One can develop a revolutionary outlook on many things, including medical work. This is an article from the Peking Review (Vol. 9, #6, Feb. 4, 1966, pp. 25-28), which discusses the creative application of Marxism-Leninism-Maoism to the treating of burns in Chinese medical care facilities. This article was part of a series known as “Applying Mao Tse-Tungs Thinking”, which discussed the practical application of Mao Tse-Tung Thought to various occupations and daily life.
A Revolutionary Outlook in Treating Burns
by Kuo Wang-ho
THERE is a new hospital in Peking—the Jishuitan Hospital, with a new Department of Traumatology. No such department existed in China‘s hospitals before liberation. Furthermore this department has a new unit specializing in burns, a speciality which did not exist in pre-liberation China. When it was established in 1958, eight of the unit‘s ten surgeons were under 30 years of age. Three of the group had considerable experience in surgery but the other seven had only recently graduated from medical college. None of the ten had specialist training in burns. Yet since the unit was set up, the rate of recovery from burns covering more than 20 per cent of the body area has risen steadily from less than 70 per cent in 1958, to over 95 per cent in 1965.
Foreign medical literature agrees that few persons recover from burns covering over 80 per cent of the body area or from third degree burns (burns destroying the full thickness of the skin) exceeding 30 per cent of the body surface. China‘s young surgeons, however, have not been deterred by the difficulties involved. In 1958, the Shanghai Guangci Hospital, in collaboration with other medical units, successfully treated Chiu Tsai-kang, burnt over 89 per cent of his body, and thus set a new record in curing such cases in our country. Encouraged by this example, the Burns Unit of Peking‘s Jishuitan Hospital has cured 17 similar cases in the last few years. These included one with a total burn area of 96 per cent, another with third degree burns on 47 per cent of the body area. The quality of treatment for moderate and mild burns has also been markedly improved and the duration of treatment in such cases has been shortened by a third to a half. In this field of medicine China is now on a par with or ahead of the most advanced world levels.
How have these results been achieved? Have Chinese surgeons got any new techniques?
It is true that new achievements in medicine are often linked with new technique. Does this Burns Unit then employ any new technique? The answer can be: No, or yes. No, if by new technique is meant new equipment or drugs hitherto unheard of in the world. Yes, if it is taken to mean new ways of employing existing equipment and drugs. The unit has devised many new ways of doing things. Its success is the fruit of the application of Mao Tse-tung‘s thinking in medical practice, the fruit of new medical thinking consciously based on Marxist dialectical materialism applied to medicine. The endless vitality of materialist dialectics inspires medical workers to seek continually for new techniques.
Deal With a Part While Keeping the Whole in View
A concrete example may help to give some idea of what this involves. At a recent discussion, Dr. Wang Chang-yeh, head of the unit, put forward the idea of “grappling with a part while keeping the whole in view.”
The antithesis of this idea is found in a common Chinese saying: “Treat the head when there‘s a headache, and the foot when there‘s a footache.” This metaphysical approach exercised considerable influence in certain Chinese medical circles in the past and has not been thoroughly overcome even to this day. In treating burns, the doctor is often confronted by extremely complicated and ever-changing problems. A patient may be simultaneously beset by many ills. Initially, not knowing how to cope with such cases, they tried everything all at the same time. If the patient had a fever, they dosed him with antipyretic; they gave him medicine for his headache and prescribed tranquillizer to calm him down; if he had diarrhoea, they treated that. All these measures were taken at the same time. Now a dose of medicine, then an injection, and then something else. The patient became so fatigued by overtreatment that instead of getting better, he got worse. Such treatment seemed to have taken the “whole” into consideration, but actually it was a piecemeal approach. Then they began to understand that in treating a patient, as in everything else, it is necessary to seize and grapple with the key aspects of a case. In burns, the key problem is healing the burnt area but this must be tackled with a full understanding of the relation of this key aspect to the body organism as a whole and as a sum of parts. If some aspects of the case are treated—shock or headache, for instance, this has to be done with the key aspects and the whole held in mind, not in isolation. Before they had fully understood this they had, for example, even administered a general anaesthetic in order to give the burnt area a thorough cleansing. This amounted to giving the patient two fresh blows in addition to the burn. The burnt surface was thoroughly cleaned but the case was aggravated. In such circumstances, a few remaining germs might prove to be formidable foes.
Learning lessons from such failures, the unit gradually came to see that it was simply impossible “to tackle the whole all at once,” and that the correct approach could only be “to grapple with a part for a start.” At every stage, the main therapeutic measure applied should be directed at one specific part. This is one side of the question. The other side is that while “grappling with a part,” it is necessary to “keep the whole in view.” Some parts have a decisive effect on the whole and some don‘t. In treatment, those parts that affect the whole should be brought under control first. Depending on circumstances, those that do not affect the whole, may either be treated or ignored. Whether or not a part has a decisive or important bearing on the whole depends on the given conditions and may change as conditions change. For instance, a needle puncture following an injection generally has no effect on the whole organism. But if the patient is extremely weak, germs might penetrate through the puncture hole and cause septicaemia, thus severely affecting the whole organism.
The metaphysical error in “treating the head when there is a headache and the foot when there is a footache” does not originate from “grappling with a part.” Quite often, to cure a “headache” or a “footache,” one has to start with the “head” or “foot.” But in treating the “head” or “foot,” one must first of all have a clear understanding of the relationship of that “head” or “foot” ache to the other parts of the body. Otherwise one will be considering only individual parts and not the whole and so may either fail to cure the “head” or “foot,” or may “cure” the part at the expense of the body as a whole.
Dialectics in Medical Work
The foregoing is only one instance of their conscious, creative application of materialist dialectics. The members of the unit discuss the dialectics of their work as a regular practice. Often a discussion of a therapeutic programme ends up in a discussion on dialectics. This reporter spent some two weeks interviewing all the ten doctors of this unit. I asked many kinds of questions as my interests were varied, but each time the conversation led quite naturally to the dialectics of the matter. So finally I asked to attend their philosophical seminar, which I did twice. The following gives an idea of what was said at such meetings:
Chang Chung-ming: The proper handling of burn eschar (tissue coagulated by the heat of the burn) is important to the healing of the burnt surface. Eschar has a dual character. In the past, we paid too much attention to its negative aspect, being over credulous of what is said in some medical literature about eschar being dead matter and therefore very susceptible to infection. As a result of this we always tried to remove it as soon as possible. But later we saw the other side of the question: eschar has a protective value and, if properly sterilized and dried, can protect against infection. So later we turned to the method of protecting the eschar in treating extensive burns. Naturally, its timely removal is necessary when it becomes a hindrance to the growth of skin or granulation tissue.
Tsao Ta-hsing: To prevent or treat septicaemia, we use a lot of antibiotics which have proved to be efficacious. But if used improperly, antibiotics can be dangerous and even fatal. This is their dual character. In the past, we sometimes saw only the positive side and neglected the negative side. In one case, we gave the patient a series of heavy intravenous doses of antibiotics as a means of controlling septicaemia. This so overtaxed his kidneys that he did not have the strength to resist a subsequent bacterial invasion. This painful experience shattered our blind faith in antibiotics and now we always take their dual character into account.
Dr. Kao Chih-jen noted that doctors naturally want to protect and reinforce the power of resistance of the patient by giving him a high-calory, high-protein diet, but they soon learnt that not every patient can eat nutritious foods like meat, eggs or milk. Some seriously ill patients have no appetite for such foods, or cannot digest them. In such cases, in order to eat well, the patient should first eat less. That is, light food such as gruel should be given first and rich food later when the patient is well enough to digest it and has the appetite for it. Thus “eat less” can be transformed into “eat more,” and “less nutritious” can be transformed into “more nutritious.”
On several occasions Dr. Chang Chih-teh and his colleagues compared treating a disease to fighting a war. The situation is changeable and conditions vary from case to case, each having its own special features. The soul of materialist dialectics is the concrete analysis of concrete things. For instance, we have just mentioned that antibiotics have their harmful side. But if a patient is critically ill and it appears that he cannot possibly be saved without large doses of antibiotics, then the doctor naturally decides to save the life of the patient first and to treat his burns later. Mechanical uniformity is not dialectics. This Burns Unit scored a series of successes precisely because its workers have skilfully applied their knowledge of dialectics.
Bold in Medical Practice,
Diligent in Reviewing Experience
How did these young doctors achieve so much so quickly? This also involves the question of their attitude to practice based on Chairman Mao‘s thesis that knowledge comes from practice. While learning from the experience of others, they pay very great attention to their own investigations and studies. Day and night they are in attendance on their seriously ill patients, keeping a close watch, carefully weighing every new development and noting them down in the case history. Sometimes, within a few days, a case history can grow into a thick volume.
They are tireless in conducting experiments. One example is their investigation and study of B. pyocyaneus. This germ is a source of worry to doctors for it can cause septicaemia which is the main cause of death following burns. Patients must therefore be strictly protected against it. But how? Some foreign studies state that since 10 per cent of healthy people carry this germ in their faeces, infection may come from the patients themselves and that it is, therefore, difficult to prevent. At first no one in this Burns Unit doubted this conclusion. Then one of its surgeons went to northwest China as a member of a rescue mission. There he saw a big burn which had not been infected by B. pyocyaneus over a period of three months even in the absence of strict sterilization and isolation. This went against all expectations. Was this purely accidental? Knowing that necessity is inherent in chance, they decided to get to the bottom of the matter. After making cultures of the faeces of 1,270 patients, they found that only 1.1 per cent, not 10 per cent, carried B. pyocyaneus. This forced them to the conclusion that the main source of infection was not the patients themselves. The investigation therefore shifted to the patients‘ environment. They made 1,080 cultures and found large numbers of B. pyocyaneuson various articles, on the floors, walls or in the air of the ward and relatively heavy contamination with this germ on the hands, working clothes and shoes of personnel in the ward. Measures were immediately taken to sterilize these sources still more thoroughly and to prevent cross infection by the establishment of a special isolation ward and by the strictest sterilization of everything going into that ward. These measures, subsequently improved, have markedly reduced the incidence of B. pyocyaneus infection and B. pyocyaneus septicaemia which were largely responsible for the high mortality rate in cases of burns exceeding 50 per cent of the body area before 1960.
In early 1960, the hospital was still unable to cure patients with burns exceeding 70 per cent of the body surface or with third degree burns exceeding 40 per cent of the body area. It was the secretary of the hospital Party Committee, Jung Tsu-ching, who then raised the question of summing up past experience in order to find effective means of curing such cases. In preparation for this task all members of the unit once again studied Chairman Mao‘s works On Practice and On Contradiction. This was followed by an analytical study of every important case treated and every important measure adopted. Many group discussions were held. All this was of great help in improving their understanding of burns and, strengthening their confidence that they could suecessfully heal these extreme cases. They soon had occasion to use the skill and knowledge they possessed.
Some months later, Ma Yuan, a kiln worker, was admitted to the ward; 90 per cent of his body surface had been burnt and of this area 22 per cent had suffered third degree burns. After emergency treatment, his case took a turn for the better.
Some three weeks later came another patient, Kao Teh-shan. He had an 85 per cent burn including 30 per cent third degree. The experience gained in treating Ma Yuan was applied to the new arrival.
Three months passed and the two had not yet fully recovered when two more patients, Chu Lien-jui and Yin Teh-lu, arrived, both with 87 per cent burns. With enhanced experience, the Burns Unit successfully treated the two newcomers. In the short span of seven months they had consecutively created four new records.
Meticulous and dedicated care of the patients, based on a wholehearted dedication to service to the people combined with skilful application of materialist dialectics, had achieved the desired results.
Discussing the development of the unit‘s new attitude to work, Chang Tung, the present secretary of the hospital‘s Party Committee, told us: “As in the past, so even now the formula ‘Heightened Skill—Service—Heightened Skill‘ still influences the minds of some doctors in China. That is, starting from a desire to increase their skill and knowledge, such people actually use treatment (service) as a means to attain the end of raising their own qualifications. What actually lies behind this is the personal goal of becoming a ‘famous specialist,‘ an author of important scientific papers, a noted researcher, and so on. For this reason, more often than not, such persons actually take a greater interest in the sickness than in the patient! But not all sicknesses, only those that are useful to their scientific papers or research work, and those that are out of the ordinary. As to ordinary diseases, they would very much rather have others bother about them. This attitude to some extent found expression among the surgeons of this burns ward. But that is now a thing of the past. Now they work according to a new formula: ‘Service—Heightened Skill—Service.‘ That is, proceeding from a desire to be of service to their patients, they try to improve their skill through work in order to be able to serve their patients still better.”
They are waging a persistent struggle against the influence of the formula “Heightened Skill—Service—Heightened Skill” and forging ahead along the path charted by the formula “Service—Heightened Skill—Service.” At a time when emergency measures were being taken to save the lives of severely burnt patients, Dr. Chang Chih-teh lived beside his patients for several weeks at a stretch; Dr. Wang Chang-yeh‘s wife gave birth to a baby, but knowing that his wife was well taken care of, it was more than a month before he took time off for a visit home. At the height of the battle to save the life of the kiln worker Ma Yuan, Dr. Tsao Ta-hsing stayed with him day and night, sleeping by his side. These doctors were in fact in attendance in the ward all round the clock. Thus they were able to take the correct therapeutic measures exactly when needed.
Imbued with the idea of service to the people, they have extended the scope of their work far beyond the bounds of the hospital walls. When emergency treatment is needed, no matter when or where, they are always ready to go. This wide ranging practice has enriched their experience and widened their horizons. This wealth of new, first-hand material has contributed to the laying of a solid foundation for the raising of the unit‘s standards in treatment and research work.
To Make Revolution, You Must Be Revolutionary
We should now give a general answer to the questions we touched on above. What makes it possible for the comrades of the Burns Unit to carry out so well in practice the formula of “Service—Heightened Skill—Service”? What accounts for their daring in medical practice, their diligence in reviewing experience and their steady advance in understanding the dialectics of their work? How has this group of young surgeons in a newly established unit of a new hospital achieved so much?
Underlying all this is the fact that they have learnt to dedicate themselves wholeheartedly to the revolution, to serving the masses.
Through the revolutionary movements of class struggle and scientific experiment, and through diligent study of Chairman Mao‘s works, the comrades of the Burns Unit have fostered in themselves the idea of “all for the revolution.” Without this revolutionary outlook, all that we spoke about above would be inconceivable. Without being inspired by the idea of “for the revolution,” one can never “know how to make revolution.”
The surgeons of the Burns Unit have studied revolutionary dialectics in the course of practice and in summing up their experience; they have become revolutionized and are able consciously and skilfully to use the dialectic method.
Dr. Wang Chang-yeh and his colleague said to me: “When we came to understand better the relation between the part and the whole in the person of a patient, we came to see more clearly the relation between the individual and the collective—to see the individual as a part of a whole. In relation to the individual, the Party, the state, the hospital, and the Burns Unit is the whole.” In the case of the kiln worker Ma Yuan, it was the socialist state with its great concern for the working people that brought him swiftly to the hospital where it had established the burns ward; and it was the Party and Mao Tse-tung‘s thinking that had enabled the doctors in this ward to acquire a revolutionary outlook and so to master the laws of treating severe burns that they could save him. In the absence of all these conditions, the life of this kiln worker could not have been saved. Seeing the truth of this, the burns ward staff became more and more conscious that the collective must come before the individual. It is this consciousness and its practical expression in deeds that makes the difference between an individualist and a person wholly dedicated to the revolutionary cause.
When they saw how necessary it is to maintain a strict scientific approach towards all measures of treatment—that is, to understand the dialectical concept of the unity of opposites, they came to understand that it is equally necessary to have the same approach towards their own thinking and work; that in times of danger and difficulty, they should see the bright prospects and that when things are going well, they should give thought to possible difficulties. They learnt that it is precisely when a succession of successes has been achieved that the need to guard against being proud and self-complacent is greatest: that “pride comes before a fall.” Experience has taught them that every step forward along the revolutionary path should be accompanied by a search for remnants of individualism in themselves; that when marked progress has been achieved in their work, it is especially important to boldly expose shortcomings and mistakes.
Dedication to the revolution knows no limits; there is no end to learning how to make revolution. As the revolution advances, the problems that arise in every sphere of activity are endless. There can be no resting on one‘s oars. The task of renovating medical knowledge and practice in the light of materialist dialectics is a formidable one. Inspired by Mao Tse-tung‘s thinking, the staff of the Burns Unit have pledged themselves to work on boldly in full recognition of the great responsibility of that task.