＂Barefoot Doctor＂： Public History and Private Memory

Wen Chen Yingfang

For readers, reading those social history texts that take "our own life yesterday" as the research object, especially those aimed at restoring and analyzing the daily life world of ordinary people, will bring some "adventure"-"the past is a foreign country", which may be necessary and possible for historians and social science researchers. As a witness of the life/events of that era, when readers accept the "history" constructed by researchers, they may activate their memories intentionally or unintentionally, and then pursue more "what happened" and "why". At the same time, they may feel various contradictions between personal experience and objective history, including doubts that "you seem to be in it". You may even feel the discomfort of personal memory being distorted, corrected, or even personal feelings, life experiences, etc.-the historical view of "contemporary history-free" exists not only in academic circles, but also among readers.

Nevertheless, it is still a kind of luck for readers to see the rise of contemporary social history research. Through the research of scholars, we can re-understand those past lives. They are not only an objective reference for us to sort out our memories and understand our personal/family history, but also, if we are interested, we can use other materials, including various memoirs, oral records and local chronicles, to try to exert our sociological and historical imagination, cross the barrier between public history and private memory, and enter a freer and broader knowledge world.

In Fang Xiaoping’s book "Barefoot Doctors and Modern Medicine in Rural China", "Jiangcun" is the field investigation point of his empirical research. Although the author came from sociology and adopted ethnographic methods of anthropology, he defined this study as a historical study, so his real name was used in the book. Jiangcun was once a people’s commune in the 1960s and 1970s, and now it is a street in Xihu District, Hangzhou. The author introduces the evolution of Jiangcun administrative divisions and the case significance of its medical system to the history of barefoot doctors in China.

In the research of anthropology and sociology, it is a common qualitative research method to discuss some attributes and characteristics of China society or the evolution process of the system from the case of a village and a place. In fact, this is also one of the main methods that the author has practiced for many years. This method requires researchers to have a better insight into the social system and various structural forces behind the case, as well as the deep logic of social changes. Fang Xiaoping’s method has the corresponding consciousness of his academic transformation from social science to social history research, which makes us truly see the excellent text of "Understanding China from one place" —— from tracing back to the local medical world, excavating local chronicles and field materials (especially in-depth interviews with relevant groups), to introducing and analyzing the background of national system and its social structural strength, etc. This research presents us with a sincere and rigorous academic text of contemporary social history.

However, as a reader, I am still curious about the "Jiangcun" in the book: it is the name of a people’s commune, and the book also mentions that it is a "central village". What is its specific settlement form and social attributes? In the context of modern China, "village" can be understood as a natural village, or an administrative division level in rural areas, and it may also be the name of a place. As far as I know, most of the party and government organs of people’s communes in the twentieth century were established in market towns.

According to the relevant information in the book and on the Internet, Jiangcun was originally a market formed in the early years of the Qing Dynasty, and was once known as "Jiangcun City". Although geographically adjacent to Hangzhou, it has been an independent "township" in administrative divisions since the Republic of China, but more often it has been divided or merged into different townships, and it has belonged to different districts and counties (Hangzhou County and Yuhang County) in different periods —— that is to say, if it is put back to the historical process, "What village is Jiangcun" is indeed a long story.

In any case, Jiangcun was a people’s commune in the suburbs of Hangzhou when the barefoot doctor system was implemented in the twentieth century, and it was also a town where the commune institutions were located. For such a place, it is certainly not difficult for us to define and understand it in the category of "China rural society". For a long time, even in the administrative divisions of municipalities directly under the central government or provincial capitals, except for some industrial satellite cities, suburban counties are usually classified as "rural areas", and they belong to two different management systems: urban and rural. Up to now, there is still a distinction between "street" and "town" and "township" in the framework of grassroots social administration in urban suburbs. At the same time, different from the county-level city in the administrative level, the county as an administrative division and the county-level society in the sociological perspective, including small and medium-sized towns, still belong to the rural society in the national governance system and some academic paradigms.

But this does not prevent readers from having different perspectives and imaginations-everyone will see China from a "special place" of their own, and understand the world according to their own knowledge inventory and thinking habits. "XX City" and "XX City" were once very common town names in the south of the Yangtze River around Taihu Lake Basin. Because the author grew up and worked in this area for a long time, the name "Jiangcun City" naturally reminds me of the concept of "Jiangnan Town", and from this, I can understand the society described by Fang Xiaoping and imagine the life world that the author did not involve in the book. Although my field visits to these places and the research topics involved are very limited in my sociological research career for many years, the towns in the south of the Yangtze River are indeed one of my starting points for seeing China, and the "city-town-township" relationship model in the south of the Yangtze River formed since the Ming and Qing Dynasties is also an important basis for me to think about the urban-rural continuum.

Jiangnan research is an important field in academic circles. In recent years, some studies have attracted much attention because of their re-evaluation of the development level and significance of towns in Jiangnan area in Ming and Qing Dynasties. Influenced by it, in my own investigation of urban community life in Pudong, Shanghai in the past few years, I began to try to understand what changes have taken place in the "suburban rural areas" in Shanghai during the People’s Commune period and the relationship between cities, towns and villages in other counties in the south of the Yangtze River, and what kind of logical relationship exists between those changes and the current "urbanization" or "suburbanization".

As we know, in the 1950s and 1970s, in order to develop heavy industry, the country put the emphasis of industrialization and urbanization on the central and western regions, and "Mr.’ s postpartum life" was also an important principle of urban planning and municipal management during the socialist construction period. In this process, the construction of towns in the southeast coastal areas has stopped for a long time. However, the stagnation of urban development does not mean that the society remains unchanged-although the dense urban network in Jiangnan during the Republic of China, its physical form and spatial distribution were basically preserved before the end of the 1970s.

First of all, in terms of administrative divisions, according to the scale and spatial distribution, the towns in the south of the Yangtze River are divided into central towns and rural markets. The central town is usually the location of commune institutions. Some residents in the town are classified as "urban residents" because they work in party and government institutions, cultural, educational and health units, or are arranged to continue to engage in industrial and commercial activities, and some elderly residents who are unable to engage in agricultural labor. The rest of the residents who were originally engaged in non-agricultural labor were mostly classified as agricultural registered population, and were arranged to engage in agricultural labor in production brigades around the town (generally called "vegetable brigade" or "town production brigade", etc.). Other towns within the commune are generally classified into production brigades around the market town, and the residents in the market town are generally classified as agricultural registered permanent residence, engaged in agricultural production, except for a few people engaged in non-agricultural occupations.

Secondly, with the collectivization of industry and commerce, the socialist transformation of ownership, and the promotion of policies such as unified purchase and marketing of agricultural products, the government closed down the market in the town and a large number of shops along the street in the central town. In the market of non-central towns, except for the extension shops of supply and marketing cooperatives and credit cooperatives, only individual agricultural and sideline products market trade points (dynamically regulated by the government) and teahouses are generally reserved. That is to say, during the social turning point in the 1950s, the town society in the south of the Yangtze River actually experienced a process of rural development, including the agricultural population and the rural space.

At the same time, the medical resources in the villages and towns in the south of the Yangtze River showed a process of gathering in the central towns. As Fang Xiaoping described in his book, since the early 1950s, the government has required private clinics and individual practitioners to organize and set up joint clinics. This policy has been widely implemented. Take Changshu County, Jiangsu Province as an example. Private clinics and medical practitioners originally scattered in towns, markets and villages around the county began to organize in 1951, and by the end of that year, 51 joint clinics had been established. Outside the county, joint clinics are mostly established in central towns and market towns (some joint clinics set up branches in other market towns in the township). By 1957, the number of joint clinics had grown to 91. However, at the beginning of the following year (1958), the government asked the joint clinics in various townships to be unified and merged, and a township-run private hospital was established in the central town of the commune (renamed "commune hospital" after the establishment of the people’s commune in September of the same year). By 1962 (in January 1962, 14 communes and a farm belonging to Changshu County were classified as the newly established "Shazhou County", which is now Zhangjiagang City), there were 33 commune hospitals and commune joint hospitals in Changshu County, which were renamed as "commune hospitals" in 1965. In this process, the number of self-employed doctors in society decreased rapidly, accounting for about 21.8% of the total number of local medical practitioners in 1957, and basically disappeared in 1958.

The author was born and raised in a town in Dongxiang, Changshu. At different times in history, the local area was once the central town where districts, townships and communes were located. In addition to the central town, there are several rural market towns in the commune (three in the early 1950s, one of which was later included in another commune). There is a hospital and a "medicine shop" in the town. Recently, because of reading Fang Xiaoping’s research, I looked curiously at the medical career in the local town records, and found that doctors in local towns and villages were distributed all over the country during the Republic of China. In addition to the clinics of internal medicine, surgery and gynecology in several towns, some doctors practiced in the countryside. Some of them were famous doctors handed down from generation to generation, and some came from local famous gentry families. There are four "medicine shops" in the central town, and one and three in the other two market towns.

That is to say, doctors and pharmacies that were originally distributed in various towns and villages closed down one after another in the 1950s, or concentrated in the central town of the commune. Such a change in the medical system in villages and towns in the south of the Yangtze River is undoubtedly beneficial to the government’s management of the medical industry and health care system, as well as to the government’s promotion of epidemic prevention and the improvement of medical technology, including the setting of hospital beds, the allocation of medical equipment and the training of medical staff. But at the same time, the medical resources in the township society were unified and concentrated in the central town of the people’s commune. Such a gathering of medical resources will undoubtedly increase the difficulty for farmers to ask for medical treatment. In the author’s opinion, the organic commercial system and living space of city-town-country, which has been formed for a long time in Jiangnan since Ming and Qing Dynasties, was changed in the rapid social changes in the 1950s, which inevitably affected the daily life of farmers. In fact, this constitutes a realistic background that local grass-roots governments began to restore agricultural and sideline products trading points in some market towns in the early 1960 s and set up "comprehensive stores" and semi-medical and semi-agricultural health workers in production brigades.

This perspective may also be used to explain why the earliest barefoot doctor appeared in Jiangzhen, Chuansha County, Jiangnan area in 1965. As Fang Xiaoping pointed out, the barefoot doctor system, which was officially named and popularized in the late 1960s, is actually an extension of the original brigade health worker system.

In the book, Fang Xiaoping convincingly shows, with empirical data, that factors such as the efficacy of western medicine in quickly treating diseases and price changes are important factors for farmers to widely accept western medicine. In this process, barefoot doctors have played an important media role. But as far as my experience is concerned, the popularization of western medicine is also influenced by the industrialized system.

Traditional Chinese medicine has always been an ordinary medicine in small towns in the south of the Yangtze River. I still remember seeing the dregs dumped in the middle of the road on the roads around the town. It is said that patients believe that the dregs they have drunk will be cured quickly if they are trampled by many people. But since I was a child, I don’t seem to have the impression of drinking Chinese medicine, and I don’t remember cooking Chinese medicine at home in those days. When I think about it today, it’s not because my parents reject Chinese medicine, but because there is a clinic for western medicine in their work unit. Workers and their children in the factory will go to the clinic if they have a cold, cough or various minor illnesses. The factory doctor is a female doctor assigned from the county seat. She can directly prescribe prescriptions, fill prescriptions and give injections.

Parents’ unit is the early product of the country’s socialist industrialization. When the Korean War broke out in 1950, because the United States imposed a cotton embargo on China (cotton was not only the raw material of cotton textile industry, the pillar industry of China’s light industry at that time, but also the strategic material needed to make explosives), the government immediately managed the domestic cotton purchase and vigorously promoted cotton planting. At the same time, the government set up a state-owned cotton processing factory in the cotton planting area as quickly as possible-the factory where my parents were located was established in 1951 and put into production that year. Similar to the third-tier factories established by the state in the central and western regions, the unit provides various internal service facilities and welfare benefits for the daily life of employees and their children. Many of our children basically grew up in the factory as "children in the factory".

Recently, looking through the town records, I accidentally saw that there were three local western doctors practicing medicine in the countryside during the Republic of China. In addition to one in the central town and another market town, there is also one in a private ginning factory in the town-it turns out that there is a precedent in the local town for enterprises to hire western medicine to practice in the factory. This made me realize that the popularity of western medicine in urban and rural areas in the south of the Yangtze River is closely related to the development level of commodity economy and the degree of industrialization in history. Different from traditional agricultural labor, in modern factories, one worker holds one post, and the physical condition of employees is directly related to the normal operation of machines and the production efficiency of enterprises. It is not difficult to understand that business owners have a demand for western medicine that can cure diseases quickly.

This can also be used to explain the formation mechanism of the "labor insurance and medical care" system after 1949. According to the local records of Changshu County, when the new regime was established in 1949, several factories in the county provided free medical benefits for the employees of this unit. Since 1951, some qualified state-owned factories, enterprises and institutions have implemented "labor insurance medical care". In addition to free medical care for employees, their immediate family members have enjoyed half-fee medical care, and some larger units have started to run their own medical and health care rooms. It is reported that in 1952, 12 factories in the county implemented labor insurance medical treatment, and in 1959, the number of such units increased to 132 (benefiting 12,900 employees). By the end of 1970s and 1980s, some collective enterprises began to set up health care rooms in factories. At the same time, due to the rapid rise of township enterprises in southern Jiangsu, the number of employees enjoying labor insurance medical care in the county increased to 200,000 in 1985.

These medical history information in local history made me realize that the history of industrialization constituted an important mechanism for the popularization of western medicine in China, and the formation of labor insurance medical system had been gradually promoted from bottom to top.

As far as I can remember, most of the cases in which factory workers were sent outside for medical treatment due to serious illness were due to work-related accidents. At that time, if workers were disabled at work, they would get medical/living security. There was a master in the factory who lost a foot in an accident, and later installed a prosthetic foot, and has been working in the original technical post. In the 1980s, a young worker lost an arm in an accident, and was still left in the asset management team of the enterprise until the factory was finally transformed. As for the story of employees’ serious illness medical treatment, from childhood to adulthood, what I heard most from the old employees was my father’s business. "Your father got tuberculosis when he was young. At that time, we all felt that he was definitely dying. I didn’t expect to be cured." My father’s lung attack was at the beginning of the factory, and I was not born yet. I asked my father about it several times later, and every time he replied simply: "That’s because the country bought me Remifentanil medicine with foreign exchange." On one occasion, he also mentioned that for his recovery, the factory canteen once cooked special nutritious juice for him every day.

Tuberculosis, commonly known as "consumption", was an infectious disease that was similar to a terminal illness until the invention of the specific drug "Remifentanil" (isoniazid, synthesized by German doctor of chemistry in 1912, started clinical trials in new york in 1951, and was first listed in the United States by Roche in 1952). In the fifties and sixties, although there were specific drugs abroad, they were still rare in China. In some memoirs published in recent years, we can also see the past when someone in Shanghai used gold to entrust relatives and friends in Hong Kong to buy medicine. As an ordinary employee of a local state-owned enterprise, my father was able to get such medical treatment, of course, not because of his special political status. I believe that it is mainly because of his skills. Under the industrialized national system in the 1950s and 1960s, it should be a special case for the scarce senior technicians.

 

Looking back today, we can easily see some logics of the allocation of national medical resources in the era of socialist industrialization under the background of the Cold War-that is, utilitarian logic with the characteristics of giving priority to efficiency, means obeying goals, and results being more important than everything else. Under such logic, the developed areas of the former commodity economy in the southeast coast have experienced a process of de-urbanization, including the spatial agglomeration of social medical resources. At the same time, a social system of differentiated allocation of national medical resources has been gradually established among different occupational groups. In the late 1960s, the rural cooperative medical system and its barefoot doctor system appeared under such a social background. It is a great pity that such a system was structurally and more finely applied to the new medical security system in the later social evolution.

Based on the same logic, in that special country’s industrialization period, workers and their labor and life were once endowed with the attribute of "public" and were considered to have the value of "for the country", which needed the protection of enterprises and the state. In contrast, in the tide of industrialization since the 1990s, workers have been relocated to the capital market, which has given hundreds of millions of farmers the opportunity to enter the labor market freely. But at the same time, the meaning of "public" of labor is gradually dissolved, workers’ lives are classified into private areas, and even the identity of "workers" is replaced by special labels such as "migrant workers", "migrant workers" and even "factory workers". These changes are attributed by some scholars to different thoughts or doctrines, and what I see from the empirical social history is the continuity of the logic of state governance.

(Barefoot Doctors and Modern Medicine in Rural China, written by Fang Xiaoping, translated by Dong Guoqiang, Gan Lin and Wang Yiyang, Social Science Literature Publishing House, 2024).