1 Introduction

In 1919, soon after returning from Europe where she had served as a nurse in the First World War, Vashti Rebecca Bartlett (1873–1969) sailed for Russia, via Japan, with the American Red Cross (arc) Commission to Siberia. The Commission’s stated objective was to assist with the complex humanitarian crisis caused by revolution in Russia. Thousands of people had fled eastwards to seek refuge from the brutalities that ensued and were living in terrible sanitary conditions that continued to deteriorate. Within days of her arrival in Vladivostok, Russia’s eastern-most port, Bartlett, with a team of nurses under her supervision, was dispatched to nearby Harbin, North China, to help contain and stem an epidemic of cholera. This encounter – which occurred in an emergency medical context of short duration, from August to November 1919 – bears historical significance because Bartlett’s personal experiences, activities, and archives render visible an understudied form of power manoeuvres employed by the United States (US) in that region.¹

Drawing upon the ground-breaking scholarship of Emily Rosenberg and Amy Kaplan, historians who embrace the postcolonial turn generally recognize that the expansion of US influence globally in the twentieth century has been rooted in imperialism.² Instrumental to this process, as other historians show, were medical and public health personnel serving with non-state agencies who were dispatched internationally in the aftermath of World War I, including thousands of arc nurses.³ Broadly influenced by historiographies that explore colonial medical encounters from postcolonial perspectives, these scholars interpret scientific medicine, explicitly or implicitly, as a “tool of empire.”⁴ On the one hand, US governments and diplomats used non-governmental medical personnel as symbols of friendship that could differentiate the United States from explicitly imperialist powers (especially Britain, France, Germany, Japan, and Russia) and thus convince foreign populations of its noble intentions. On the other hand, these medical humanitarians, individually and collectively, promoted US political ideologies and cultural values through their medical and public health interventions. As an arc nurse in China, Bartlett embodied this capillary, or, friendly, power.⁵

Close inspection of Bartlett’s motives and reactions discloses a specific and significant vector of friendly US imperialism transmitted by non-governmental agencies, institutions, and individuals: scientific medicine, widely interpreted in this period as universal and objective, and which therefore transcended politics, culture, or morality. Examining Bartlett’s experiences in Harbin, we demonstrate her strong tendency to differentiate between the foreign and the familiar, or, to show an appreciation or bias towards persons or groups, measured primarily against her scientific ideals. She also identified as American, wealthy, educated, female, and white, and these were identities she used as instrumental measures in the pursuit of her objectives. Within the context of her international nursing activities, however, we suggest that she identified principally as a nurse, and, specifically, as a scientific practitioner trained at Johns Hopkins where she internalized a set of scientific ideals that we associate with a particular “Hopkins ethos.”

Bartlett’s archive, described below, indicates overwhelmingly that she viewed herself as part of what Johns Hopkins co-founder, William Osler, described as “a sort of guild or brotherhood, any member of which can take up his calling in any part of the world and find brethren whose language and methods and whose aims and ways are identical with his own.”⁶ The Hopkins ethos was rooted, first, in the notion that scientific medicine was inherently objective and universal, and, therefore, transcended nationality, politics, morality, and culture; and, second, that Johns Hopkins medicine was an exemplary model to be learned, disseminated, and emulated. While Bartlett’s identity was unquestionably multifaceted, we argue that her self-identification as a practitioner of scientific medicine, as defined by the Hopkins ethos, led her to interact in unexpected ways with fellow nurses, physicians, patients, and local cultural and medical practices in all the places where she nursed, including Harbin, China in 1919. Bartlett’s commitment to what she perceived as the universal principles of scientific medicine enticed her to grapple with, and, in some cases, reconcile her national, gendered, racial, and professional identities with her overriding scientific identity, which, in turn, rendered her a useful agent of US friendship policies in China.

Bartlett left behind a comprehensive record of her work with the arc Commission to Siberia. This material is part of the impressive collection of personal papers donated by Bartlett’s family to her alma mater after her death in 1969. Today, the Vashti Bartlett Collection is held by the Alan Mason Chesney Medical Archives at Johns Hopkins in Baltimore, Maryland. The materials are of an eclectic, intimate, and reflective nature. Sources related to her experiences in Siberia and Manchuria include a personal diary, private letters, official arc correspondence, administrative documents, related publications and article clippings, published and unpublished writing by fellow arc personnel, and many photographs with descriptive captions added by Bartlett. We subjected these unique primary sources to close study and subsequently to historical and historiographical contextualization.

Our analysis unfolds in three sections. First, we examine how Bartlett internalized the Hopkins ethos during her training and how she committed to disseminating the Hopkins model in her early career. Next, we study her significance as a nurse and agent of US friendly power within the context of the arc’s international interventions, especially in Russia and China. Finally, we analyse how Bartlett’s scientific and professional ideals permeated her approach to nationality, race/ethnicity, class, and gender in personal and clinical scenarios. By interrogating this snapshot of Bartlett’s career, we shed additional light on the subtle interplay between US global expansion and scientific medicine in the early twentieth century, and, in particular, the experiential and interpersonal mechanisms by which US nationalism and US scientific medicine were subtly reconciled and performed by individuals such as Bartlett as a mean to support the rhetoric of US exceptionalism in China.

2 Bartlett’s Scientific Identity: the Johns Hopkins Ethos

In 1914, Vashti Bartlett gathered with other prominent alumni and faculty members at Johns Hopkins Hospital to celebrate its twenty-fifth anniversary. The productive power of the Hopkins ethos was a common theme in the many congratulatory speeches delivered that day. William Osler, the institution’s famous first chief of medicine, recalled how everyone who worked there had been bound together by “the spirit of the place.” Teachers and students “felt the presence and subtle domination” of a “sweet influence,” the origins of which, Osler declared, were unidentifiable. Rufus Cole, a medical graduate in 1899, later described how modelling had perpetuated the Hopkins ethos. “The professors made little or no effort to urge [us] to work,” he explained. Cole recalled how medical students had toiled arduously but happily. “The explanation is that they had all been converted to perfectionism [and] a fellowship developed among these disciples like that which is present among the followers of a religion.”⁷ The first director of the nursing school, Isabel Hampton, proclaimed at its opening ceremonies in 1899 that “the university and hospital are looked to from all quarters for what is best in science,” and she promised that Hopkins nurses would “uphold their part of a grand work with all faithfulness.”⁸ According to such testimonies, an exceptional and inescapable ethos was at work within Johns Hopkins medicine during its formative first quarter century.

Born on 15 November 1873, Bartlett was the eldest of four siblings in a wealthy American family that resided in an affluent area outside Baltimore. She came of age during a time of profound transformation in the United States. Industrialization and economic growth continued apace, especially in the country’s northeast, with the pernicious side effect of markedly and visibly increasing socio-economic inequalities among US citizens. Beginning in the 1890s, an upsurge of disparate reform movements emerged in this context, driven by middle-class concerns about the social disorder that accompanied escalating industrialism, capitalism, and immigration. Goals and strategies varied across diverse movements, but many self-described progressive reformers put their faith in collective action, economic and political efficiency, and, especially, scientific expertise to address social problems of every kind.⁹

Within this context, a transformation within US medicine that had begun earlier in the nineteenth century manifested fully in new university hospitals. Between 1880 and 1920, these institutions became essential to research, education, and careers in medicine. The medical apprenticeship was largely displaced by competitive placement, laboratory training, and bedside instruction at a university-affiliated hospital. The identity of North American doctors rested increasingly not on traditional therapeutics but on shared educational experiences and a claim to specialized, scientific knowledge.¹⁰ When Johns Hopkins Hospital opened in the late 1880s as the fulfilment of its namesake’s humanitarian aims, it was also a conspicuous embodiment of the new “scientific medicine.”¹¹

Concurrently, an unprecedented number of North American women, mostly white, began to enrol at institutions of higher education. The proportion of female students on US campuses nearly doubled between 1870 and 1910.¹² Professional colleges and university degrees remained out of reach for the vast majority of persons living in the United States, especially for women and racialized men – and most injuriously for women of colour – who all faced systemic barriers to higher education. In this context, Bartlett was one of the privileged few to access advanced education. Between 1887 and 1892, she attended the Bryn Mawr School in Baltimore, a progressive private institution and the country’s first college-preparatory school for women. In addition, she accessed a worldly education by travelling with her wealthy family throughout Europe. Young Bartlett’s debutante activities (recorded in the society pages of Baltimore and Washington, D.C. newspapers), and her late calling to nursing may suggest that she anticipated a more conventional life trajectory that did not transpire (e.g., becoming a wife and mother).¹³ Unmarried at age 30, her favourable socioeconomic position and the nation’s burgeoning social progressivism allowed her to aspire to higher education. When Bartlett enrolled in the Training School for Nurses at Johns Hopkins Hospital in 1903, it was widely considered some of the most advanced nursing education in North America.

Johns Hopkins University, opened in 1876, was designed around Germanic academic principles to emphasize graduate education and scientific research, making it the first university of its kind in North America. When its medical school opened in 1893, it was heralded internationally as the most sophisticated science-based medical training available in the United States.¹⁴ Johns Hopkins medicine was rooted in laboratory and clinical scientific principles. The institution’s self-defined mission was to shape the new scientific medicine in all its facets and to disseminate the Johns Hopkins medical model widely. Through prominent founding faculty such as Osler and William Welch, and compounded by the influence of the 1910 Flexner Report, the Hopkins model permeated the development of medical education in the twentieth century within and beyond the United States.¹⁵ Welch was appointed president of the Rockefeller Institute for Medical Research in 1901 and served on many of the Rockefeller Foundation’s commissions and steering committees, including its General Education Board, established in 1913, and its China Medical Board, created in 1914.¹⁶ Bartlett’s experiences in Harbin occurred, therefore, within an emerging context in which the Johns Hopkins model and influence would function as a tool of friendly US power in China.

The Hopkins medical model was influenced by the visions of its founding faculty and the Baltimore philanthropists who together brought the new medical school into existence. Initially, the university’s trustees had ample resources to execute the model and attracted talented people. John Shaw Billings designed the hospital and medical campus. Billings himself acknowledged that his architectural choices were not nearly as important as the careful selection of “proper and suitable persons” – he specified six men and one or two women – “to be the soul and motive power of the institution.”¹⁷ The educational and scientific vision of inaugural leaders such as Welch and Osler incorporated laboratory and clinical traditions in new ways and gave form to the Hopkins model that emerged.¹⁸

These founding visions were, by default, white and male. It was not until the 1960s that Black physicians earned degrees from the famous medical school.¹⁹ Indeed, historians have shown how the influential 1910 Flexner Report, which recommended that all North American medical schools adopt the Hopkins model, instigated the widespread closure of medical colleges for Black physicians and female physicians.²⁰ When a substantial financial shortfall prevented the medical school from opening, a group of wealthy Baltimore socialites (in whose circles Bartlett likely orbited at least peripherally) agitated for a share in the vision. Led by Mary Garrett, the Women’s Fund Committee offered Johns Hopkins trustees half a million dollars in exchange for higher academic admission criteria and the equal admission of qualified female medical students. Eventually, the trustees accepted the gift and the demands attached.²¹ These early leaders and philanthropists institutionalized the new scientific medicine at Johns Hopkins. Their visionary decisions stimulated the Hopkins ethos and did much to forge the professional identities of alumni such as Bartlett.

Among these was Adelaide Nutting, the principal of the nursing school between 1894 and 1907. A graduate of the first class of Hopkins nurses, Nutting left an indelible imprint on the Hopkins model and individual pupils. During her mandate, she managed to implement educational innovations developed by her mentor and predecessor, Isabel Hampton Robb. In particular, she succeeded in extending the curriculum from 2 to 3 years. She reduced the hours students spent working in hospital wards or private homes, and she eliminated the nominal payments for those shifts, so that more of students’ time was devoted to nursing education exclusively. In 1900, Nutting also convinced Hopkins administrators to implement a six-month preclinical course for the nursing program so that students could immerse themselves fully in mastering fundamental science, theory, and techniques of nursing.²² Both Nutting and Bartlett were elite members of a new cohort of hospital-trained and registered nurses who, as historian Patricia D’Antonio argues, forged their professional identity and gained new authority by emphasizing the scientific component of their training and work, as well as the righteousness of their personal character.²³

Due to class and gender inequities at the time, it was not easy for Hampton and Nutting to win support for these exceptional innovations in North American nursing education. Indeed, all female faculty members and students at Hopkins – in medicine and nursing – routinely faced condescension from the male majority and barriers erected to facilitate sexism and paternalism.²⁴ Osler had signed a letter in support of accepting the conditions of the Women’s Fund Committee; Welch had refused. Both men upheld the Victorian view that propriety required separate spheres for women and men. Under the inescapable influence of the Hopkins ethos, women at Johns Hopkins understood that, to become model scientific practitioners, they must degender themselves in order to be tolerated and admitted by the brotherhood of scientific medicine. “A woman has no business going into medicine,” one Hopkins medical student wrote to his fiancée in 1906. “She can’t do it without unsexing herself.”²⁵ Hopkins women performed this degendering by exhibiting tough, serious, and righteous demeanours. Nutting was famously recognized as the quintessence of rigorous social and scientific protocol, which helped convince male colleagues and administrators to accept her educational reforms.²⁶

The limitations of its sexist and paternalistic hierarchy notwithstanding, the Hopkins model required the integration of medical and nursing training. This integration reflected new personnel requirements demanded by scientific medicine, especially in the areas of diagnostic technology, laboratory testing, and new anti-septic surgical conditions. Nursing students were required to take scientific courses taught by the same clinical faculty who taught medical students. As her student notebooks indicate, during her three years of training Bartlett completed courses taught by both nurses and physicians on anatomy, physiology, bacteriology, pathology, surgery, internal medicine, urinalysis, gynaecology, orthopedics, pediatrics, and infectious diseases.²⁷ In his detailed instructions to the hospital trustees who would enact his endowment, benefactor Johns Hopkins had been explicit about this union and the training school for nurses had opened concurrently with the admission of the hospital’s first patients in 1889.²⁸ It was not an academic department that awarded university degrees, but it was an integral component in the successful execution of the Johns Hopkins medical model.²⁹ As part of the standard nursing curriculum, Bartlett also trained on all hospital wards to learn science-based techniques and procedures associated with each of the medical specializations listed above, in addition to administrative duties. It was on the wards, too, that she internalized the Hopkins ethos through intimate work, training, and interactions with Johns Hopkins faculty and personnel.³⁰

Photographs taken during the period Bartlett trained at Johns Hopkins show the integration and closeness of nursing and medical personnel, including students. While not exclusive to Johns Hopkins, we view this phenomenon as emblematic of its influential model. This sense of integration is particularly vivid in Figure 1, a photograph of nursing students posing with faculty and clinicians in a Johns Hopkins ward – some posed unceremoniously (Bartlett is standing, second from right). Professional intimacy among nurses and physicians, furthermore, went beyond the boundaries of codified working spaces. In a photograph evidently taken soon after some of the subjects had finished a surgical procedure (Fig. 2), this closeness also extended to moments of rest and fellowship within the unique shared experience of the Hopkins ethos.

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Photographs taken during the period that Vashti Bartlett (standing, second from right) trained at Johns Hopkins (1903–1906) reflect the interdependence of nursing and medicine in scientific medicine. While not exclusive to Johns Hopkins, this phenomenon was particularly emblematic of its influential model, which Bartlett and others disseminated internationally

Citation: European Journal for the History of Medicine and Health 78, 1 (2021) ; 10.1163/26667711-bja10003

reproduced with the permission of alan chesney medical archives, johns hopkins medical institutions, baltimore, md

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Staff and trainees in repose at Johns Hopkins Hospital, 1897. Those who internalized the Hopkins ethos could conceptualize themselves collectively as full members of the fellowship of scientific medicine, even in spite of obvious inherent gender and racial/ethnic inequities (Bartlett is not pictured here)

Citation: European Journal for the History of Medicine and Health 78, 1 (2021) ; 10.1163/26667711-bja10003

reproduced with the permission of alan chesney medical archives, johns hopkins medical institutions, baltimore, md

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The close integration of medicine and nursing at Hopkins is also discernable in institutional discourses. As an example, in his address to the first class of nurses to graduate in 1891, Osler emphasized that doctors and nurses shared the mission to shelter mankind from suffering and disease. “Remember what we are,” he told Nutting and her classmates, “useful supernumeraries in the battle.” He continued: “we” who spend our professional lives so near the dark river of Death and help so many patients embark with the “old boatman.”³¹ There were inherent gender inequities and hierarchical dynamics among men and women, faculty and students, nurses and doctors at Johns Hopkins in this formative period. Concurrently, those who internalized the Hopkins ethos could conceptualize themselves collectively as paragons of the new scientific medicine, convinced of their mutual interdependence, like-mindedness, and compatibility.

Exceptionalism was fundamental to the Hopkins ethos. During her training, Bartlett learned to act as an integral component within a model of scientific medicine that the institution deliberately exemplified, at home and internationally. Her credentials signalled – to others and to herself – that she possessed outstanding expertise in her field. Photographs and writings from her early career reveal that, as she practiced nursing across drastically different contexts, she remained governed by the Hopkins ethos and steadfastly disseminated the Hopkins model to those settings. Like medical missionaries and colonial medical workers embedded in their “civilizing missions,” she was committed to transporting scientific medicine to those she deemed in need of medical proselytization. Several photographs taken in 1908, for example, while Bartlett was Chief Nurse at St. Anthony’s Hospital (part of Dr. Wilfred Grenfell’s Royal National Mission to Deep Sea Fishermen in Newfoundland, Canada) appear to function as visual confirmation for friends and colleagues of her ability to maintain high standards of bed-making, bandaging, and surgical care, even in an isolated outpost in the Canadian north.³² When Bartlett worked in a rural hospital in the Blue Ridge Mountains in North Carolina in 1911, she openly lamented the backwardness and poor living conditions she found there. She described home remedies used by the local population that were “strange in the extreme.” Bartlett insisted, however, that she maintained high standards in her small hospital and promised to spread scientific medical knowledge in the region. “The infirmary is well-equipped,” she assured colleagues in a dispatch published in her alumni magazine, “and any Hopkins nurse who goes down will find things very much as she is accustomed to find them.” If the locals could be convinced to “abandon their weird concoctions,” and to open their cabins to ventilation and sunlight, it would “go far towards strengthening the people against the ills of the mind and flesh.”³³ These examples show how Bartlett had internalized the Hopkins ethos and her commitment to implementing and disseminating scientific medicine, regardless of context, including producing written and photographic attestations of that commitment. Her archive also discloses her deep confidence that, as a Hopkins nurse, she not only supplied scientific medical interventions to the populations she served, but also social and moral uplift.

3 arc as a Political Tool: from Siberia to China

When she joined the American Red Cross (arc) in 1913, Bartlett’s specialized training at Johns Hopkins and diverse experiences were compelling credentials. Her first posting was with ten other nurses to provide disaster relief for flood victims in Dayton, Ohio supervised by Jane Delano, head of the arc Nursing Service.³⁴ At the start of World War I, the arc made Bartlett head nurse at two of its hospitals, first in Pau, France and later in La Panne, Belgium. Upon returning to the United States in 1917, she was appointed assistant to Clara Noyes at arc headquarters in Washington, D.C. Noyes directed the arc’s Bureau of Nursing and was a fellow graduate of Johns Hopkins (1896). Their later correspondence reveals that Bartlett and Noyes developed a strong professional and personal alliance. “My letters to you are so often not official,” Bartlett acknowledged in the familiar tone of their exchanges, “but are written just to give you a picture of our daily life.”³⁵ Their shared internalization of the Hopkins ethos also suffused this working friendship. “You will I know be interested to know that our C.O. is Lt. Col. Abbot,” Bartlett wrote while was serving the U.S. Army Nursing Corp as Chief Nurse with Base Hospital Unit 71 in France. “He tells me he gave the first lectures to the nurses at J.H.H. married Dr Oslers [sic] niece, knows most of our elder doctors and nurses.”³⁶ In April 1919, after her military service, Bartlett applied for what she initially described to family as “foreign service with the Czecho-Slovak Unit.” In June, she sailed from San Francisco for duty with the arc’s Commission to Siberia. Bartlett’s Hopkins training and professional rigor were considered vital assets, not only on a humanitarian basis, but also from a political point of view.³⁷

In November 1917, the militant wing of the Socialist Workers Party led by Vladimir Lenin, who called themselves the Bolsheviks, ousted the Provisional Government of Russia established after the forced abdication of Tsar Nicholas ii.³⁸ Rioting women, striking workers, defecting soldiers, and the Bolsheviks had ended Russia’s monarchy. The successful armed coup unleashed a long and painful battle for political power. To start fulfilling his promise of “Peace, Land and Bread” for all Russians, Lenin had negotiated a truce with Germany and ended Russia’s involvement in the war, a strategy that consolidated his power. Simultaneously, his government solicited official recognition and assistance from the United States and welcomed arc relief and personnel. For complex reasons – but especially because Lenin’s truce with Germany was viewed as having compromised allied military positions, and because Bolshevism was deemed a threat to both democracy and US economic interests – the United States refused to acknowledge the revolutionary government. Consequently, president Woodrow Wilson deployed his military forces to Russia in the summer of 1918 to support anti-Bolshevik factions in the civil war, and to support the allied Czechoslovakian forces stuck in Siberia by the truce. Wilson was backed by Britain, France, Japan, and Italy as well as popular opinion at home. Concomitantly, he ordered all US civilians out of Russia and placed the arc under the control of the Supreme War Council of the major allies formed in response to the revolution.³⁹ The War Council deployed arc personnel to areas still not under Bolshevik rule, including Siberia. By the time Bartlett arrived there a year later, the arc’s anti-Bolshevik position was barely disguised by its professed politically-neutral humanitarian ideal. Indeed, the arc was operating not only as a quasi-official US military unit, but as an auxiliary to US foreign policy.⁴⁰

The arc had been in Russia since 1917. Its official mandate was to provide impartial relief to populations afflicted by the upheaval of war and revolution. As historians have shown, however, the arc’s involvement in the region was a product of complex and increasingly evident political forces.⁴¹ Remote and sparsely populated, Siberia was buckling under the weight of a massive influx of refugees escaping from western Russia. Crowded and unsanitary living conditions provided fertile ground for outbreaks of tuberculosis, typhus and cholera, which preoccupied the arc. Disease was a serious threat, not simply on humanitarian grounds, but also to allied personnel and thus victory over the Bolsheviks. Subsequently, the arc deployed multi-pronged strategies to contain contagious diseases in the region, from establishing hospitals and sanitoriums to funding public health campaigns. “The medical service for the benefit of American and Allied troops and numerous refugees,” a 1919 arc report stated explicitly, “was probably the most important work carried on by the Red Cross.”⁴²

When Bartlett arrived in Siberia in August 1919, arc personnel were engaged in a unique battle against typhus. Travelling by so-called sanitary trains all along the trans-Siberian railroad, they disembarked wherever necessary to mitigate typhus outbreaks by delousing people and disinfecting their belongings.⁴³ In addition, they supplied material relief of food, clothing, and household items to refugees and locals. They also provided medical treatment to soldiers and civilians.⁴⁴ The arc’s objectives, however, went beyond its stated mission of politically-neutral humanitarian relief. Its interventions were also designed to “revive” Russians socially, economically, and politically. As such, it opened or supported orphanages, schools, and homes for the elderly; put local civilians to work in various economic sectors; and, restored and secured reliable transportation and communication.⁴⁵ As part of this extended mission, Bartlett was not only assigned to nursing duties, but also taught courses in domestic hygiene, nutrition and cooking, as well as basic nursing to local Russian women.⁴⁶

When Bartlett’s arc unit was dispatched to nearby Harbin in North China, she understood the assignment’s significance to political and health contexts in Siberia. Her duty was to help the Chinese quell a cholera epidemic before it breached the Russian border. “Any help we can give to help stop the disease is helping the Russians,” she explained in the pages of her Hopkins alumnae magazine, “as it spreads from the Chinese to them.”⁴⁷ Indeed, the 1919 cholera epidemic in East Asia was well known to have originated in cross-cultural transmission, entering China from the Philippines via the Southern ports of Shantou (Swatow) and Fuzhou (Foochow). It reached Manchuria by the port of Yingkou (Newchwang) on 22 July and Harbin on 5 August, then continued to eastern Russia, Korea, and Japan.⁴⁸

Bartlett’s dispatch order to Harbin was also motivated by long-standing multifaceted US interests in China, particularly Manchuria. The aftermath of the Opium Wars (1840–1842; 1856–1860) had forced international trade and foreign presence on China. Imperialist powers scrambled to acquire more and more of a foothold in the region. Men and women connected to US commerce, diplomacy, and Christian missions had converged on Chinese soil at the end of the nineteenth century, competing with European, Russian, Japanese, and British counterparts to exert and consolidate their influence.⁴⁹ At the beginning of the twentieth century, Manchuria became a critical strategic location for this battle. The US secretary of state, John Hay, had proposed the Open Door policy in 1899 to prevent any official partition of China among the imperialist powers and thus safeguard a fair share of the Chinese open trade market for the United States. Subsequently, places such as Harbin were important sites for patrolling the new policy. In 1905, Japan’s unexpected victory in the Russo-Japanese War had forced Russia to cede the Liaodong Peninsula and its rail lines to Japan.⁵⁰ Japanese expansion into Manchuria weakened US trade there, but the United States continued to stake its claim. It infused capital and expertise across various sectors to prohibit either Japan or Russia from encroaching upon the Open Door policy, and, by extension, on Chinese sovereignty.⁵¹

For these reasons, the arc also had a history in Manchuria. Beginning in 1906, it had targeted China for its flood and famine relief programs. When a deadly epidemic of pneumonic plague struck Manchuria in 1911, the arc took an extra step to sponsor two medical experts to travel from the US-occupied Philippines to assist the Chinese: Dr. Richard Strong, chief of the Biological Laboratory at the United States Science Bureau in Manilla, and his assistant, Dr. Oscar Teague. Concerned that Russia or Japan would exploit the upheaval to tighten control over the region, and wary that the arrival of two US medical experts might appear to undermine Chinese authority, US and Chinese diplomatic agencies justified the presence of Strong and Teague in Manchuria based on their upcoming participation in the Mukden International Plague Conference scheduled for a few months later. Importantly, they also relied on the arc’s famous apolitical stance to place American envoys at the disposal of the Chinese government.⁵² Consequently, Strong and Teague worked under the supervision of Dr. Wu Liande (Wu Lien-teh), a Malay British subject of Chinese descent who had obtained his medical degree from Cambridge University in England. At the time, Wu was serving in the Chinese military as vice-director of medical services at the Army Medical College in Tianjin. In 1911, Qing authorities mandated him to quell the plague epidemic in Manchuria. His success was rewarded by his presiding over the Mukden conference in April later that year, and by his appointment as director of the new Manchurian Plague Prevention Service in 1912. As a model of scientific modernity, Wu’s successes advertised the emergent Chinese republic and its reaffirmed sovereignty.⁵³

The US presence was pervasive in China at the opening of the twentieth century, but it was never unquestioningly welcome. On many occasions, such as the Boxer Uprising in 1900 or during the aftermath of 1919’s May Fourth (or, New Culture) Movement, US goods or holdings – even US nationals themselves – were targets of angry, sometimes violent, Chinese anti-foreign protesters.⁵⁴ For US political, economic, and religious leaders in China, providing humanitarian aid and medical assistance helped mollify tensions, build trust with Chinese groups, and, ultimately, advance diverse US agendas.⁵⁵ Christian missionaries had pioneered this strategy, even before the Opium Wars, using access to education and medical treatment as tools of proselytization.⁵⁶ Such tactics made US missionaries prominent vectors for scientific medicine in China.⁵⁷ This role was taken over by a secular US philanthropic organization when the Rockefeller Foundation created the China Medical Board in 1914. Notably, William Welch, the first dean of Johns Hopkins medical school and by now director of its new School of Hygiene and Public Health, served on its board of directors. In 1915, the Rockefeller Foundation also organized the Peking Union Medical College based on the Hopkins model.⁵⁸ Developed in collaboration with political and medical leaders in China who adapted them for the Chinese context, both the China Medical Board and Peking Union Medical College were conspicuous products of the exceptionalist Hopkins ethos.⁵⁹ Established to improve public health in China and to set high standards for training in scientific medicine, they awarded funds to both foreign missionary and local Chinese medical institutions who were deemed worthy and promising vectors of the Hopkins model.⁶⁰

The arc regularly collaborated with US medical missionaries and Rockefeller personnel in China.⁶¹ Americans representing government and commercial interests, moreover, often knew about, supported, or solicited these medical initiatives. Why? Because the provision of scientific medicine was widely considered a potentially effective means of stabilizing the political situation and was seen as undeniable proof of the United States’ concern and friendliness towards the Chinese people – both of which served complex US interests in China at the beginning of the twentieth century.⁶²

By 1919, the arc made little pretence that it represented US political interests and values. This was a particularly salient feature of its presence and activities in Siberia. The assistance it offered, therefore, was shaped to remind beneficiaries where it came from. The flags of the United States and the Red Cross flew side by side at arc facilities, as they did on arc posters from the period (Fig. 3).⁶³ In a letter to Clara Noyes, Bartlett noted that male arc personnel were issued military uniforms emblazoned with “U.S.” instead of “A.R.C.” (Fig. 4).⁶⁴ She asked Noyes why men’s and women’s arc uniforms were differentiated and declared that female arc nurses ought to have military association that was similarly identified on their uniforms. Undoubtedly, Bartlett’s remark was rooted in the reality that women deserved greater recognition for the medical labour and political service they performed. And, in the same breath, she expressed her desire to be recognized, like her male colleagues, as an official representative of the United States in the region.⁶⁵

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By 1919, the United States made no attempt to disguise the fact that the American Red Cross (arc) was an extension of its political and military interests around the world. The two flags flew side by side at arc facilities in Siberia and North China, as they did on this poster from the period

Citation: European Journal for the History of Medicine and Health 78, 1 (2021) ; 10.1163/26667711-bja10003

reproduced with the permission of the library of congress prints and photographs division, washington, dc

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Vashti Bartlett led a team of nurses as part of the arc’s Commission to Siberia in 1919 that was deployed to Harbin to assist the Manchurian Plague Prevention Service, directed by Dr. Wu Liande (standing left of centre, and holding a Red Cross pendant), to contain a cholera epidemic. arc humanitarian interventions saved or improved many lives and simultaneously functioned as a tool of US “friendly” power in the region. Bartlett is not pictured here (she was perhaps the photographer)

Citation: European Journal for the History of Medicine and Health 78, 1 (2021) ; 10.1163/26667711-bja10003

reproduced with the permission of alan chesney medical archives, johns hopkins medical institutions, baltimore, md

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She and her female nurses were never issued US insignia to add to their arc uniforms. Nevertheless, Bartlett was aware of the political implications of arc action in Siberia, which included her unit’s efforts in Harbin. The arc’s publications reminded US readers of their debt to the Russian people for helping to win the war, and the United States’ duty to protect and restore its allies by providing relief and democracy.⁶⁶ Bartlett’s letters and reports echo these sentiments. She emphasized the desperate living conditions of local populations, and regularly justified arc involvement in the region, alongside the US military, in both political and humanitarian terms. In rough handwritten notes hastily enclosed with a family Christmas letter in late 1919, Bartlett remarked on the importance of sending “the correct type of people to represent us” in Russia because the “future relations of both countries may depend upon it.” When she felt frustrated by the magnitude of her task, she consoled herself by remembering “how they joined in our cause” and “went against the enemy Germans with clubs in their hands.”⁶⁷ As these few lines demonstrate, Bartlett understood and sanctioned the political dimensions of her unit’s medical intervention in the region. Moreover, there was a “correct type” of effective US representative for the task, and we sense that Bartlett viewed herself as exemplary in this regard.

4 Scientific Medicine: Bartlett’s Self-Identity and US Friendly Power

Bartlett never explicitly verbalized what she meant by the “correct type of people” to represent the United States. Her meaning is glimpsed, however, in her self-expression and attitudes while in Siberia and China. She brought to Harbin the technical skill and scientific knowledge about infectious disease that she had acquired at Johns Hopkins, but also the Hopkins ethos. Recent historiographical interpretations argue that the actions of arc workers in settings culturally foreign to them were generally informed by the imperialist mindset which claimed superiority based on notions of Westernness, whiteness, and civilization.⁶⁸ On close inspection, Bartlett did not derive her own sense of authority primarily from her white, wealthy, or national identity. As her archives reveal, while she fully embodied these intersectional identities, the Hopkins ethos consistently exercised a strong influence on her interpretations of difference in ways that are somewhat unexpected. Osler had famously declared that, within medicine, “distinctions of race, nationality, colour, and creed are unknown.”⁶⁹ Like the modern medical professionals studied by Helen Kang, Bartlett did not employ scientific objectivity simply as a political or professional strategy. The ideals of universalism and membership in the fellowship of scientific medicine suffused her clinical and personal encounters with others.⁷⁰

Bartlett had travelled extensively, but never to this part of the world. It was her first contact with both Russian and Chinese cultures. When she reached Harbin from Vladivostok by train on 26 August 1919, the cholera epidemic was at its peak. With five nurses under her supervision and alongside five arc doctors, her mandate was to assist the Manchurian Plague Prevention Service, led by Dr. Wu Liande, to treat the sick and contain the outbreak. Further, it was important that the arc make its presence felt in Harbin, and – at least symbolically – take the lead in resolving the sanitary crisis. One of Bartlett’s photographs, which we suspect she took herself, illustrates these combined objectives: the two medical teams pose together, relaxed and friendly, including a smiling Wu who displays a Red Cross pennant (Fig. 4).⁷¹

The appearance of cholera in North China that summer coincided with unusually hot and dry weather, which dried up wells and attracted more flies. Subsequently, Harbin’s inhabitants consumed more uncooked foods, especially thirst-quenching fruits such as watermelons; and, contrary to their habits, drank unboiled water. The development of basic sanitation facilities in Manchuria, moreover, had been insufficient in the face of rapid population growth. This was especially true for newly opened and contested areas such as Harbin, where Chinese migration and settlement had been encouraged by government policies in order to counterbalance foreign presence and influence.⁷² Cholera is an infectious bacterial disease (Vibrio cholerae) that causes severe diarrhea, vomiting, and dehydration. The medical treatment is intravenous hydration. Untreated, death occurs within hours. Cholera spreads through water and food contaminated chiefly by infected human excreta and vomitus. In 1919, all conditions for a severe outbreak were met in North China. The Manchurian Plague Prevention Service and the Harbin community struggled to cope with scarce resources and mortality was high. Wu reported that in six weeks there were 13,000 cases and 4,500 deaths.⁷³

For many foreigners, the situation conformed with a national identity they had constructed for China: the “Sick Man of Asia”. Indeed, upon her arrival in Harbin, Bartlett noted that cholera raged in Fuchiatian, the town’s Chinese district, but not in its Russian and commercial quarters. This integral and well-studied narrative conveyed the eugenic metaphor of uncivilized China (and Chinese people) as weak, sickly, and degenerate, in contrast to the strength, vigour, and health of civilized Europe and its descendants.⁷⁴ In this popular trope, the Chinese body was inherently pathological. As historian Yuehtsen Juliette Chung shows, foreigners portrayed Chinese persons, and, specifically, their perceived “cultural backwardness”, as the cause of sanitary crises such as the 1919 cholera epidemic.⁷⁵ “The gutters were filled with indescribable filth,” Bartlett reported initially of conditions in the Chinese districts, “and swarms of pestilential flies were everywhere.” She estimated the death rate to be 200 to 300 per day. People suffering and dying from cholera could be seen “at every turn” amid hundreds of “unburied bodies swarming with flies.” Notably, however, Bartlett did not invoke the common trope in her descriptions of the crisis, not even implicitly. Rather, she enumerated various causal factors, including rapid industrial expansion and population growth in the Chinese district, in part due to foreign encroachment in the region. “Large stores and houses had been built,” she explained, “but no attention paid to sanitation or roads.”⁷⁶

Her archives contain several examples of conscious attempts by Bartlett to distinguish personal prejudice from professional assessment rooted in scientific principles. Moving away from the Sick Man of Asia trope, she praised Chinese hospitals and medical personnel under Wu’s authority because their operations aligned with those ideals. “The Chinese were fortunate,” she wrote, “having a well-equipped hospital and an efficient staff under the direction of Dr. Wu Lien-teh.”⁷⁷ Wu was an impressive figure who certainly impressed Bartlett. When they met, he was relatively well-known for his previous work on plague in Manchuria and he was on his way to becoming an internationally recognized leader in public health and infectious disease. In reality, he was also a foreigner of Chinese descent in Manchuria. Their common fellowship in scientific medicine, nevertheless, mediated Bartlett’s interpretations of othering narratives such as the Sick Man of Asia. Her archive highlights the enormous admiration that she developed for Wu as she worked alongside him and his Chinese personnel during the cholera epidemic. Bartlett even requested of Wu that he inscribe a portrait of himself as a keepsake.⁷⁸ According to his published record of his own veneration for Johns Hopkins and its founders, it is also likely that Wu reinforced for Bartlett the exceptionalism of the Hopkins ethos.⁷⁹

Based on those same ideals, Bartlett condemned the way the Russians handled the sanitary crisis as “pitiful.” As Europeans, Russians in Harbin enjoyed social privilege, but they were “slow to recognize the importance of organized preparation,” according to Bartlett, and conditions in Russian-operated hospitals were chaotic and unsanitary. Evidence of Russians’ lack of scientific rigor was in the details of ward operations. Incoming patients on stretchers, incontinent and vomiting, were unloaded anywhere there was room, including the floor, while other sick patients lay in beds with bloodied or soiled sheets.⁸⁰ “I was in a ward with three Russian doctors and nurses,” Bartlett reported to fellow Hopkins nurses in their alumni magazine. “A patient was sick and they let her vomit three times and made no motion to get a bucket or basin” to interrupt the main transmission route of the bacterium.⁸¹ Bartlett’s sense was later corroborated by official mortality records. Even though the two Russian hospitals admitted far fewer cholera patients than the two Chinese-operated hospitals (580 and 2147, respectively), Russian hospital death rates were almost double (34% versus 14%).⁸² Bartlett also found moral standards among Russian medical personnel unacceptable. “Men and women are put in the same room in beds next to one another and I have yet to see a screen,” she complained. “I have seen them bring [nude] patients the length of the building on a stretcher without any thing on them.” She was eventually able to report, however, that “now they know we insist upon a sheet.”⁸³ We contend that this “we” did not refer to the American Red Cross, but rather the fellowship of scientific medicine to which, in Bartlett’s view, Wu and his team also belonged.

Bartlett emphasized on several occasions the success of the arc’s emergency intervention in Harbin. In a matter-of-fact description of their remarkable first day, she and her nurses “divided their forces” and promptly transfused as many cholera patients as possible in twenty-four hours. “In a surprisingly short period of time the situation was well in hand,” she reported confidently, “[and] the death rate was immediately reduced.”⁸⁴ In her personal diary, she proudly reflected: “bringing people back from certain death makes one feel that the day was worth living.”⁸⁵

Despite her status as a foreigner, Bartlett did not doubt her own authority in this emergency medical context. Like the female US missionaries defined by Carol C. Chin as “benevolent imperialists,” Bartlett exhibited no discomfort or recognition of the privilege enjoyed by herself and US nationals generally within the context of the arc’s medical mission.⁸⁶ In a letter to Clara Noyes, for example, she described how the arc contingent had “descended” upon the home of their host, US official William Dawson. “His Chinese cook has hard work to feed us,” she told Noyes. “I am trying to teach him the dishes I know, but without a cook book it is hard work.”⁸⁷ By “trying to teach” him recipes, she exerted her authority (albeit in a friendly manner) over what meals and flavours were acceptable to the US diners. Bartlett also reported that her contingent had a “Chinese boy” named Chang, who likely functioned as a guide, liaison, and interpreter. When Chang was arrested for fighting, he called for “his American master” (that is, Bartlett and arc colleagues). “As he seemed to be in the right,” Bartlett reported, “we went to his assistance.”⁸⁸ She did not appear to question her right to judge this local situation or use her influence to intervene on Chang’s behalf.

Certainly Bartlett used her superior position to try to impose the Hopkins medical model, not only to save cholera patients and prevent contagion, but also to “uplift” or “revive” local populations morally and politically. In Siberia, she taught a course on “Nursing in the U.S.” to Russian women that included bacteriological explanations of disease prevention, first aid, and personal and domestic hygiene. The goal was to change customs and create agents of further dissemination.⁸⁹ In one telling example, she was ready to impose her authority to override local burial customs, but was eventually convinced to accept this cultural difference once she realized bacteriological principles were not threatened. Chinese in Harbin, she reported, did “not bury their dead under ground” because most were recent migrants from Shandong province and intended to return their dead kin to their ancestral lands further south for proper burial when possible.⁹⁰ As a result, when the arc first arrived, they soon observed that many who had died from cholera were placed “almost anywhere convenient.” In consultation with Chinese authorities, the arc prepared to collect and bury the infectious corpses “in large limed trenches” at Harbin.⁹¹ Bartlett initially had no qualms about overriding local funeral practices to stop the spread of cholera. Once she understood the cultural significance of ancestral burial to Chinese families, however, the solution was adapted. Immediate burial was not essential, but infectious human remains had to be isolated. “A sum was immediately contributed by the A.R.C. and local societies, to procure coffins for all,” she reported to arc headquarters and her family in Baltimore. When Bartlett and colleagues visited a nearby cemetery – normally reserved for wealthy Chinese, but where coffins belonging to all families were stowed now due to the outbreak – they posed for photographs to record the results of this judicious compromise (Fig. 5). “No attempt is made to bury the coffins,” she emphasized. “They are placed on the ground in rows, scarlet and gold next to the plainer wooden ones.”⁹² Scientific medicine made conceptual room to accept some cultural differences and functioned to reaffirm the humanitarian and thus “friendly” nature of the arc’s medical action in Harbin.

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Based on the principles of scientific medicine, Bartlett (standing, far right) was ready to invoke the political authority of the arc to override local funerary practices in Harbin, but was eventually convinced to accept cultural difference once she realized they were harmless from a bacteriological perspective

Citation: European Journal for the History of Medicine and Health 78, 1 (2021) ; 10.1163/26667711-bja10003

reproduced with the permission of alan chesney medical archives, johns hopkins medical institutions, baltimore, md

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Concurrently, crude assumptions and demeaning terms that functioned to “other” Chinese persons are largely absent from Bartlett’s archive. On the contrary, her plain and descriptive portrayals of Chinese customs that were unfamiliar to her indicate some self-awareness about how she ought to depict them. There are subtle examples, such as sanguine descriptions of local foods in letters to family and friends that she surely knew would strike them as strange or disgusting (including the local custom of snacking on sunflower seeds by cracking them open between the teeth).⁹³ But there is more explicit evidence that Bartlett recognized and monitored aspects of her own cultural bias. In her description of a memorable social evening at a Chinese theatre, she noted that the most striking feature of the performance “was the weird music” characterized by the “monotonous nasal tones” of the singing and “even more monotonous” sound of the “queer” musical instruments. She concluded, however, with a frank admission that musical tastes are learned: “it was not at all pleasing to us who had not been in the country long enough to develop an appreciation for Chinese music.” Perhaps written with publication in mind, this typed document also shows Bartlett’s handwritten corrections and revisions to her initial composition. She crossed out several derogatory words and passages. In the revised version, therefore, she decided to omit the adjective “vociferously” to describe how Chinese individuals cracked sunflower seeds between their teeth; and, from her description of the local practice of leaving towels to soak in tubs of water for bathing and cooling off, she purged the judgement “rudimentary.” Regarding her experience at the Chinese theatre, she replaced “I would not care to have repeated [it]” with “I should not liked to have missed [it].”⁹⁴ Bartlett’s acknowledgement of her own cultural bias reflected her stronger commitment to her scientific ideals and its apparent transcendence of cultural difference.

Bartlett also specified how Chinese authorities appreciated the arc’s interventions. To Noyes, she wrote: “I do not want to make too much of it but thought you might be interested to hear that all the Nurses and Drs who helped the Chinese in this cholera epidemic have received medals.”⁹⁵ In her letters and reports, she recounted dozens of times, in glowing terms, the details of a luncheon given by Chinese officials to thank arc personnel for their assistance. There are six different photographs in her archives that depict the same group portrait taken after the luncheon. Several are smaller amateur photographs, taken with at least two different cameras, and there is a 4” × 6” print of better quality, perhaps taken by a professional photographer. Bartlett also possessed an 8” × 10” copy of superior quality with a caption in Chinese added at the top and signed by Wu at the bottom (Fig. 6). This copy was likely presented as a thank you gift and reminder of the event, since it was enhanced after it was printed.⁹⁶ Bartlett was convinced that the arc’s medical intervention in Harbin was justified and helpful to the Chinese, and this public display of gratitude indicated to her that the Chinese themselves recognized it as such. Outwardly, this indeed appeared to be a friendly collaboration.

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At a luncheon hosted by Chinese officials in honour of the arc’s service in the cholera epidemic, Bartlett (standing, the only woman in the front row) was gratified when her fellowship in scientific medicine was acknowledged publicly on par with that of Wu Liande (standing, front row, fifth from left). “I was very much honoured being given a seat at the centre table next to Dr. Wu,” she wrote to her sister

Citation: European Journal for the History of Medicine and Health 78, 1 (2021) ; 10.1163/26667711-bja10003

reproduced with the permission of alan chesney medical archives, johns hopkins medical institutions, baltimore, md

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• Download figure as PowerPoint slide

Bartlett was proud to be recognized for her medical achievements. According to her letters, she and her nurses were the first women ever to be entertained publicly in Harbin. She also noted that she was pleased to be placed on par, in public, with male medical personnel: “I was very much honoured being given a seat at the centre table next to Dr. Wu.”⁹⁷ She sent the photograph to her sister, noting with pride that “it is something to be on the front row with noted Chinamen.”⁹⁸ The relative space that the event occupies in Bartlett’s archive demonstrates the importance she attached to it. Her personal reflections reveal that she was gratified to have her fellowship in scientific medicine acknowledged publicly on par with that of Wu – irrespective of his ethnicity or her gender (Fig. 6).

Bartlett’s obvious admiration for Wu contrasts strikingly with her lack of affinity with local women, something we connect to the degendering impulse of the Hopkins ethos. To Noyes, for example, she mentioned a recent magazine article that espoused the benefits of assigning military style rank to arc nurses. “It stated that the position of women in many of the foreign countries was so below that of men,” she explained, “[that] had we rank we would not be classed with them.”⁹⁹ Bartlett, in other words, did not want to be confused or associated with Russian or Chinese women. Rank represented an effective way to degender arc nurses, and to ensure they were valued as practitioners of scientific medicine. She often remarked how gender relations in China were different than those to which she was accustomed. In a society governed by strict norms of sex-segregation, she told friends, aghast, not only were Chinese women in Harbin not entertained in public, but a wife might not even know her own husband’s closest friend.¹⁰⁰ Her apparent astonishment may indicate the extent to which Bartlett had succeeded in degendering, since there was obvious gender discrimination at home and she knew how the Women’s Fund Committee had had to strong-arm Johns Hopkins into admitting female medical students only twenty years earlier. She did express sympathy for one Chinese patient whose feet had been bound in childhood, emphasizing how surprised she was to see many young girls with bound feet because the practice had been declared illegal.¹⁰¹ Bartlett’s silences are also significant. She did not denounce patriarchy, sex-segregation, or misogyny as unjust; nor did she portray the condition of Chinese women as a salient manifestation of cultural backwardness or an uncivilized society. It was, we suggest, her feelings of belonging to the brotherhood of scientific medicine that explains this aloofness and sense of detachment from the plight of other women.

5 Conclusions

Through close examination and contextualization of Vashti Bartlett’s archives and experiences during the 1919 cholera epidemic in Harbin, we show how an individual could embody a form of imperialist US power that scholars have termed friendly and capillary. Yet Bartlett’s record of her attitudes and actions while assisting Wu Liande and the Manchurian Plague Prevention Service during the epidemic do not fit squarely within our expectations of the imperialist mindset rooted in white colonial European and North American superiorities. Significantly, in our examination of Bartlett we identify yet another, perhaps even friendlier, form that US friendly power could take: scientific medicine. Early twentieth-century proponents of scientific medicine somewhat naively perceived it as universal and objective, and, therefore, beyond nations, politics, culture, or morality. By interrogating Bartlett within the intersectional contexts of US global expansion and scientific medicine in China, we demonstrate how, at a subtle and individual level, she understood and lived her function as an agent of friendly power, medical imperialism, and cultural influence.

As an arc nurse dispatched with the organization’s Commission to Siberia, Bartlett was aware of her status as an agent of US political expansion and exceptionalism in the region. As a Johns Hopkins nurse, she was equally aware that she had a duty to embody and disseminate the Johns Hopkins medical model internationally. Bartlett identified as white, wealthy, female, American, and, most importantly, we suggest, a Johns Hopkins nurse whose scientific expertise was acknowledged globally. Immersed in what we term the “Hopkins ethos” during her training, she not only acquired skills and knowledge, but also an unwavering sense that she was part of a professional fellowship of scientific medicine whose members defined themselves according to shared principles of objectivity and universalism, as well as a general orientation towards political and moral neutrality, at least on the surface. The notion that Johns Hopkins medicine was a model to be emulated and disseminated was absorbed and endorsed by its early faculty, staff, and pupils, including Bartlett.

While scientific medicine, including at Johns Hopkins, operated largely according to a paternalistic, sexist, and racist hierarchy, skilled nurses – who were exclusively female in this period – had nevertheless become indispensable to its execution. Bartlett’s professional identity – not simply as a graduate nurse, but as an integral member of the brotherhood of scientific medicine – permeated her approach to nationality, race/ethnicity, class, and gender. It dictated how she related to others personally and clinically, often in ways that challenge some of our assumptions surrounding status in the early twentieth century. For example, her strong identification with the so-called scientific and moral universality of modern medicine frequently led her to be cautious and reflective about her own biases. Moreover, while Bartlett evidently derived a sense of superiority from her status as a white and wealthy American, her archives reveal that she more frequently ascribed her authority to her scientific identity. In Bartlett’s example, we see that scientific medicine allowed for some acceptance of cultural difference, and even some disruption to bigoted characterizations of China as the Sick Man of Asia. In the case of providing coffins for the remains of cholera victims awaiting return to Shandong for ancestral burial, for example, neither Chinese customs nor bodies were viewed as inherently pathological. Thus did scientific medicine prove an especially friendly form of US friendly power. Indeed, it was precisely the mantle of scientific medicine – which, paradoxically, Bartlett supposed ought to transcend barriers of nationality, race/ethnicity, class, or gender – that she believed was representative of US contributions on the international stage and that therefore justified US presence and interventions abroad.

Vashti Bartlett was part of the global advance of US political and cultural influence in the world in the decades before and after the First World War. Living according to her scientific and professional ideals was her own intricate way to reconcile that influence with her unassertive nationalism. Guided by the principles of scientific medicine, her personal and professional choices during the 1919 cholera epidemic in Harbin helped to underpin the rhetoric of US exceptionalism and thus bolstered US friendship policies in China.