural commune.

In the afternoon before we saw the play, my wife had visited one of Shanghai’s many day nurseries. This one was located in several old-style houses built around a court. Mothers brought their babies and toddlers in, she learned, at six o’clock in the morning before they went to work, and they called for them at four in the afternoon. The nursery had plenty of toys and beds, and the care was kindly. Discipline, teaching, and play went hand in hand, and the children were well led. Their clothes were amazingly patched. This bore out what we had been told — that the annual allowance of cotton cloth per family is very small indeed; although we had seen newly planted fields of cotton in the south. The patches, the cleanliness of the clothes, the appearance of the children, and their excellent behavior all bore witness to loving care at home.

Objective evidence came to us from every side. The small family unit remains strong in the face of poverty. Multiple families under one roof have disappeared, and the grandparent unable to work is often cared for by a son or daughter. The Chinese still visit the graves of their ancestors in the spring, and colleges take a recess for a few days so that student and teacher can devote the time to this pious pilgrimage.

The best opportunity to see people in the mass is in the parks on Sunday and holidays. In one of the Canton parks, there was a stadium, accommodating sixty thousand spectators, planned for soccer games and track sports. Another park looked down on the city from a hill, and we saw the lights coming on in the city while the golden harvest moon was rising. Looking down from the other side of the hill we saw a large double swimming pool, half for youngsters and half for adults. Lights were on, and the haunting music of a Chinese violin came up to us.

WHAT I saw, on my first visit to China in 1943, has made it easier for me to understand what is happening there today in the field of education and medicine. Under the most appalling wartime conditions, the people in Chungking and Chengtu were cheerful, clean, industrious, as they are now. They were our allies then: Mao Tse-tung in the north and Chiang Kai-shek in the south were fighting against Japan. I had come there because I was a surgeon and was familiar with secret scientific information that might be made available from Allied Research Councils if the Chinese could use it properly. Could we help the medical service of the army in the south? That was the question, and I had come to find the answer.

The surgeon general, Lu Chih-teh, whom we called Dick Lu, was a first-class physician trained in the Peking Union Medical College. He told me that Chiang Kai-shek’s army of five million soldiers called for nineteen thousand medical officers. He had fifty surgeons, only thirty of whom he considered well trained. The rest of his medical service consisted of orderlies. He did not seem to be dismayed. But I was — fifty surgeons to five million men! Even so, that was better than the proportion of civilian doctors to the Chinese population at the time.

Dick Lu gave me a good example of what a welltrained Chinese professional man can create for himself. He took me, with two Canadian Medical Missionaries, Stewart Allen and Leslie Kilborn, to his Medical Service Headquarters hidden away from the enemy outside Chungking. He was a modest little man who had taught physiology for eight years before he became surgeon general; but he astonished me with three unexpected achievements. He had complete statistics of army hospital admissions with totals up to the previous December (1942). The records were well kept; patients with war wounds (classified as to site of the wound) totaled 946,273. Those suffering from various diseases were slightly more numerous. Furthermore, a factory housed in multiple camouflaged bamboo huts was making excellent surgical instruments and artificial limbs—better limbs, it seemed to me, than those I had seen for amputees in the Soviet Union a month earlier. And an herbarium of more than two hundred acres was producing common drugs.

After the war was over, and after the Communists had driven the Nationalists from the mainland, foreigners were likewise swept out of the mainland by one device or another. Within two years (19491951) the exodus was complete, as George Kennan put it, “to the last man, to the last pound sterling, to the last dollar, to the last missionary.” And yet in 1962, only thirteen years after “liberation,” I found teaching hospitals and medical colleges in the major centers doing first-class work. How could that be, when there was only a handful of welltrained physicians in the vast country?

The answer is that the Christian medical missionary colleges and the Peking Union Medical College established by John D. Rockefeller had initiated the training of a few men very thoroughly, and that the flow of professional literature into China has never stopped. The wall of isolation that the Communist government sets up around the People’s Republic shuts off the people from the rest of the world, but there are very effective loopholes in it. A second factor is this: When they have had a liberal education, the Chinese are capable of sustained intellectual excellence and creative advance as well as hard work.

THERE is a remarkable renaissance of Western learning now going on throughout China. The mission schools have been taken over, and new colleges have been created in each of the departments of higher education. Western literature and textbooks are translated, but the entrance examinations, which still turn away millions of teen-agers, demand one Western language of each applicant. In spite of the drive for Western learning, the Chinese classics are not ignored.

During our days in Shanghai, I was invited to give an evening lecture on speech and perception. Actually, I myself was only an interested member of the audience, drinking tea while a young neurosurgeon, Dr. Chi, delivered my address in Chinese. He had written out his translation in Chinese characters, and it is interesting that his manuscript used only half as many pages as mine. He had memorized the first half, that on the cerebral mechanisms of speech, and to my complete amazement gave it without referring to the text. My former pupil was sitting beside me in the audience, comparing the address with the English text. He assured me that the Chinese presentation lost nothing. I had intended to give two separate lectures, but instead of that, they put them on at one sitting, with an intermission between the portion on speech and that on perception.

My lectures were all handled in the same way. The texts of five different addresses, which I put together under great pressure after reaching Peking, had to be handed over, together with the lantern slides. They were then translated by different men. The members of the audience were present by invitation, and a seminar of senior medical teachers was held for me a day or two later with good questions and good discussions in English.

Undergraduates were present at only one lecture. That was in Shanghai, where the young men stood in the garden and I could see their faces through the open windows. When we came out of the hall, they stood around our car, staring and silent. I grinned at the students and said “good-bye.” They smiled then, and a few echoed slowly “good . . . bye.” I wondered what they were thinking. How far removed is this new medical generation from us?

Our interpreter, Mr. Woo, accompanied us all through China. He is a man of thirty who looks younger than that. He had been a student in an arts college, planning to become an engineer, when he “was asked” to change. He became an interpreter then instead, and studying with teacher and linguaphone, acquired a good English accent. One day we sat at lunch after visiting a Buddhist temple in Fushan. We had seen no priests and no worshipers in the temple, so I asked him to tell me about religion in China.

“My mother,” Mr. Woo said, “used to wash her hands and burn incense every morning in our house when I was a boy. That was part of the religious ritual. And during the summer site would eat no meat. But we in the younger generation have no religion today. It is only the old people who continue that sort of thing.”

I looked at him and waited. But he felt he had disposed of the subject.

“You are wrong,” I said. “Some parts of your own ideology amount actually to a new and very compelling religion — to serve a cause which you and I have never discussed, because it is too close to political theory. You have a religion. Perhaps it is to serve the people of China.”

“Well, perhaps I have,” he said, “and I believe in Marxism.”

Then he looked at my wife and me. “Are you religious people?”

I nodded. “Yes, but we think ours is an enlightened religion. You will realize someday that, somehow, God is back of all that is good in the changing ideas and ideals around the world.”

Young Mr. Woo smiled quietly and said no more. When the smile faded, his face became inscrutable, “oriental,” with no expression except in the eyes.

Life in the People’s Republic of China is surprisingly puritanic and law-abiding. I saw no signs of chronic malnutrition. There are no extras, that is certain; but we never saw a beggar. There seems to be little or no thievery. Hundreds of bicycles are left parked outside the public buildings in Peking. None is locked. Hard work is the rule. Police are rarely seen except at traffic crossings.

The great movement that is bringing the Chinese Giant to his feet after so many years of apathy seems to be a popular one, at least with the younger generation. There is much evidence of pride in this new strength. How much discontent there may be,

I cannot tell. I do not know what the people really think of their political leaders. The common people, the professional people, talk very little of the world outside, a great deal about the scene within. Every man will tell you that the droughts and the floods of China can be controlled by reforestation and by dam-building, and he will boast that he has given volunteer labor to such projects. In the central highlands we saw large areas where the hillsides are covered with newly planted trees.

The common people believe, and I think they are sincere in this belief, that the United States intends to try to conquer the mainland. They believe that Chiang Kai-shek speaks for the United States from nearby Taiwan, and because of all this, there is fear among them and anger.

What we saw within the wall — small families clinging to their past and turning, old and young, to Western learning with high hopes and a sense of exhilaration — is, I suppose, only half of the picture. But as far as it goes it is true, without regard to the political aims of those who govern.

In a town near Canton, we watched three women pushing and pulling a heavy two-wheeled cart loaded with coal dust. I asked the dean of the Canton Medical College, “Do you think the people will be happier when mechanization comes to China?”

“It will come,” he answered, “and the people will not have to work so hard.”

I had hardly hoped for a direct answer. My thoughts were turning to the problems we face at home in the lands of Western plenty.

“All you have to face in China,” I said, “is the problem of too little. Wait till you face the problems of too much!”

He did not answer, but he looked puzzled.