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Protestant medical missionaries, who started entering China during the beginning of the 19th century, set the goal as propagating Western medicine to the Chinese while spreading the Christian gospel. Back in those days, China formed deep relations with their own ideology and culture and depended on Chinese medicine that caused major influence on their lives instead of just treatment behaviors. Accordingly, it is natural to see information about Chinese medicine in documents that were left behind. Yet, there are not many studies which dealt with the awareness of Chinese medicine by medical missionaries, and most were focused on the criticism imposed by medical missionaries regarding Chinese medicine. Thus, there are also claims amongst recent studies which impose how the medical missionaries moved from overlooking and criticizing Chinese medicine to gaining a "sympathetic viewpoint" to a certain degree. Still, when the documents left behind by medical missionaries is observed, there are many aspects which support how the awareness of Chinese medicine in medical missionaries has not changed significantly. In addition, medical missionaries actively used medicine like traditional Chinese drugs if the treatment effect was well known. Yet, they barely gave any interest to the five elements, which are the basics of traditional Chinese drugs prescription. In other words, medical missionaries only selected elements of Chinese medicine that were helpful to them just like how the Chinese were choosing what they needed from Western knowledge. The need to understand Chinese medicine was growing according to the flow of times. For instance, some medical missionaries admitted the treatment effect of acupuncture in contrast to claiming it as non-scientific in the past. Such changes were also related to how focused medical missionaries were on medical activities. The first medical missionaries emphasized the non-scientific aspect of Chinese medicine to verify the legitimacy of medical mission. Then, medical missionaries gradually exerted more efforts on medical treatment than direct mission activities so the need of Chinese medicine became greater. This was because Chinese relied on Chinese medicine the most and even used Chinese medicine terms that they knew to explain their conditions while getting treatment from doctors who learned Western medicine. Additionally, medicine missionaries witnessed patients getting better after receiving treatment so they could not completely overlook Chinese medicine. However, medical missionaries strongly believed in the superiority of Western medicine and considered that China certainly needed Western medicine from a scientific perspective. Chinese doctors who were close to medical missionaries and learned about Western medicine believed in Western medicine and thought that Chinese medicine only held historical value besides some fields like Chinese traditional drugs.

In this paper, we investigated what kind of efforts were made to expand vaccination amid a smallpox epidemic in Shanghai in 1938-39, as well as the significance of such efforts. In Shanghai, various strategies were employed to achieve universal vaccination. When it was first introduced, theories of Chinese medicine were borrowed to help people’s understanding, and various media outlets were used to promote the effect and safety of vaccination. Health institutions in the foreign concession and the Chinese elites helped to expand free vaccination. At the time, vaccination was not mandatory, and people voluntarily visited a clinic for innoculation. Between 1932 and 1937, the number of fatality from smallpox fluctuated and did not reach a threatening level due to the vaccination effort. However, upon the outbreak of the Sino-Japanese War, the number of smallpox patients and the subsequent death toll surged. Some of the refugees who fled to the foreign concession to avoid the war had smallpox, and the disease spread from there. The Japanese military force that occupied Shanghai began mandatory vaccination in a bid to protect the health of Japanese people and soldiers as well as the safety of Japan. Setting aside justifications for war and pillage of the colony, the Japanese occupation helped to expand universal vaccination to an extent. Statistical data indicate that the number of vaccination applied by Japan’s health institutions is significant, and the military institution enabled forced vaccination. Various institutions including the Japanese military force, health institutions, hospitals, clinics, charity organizations in the foreign concession joined hands for the shared goal of fighting against smallpox. Due to the nature of an epidemic that does not distinguish between friends and foes or across races, an odd cooperative relationship was formed in Shanghai. The significance of an increase in vaccination can be observed in that its infrastructure and method were replicated to fight cholera. Specifically, the two approaches―active and forced innoculation by the authorities and free innoculation in the form of traditional charity work―were first made to increase vaccination and then fully applied to expanding cholera inoculation. Vaccination also paved the way for universalization of inoculation. At the time, the Chinese people were not familiar with the method of cholera inoculation, and its effect was dubious. They suspected that the Japanese injected poison and shunned cholera inoculation. When a rule was implemented that banned people without a certificate of cholera inoculation from traveling to other regions, people forged certificates. In comparison, over a century had passed since vaccination was introduced in China, and people knew its effect well. For this reason, the public probably did not strongly oppose forced vaccination by the Japanese. However, this is merely in comparison with cholera inoculation, and the goal of universal vaccination was not attained. Smallpox continued to break out after 1939, and many people remained reluctant to receive vaccination. For peaceful ruling, the People’s Republic of China had to endeavor for vaccination from the beginning of its foundation as did the authority of the foreign concession and the Japanese military force. Reasons for a failed attempt to achieve universal vaccination despite tenacious efforts need to be investigated from various angles including political, social and cultural aspects.