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Fwd: [OrderofSkullandBones] Fwd: Cracks in the Foundation: Frederick T. Gates, the Rockefeller Foundation and the China Medical Board

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    ... Begin forwarded message: From: Robert Millegan Date: July 2, 2005 8:54:44 AM PDT To: OrderofSkullandBones@yahoogroups.com Subject:
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      From: Robert Millegan <roadsend@...>
      Date: July 2, 2005 8:54:44 AM PDT
      Subject: [OrderofSkullandBones] Fwd: Cracks in the Foundation:  Frederick T. Gates, the Rockefeller Foundation and the China Medical Board




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      From: "Aaron E. Baldwin" <aaron@...>
      Date: July 1, 2005 9:27:24 PM PDT
      To: Linda Minor <lminor@...>, Kris Milligan <ramillegan@...>
      Subject: Cracks in the Foundation:  Frederick T. Gates, the Rockefeller Foundation and the China Medical Board


      Cracks in the Foundation: 
      Frederick T. Gates, the Rockefeller Foundation,
      and the China Medical Board

      John S. Baick
      Western New England College1



           As his lengthy career neared an end, Rockefeller advisor Frederick T. Gates made a bold and unsuccessful proposal to the trustees of the Rockefeller Foundation in 1924, asking them to invest $265 million in the China Medical Board. Founded in 1914, the China Medical Board (CMB) was one of the earliest ventures of the Rockefeller Foundation, the most prominent of the Progressive Era's giant secular philanthropic foundations. The CMB was also the last major philanthropic effort by Gates, the man most responsible for shifting the Rockefellers from denominational charity to international philanthropy. After a decade in existence, the CMB had not come close to realizing the hopes of its founder. Only with this massive, unprecedented infusion of capital, Gates explained, could his dream "spring into existence full panoplied."2 This dream was never fully realized because of its astonishingly grandiose scale and complexity: its goal was to make Chinese medical care the finest in the world, and in the process close the chasm that he saw between denominational Christianity and the needs of the modern world. Although the story of the China Medical Board is the story of a failed vision, it also affords a glimpse of the cracks at the base of modern American philanthropy.


      1

           American secular capitalist philanthropy has its origins in the ill-defined border between the Gilded Age and the Progressive Era, as newly-created foundations—brazenly confident in their inevitable success—sought to use their founders' immense wealth to change American society and the world. These foundations embody some of the hallmarks of Progressive thinking, such as the faith in experts and in their ability to address social problems. But these new institutions also reveal many of the weaknesses of the era, including elitism, arrogance, and naiveté. It is ironic that these institutions were called foundations, for they were far from deep or secure, but enmeshed in the agendas of their founders, officers, and the nation. As a crucial building block for the Progressive Era, foundations were almost laughably flawed in their conception and contradictions. Indeed, a closer examination of the most notable of these foundations—the Rockefeller Foundation—reveals profound cracks in matters of ideology and implementation.


      2

           To understand this tension, one should start with Frederick T. Gates, the driving force behind the creation of the Rockefeller Foundation. Gates was less a representative Progressive figure than a transi- tional figure from the Gilded Age to the Progressive Era. His creation of the China Medical Board is an important case study to examine the opportunities and contradictions of capitalist philanthropy. The Rockefeller Foundation has been subject to a broad range of scholarship ranging from the hagiographic to the hypercritical. The history of one piece of the Rockefeller Foundation suggests that there is a need to revise and complicate our understanding of one of the earliest and most influential of the secular charitable foundations.


      3

           The China Medical Board has been attacked by critics as a clear example of American imperialism, and lauded by its supporters as an admirable effort of American benevolence. It has also been overshadowed by Rockefeller ventures such as the Rockefeller Institute for Medical Research and the General Education Board.3 This article argues that the story of the China Medical Board reveals the tensions present in the formative period of American philanthropy. By looking at the origins of one of the Rockefeller Foundation's earliest yet least well understood ventures, one can see the cracks in the foundation of the world's most significant secular philanthropic institution. To understand the history of the CMB is to delve into a series of public and private negotiations that stretched from New York to Peking.4 These negotiations involved some of the most prominent members of the American medical and Protestant establishment, and originated within the genteel conscience and passionate vision of Frederick Taylor Gates.


      4

           To create the China Medical Board, which officially sought to revolutionize medical care in China, Gates assembled an eclectic coalition of forces that was often at cross-purposes to his own. His "closely guarded" mission was one that has eluded both the critics and defenders of the CMB, a mission that was simultaneously radical and naive: converting Western missionaries by shifting their efforts from ministering to souls to ministering to the bodies of the "hated heretic."5 Rather than viewing China through the nineteenth century missionary lens of a mass of heathens to be converted, Gates placed his faith in his own notion of Christianity and in the growing sect of American science.


      5

           Gates, like his Puritan forbears, was armed with an enormously powerful sense of how to reorder the world, and if the Rockefeller Foundation was not a "city on a hill" by name, it surely was in spirit. It is perhaps not surprising that a descendant of the Puritans would seek to reorder Protestant Christianity, but it is surely indicative of the times that his primary spiritual touchstones would include not just the scriptures but also scientific monographs.


      6

           At the intersection of philanthropy, imperialism, business, religion, and science, the China Medical Board was the last major effort of the Rockefeller advisor Gates, who had been reshaping Rockefeller philanthropy over decades, shifting the direction from religious charities to decidedly more secular pursuits like medical research and education.6 In his final philanthropic effort, Gates would return to the ambiguous question of religion which had plagued him all his life and seek to answer it with what he saw as the clarity of modern medicine.


      7

           Frederick T. Gates was a member of the first generation of "foundation officers," one of a handful of professionals who were creating the new field of large-scale, private, secular philanthropy.7 This was a time when an increasing reliance on such notions as "expertise" meant the ascent of such groups as physicians and academics, a time when moral authority and leadership were migrating from such traditional sources as religious organizations and missionaries to new secular ministers like philanthropists and "experts."8 Gates' efforts in creating (and eventually losing control of) the China Medical Board illuminate the shifting terrain of authority and power in philanthropy in the early twentieth century.


      8

      Life Before Rockefeller


       

           Gates' early years were marked by two concerns that would finally come together in the China Medical Board: religion and medicine. Frederick T. Gates was born in upstate New York in 1853, the son of an evangelical Baptist minister, and a descendant of a long line of Pilgrims and Puritans in which religious orthodoxy burned brightly. His poor rural childhood was filled with illness and death, and the inexplicable death of a brother was a tragedy that would scar the entire family. Gates would later judge such episodes as preventable, but to Gates as a child these moments were simply pieces of a difficult life. It would not be until he reached the position of Rockefeller advisor that he would fully grasp the weakness of American medicine.9


      9

           As Gates matured, he grew increasingly disenchanted with organized religion, as a life shaped by an evangelical faith left him wanting, with "no other result than agitation and resistance."10 He resisted many of the tenets of what he called "doctrinal speculation," and felt no "deep sense of guilt. . .and little fear of hell." If he rejected some of the forms of organized Christianity, he did develop a self-righteous moral code and a paternalistic sense of responsibility, and what he lacked in specific doctrinal faith he compensated with his burning conviction that Christianity was about a "life of disinterested public service."11 Gates attended the University of Rochester in the 1870s, an experience which reinforced both his desire to enter public service and suspicions about denominational Christianity. In upstate New York, however, a man of modest means had few outlets for such nondenominational evangelical fervor.12


      10

           Despite his doubts, the need for stability and a regular income were strong. Following the path of least resistance, Gates trained at the Rochester Theological Seminary and entered the ministry. It was a practical move for a young man who wanted to achieve a measure of independence, but this was a job rather than a calling. His formal preparation for a life of the cloth included practical and somewhat cynical advice on preaching. A new pastor, he was taught, should amass a proverbial "barrel" full of several hundred sermons, and draw on this barrel for a weekly sermon. After a few years, the barrel would be empty, and the pastor should move to a new congregation, and the full "barrel" could be used again and again.13


      11

           Gates began his pastoral career in Minneapolis in 1880, where he proceeded to empty the barrel for a few years. Although these were years marked by "uninterrupted prosperity" that sharply contrasted with his poor rural childhood, Gates quickly tired of his Minneapolis pastorate. Gates was also struck by the limitations of medicine, as his first wife died of an ailment "never. . .properly diagnosed by our physician."14 To add insult to his loss, he was approached by what he derisively called the "usual quota of faith healers, Christian Scientists, and medical non-descripts [sic]" seeking support from their pastor, and "actively canvassed" by homeopathic physicians seeking public validation from the local minister.15


      12
           A new opportunity came in the form of Baptist fundraising. Gates speculated that it was his "irrepressible" nature and "interest in everything" that led him to gain influence on "various influential boards and meetings." He "mastered in minute detail the history and present condition of every mission field in Minnesota," and received favorable attention from church leaders and prominent lay Baptists.16 He distinguished himself in raising money for education, noting that his work was "the only successful money-raising campaign that Baptists had seen for many years." Gates revitalized an otherwise parochial field, and his ability to marshal facts, figures, and disparate individuals would serve him well in his later career.17
      13

           Gates came to the attention of national Baptist fundraising efforts and helped in the effort to found what would become the University of Chicago, leading to his first contacts with the businessman and Baptist John D. Rockefeller. Besides convincing Rockefeller to give millions in support, Gates made a strong and lasting impression on someone who was searching for help with his charitable work. In 1891, Rockefeller hired Gates.18


      14

           Gates' decision to turn from his stern Baptist upbringing to another career was not unusual for his generation, for the face of American Protestantism was being redrawn in these years, and the dawning Progressive impulse led some to follow such increasingly secular paths as liberal Protestantism and the Social Gospel.19 Yet he did not accept the offer without doubts, for Rockefeller philanthropy in the early 1890s was denominational and modest, with no hint of the massive, focused giving that would mark the great philanthropic foundations of the era. But the job was a step further away from the limited horizons of Gates' upbringing.20


      15

      Gates and the Rockefellers


       

           The cause for which Gates would come to feel most passionate was the advancement of modern scientific medicine. As a Rockefeller advisor, Gates would complete his journey away from the doctrinal faith of his father, with medicine becoming his new denomination. But before Gates could envision a future in which modern medicine would be in the vanguard of civilization, he would first put in years of work for the Rockefeller family.


      16

           Rockefeller biographer Ron Chernow argues that Gates was one of several 1890s' hires that Rockefeller made to distance himself from the earlier, bruising work that had made Standard Oil so powerful and notorious. These new men could act both with clean consciences and clean slates. Gates in particular, as a former minister, possessed a moral standing with which Rockefeller was eager to associate. And though Gates would soon come to occupy a large role in Rockefeller business, he was kept separate from the often unclean affairs of Standard Oil.21


      17

           Gates' job was to bring order to Rockefeller charity, which was deluged with tens of thousands of requests a year. Gates focused on larger gifts to state and national bodies, shifting giving from what he called "retail" to "wholesale."22 It is illuminating to see Gates employ such corporate vernacular, for he brought the corporate managerial innovations of the Gilded Age—what business historian Alfred Chandler has called the "visible hand"—to Rockefeller philanthropy.23 As Rockefeller was one of the pioneers of the restructuring of business, Gates was a pioneer in bringing these practices to philanthropy, effec- tively becoming the manager of the business of Rockefeller philanthropy. Rockefeller, whose own Standard Oil had benefitted so much from a similar strategy, heartily approved.24 Gates was a victim of his own success, for Rockefeller would soon rely on him for financial as well as philanthropic efforts.25


      18

           The demands of his dual philanthropic-business career nonetheless left Gates with a singular platform to implement his own ideas, for he had earned the trust of John D. Rockefeller. In 1897, Gates began a fundamental reorganization of Rockefeller philanthropy, going beyond his centralization efforts toward a shift into entirely new fields. He embarked on an investigation of American medicine, returning to a theme that had troubled him his entire life.26 Gates had long held the belief "that medicine as generally taught and practiced in the United States was practically futile."27 He plowed through Dr. William Osler's Principles and Practice of Medicine, a thousand page survey of American medicine first published in 1892. Osler was the preeminent physician at the nation's finest medical school, Johns Hopkins. The book, Gates explained, "confirmed my suspicion" about the poor condition of medicine in America, especially the almost total ignorance about disease. Here was an answer to the bedeviling questions of illness and death that had plagued him, and here was a bastion to replace his eroding Baptist faith.28


      19

           Gates' conversion was continuing, with Osler as his spiritual text and the transformation of American medicine his new mission. But spreading his new faith would not be a simple task, for this was an era before professional expertise in fields like medicine was recognized and valued. Medicine was a local matter, and the vast majority of physicians were poorly trained. He would also have to overcome the doubts of Rockefeller himself, who is described by a biographer as being "emotionally wedded to traditional medicines." Indeed, the man who would be prodded by Gates into being a great patron of modern medicine "smoked mullein leaves. . .to heal respiratory problems and never lost a residual suspicion of medical doctors."29 Yet despite these obstacles, Gates oversaw—and perhaps more accurately, managed—the 1901 creation of the Rockefeller Institute for Medical Research, which would dramatically change the field of medical research. The Rockefeller Institute was also the first philanthropic foundation to have its own director and board, a hallmark of Gates' desire to bring business practices into benevolence.30


      20

           But if the Rockefeller Institute was a sign of Gates' new faith, it did not directly address the practice of medicine in America, nor did it address his frustration with American Christianity. In 1905, Gates convinced Rockefeller to at least give to another denomination, granting a request for $100,000 to the Boston-based Congregational Board of Foreign Missions. This was Gates' first effort at shifting Rockefeller toward the nexus of religion and medicine, for one of the focal points of the Congregational Board was medical missionaries.31


      21
           This bequest led to a national backlash, as news of the gift was interpreted by Progressive journalists and Protestant religious leaders alike as an unsolicited attempt by Rockefeller to use his "tainted money" to improve his image. Indeed, the words "tainted money" would linger in the public imagination for years.32 This incident rekindled all of Gates' distrust for American denominational Christianity. By the time the Congregational Board acknowledged that the gift had been solicited, the damage had already been done both to the Rockefeller's reputation and to the efforts of missionary boards to raise money from Rockefeller. It would be "ten years before the greater foreign boards" would get "their great gifts for medicine and education in foreign lands" in the form of the CMB.33
      22

           A plausible argument can be made that Gates' decision to focus on China was because he wished to avoid the tangled skein of American Progressivism. Although Gates approved of many of the general themes of Progressivism—the search for root causes, the reliance on experts—he was also aware that Rockefeller was viewed by many Progressives as one of the great problems of the day. Gates was deeply scarred by the "tainted money" episode, and his reluctance to engage in new domestic philanthropic work in such an atmosphere is understandable. Yet when Gates turned Rockefeller philanthropy to look toward China, his effort should be seen in a far larger context than just avoiding Progressive vitriol. It is most clearly in the CMB that Gates' faith in modern medicine, his doubts about sectarian Christianity, and his skills and influence as Rockefeller philanthropic manager would come together. It is also in the CMB that one can locate Gates as a note in a general chorus of American interest in China.


      23

      Looking Toward China


       

           In the early twentieth century, Americans commonly viewed China as at once a vexing problem and a tremendous opportunity.34 Businessmen, including the Rockefellers, eyed China as the most important new market. Missionaries saw China as the most important battle for a war to save hundreds of millions of souls. And political leaders, with the Philippines an American possession since 1898, saw China as tantalizingly close. There was a growing sense that the two nations had a "special relationship" that both allowed and required the U.S. to shape China.35


      24

           Gates' interest in China dates back to his college years in the 1870s, when some of the most "powerful" and "formative" lessons he learned included those about the condition of China. Gates was taught that the English and Russian rivalry for dominance in East Asia would lead to the "break up of the frozen civilizations of the East."36 By the early twentieth century, this rivalry included all of the major Western powers, including the United States.


      25

           Against this background of personal and national interest, Gates received a 1906 proposal calling for the creation of a nondenominational Christian university in China. The two lead writers were Ernest Burton, Gates' classmate at the Rochester Theological Seminary, and Harry Pratt Judson, president of the University of Chicago. China, they argued, was the key to the world's future, and it was America's responsibility to educate the Chinese. They added that a Christian university would bolster the American missionary presence.37 Included with the proposal was a letter from a Baptist missionary, who dreamed that the proposed university would function as the headquarters for a new "Christian Crusade," pitting the forces of God and good—"the great missionary body"—against the teeming "heathen" Chinese masses, thus advancing the "far-flung battle-line" of "our Western civilization."38


      26

           Burton and Judson were both acquaintances of Gates, but it is clear that they were not well-acquainted with the sentiments of the ex- minister. Gates' drift from denominational Christianity was complete by 1906, and he had already reached the conclusion that "Christ had neither founded nor intended to found the Baptist Church, nor any church."39 Gates must have seen the proposal—especially the letter from the Baptist missionary—as a reminder of the parochial nature of sectarian Christianity. And—as he would later reveal to a few close associates—he dismissed entirely the importance of converting the "heathen" masses.


      27

           Gates made no promises, but suggested that he was seriously considering funding a trip to study the proposal's feasibility.40 Gates also began researching the matter himself. In the same manner that made Gates such an effective manager in the reorganization of Rockefeller philanthropy and business, he would not act until he had investigated the subject thoroughly. He would spend over a decade considering what role Rockefeller philanthropy should play in China.


      28

           A crucial element of this research was anticipating the actions of missionaries and religious groups. Over the next few months, Gates canvassed religious leaders. He explained to one missionary leader that "I am just now studying the question of the best methods of promoting the welfare of the Chinese," and considered a conference to discuss the question, a conference that would materialize seven years later. Gates also dangled the possibility of a large Rockefeller investment, "perhaps a considerable expenditure covering an indefinite period."41 With such comments, Gates quickly gained the attention of religious groups.42


      29

           One such group was the China Centennial Conference, a meet- ing in Shanghai that drew representatives from every major Protestant missionary group and is considered the "last major collective expression of their theology by Protestant missionaries in China."43 Reverend Arthur Smith wrote to Gates on behalf of the conference, and warned that any charitable effort in China must involve the cooperation of missionaries. Smith smugly added in another letter that the only "suitable men available" for philanthropic work in China were in the "missionary ranks."44


      30

           Gates received several letters like this as word of Rockefeller philanthropic interest in China spread. One Baptist missionary confided to Gates his hopes of expanding "our own Baptist work. . .on the foundations we have already laid."45 American religious leaders and missionaries were transfixed by the possibility of Rockefeller support, and were clear in their intent to exercise control. Baptists in particular thought they had the inner track with Gates.


      31

           After over a year of research and inquiries, Gates finally approved the research trip to China. The 1908-1909 Rockefeller-funded Oriental Education Commission concluded that founding a non-denominational university in China was impossible, for it would face opposition from missionaries who would see it as a threat to proselytizing. The Commission therefore advocated a focus on medicine. Wallace Buttrick, the first director of the China Medical Board, would cite the Oriental Education Commission report as central to the creation of the CMB, claiming that the report turned Gates' thoughts to medical work in China.46


      32

           Giving such significance to the Oriental Education Commission report fails to take into account Gates' own motivations. Gates knew that any Rockefeller philanthropic effort in China would attract the attention and meddling of missionaries. Furthermore, Gates was con- stantly seeking ways to advance modern scientific medicine, and did not need to be told about the potential impact on a nation that he saw as "wholly unacquainted with modern medicine, and weltering in unrelieved suffering from disease and semi-starvation."47 An alternative explanation is that Gates used the Commission's report to justify an action he had already planned, and perhaps had in mind as early as the "tainted money" scandal in which he had designated Rockefeller aid for medical missionaries. On the surface, Gates was simply investigating a new philanthropic opportunity. His true motivation, as it would emerge over the coming years, was more original and subversive: he meant to elevate the practice of medicine in China and simultaneously use medicine to convert the medical missionaries to the cause of science.


      33

           As Gates would argue in private Rockefeller reports and explain later in his private papers, the missionaries in China were trapped in the "bondage of tradition and…an ignorance and misguided sentiment in the supporting churches."48 To understand Gates' effort, one must first appreciate the scope and goals of the Western missionaries. Christian missionaries had been in China for centuries, and Protestant missionaries had become the dominant Christian missionaries by the mid-nineteenth century.49 Although the missionaries had worked diligently for generations, little progress had been made in terms of conversions, a prime benchmark used by missionaries themselves. By the twentieth century, China had become one of the most popular missionary targets in the world, and thousands of men and women flocked to join the missions, especially from the United States and parts of Western Europe. If the missionaries had made few inroads in proselytizing, however, they had made marked progress in the field of medicine, and the hundreds of medical missionaries rarely lacked for patients.50


      34

           The medical function of these medical missionaries was secondary to their ultimate goal of converting the Chinese. The practice of Western medicine had become a focal point for evangelization, and missionaries implicitly and explicitly linked Western medical "miracles" to the teachings of Christianity. Instead of focusing on the health of their patients, medical missionaries urged sick and dying patients to convert. One historian of American missionaries in China notes that for the medical missionaries, "evangelical standards" came before "professional standards," so much so that one prominent doctor recommended accepting fewer patients so "[we] have a better opportunity to help them spiritually." This process might have been a violation of their ethical charge as physicians, for some were medical doctors, but it caused little distress among medical missionaries whose primary concern was the soul, not the body.51


      35

           Gates saw in American medical missionaries in China the confluence of the two great forces that shaped his life: sectarianism, his bête noire; and medicine, his hope for human progress. Gates was clearly offended by the use of the latter to advance the cause of what he considered "evangelistic propaganda," but he also saw this offensive situation as an opportunity.52 Using the power of his position with the Rockefellers, Gates sought to transform both practices to conform to his vision.


      36

           Gates' interest in China and medicine was also energized by the Flexner Report. Issued by the Carnegie Foundation for the Advancement for Teaching in 1910, Abraham Flexner's harsh criticism of medical education in North America was lauded by many outside of medicine, such as Gates, who saw the entire field as ripe for reform. The report was one of the most conspicuous early efforts of a philanthropic foundation to shape national affairs. Yet many of those in the field of medical education were outraged by Flexner's presumption in judging the field so harshly and so publicly.53 In his work to change the practice of medicine in China, Gates would draw on Flexner's findings, and seek to turn China into a laboratory for medical reform.


      37

           Before Gates made any substantive plans, he had to wait for the creation of a permanent Rockefeller philanthropic foundation. The history of the Rockefeller Foundation has been frequently told, but what has been overlooked is that one of Gates' objects in establishing this foundation was extending aid to China.54 He meant to spend millions of dollars—and eventually hundreds of millions—on aid to China over an indefinite period. Such an effort required a permanent base. One of his most important allies in creating the foundation was John D. Rockefeller, Jr., who had trained under Gates' careful eye for years.55 Rockefeller, Jr. assumed control of the family business when Gates chose to focus entirely on philanthropy in 1912.56 Gates may have been pressed by a sense of personal urgency, as his health began to deteriorate.57 But he was also increasingly focused on what would become the China Medical Board. In 1913, with the creation of the Rockefeller Foundation, the time had come to turn back to China.


      38

           Yet besides successfully shifting Rockefeller philanthropy to a permanent basis, Gates had also lost some of his access to power and influence. Gates had been the dominant voice in philanthropic matters for two decades, but with the creation of the Rockefeller Foundation, he was only one of nine trustees.58 Where he once had the ear of Rockefeller, Sr., now he had a board of trustees with Rockefeller, Jr. as president. Gates would continue with his philanthropic mission, but the process had changed. The China Medical Board would end up his last great project, a symbol of both his power and his weakness.


      39

      The China Conference


       

           Soon after the Rockefeller Foundation was created, Gates called for a conference in New York on the question of China. In keeping with the Progressive Era, Gates assembled the experts in the fields involved: missionaries, academics, and philanthropic advisors.59 Those in attendance at the January 1914 China Conference included Harvard President Emeritus Charles Eliot; President Judson of the University of Chicago; Jerome Davis Greene, Secretary of the Rockefeller Foundation; John R. Mott, representing the International Committee of the YMCA; Wallace Buttrick, head of the Rockefeller-funded General Education Board; Professor Paul Monroe of Columbia University's Teachers College, an authority on Chinese education; Professor Thomas Chamberlain of the University of Chicago, a member of the Rockefeller- funded Oriental Education commission; and Robert Speer of the Presbyterian Board of Foreign Missions.60


      40

           Presiding over the meeting was John D. Rockefeller, Jr., who announced that he wished to gain the counsel of experts before making any moves in China.61 Charles Eliot argued that the best work the Rockefeller Foundation could do—not just in China but in the entire world—was to advance the cause of Chinese education in general and medicine in particular.62 John Mott focused on "our ministry," and derided the "new educational and medical schemes and enterprises" because they failed to rely on the "wealth of experience" of missio- naries.63


      41

           A number of participants, including Teachers College's Paul Monroe, argued that the Rockefeller Foundation could best serve China's interest by aiding the missionary schools, and possibly sponsoring a major university. Rockefeller, Jr. carefully questioned Monroe on the university topic. At this point, Gates made his only significant foray into the conference discussion, challenging Monroe's assertion that a large university could be established.64 Besides his challenge to Monroe, Gates also spent some of the last few minutes of the conference musing over the possibility of retraining missionary physicians. But for a two day conference that he planned for several years, a few minutes of talking was an understated approach.65


      42

           Gates' reticence was certainly out of character, for he was normally a gregarious and often an overwhelming presence.66 But Gates was not at the meeting to learn, but to develop a coalition of support. As he later explained, the missionaries were "so desirous of being relieved" of their crippling foreign missionary expenses that they were willing to go "as far as possible in the direction of adjustment and compromise." If one of Gates' desires was to shift the "whole power of Christian sentiment" in the missionary enterprise toward "practical service," part of this effort was maintaining the appearance of consulting with missionaries and appropriate authorities.67 Such consultations had, after all, become a staple of Progressive reformers and philanthropists by the early twentieth century. 68 Significantly, in his private account of the history of the CMB, Gates made no mention whatsoever of the China Conference, despite its official status as the genesis of what would become the China Medical Board.


      43
           The meeting was also a sign of the changing relationship of Gates to Rockefeller philanthropy. Rockefeller, Sr. had essentially retired in 1895, spending no more than an hour a day on financial and philanthropic interests. Gates assumed the role of mentor for Rockefeller, Jr., and the dutiful Rockefeller heir had quietly accepted his role as apprentice for years. 69 By the time of the China Conference in 1914, however, Rockefeller, Jr. had assumed the leading role in family business and philanthropic matters, and was in the process of becoming "the first conscientiously modern philanthropist."70 No longer could Gates simply set the agenda based on the force of his convictions, as he had with the Rockefeller Institute for Medical Research. Rockefeller, Jr. was no longer the self-described philanthropic "go between" for his father and Frederick Gates.71 Gates was openly deferential in one of his protégé's first major appearances as the official head of the Rockefeller Foundation.
      44
           Gates could not simply play the dominant mentor. Rockefeller, Jr.'s comments at the conference suggest that he was drawn to the idea of a bold stroke, such as a Rockefeller university in China. Although Gates knew that a university was not possible, he still let the new president of the Rockefeller Foundation publicly pursue the question. He then politely steered matters his way by attacking an expert rather than Rockefeller. In the future, however, Gates would not win every encounter with experts regarding Rockefeller work in China.


      45

      The China Medical Board


       
           On January 29, 1914, Frederick Gates presented to the trustees of the Rockefeller Foundation the official blueprint for Rockefeller philanthropic activities in China. The title was straightforward, if verbose: "The Gradual and Orderly Development of a Comprehensive and Efficient System of Medicine in China." The report called for researching medical missionary work, identifying the most promising geographic area of work, retraining medical missionaries, and recruiting Chinese for medical training. The final result, as Gates audaciously offered, was that "China will. . .lead the world in medicine."72 In a fashion reminiscent of his Calvinist forbears, Gates imagined all of China as the medical school on a hill, a beacon for all to follow.
      46
           The trustees authorized a new commission, which would come to be referred to as the Judson Commission, made up of Henry Judson of the University of Chicago, Francis Weld Peabody of Harvard Medical School, and Roger Sherman Greene, a former American diplomat and the brother of Rockefeller Foundation Secretary Jerome David Greene. Roger Sherman Greene was well qualified for the position, having spent the last several years as an American representative in several East Asian posts, most recently China. Greene had no experience with medicine, but did have a measure of standing and authority in China, and was an experienced negotiator.73
      47
           The Judson Commission visited dozens of hospitals and medical schools, met with government officials and missionaries, and reaffirmed Gates' beliefs about the dreadful medical conditions and missionary intransigence. A few weeks after the Commission formally presented its report, the China Medical Board was created on November 30, 1914.74
      48
           The leadership of the CMB quickly fell into place. Wallace Buttrick was the director in New York, and Roger Greene was appointed resident director in China. The chairmanship fell to John D. Rockefeller, Jr., with the assurance that Gates would be a member and bear "the brunt of the work." Other members included John Mott, a participant at the Rockefeller-sponsored China Conference and a leading figure in missionary circles; Frank Goodnow of Johns Hopkins University, president of the university and former advisor to the ill-fated Chinese president Yuan Shi-kai; William Welch of Johns Hopkins, dean of the medical school and a leading figure in American medicine; and the attorney Starr J. Murphy, a Rockefeller Foundation trustee who had also worked with Gates to create the Rockefeller Institute for Medical Research. With these men, Gates had assembled his experts. He then unveiled his true agenda.75
      49
           To grasp Gates' hopes for elevating Chinese medicine and trans- forming the missionary enterprise, two crucial documents must be understood. The first is his "Gradual and Orderly Development of a Comprehensive and Efficient System of Medicine in China," discussed briefly above. Gates argued that every medical missionary should spend three months a year at a Rockefeller medical school in China, a process that would serve as "the unique central and indispensable condition of any work in China, the foundation and basis of the whole system." Gates confidently predicted that with this training, these doctors would become the "best body of practicing physicians on earth." Gates was clearly drawing on his reading of Osler's medical treatise as well as the findings of the Flexner Report. After all, many of the medical missionaries were products of the same American medical system Osler and Flexner blasted. An unstated result of CMB success with medical missionaries would be the creation of a showcase for the possibilities of medical education and a modern medical system.76
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           The medical retraining would not only make the missionaries more effective physicians, Gates added, but would affect their culture as well. Rather than working in isolation, their annual retraining visits would lead to an "esprit de corps." They would be armed with the "conscious duty" to seek out Chinese to be the first generation of Western- trained physicians. To ease any missionary skepticism, Gates emphasized that this plan depended on the "generous cooperation with the Missionary Boards [and] the whole power of Christian sentiment."77
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