The Chinese Medical Journal and the Chinese Medical Association: Centennial legacy and the institutionalization of a scholarly community

In 1932, the Chinese Medical Journal (CMJ) was officially established through the merger of The China Medical Journal and the English section of The National Medical Journal of China, marking a decisive transfer of China’s modern medical discursive authority from foreign missionary physicians to Chinese medical scholars. Measured by journal lineage, this transition unfolded over half a century; if anchored in Peter Parker’s medical practice in Guangdong beginning in 1835, it spans nearly one century; and if tracing back to the introduction of Western medical knowledge, it would deepen into even longer horizons of over three centuries. Notably, the lineage of the CMJ can be traced to China Medical Missionary Journal (CMMJ), launched in 1887, and retitled the China Medical Journal in 1907—an influential conduit for Western medical knowledge and practice in China. Meanwhile, The National Medical Journal of China, inaugurated in 1915 by the newly established National Medical Association of China (later the Chinese Medical Association, CMA), published in both Chinese and English, signaling the Chinese medical community’s entry into the mainstream trajectory of modern medical development. Prior to their formal merger, the two journals maintained close collaboration, and served as key academic platforms for advancing modern medical research and diagnosis and therapeutic practice nationwide. Although the CMA has borne different names and passed through distinct stages of development, when viewed across a century, the CMA and the CMJ function like a “double helix” in the history of China’s medical modernization, characterized by three defining features: First, as a vehicle for knowledge dissemination, they advanced the localization and translation of modern medicine while deepening international academic exchanges, ensuring the open and reciprocal circulation of medical knowledge between China and the the wider world. Second, the CMJ editorship shifted from missionary stewardship to autonomous editorship by Chinese scholars. Third, they helped build a medical discourse that integrated global perspectives with Chinese experience, aligning international narratives with the local practice and, through this plasticity, moving the national medical system from importation toward independent innovation. Origins and early contestations: In March 1887, the China Medical Missionary Association (CMMA), established by Western medical missionaries in China, launched its official journal, the CMMJ, to disseminate Western medical knowledge and support the missionary enterprise. As a principal vehicle for the introduction of Western medicine at the time, the journal brought modern medical theories and practices into China, facilitated exchanges on diagnosis, treatment, and public health, and directed attention to endemic diseases, thereby integrating Chinese concerns into global medical knowledge circulation. Its inaugural volume was listed in Index Medicus in 1888, signifying incorporation into the international medical journal system.1–3 During this phase, the CMMJ reflected the dominance of the missionary community (regular membership in the association required active engagement in medical missionary work), yet its scholarly content laid essential groundwork for the early enlightenment of modern medicine in China. As W.J. Venable noted in 1915, “CMMJ is our organ of mutual communication; in other words, it’s our nervous system, the means by which we keep in touch with the progress of medical science.”4 Early content focused on the prevention and control of infectious diseases (e.g., leprosy, plague, cholera) and on practices in mission hospitals. During this period, CMMJ showcased advances in medical research in China to the international community, and several articles were cited by journals across various countries.5 Entering the 20th century, as increasing numbers of physicians returned to China after overseas study, they participated in the academic activities of CMMA—such as discussions on standardization of medical terminology and the publication of research in the association’s journal—while also actively planning to establish an academic organization led by Chinese physicians. At the same time, foreign physicians in China recognized the necessity of collaborating with Chinese peers, particularly as rapid medical technological progress redirected their efforts from proselytization to clinical practice. Consequently, in 1907, the CMMA resolved to remove “missionary” from the journal’s title, renaming it the China Medical Journal. The English name of the CMMA was not officially changed to “The China Medical Association” until 1925, following a vote. The association’s membership system also revealed its limitations: regular members had to meet the dual criteria of graduating from a recognized medical school and engaging in medical missionary work. This effectively excluded domestically trained Western-style physicians from the core academic circle. Graduates of indigenous institutions such as the Beiyang Medical College in Tianjin and St. John’s University in Shanghai possessed professional qualifications but, lacking missionary affiliation, found it difficult to attain full membership. This system mirrored the underlying tensions between missionary doctors and emerging local medical community. In 1915, more than twenty leading Chinese physicians, including Wu Lien-teh and Yen Fu-ch’ing, founded the National Medical Association of China. Many were graduates of institutions such as St. John’s University and Peking Union Medical College, combining training in modern Western medicine with local clinical experience and thereby fostering a distinctive cross-cultural academic identity. Committed to “serving the nation through scholarship”,6 they launched the bilingual The National Medical Journal of China (NMJC), establishing China’s first fully autonomous academic publishing platform. This marked the Chinese medical community’s systematic effort to contest and shape the academic discourse of medicine. The CMA and CMMA thereafter entered a dynamic relationship of both competition and cooperation, and it became common for members of each to publish in the other’s journal. From the 1920s onward, the CMJ and its predecessors published a series of studies on the chemistry and pharmacology of traditional Chinese medicine (TCM), including research on ephedrine,7Angelica sinensis,8Poria cocos,9 and mineral medicines.10 These works not only highlighted the value of applying modern medical methods to native materia medica by Chinese medical scholars but also laid groundwork for an academic paradigm integrating Chinese and Western medicine. Meanwhile, the proportion of Chinese authors rose from 20 (out of 531 total authors, 3.8%) in 1923 to 221 (41.7%) in 1933. By constructing a triadic “academic–clinical–policy” knowledge network, the CMA gradually supplanted the CMMA and became the leading force in Western medicine in China. Its success derived not only from its incorporation of domestic medical talent but, more importantly, from its establishment of operational mechanisms aligned with modern academic norms. This shift marked China’s medical community’s transition from passively receiving Western medical knowledge to actively participating in its production, laying crucial institutional and epistemic foundations for the medical system of the People’s Republic of China (PRC). Construction of the academic community and the “Golden Age” (1932–1941): In 1932, following over two years of negotiations, the CMA and the CMMA formally merged in Shanghai. The English section of the National Medical Journal of China was integrated with The China Medical Journal (which had evolved from the CMMJ), forming the prototype of the modern CMJ. The merger and publication of the journal took place earlier than the merger of the two associations on April 15, 1932. The legacy volume numbering of the CMMJ was retained to ensure bibliographic continuity and to signal a respectful yet decisive transition. This institutional integration consolidated a paradigm shift in the CMJ—from a missionary-led instrument of knowledge transmission to an infrastructural vehicle for building a homegrown scholarly community. By 1935, more than 70% of the editorial board consisted of Chinese scholars, underscoring the transfer of academic leadership. During this period, the scholarly quality of the CMJ rose markedly. Religious themes receded, while original clinical and epidemiological investigations expanded. For example, public health studies such as “epidemiological survey of filariasis in Fuzhou” and “Changsha filariasis”, both published in 1937, exemplified a deliberate turn toward locally grounded research agendas.11,12 In parallel, editorial policies were professionalized: section editors were tasked with soliciting high-quality submissions across key specialties; methodological reporting and statistical rigor were strengthened; and reviews and commentaries facilitated knowledge dissemination for clinicians who lacked ready access to foreign journals outside the major coastal cities. Supplements published between 1936 and 1940 created an important platform for international academic exchange. These included the proceedings of the inaugural meeting of the Society of Pathology and Bacteriology (1936), Hans Zinsser’s series on typhus (1938), a pathology compendium by Eugene L. Opie (1940), and McQarrie Irvine’s monograph on multisystem metabolism (1939). Collectively, these supplements spanned the continuum from basic science to clinical application, showcased the journal’s capacity to convene leading authorities, and served as reference texts for medical teaching and hospital practice in China. During the Chinese People’s War of Resistance Against Japanese Aggression, the journal faced severe operational challenges. Despite shortages of paper, disrupted transport, and the displacement of contributors, the Beiping editorial office persevered through 1941, successfully completing ten volumes. During these years, the journal understandably prioritized topics of immediate public health and clinical relevance, including malaria control13 and blood transfusion practices.14 As the war intensified, the CMJ adopted a multi-version publication strategy—issuing parallel editions tailored to divergent distribution conditions and readerships at home and abroad. Although periodicity became irregular and production constraints multiplied, the journal maintained core editorial standards and continued to function as a vital conduit linking laboratory research, bedside practice. War, fragmentation, and parallel editions (1942–1949): During the Chinese People’s War of Resistance Against Japanese Aggression, the ecology of medical publishing was significantly altered in China. In 1942, the CMJ adopted a nonstandard “one journal, three editions” pattern: a Shanghai edition issued in the occupied area, a Chengdu edition produced in the wartime rear area, and a Washington edition dedicated to international communication. Together they sustained a scholarly community under conditions of displacement and censorship. In Shanghai, acting editor-in-chief Hsiang-Chuan Hou compressed the publication schedule from six issues annually in 1942–1943 to three in 1945 to ensure wartime survival. Despite pressures from the occupation authorities—entailing the processing of numerous censorship files—the journal refused to register and leveraged the academic activities of specialty societies to maintain continuity of knowledge production. For instance, the Pediatric Society issued a Practical Pediatrics volume and four special numbers; the Ophthalmological Society published four ophthalmic special issues; and the Sub-society for Medical History produced two special issues—collectively demonstrating disciplinary depth amid war. The Chengdu edition (1942–1945) was established with CMA authorization due to the disruption of postal routes, and a six-member editorial board took charge. Supported by the American Bureau for Medical Aid to China (ABMAC) and the British Ministry of Information, this edition completed three volumes.15 The Washington Edition (1943–1944), directed by Jui-Heng Liu and Sze-ming Sze, conveyed China’s wartime medical developments to an international audience.16 In the occupied zone, the Shanghai edition preserved the academic lifeline of Chinese medicine. Taken together, the three editions secured the regional circulation of scholarly information and provided a crucial window connecting China with the international scientific community—thereby conserving core capacities and networks essential for postwar reconstruction.17 Wartime disruption, the dislocation of institutions, and the gradual resumption of manuscript flow led to confusion in volume numbering across the different editions. The Shanghai editors proposed that the Chengdu and Washington editions continue the Shanghai volume sequence, but be distinguished as volumes A and B. Around the same time, the Washington editors suggested designating the first Washington issue as “volume 61, number 1” (January 1943) and the Chengdu edition as “volume 61A,” with its first issue dated October 1942. In the end, only the Chengdu edition adopted this scheme; both the Shanghai and Washington editions began directly with volume 61. Ultimately, the Chengdu edition ceased publication in October 1945 with volume 63A, the Washington edition ended in 1944 with volume 62, and the Shanghai edition resumed in 1946 with volume 64. After the victory in the Chinese People’s War of Resistance Against Japanese Aggression, the headquarter of CMA moved back to Shanghai, and the wartime editions of CMJ published in Washington, Chengdu, and Chongqing came to an end. From 1946 onward, both the NMJC and CMJ were published in Shanghai and reverted to a monthly schedule. However, with the resumption of civil war, political turmoil, and soaring prices, the two journals could only struggle to survive: issues were often combined (two numbers in one), and even the printing paper was of relatively poor quality. Although bibliographically irregular and lacking standardization, this multi-edition arrangement functioned as an “academic lifeline”: it safeguarded key personnel and research materials and served as a model for the future development of China’s medical journal system.18 Despite formidable logistical obstacles, the CMJ tracked and disseminated the latest research advances from the Chinese and overseas Chinese medical communities.19 Editorial priorities centered on frontline and civilian emergency care, wartime child health (e.g., volume 64, No. 3, 1946), infectious-disease control (notably tetanus and cholera), and innovations in public-health practice. Representative contributions included practical protocols by Ta-chih Chi and Der-long Su for delousing operations in refugee camps20–22 and studies on nutrition under conditions of scarcity.23 These efforts exemplified an academic praxis that integrated Western biomedical and preventive frameworks with China’s wartime realities, translating global know-how into context-sensitive guidance for clinicians, public-health officers, and relief workers while preserving the continuity of scientific discourse across fractured geographies. State-led normative development (1949–1978): Following the founding of the PRC, the CMA was designated a core institution in the national health enterprise, guided by the principles of “serving workers, peasants, and soldiers” and “integrating Chinese and Western medicine”. As the CMA’s official organ, the CMJ was tasked with “uniting domestic and foreign medical researchers”, thereby marking the beginning of a state-led phase of standardized development. From the 1950s until the eve of Reform and Opening, the CMA institutionalized expert peer review and established an editorial network to ensure the CMJ’s scholarly rigor. In 1951, the journal’s editorial office moved with the CMA from Shanghai to Beijing, and the CMA-led “unification of medical terminology” campaign significantly enhanced medical professionalism—for example, standardizing terms such as “tuberculosis” in place of older vernacular like “lung consumption”.16 Even within various constraints, the CMJ identified and seized opportunities, making significant progress that reshaped the research agenda. In 1965, it published analyses of the organization and delivery of the new nation’s health services that were subsequently recommended by the World Health Organization as reference cases for public health in developing countries.24,25 In 1963 (volume 82), the journal reported advances in chemotherapy and surgical management of choriocarcinoma, protocols for the treatment of extensive burns, and the first successful replantation of a severed digit—work that in several respects reached, and in some instances defined, the international frontier. Theodore Fox, former editor of the Lancet, judged its papers to be “in excellent English and of international standard’”.26 The of the and early brought severe the like other CMA specialty ceased first in its A journal, China’s was proposed and but only two In the CMA and the CMJ editorial office was China’s ceased publication in first in its In March the CMA the Ministry of Health to the Ministry reported to the which the in Although the CMA’s were not fully until the CMJ had resumed publication in as a it was not until that the journal reverted to a monthly of the formal The new CMJ issues that of domestic significant over the including replantation and integration of Chinese and Western medicine was the of articles with diseases, of Chinese in this During this period, the CMA maintained the “academic through two principal First, it national academic as the on the integrated to published the proceedings as CMJ thereby preserving peer and academic Second, the CMA’s as a the journal issues to an overseas by the of the journal had to medical institutions in more than Notably, in the was by the and international and began to in an of From to the of and by the National on in CMA formally resumed signaling a academic In editor-in-chief a quality as and methodological and innovation. the CMJ faced two challenges. 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