Reinterpreting the Role of Traditional Chinese Medicine in Public Health in Rural China in 1970s

Xiaoping Fang, Ph.D. University of Technology, Sydney

12:30-2:00pm, 13 March, Wednesday The Global Health Histories seminar series The World Health Organization (WHO)

Chinese barefoot doctors attending the World Health Assembly (WHA), 1974

Map of Zhejiang Province, China

Map of Hangzhou Prefecture, Zhejiang Province, China

Map of Jiang Village Township, Yuhang County, Hangzhou Prefecture Knowledge Transmission and Structures Age Distribution of Barefoot Doctors (Unit: Person)

20 18 16 14 12 10 Number 8 6 4 2 0

• Sources: The barefoot doctor survey in Hangzhou Prefecture conducted from 2003 to 2005; Xiaoshanxian weishengju [Xiaoshan County Health Bureau], “1971 nian eryue tuijian qu hangwei xuexi mingdan” [The Trainee List Recommended to Study in Hangzhou Health School in February 1971], XSA, Vol. 25-1-38; Huanshan renmin yiyuan [Huanshan People’s Hospital], “Fuyangxian chijiao yisheng fuxun dengjibiao” [Registration Forms for Fuyang County Barefoot Doctor Re-training Class], October 1978, FYA, Vol. 74-3-29; Gaoqiao renmin yiyuan [Gaoqiao People’s Hospital], “Qingyunqu 1981 nian diyiqi chijiao yisheng peixunban huamingce” [Roster of the First Barefoot Doctor Training Class in Qingyun District in 1981], April 9, 1981, FYA, Vol. 74-3-29; Sandunzhen zhongxiyi jiehe yiyuan [Sandun Township of Integrated Chinese and Western Medicine], “Sandunzhen xiangcun yisheng qingkuangbiao” [Roster of Village Doctors in Sandun Township, Hangzhou City], January 17, 2005, SDA.

Percentage of Woman Barefoot Doctors in Hangzhou Prefecture, 1968-1985

100% 90% 80% 70% 60% Female 50% Male 40% 30% 20% 10% 0% 1974 1975 1976 1977 1978 1979 1980 1981 1982

Sources: Hangzhoushi weishengzhi, pp. 84-87.

Educational Backgrounds of Barefoot Doctors in Selected Years and Comparison with Villagers (Unit: 100%)

Period College High School Primary School Illiterate

Senior Junior Senior Junior

1978 0.00 24.1 44.8 18.9 12.0 0.00

1981 0.00 15.5 46.7 24.4 13.3 0.00

Average 0.00 19.8 45.7 22.65 12.65 0.00

1982 rural census 0.08 3.77 15.85 40.59 39.85

Sources: •Barefoot doctor survey in Hangzhou area conducted from 2003 to 2007; •Huanshan People’s Hospital, “Fuyangxian chijiao yisheng fuxun dengjibiao” (Registration Forms for Fuyang County Barefoot Doctor Re-training Class) (October 1978), FYA. vol. 74-3-29; •Gaoqiao People’s Hospital, “Qingyunqu 1981 nian diyiqi chijiaoyisheng peixunban huamingce” (The First Barefoot Doctor Training Class Roster in Qingyun District in 1981) (June 10, 1981), FYA vol. 74-3-29. •Zhongguo renkou: Zhejiang fence (Population of China: Zhejiang) (Beijing: Zhongguo caizheng jingji chubanshe, 1988), p. 348.

Barefoot Doctor Textbooks and Journals 1969-1981 Collected by National Library of China (Unit: book)

6

5 Books 4

3

2

1 Journals

0 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981

Sources: National Library of China website.

Barefoot Doctor Xu Peichun’s Reading List

Book Place & Time Way of obtaining Textbook for Rural Health Workers Hangzhou 1966 No indications

Common Medicine Dosage for Shanghai 1966 bought on May 24, 1969 in Fenkou Child District training class Preventing Respiratory Infectious Hangzhou 1970 Pamphlet distributed from the above Diseases, Common Chinese and Herbal Hangzhou 1970 Bought at District June 26 Mao Zedong Medicines in Zhejiang Province Thought Study Class in July 1970

Pesticide Usages and Poisoning Hangzhou 1971 No indications Prevention Manual for Health & Epidemic Hangzhou 1974 Awarded by Chun’an County Health & Prevention Epidemic Prevention Station in June 1976

Common Medicines Used by Shanghai 1975 Awarded by Hangzhou Prefecture Health Barefoot Doctors Bureau in June 26, 1976 Population Must Be Controlled Hangzhou Pamphlet distributed from the above

Sources: Supplied by barefoot doctor Xu Peichun, March 2004. The Knowledge Structure of Candidates for the Excellent Village Doctor Award in China, 2005 and 2010 2005 2010 Time of becoming barefoot doctors Category Total Before 1983 After 1983 Total Number % Number % Number % Number % Western 94 64.8 38 69 132 66 147 73.5 Chinese 36 24.8 15 27.2 51 25.5 51 25.5 Integrated 13 8.9 2 3.6 15 7.5 1 0.5 Mongolian 1 0.7 0 0 1 0.5 - - Tibetan 1 0.7 0 0 1 0.5 - - Chinese-Tibetan - - - - - 1 0.5 Total 145 100 55 100 200 100 200 100

Source: Zhonghua renmin gongheguo weishengbu [The Ministry of Health of the People’s Republic of China], http://www.moh.gov.cn/moh (access June 20, 2005); “2010 nian quanguo youxiu xiangcun yisheng houxuanren mingdan” [List of Candidates for the Excellent Village Doctor award in 2010], Jiankangbao [Health Bulletin], November 30, 2010 (accessed May 28, 2011). Average Number of Medical Staff Members in Commune Clinics (or Union Clinics) of Selected Counties within Hangzhou Prefecture (Unit: person)

County 1950s 1960s 1970s 1980s Fuyang 5.3 5.7 9.6 12.9 Xiaoshan 5.3 6.15 10.4 16.5 Lin’an 5.2 6.6 10.8 Hangzhou Prefecture 6.12 12 Average 5.3 14.7 National average 5.8 13.9

Sources: Xu, Fuyangxian weishengzhi, 68–69; Xiaoshan weishengju, Xiaoshan weishengzhi, 54–56; Lin’anxian weishengzhi bianzhuan weiyuanhui, Lin’anxian weishengzhi, 107–16; Hangzhoushi weishengju [Hangzhou Prefecture Health Bureau], “1965 nian weisheng shiye zonghe baobiao” [Comprehensive Statistical Health Work Form in 1965], HZA, Vol. 87-3-262; “Hangzhou diqu nongcun shengchan dadui shengchandui weisheng zuzhi qingkuang” [Survey of Health Organizations in Production Teams and Production Brigades in Rural Areas of Hangzhou Prefecture], 1975, HZA, Vol. 87-3-302; “Hangzhou diqu nongcun shengchan dadui shengchandui weisheng zuzhi qingkuang” [Survey of Health Organizations in Production Teams and Production Brigades in Rural Areas of Hangzhou Prefecture], 1976, HZA, Vol. 87-3- 307; Zhongguo weisheng nianjian bianweihui [Editorial Board of China Health Yearbook], ed., Zhongguo weisheng nianjian 1983 [China Health Yearbook 1983] (Beijing: Renmin weisheng chubanshe, 1983), 57. Percentage of Chinese Medicine Doctors in Commune Clinics (or Union Clinics) of Selected Counties within Hangzhou Prefecture (Unit: Percentage)

County 1950s 1960s 1970s 1980s Xiaoshan 59% 29.45% 29% 19.4% Lin’an 60.6% 47.33% 26.4% 22.7% Yuhang 71.5% 50.6% 34.9% 17.9% Seven counties 48.6%

Average 63.7% 30% 20%

Sources: Xiaoshan weishengju, Xiaoshan weishengzhi, 54–56; Lin’anxian weishengzhi bianzhuan weiyuanhui, Lin’anxian weishengzhi, 116; Yuhangxian weishengju weishengzhi bianzhuanzu, Yuhangxian weishengzhi, 80; Hangzhoushi weishengju, “1965 nian weisheng shiye zonghe baobiao,” HZA, Vol. 87-3- 262. Average Number of Barefoot Doctors per Commune Clinic in Selected Counties within Hangzhou Prefecture during the 1970s (Unit: person)

County Average Maximum (Year) Minimum (Year)

Fuyang 28.9 36.5 (1977) 23.5 (1973)

Chun’an 24.7 33.7 (1976) 16 (1973)

Jiande 23.5 53 (1970) 12 (1975)

Average 25.7 41.6 13.8

Sources: Xu, Fuyangxian weishengzhi, 73; Hangzhoushi weishengju hangzhoushi weishengzhi bianji weiyuanhui, Hangzhoushi weishengzhi, 87; Chun’anxian jihua weiyuanhui [Chun’an County Planning Commission], Chun’anxian guomin jingji tongji ziliao, 1949–1978 [Statistical Data of Chun’an County’s National Economy, 1949–1978] (Chun’an, 1980), 333–46; Yan, Jiandexian yiyao weishengzhi, 70. Epidemiologic Transition and Pharmaceuticals in the Villages

Prices for Major Western Medicines in Hangzhou Prefecture, 1953–1984 (Unit: RMB)

Medicines Specification Unit 1953 1957 1965 1969 1984 Penicillin 0.2 million bottle 1.12 0.83 0.31 0.25 0.14 Streptomycin 1 million bottle 2.84 2.15 0.62 0.43 0.28 Antondin 10x2ml box 0.94 0.78 0.80 0.61 0.69 Analgin 100x0.5g bottle 10.66 5.54 2.50 2.30 Tetracycline 100x0.25g bottle 170.13 18.13 6.00 3.50 Terramycin 100x0.25g bottle 177.88 10.25 4.38 2.50 Chloromycetin 100x250mg bottle 74.56 20.72 6.72 5.00 Sulfapyridine 1000x0.5g bottle 73.73 72.87 74.16 34.80 28.0 Sulphaguanidine 1000x0.5g bottle 17.00 16.72 15.00 14.17 13.0

Sources: Hangzhou yiyao shangyezhi bianzhuan weiyuanhui, Hangzhou yiyao shangyezhi, 254; Zhongguo yiyao gongsi, Zhongguo yiyao shangye shigao, 274. Vaccines in Four Selected Counties in Hangzhou Prefecture, 1949–1970

Vaccine Year of first inoculation Smallpox 1950 Typhoid, paratyphoid 1950 Bubonic plague 1952 BCG 1952–1957 Diphtheria toxin 1952–1954 Pertussis 1954 Epidemic Japanese b encephalitis 1957–1958 Anthracnose 1960 Diphtheria, Pertussis, Tetanus 1961 (DPT) Dysentery bacteriophage 1961 Polio 1962 Para-cholera 1962 Leptospirosis 1961–1966 Measles 1967–1970 Epidemic cerebrospinal 1970 meningitis

Sources: Yan, Jiandexian yiyao weishengzhi, 141–42; Lin’anxian weishengzhi bianzhuan weiyuanhui, Lin’anxian weishengzhi, 257; Xu, Fuyangxian weishengzhi, 15–16, 173–77; Xiaoshan weishengju, Xiaoshan weishengzhi, 139–79; Qian Xinzhong, Zhongguo weisheng shiye fazhan yu juece [Health Development and Decision Making in China] (Beijing: Zhongguo yiyao keji chubanshe, 1992), 850–86; Huang Shuze and Lin Shixiao, eds., Dangdai zhongguo de weisheng shiye [Health Development in Contemporary China], Vol. 2 (Beijing: Zhongguo shehui kexue chubanshe, 1986), 291–343. Incidence Rates of Notifiable Infectious Diseases in Hangzhou Prefecture and Zhejiang Province, 1949–1990 (Unit: 1/100,000)

6000

5000

4000 Hangzhou 3000 Prefecture Zhejiang 2000 Province

1000

0

Sources: Hangzhoushi weisheng fangyizhan, Yiqing ziliao huibian,1950-1979, 12; Zhejiangsheng weisheng fangyizhan [Zhejiang Province Sanitation and Epidemic-Prevention Station], ed., Zhejiangsheng yiqing ziliao huibian, 1950–1979 [Compiled Data of Epidemic Diseases in Zhejiang Province, 1950–1979] (Hangzhou: Zhejiangsheng weisheng fangyizhan, 1982), 1–4; Zhejiangsheng yiqing ziliao huibian, 1980–1989 [Compiled Data of Epidemic Diseases in Zhejiang Province, 1980–1989] (Hangzhou: Zhejiangsheng weisheng fangyizhan, 1994), 7.

Mortality Rates of Notifiable Infectious Diseases in Hangzhou Prefecture and Zhejiang Province, 1949–1990 (Unit: 1/100,000)

90 80 70 60 50 Hangzhou Prefecture 40 30 Zhejiang Province 20 10 0 Fatality Rates of Notifiable Infectious Diseases in Hangzhou Prefecture and Zhejiang Province, 1949–1990 (Unit: Percentage)

2 1.8 1.6 1.4 1.2 1 Hangzhou 0.8 Prefecture 0.6 0.4 Zhejiang 0.2 Province 0

Gathering and Planting of Medicinal Herbs in Cooperative Medical Stations in Hangzhou Prefecture, 1976

Production Brigades Brigades with a cooperative medical service County Gathering and planting of Area of medicinal herb fields medicinal herbs Total Total Total number % mu Per brigade number number Xiaoshan 750 736 165 22.41% 212 1.28 Yuhang 550 550 165 30.00% 473 2.87 Lin’an 636 581 180 30.98% 80 0.44 Tonglu 407 407 163 40.04% 98.9 0.61 Fuyang 589 451 292 64.75% 60.47 0.21 Jiande 515 492 281 57.11% 200 0.71 Chun’an 852 815 463 56.80% 307 0.66 Average 43.16% 0.97

Source: Hangzhoushi weishengju [Hangzhou Prefectural Health Bureau], “Nongcun chijiao yisheng weishengyuan jieshengyuan qingkuang” [Statistical Data of Rural Barefoot Doctors, Health Workers and Midwives], 1976, HZA, Vol. 87-3-307. Healing Styles and Medical Beliefs: Consuming Chinese and Western Medicine

Expenditures on Different Kinds of Pharmaceuticals in Jiande County, 1961–1983 (Unit: RMB 1000)

Source: Yan, Jiandexian yiyao weishengzhi, 110–11. Materia Medica Consumption Per Capita in Jiande County, 1960–1983 (Unit: jin or 500g)

Source: Yan, Jiandexian yiyao weishengzhi, 110–11.

Materia Medica and Chinese Patent Medicine Consumptions in Three Counties of Zhejiang Province, 1961-1978

Materia Medica and Chinese Patent Medicine Consumptions in Three Countries of Zhejiang Province, 1970-1987

Top ten medicines consumed per capita in Jiande County throughout the 1970s

Rank Pharmaceuticals 1 tetracycline 2 penicillin 3 Terramycin 4 Gastropin 5 piperazine citrate (for repelling ascarids) 6 anti-pyretics 7 painkiller tablets 8 Anlagin 9 ephedrine tablets 10 syntomycin

Source: Yan, Jiandexian yiyao weishengzhi, 110–11.

Conclusion

Thank you!