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efore finally leaving occupied territory I had paid two visits to the Border Region. In the summer of 1940 I paid a short visit to East Hopei （Hebei） and helped to treat some wounded. In the summer of 1941 I wished to go to work in the liberated area but couldn’t proceed as a Japanese offensive was in progress. I finally left the occupied area in December 1941.
After I left Peiping I went to P’inghsi （Pingxi） headquarters. I stayed at the P’inghsi headquarters for a week or two and then went on to Chin-Cha-Chi （Shanxi-Chahar-Hebei） headquarters. Here General Nieh asked me to teach at Bethune Medical School and so after about a week at headquarters I went back there. At that time the school was at Ko Kung， a big village about 25 miles from the front where I stayed altogether for about three years. When I arrived the total of teachers， nurses， workers and students approximated a thousand. In the same village was the main International Peace Hospital. After staying there for about two weeks to get acquainted with the situation I was asked to start teaching the advanced class.
The background of the class was below that of the average western student. The average was only middle school standard， but since they had had three years of study and practical work before the advanced class started it was possible to do advanced work with them. Teaching was very difficult at first as my Chinese at that time was not good. I had to write everything out and have translated all the words I did not know. As a result it took about eight hours to prepare one hour’s lecture and I had six lectures per week. Because the school had never been able to get any new books， they knew little of recent developments， nothing about sulfa drugs and little about atabrine， etc. To begin my course， therefore， I concentrated on recent developments in medicine.
At that time the ordinary course for army doctors and surgeons lasted two years with an additional six months of practical work. There were also courses for pharmacists and dispensers and one-year courses for nurses whose primary school background was even lower than that of the medical students. It was necessary therefore to give special pre-medical training. There were classes in anatomy， physiology， histology， pathology， bacteriology， clinical diagnosis， and pharmacology and also a few courses in chemistry， physics and mathematics. On the average each subject was taught from 50 to 150 hours. Regular medical and surgical training carried courses on eye， ear， nose and throat diseases， on skin and venereal diseases， and there were a few on obstetrics and gynecology. Only the advanced class had any pediatrics. The work of the school is made difficult by its very limited budget which means a shortage of simple materials like paper and ink for both students and teachers and also a shortage of books. The latest book is a 1940 Review of Medicine. Most of the books were published in 1935 or 1936. Because there were no modern medical journals， I have been translating while in Yenan some articles from recent American journals and sending them out. Though the school has a fair number of elementary books they are irreplaceable and thus have to be kept hidden away most of the time. They are taken out only when specially needed because of the difficulty in hiding books securely if there is a sudden Japanese attack.
New students come to the school with absolutely no knowledge of medicine but after two or three years they have a fairly good idea of all the important subjects. Teaching is concentrated on what will have practical value. Diseases not found in North China are not taught. Those found are taught very thoroughly. A great deal of time is spent on malaria， typhoid， relapsing fever， and war surgery.After graduating from school， students are sent to the front or to one of the sub-district hospitals where they work another six months under the supervision of qualified doctors.
Medical work is very much limited on account of a shortage of instruments and medicines. Even simple things like stethoscopes and thermometers are so scarce that some doctors have trained themselves to work without a stethoscope. Every two months each doctor gets a copy of a journal put out by the medical advisory committee of the Border Region. This journal is mimeographed and contains articles on current subjects and methods of overcoming difficulties. It is mostly written by the teachers at the school.
When I first arrived at the school， Dr. Dwarkanath Kotnis was still superintendent. Under his supervision a number of more or less well-trained surgeons were graduated. His attitude towards work and his friendship and understanding for his Chinese friends as well as his hatred of the Japanese made an unforgettable impression on all those who met him. Unfortunately he died in December 1942， from an attack of epilepsy and left his wife， （a former PUMC nurse） and a small baby. His death was a great loss， not only to the school， but to the entire Eighth Route Army. He did magnificent work and saved many lives.
The staff members of the school are all educated doctors or surgeons and most of them take part in the practical work of the hospital. Although the International Peace Hospital is the best equipped and staffed of the entire region， its equipment is worse than anyone would suspect. The instruments brought by Dr. Bethune in 1938， still in use， are practically the only ones available. Medicine is for the most part locally manufactured. The IPH does not look like a hospital but like ordinary village houses. There are five sets of wards： medical， surgical， infectious diseases， obstetric， and eye. The patients lie on kangs. There is a laboratory with three microscopes （shared with the school） but equipment is very scarce. For example there is a shortage of dyes， and， recently， it has become virtually impossible to get new supplies from occupied territory. There are also an operating room， a dental office and an OPD. The outpatient department which gives both treatment and medicine free handles about 100 patients per day. There is an X-ray but no generator， and it can thus be used only at the nearest arsenal. Even then， operation with an interrupter from a direct current dynamo is not very reliable.
Most of the medical patients have malaria， relapsing fever， gastroenteritis or intestinal disturbances while the surgical department handles all kinds of wounds. The kinds and numbers of operations are limited by the instruments available. Cotton， gauze， and even catgut are all made locally.
Every year I went to the front for two or three months on a tour of inspection and so obtained an opportunity to see the conditions under which Bethune Medical School students have to work after graduation. It really takes a good doctor to work under the conditions at the front with no laboratory， no X-ray， and usually not even a stethoscope or thermometers. In spite of all these difficulties they usually manage to make correct diagnoses. The doctors at the front are all very eager to study and learn and during each trip I spent a considerable time teaching and lecturing.
Besides a shortage of instruments and apparatus， there is also very little medicine. For example most of the people have malaria every year. With a total population of 19，000，000， there are only 30 to 50 lbs. of quinine available.
During the past two years we have been experimenting with other methods of malaria treatment and have come to the conclusion that quinine， even in sufficient amounts， is not an adequate treatment for chronic malaria. On the other hand， we have found that old Chinese methods， used for centuries， have some effect and so we have made considerable use of acupuncture. We use an ordinary needle， disinfect the skin and prick it in selected places. We have been able to prevent most attacks and have saved hundreds of pounds of quinine. Both civilians and soldiers have been taught these methods and quite a number of peasants are now able to give treatment to their neighbors in the absence of doctors. Acupuncture is done two or three hours before the attack. Pricks about 2 mm. deep are made between the seventh cervical vertebra and the first dorsal and between the 6th and 7th dorsal vertebrae. After pricking the skin the place is massaged and one or two drops of blood squeezed out. Checking this method by microscopic examination we found that， after acupuncture the parasites disappear from the blood or definitely decrease in number in about 70% of the patients. At the same time there was also a certain increase in white blood cells. This is the outline of one method but there are other Chinese methods which have had some effect.
The results of this nervous irritation method stimulated me to make further investigation of similar treatments and during my stay at the school I worked on the problem for two years. The work， based on the theories suggested in Speransky’s A Basis for the Theory of Medicine， often had astonishing results and hard to explain by ordinary theories. For example， I treated some cases of gastric ulcer by an injection of novocaine as sympathetic lumbar block. Patients who had been vomiting blood for a number of years were cured by this treatment and up to the time I left the school， about two years after the treatment， there had been no relapses. By injecting novocaine into the tissue surrounding the kidney we treated three cases of Reynaud’s disease， which cleared up entirely. The gangrene stopped spreading and all three cases recovered losing only some minor functional ability. Two cases of allergic dermatitis have also been treated effectively by this method.
Another method is spinal pumping. Spinal fluid is drawn out and pumped in ten to twenty times and finally 10 to 12 cc. withdrawn. This method has been effectively used in two cases of epilepsy where it not only prevented the onset of the fit but also brought about an amelioration of the attacks. Attacks which used to last one or two hours after treatment lasted only five to ten minutes. Surgical diseases like ulcers of the leg and affection of the lower abdomen have been treated by the lumbar block method with some success. This treatment was also effective in cases of neuralgia. Because of conditions at the front， research work cannot be well systematized. With offensives once or twice a year you do not often see patients again. Though there were some failures， this kind of irritation treatment seems to have a definite future and I hope to be able to do some more work on it at Yenan.
After I left Peiping I went to P’inghsi （Pingxi） headquarters. I stayed at the P’inghsi headquarters for a week or two and then went on to Chin-Cha-Chi （Shanxi-Chahar-Hebei） headquarters. Here General Nieh asked me to teach at Bethune Medical School and so after about a week at headquarters I went back there. At that time the school was at Ko Kung， a big village about 25 miles from the front where I stayed altogether for about three years. When I arrived the total of teachers， nurses， workers and students approximated a thousand. In the same village was the main International Peace Hospital. After staying there for about two weeks to get acquainted with the situation I was asked to start teaching the advanced class.
The background of the class was below that of the average western student. The average was only middle school standard， but since they had had three years of study and practical work before the advanced class started it was possible to do advanced work with them. Teaching was very difficult at first as my Chinese at that time was not good. I had to write everything out and have translated all the words I did not know. As a result it took about eight hours to prepare one hour’s lecture and I had six lectures per week. Because the school had never been able to get any new books， they knew little of recent developments， nothing about sulfa drugs and little about atabrine， etc. To begin my course， therefore， I concentrated on recent developments in medicine.
At that time the ordinary course for army doctors and surgeons lasted two years with an additional six months of practical work. There were also courses for pharmacists and dispensers and one-year courses for nurses whose primary school background was even lower than that of the medical students. It was necessary therefore to give special pre-medical training. There were classes in anatomy， physiology， histology， pathology， bacteriology， clinical diagnosis， and pharmacology and also a few courses in chemistry， physics and mathematics. On the average each subject was taught from 50 to 150 hours. Regular medical and surgical training carried courses on eye， ear， nose and throat diseases， on skin and venereal diseases， and there were a few on obstetrics and gynecology. Only the advanced class had any pediatrics. The work of the school is made difficult by its very limited budget which means a shortage of simple materials like paper and ink for both students and teachers and also a shortage of books. The latest book is a 1940 Review of Medicine. Most of the books were published in 1935 or 1936. Because there were no modern medical journals， I have been translating while in Yenan some articles from recent American journals and sending them out. Though the school has a fair number of elementary books they are irreplaceable and thus have to be kept hidden away most of the time. They are taken out only when specially needed because of the difficulty in hiding books securely if there is a sudden Japanese attack.
New students come to the school with absolutely no knowledge of medicine but after two or three years they have a fairly good idea of all the important subjects. Teaching is concentrated on what will have practical value. Diseases not found in North China are not taught. Those found are taught very thoroughly. A great deal of time is spent on malaria， typhoid， relapsing fever， and war surgery.After graduating from school， students are sent to the front or to one of the sub-district hospitals where they work another six months under the supervision of qualified doctors.
Medical work is very much limited on account of a shortage of instruments and medicines. Even simple things like stethoscopes and thermometers are so scarce that some doctors have trained themselves to work without a stethoscope. Every two months each doctor gets a copy of a journal put out by the medical advisory committee of the Border Region. This journal is mimeographed and contains articles on current subjects and methods of overcoming difficulties. It is mostly written by the teachers at the school.
When I first arrived at the school， Dr. Dwarkanath Kotnis was still superintendent. Under his supervision a number of more or less well-trained surgeons were graduated. His attitude towards work and his friendship and understanding for his Chinese friends as well as his hatred of the Japanese made an unforgettable impression on all those who met him. Unfortunately he died in December 1942， from an attack of epilepsy and left his wife， （a former PUMC nurse） and a small baby. His death was a great loss， not only to the school， but to the entire Eighth Route Army. He did magnificent work and saved many lives.
The staff members of the school are all educated doctors or surgeons and most of them take part in the practical work of the hospital. Although the International Peace Hospital is the best equipped and staffed of the entire region， its equipment is worse than anyone would suspect. The instruments brought by Dr. Bethune in 1938， still in use， are practically the only ones available. Medicine is for the most part locally manufactured. The IPH does not look like a hospital but like ordinary village houses. There are five sets of wards： medical， surgical， infectious diseases， obstetric， and eye. The patients lie on kangs. There is a laboratory with three microscopes （shared with the school） but equipment is very scarce. For example there is a shortage of dyes， and， recently， it has become virtually impossible to get new supplies from occupied territory. There are also an operating room， a dental office and an OPD. The outpatient department which gives both treatment and medicine free handles about 100 patients per day. There is an X-ray but no generator， and it can thus be used only at the nearest arsenal. Even then， operation with an interrupter from a direct current dynamo is not very reliable.
Most of the medical patients have malaria， relapsing fever， gastroenteritis or intestinal disturbances while the surgical department handles all kinds of wounds. The kinds and numbers of operations are limited by the instruments available. Cotton， gauze， and even catgut are all made locally.
Every year I went to the front for two or three months on a tour of inspection and so obtained an opportunity to see the conditions under which Bethune Medical School students have to work after graduation. It really takes a good doctor to work under the conditions at the front with no laboratory， no X-ray， and usually not even a stethoscope or thermometers. In spite of all these difficulties they usually manage to make correct diagnoses. The doctors at the front are all very eager to study and learn and during each trip I spent a considerable time teaching and lecturing.
Besides a shortage of instruments and apparatus， there is also very little medicine. For example most of the people have malaria every year. With a total population of 19，000，000， there are only 30 to 50 lbs. of quinine available.
During the past two years we have been experimenting with other methods of malaria treatment and have come to the conclusion that quinine， even in sufficient amounts， is not an adequate treatment for chronic malaria. On the other hand， we have found that old Chinese methods， used for centuries， have some effect and so we have made considerable use of acupuncture. We use an ordinary needle， disinfect the skin and prick it in selected places. We have been able to prevent most attacks and have saved hundreds of pounds of quinine. Both civilians and soldiers have been taught these methods and quite a number of peasants are now able to give treatment to their neighbors in the absence of doctors. Acupuncture is done two or three hours before the attack. Pricks about 2 mm. deep are made between the seventh cervical vertebra and the first dorsal and between the 6th and 7th dorsal vertebrae. After pricking the skin the place is massaged and one or two drops of blood squeezed out. Checking this method by microscopic examination we found that， after acupuncture the parasites disappear from the blood or definitely decrease in number in about 70% of the patients. At the same time there was also a certain increase in white blood cells. This is the outline of one method but there are other Chinese methods which have had some effect.
The results of this nervous irritation method stimulated me to make further investigation of similar treatments and during my stay at the school I worked on the problem for two years. The work， based on the theories suggested in Speransky’s A Basis for the Theory of Medicine， often had astonishing results and hard to explain by ordinary theories. For example， I treated some cases of gastric ulcer by an injection of novocaine as sympathetic lumbar block. Patients who had been vomiting blood for a number of years were cured by this treatment and up to the time I left the school， about two years after the treatment， there had been no relapses. By injecting novocaine into the tissue surrounding the kidney we treated three cases of Reynaud’s disease， which cleared up entirely. The gangrene stopped spreading and all three cases recovered losing only some minor functional ability. Two cases of allergic dermatitis have also been treated effectively by this method.
Another method is spinal pumping. Spinal fluid is drawn out and pumped in ten to twenty times and finally 10 to 12 cc. withdrawn. This method has been effectively used in two cases of epilepsy where it not only prevented the onset of the fit but also brought about an amelioration of the attacks. Attacks which used to last one or two hours after treatment lasted only five to ten minutes. Surgical diseases like ulcers of the leg and affection of the lower abdomen have been treated by the lumbar block method with some success. This treatment was also effective in cases of neuralgia. Because of conditions at the front， research work cannot be well systematized. With offensives once or twice a year you do not often see patients again. Though there were some failures， this kind of irritation treatment seems to have a definite future and I hope to be able to do some more work on it at Yenan.