Book review of Joshua S. Horn’s Away With All Pestsleap-1


As a Western surgeon who lived in revolutionary China from 1954 to 1969, comparisons with Norman Bethune, the famed Canadian doctor who gave his life for revolution, are inevitable. Those that Dr. Joshua S. Horn encountered, to his embarrassment, often made the comparison to Bethune, the foreign martyr who was immortalized in one of the “three most constantly read articles,” in Mao Zedong’s “Serve The People.” Despite his reluctance to accept this praise, the comparison is apt. Like Bethune, Horn gave up much of his privilege to put his skills at the disposal of the Chinese Communist Party. (1) Horn embodies the spirit of internationalism and the Maoist principal of serving the people. Horn’s book, Away With All Pests is an important first-hand account of some of the most important social experiments in both Chinese and world history. He witnessed the tremendous breakthroughs of the Great Leap Forward and the Cultural Revolution. Horn is a witness to the advances in society, especially in heath care, due to Maoism. His life is an important example of how someone from the First World can contribute to the proletarian revolution even though there is no proletariat in the First World itself.

Horn’s first encounter with China was in the 1930s:

“The beggars. The swarms of beggars of all ages, whole and diseased, vociferous and silent, hopeful and hopeless, blind and seeing. All having in common their poverty, their degradation.

The prostitutes. The smart ones in the foreign concessions with make-up, high-heeled shoes and skin-tight dresses slit to the thigh. The cheap ones in the sailors’ districts, unkempt, raucous, brazen. The Child prostitutes. The two frightened, bewildered little girls dragged along, one in each hand, by their owner who offered them singly or together for fifty cents an hour.

The poverty. The rows of matsheds where hundreds of thousands lived and died. The hunger-swollen bellies. The rummaging in garbage bins for possible scraps of food.” (2)

Horn describes a China humiliated, carved up and occupied:

“Imperialism. Shanghai, the greatest city of a sovereign country, with warships of every country moored in her main artery, their sailors roaming the streets at will, a law unto themselves. The city was sliced up into the International and French concessions, both enjoying exterritoriality… The police officers were foreigners and the ordinary Chinese policemen under their command wore foreign-type uniforms. I went to the British bank on the waterfront to cash a cheque for £10. A huge, imposing building with granite pillars with flights of marble steps. At the top, bearded Sikhs holding rifles with fixed bayonets guarded great bronze doors… a Chinese peddler sneaked past, hoping to sell his cigarettes inside. The Sikh spotted him, thrust a rifle butt viciously into his loins, and kicked him down the marble stairs. ‘Sorry, sir,’ he explained, ‘they think they own the place!’

The Chinese certainly owned Shanghai, but they would not take possession for another twelve years.” (3)

Things were very different when Horn returned. Horn describes the great contrast between then and his present day:

“The children. I can do no better than quote a Canadian hotelier who lived in pre-Liberation Shanghai for more than twenty years and who, on return visit in 1965, recalled the familiar sights of old Shanghai:

‘I searched for scurvy-headed children. Lice-ridden children. Children with inflamed red eyes. Children with bleeding gums. Children with distended stomachs and spindly arms and legs. I searched the sidewalks day and night for children who had been purposely deformed by beggars. Beggars who would leech on to any well-dressed passer-by to blackmail sympathy and offerings, by pretending the hideous looking child was their own.

I looked for children covered with horrible sores upon which flies feasted. I looked for children having a bowel movement, which, after much strain, would only eject tapeworms.

I looked for child slaves in alleyway factories. Children who worked twelve hours a day, literally chained to small press punches. Children who, if they lost a finger, or worse, often were cast away into the streets to beg and forage in garbage bins for future subsistence.’

In 1965 he searched without finding, but in the 1930s there was no need to search far for such sights were everywhere to be seen.” (4)

Horn describes China under the communists:

“The adults dressed in an austere uniformity which led me into many perplexities for I often could not tell if I was talking to a cook or professor… The women, for so long oppressed and despised, now showing their new found freedom in the dignity of their every movement… The children, full of fun, over-brimming with joy. It is rare to see children fight or cry in Peking and even rarer to see them scolded or hit… On the streets, a complete absence of beggars, vagrants, teddy-boys and prostitutes. In the shops, fixed prices, no persuasion, scrupulous honesty and no bartering. What a contrast with Shanghai 1937!” (5)

What Horn witnessed was one fourth of the world’s population working together to build a new world. Poverty still existed, but not as before. China was no longer humiliated, as Mao famously said, China had stood up. Hundreds of millions of people had thrown in their lot with revolution, willing to destroy the old order, to follow the lead of the Communist Party in the radical transformation of every aspect of life. Horn reports on the revolutionary transformation of medical practice.

In the old order, few had access to healthcare. Healthcare was largely reserved for the wealthy, the capitalists and landlords. The vast majority suffered in silence:

“Poverty and ignorance were reflected in a complete lack of sanitation as a result of which fly and water-borne diseases such as typhoid, cholera, dysentery, took a heavy toll. Worm infestation was practically universal, for untreated people lived on the fringe of starvation and this so lowered their resistance to disease that epidemics carried off thousands every year. The average life expectancy in China was stated to be about twenty-eight years. Reliable health statistics for pre-Liberation China are hard to come by but conservative estimates put the crude death rate in time of peace at between thirty and forty per thousand and the infantile mortality rate at between 160 and 170 per thousand live births. The plight of the women and children was bad beyond description. The men had to have what grain there was, to give them strength to work in the fields. The women, especially those who stayed at home to look after the children, ate only thin gruel, grass and leaves. They were so ill-nourished that by the time they reached middle age, they were toothless and decrepit. Many adolescent girls, lacking calcium and vitamin D, developed softening and narrowing of the pelvic bones, so that normal childbirth became either impossible or so dangerous that six to eight per cent of all deaths among women were due to childbirth. Babies were breast-fed for three or four years, and also resulted in child child malnutrition and such vitamin deficiency diseases as rickets and scurvy. There were no preventive inoculations against infectious diseases, and from time to time epidemics of smallpox, diphtheria, whooping cough and meningitis swept through the countryside with devastating results. Lice and poverty went hand in hand, and with them louse-borne diseases such as typhus fever. Military occupation and the licentiousness of the landlords and local gentry spread venereal diseases among the people and no treatment was available. The prevalence of tuberculosis can be gaged from the fact that in 1946 sixty per cent of all applicants for student visas for study abroad were found to be suffering from this disease.” (6)


“I also saw many old, neglected cases of which I had no previous experience. They were a legacy from the almost total medical neglect of the labouring people before Liberation. I saw dislocations of the hip, elbow and shoulder which had remained unreduced for ten years and more; fractures that had united in positions of extreme deformity or had not united at all; joints that had become stiff as a result of no treatment or bad treatment; tuberculosis of bones and joints that had been allowed to run riot. I saw patients who had lost limbs years before and had made their own artificial limbs because none was forthcoming from any other source. I saw a youth whose penis had been chopped off by a landlord because his father couldn’t pay rent. I saw a girl from Inner Mongolia who hadn’t been able to sit or squat since childhood because of scarring of the buttocks due to a burn.

I the old days, these patients had no hope of getting treatment.” (7)

Maoists say that “the masses are the true makers of history.” Maoists place a great emphasis on the energy and creativity of ordinary people. Maoists in China unleashed the power of the masses to remake all of society. Just as the People’s Liberation Army, under the leadership of Lin Biao, put people power at its center, so too Jiang Qing created a people-centered Opera. Similarly, the healthcare system was transformed on a Maoist basis. Power was put in the hands of the people to better serve the people. Healthcare was transformed from a privilege to a basic right.

One of the main tasks of the revolution was taking healthcare, once a privilege reserved only for the wealthy, to China’s poor, especially in the countryside. Prior to the revolution the vast majority of those living in China’s countryside, almost a quarter of the world’s population, lacked access to any healthcare at all. Bringing healthcare to almost a quarter of the world’s population is one of the great achievements of the Chinese revolution. Throughout the revolution, more and more people gained access to better and better healthcare. Life expectancy was doubled. Infant mortality greatly reduced. People led healthier, longer lives.

One way that this was accomplished was through the health teams. As part of the effort to break down the distinction between town and countryside, and also as part of the effort to bring care to those in need, mobile medical teams were organized and sent to the countryside. At the onset of the Cultural Revolution, Horn reports that one third of the hospital staff at his Beijing hospital were always in the countryside as part of a team on a rotation basis. Mobile teams were sent out to the poorest areas, where they were needed most. Thus people were not forced to seek out care, care was brought to them. The team that Horn referred to was made up of 80,000 people who worked among twelve people’s communes in the countryside. These teams were divided into smaller brigades. These brigades maintain many smaller clinics. Doctors and medical personnel were sent out from these clinics into the local areas and remote villages to administer healthcare. Different kinds of groups were sent where they were needed most. In addition to medical groups, there were ones that focus on dental and birth control. Some groups specialized in one affliction and were sent to areas affected by that affliction, including very remote areas. “Most villages can only be reached on foot or by riding donkeys over stony paths.” Reversing traditional medical elitism, the medical personnel usually either lived together in peasant cottages or they lived with the peasants in their homes in the villages. Healthcare was no longer a luxury. Doctors and their patients now live and work side by side. (8)

Since the Rural Reconstruction Movement in the 1930s, the Chinese Communist Party has pioneered the use of peasant doctors. Horn gives us first hand account of what have become popularly known as “barefoot doctors.” Where Horn worked, thirty-two production brigades held a meeting to select candidates for medical training. Those youths who had shown intelligence and an altruistic spirit were selected. These youths would be given a kind of abbreviated training in basic medicine. They would also be given training in the most common ailments and diseases encountered in the countryside. These barefoot doctors then stream out among the countryside. Periodically, they would return for greater formal medical training. Mobil teams also trained sanitary workers and midwives. They too raised the health of the rural community. The intention was not merely to impart medical knowledge to these youths, but to create a new kind of socialist-minded rural health worker who would retain the closest links with the peasants and who would remain permanently in the countryside. The barefoot doctor movement is an example of the Maoist belief in people power, that people are the most important resource. The masses contain tremendous creative potential that just needs to be harnessed and unlocked. If given a chance, people can solve their own problems. Horn witnessed the success of this approach first hand.  (9)

One way that people power is unleashed is through mass mobilizations. Maoism places great emphasis on mass mobilizations as a way to solve problems. During the two peaks of Chinese socialism, the Great Leap Forward and the Cultural Revolution, the power of the masses was unleashed as never before. The true power of the masses was demonstrated by the campaign against schistosomiasis or “snail fever.” Snail fever is one of the world’s greatest scourges. When Horn was writing, it affected 250 million people, almost all in the Third World. As late as 1955, there were 50 million sufferers in China alone. Among parasitic diseases in tropical and sub-tropical regions, it ranks only behind malaria it terms of socioeconomic and health importance. Even today it affects 200 million. Twenty thousand die from snail fever every year. Twenty million suffer serious consequences from the disease. An estimated 600 million people worldwide are at risk from the disease. China’s socialism launched a war against this scourge. To mobilize the peasantry in a war against the snails that carried the disease, the Maoists used the mass line:

“The first concept rests on the conviction that the ordinary people possess great strength and wisdom and that when their initiative is given full play they can accomplish miracles; that the art of leadership is to learn from the masses, to refine and systematize their experience and, on this basis, to decide on policy.

To mobilize the peasantry against the snails, it was first necessary to explain to them the nature of the illness which has plagued them for so long and for this purpose lecturers, film shows, posters, radio-talks were employed. When the peasants came to understand the nature of the enemy, they themselves worked out methods of defeating it.

Twice a year, in March and August, the entire population in county after county, supplemented by voluntary labour of all available armymen, students, teachers and office workers, turned out to drain the rivers and ditches, dig away and bury their banks and temp down the buried earth.” (10)


“In between large-scale campaigns, regular anti-snail patrols are maintained by trained snail-spotters who cruise along the rivers in canoes, scrutinizing the banks for snails… I asked a leader of the team, a young woman who had herself suffered from schistosomiasis, whether she found the work boring. ‘Yes,’ she said. ‘It can be very boring and trying. On hot days I get scorched and my head aches. Mosquitoes buzz around and under bridges, and in the dark places where we have to search most carefully, there are all sorts of creepy-crawly things. The children, too, used to annoy us. At first they didn’t understand what we were doing and they used to walk along the bank laughing at us asking why we didn’t do proper work like other grown-ups instead of playing in boats all day. I sometimes felt like asking to be transferred to agricultural work, but then I remembered how I had felt when I suffered from schistosomiasis as a child and I decided to carry on with this work, for a long-time if necessary. We asked some children to come with us in the canoe and after they experienced the discomforts themselves, they soon stopped jeering at us.” (11)

Through the people-centered approach, snail fever was all but eliminated in much of China. The Communists claimed an 85% to 95% cure rate among afflicted people. The disease was all but wiped out in areas that had been previously afflicted on an epidemic scale. The Communist Party declared that it could “cure what the powers above have failed to do.” (12)

Today, it is commonplace for the bourgeoisie to mock anti-pest campaigns in China. The biggest target is the anti-sparrow campaign during the Great Leap Forward. In fact, the anti-sparrow campaign is rightly criticized. It backfired and resulted in very bad consequences because people did not adequately understand the role the sparrow played in the ecology. Sparrows killed pests that attacked crops. Lowering the numbers of sparrows hurt agricultural production. The anti-sparrow campaign is an example of poor planning and overenthusiasm. However, we should not throw out the baby with the bath water. Mistakes will always be made on the long road to communism. To expect no mistakes is utopian. Unlike other pest campaigns, the anti-sparrow campaign was not scientific. It is wrong to dismiss the people-centered approach, to dismiss mass mobilizations, because of mistakes and excesses. The anti-snail campaign greatly benefited the Chinese people. However, when capitalism returned to China so too did schistosomiasis. Today, the epidemic is back. And, with global warming it could be worse than ever.

Other innovations advanced China’s healthcare. When the revolution came to power across the country, two kinds of medicine existed in China. There were the traditionalists who had refined their knowledge of herbal remedies and folk techniques over centuries. There was also the more modern approach that drew on biological science and high technology.  Within a year of liberation the slogan was raised to “Unite all medical workers, young and old, of the traditional and Western schools, and organize a solid united front to strive for the development of people’s health work.” (13) In order to better serve the people, the Party sought to overcome the traditional antagonism between traditional and modern medicine. The Party realized that it would be foolish to simply disregard traditional knowledge gathered over centuries simply because it was different. If folk techniques work, then they are valuable. Likewise one could not ignore the tremendous advances in medical knowledge coming from the West. Instead, what works in folk medicine should be preserved and combined with the modern.

Horn describes the successful treatment of a torn knee ligament using a combination of technique. The Western approach is to immobilize the whole limb with a plaster cast. However, this approach has the disadvantage that as swelling goes down in the cast, the ligament can heal with the knee in a lightly knock-kneed position.

“The method that we finally decided to use combined the principles of Chinese traditional medicine and modern surgery. Chinese traditional doctors believe that controlled movements do not interfere with the healing of torn tissues or broken bones but, on the contrary, promote healing. We therefore neither immobilized the knew nor operated on it, but used a method of splinting which guaranteed that knock-knee deformity could not develop and which permitted the patient to exercise the knee while the ligament healed.” (14)

Horn reports that the such approaches led to many such successes.

The Maoist road to development is based on class struggle, unleashing the masses. It was this approach that took a backward, undeveloped country that had been carved up and occupied by imperialists and turned it into a modern socialist state able to compete with the imperialists in the area of science.  People power was the force that allowed China to launch satellites, conquer the atom and be the first to synthesize insulin. Horn’s book stands as a refutation of the Theory of Productive Forces that downplays class struggle and people power.

The battle between socialism and capitalism, between revolution and counter-revolution, was of life and death. Even though socialism was defeated in China in the 1970s, the memory of socialism still inspires. Horn was witness to the amazing accomplishments of the Chinese people, of Maoism, and the Cultural Revolution. Horn writes:

“The Cultural Revolution is a culmination of this struggle for the future of China. In a very real sense, it is also a struggle for the future of mankind… For nearly fifty years Mao Tse-tung has led the Chinese revolution with a brilliance which incontrovertibly establishes him as the outstanding genius of our age. I regard the Cultural Revolution as his crowning achievement… As Vice-Chairman Lin Piao has put it, the losses of the Cultural Revolution have been tiny; the gains vast.” (15)

Our goal is communism, the end of all oppression. There will be many twists and turns on this red road. Errors will be made as they were in both the Soviet Union in its socialist period until the counter-revolution in the 1950s and China until its counter-revolution in the 1970s. Today, we stand on the edge of the next great wave of revolution. Horn witnessed the amazing power of Maoism to change thew world. Today, Leading Light Communism will take us even further.


1. Horn, Joshua S., Away with All Pests, Monthly Review Press, New York, USA: 1969. p. 34
2. Horn, ibid. pp 18-19
3. Horn, ibid. p 2
4. Horn, ibid. pp. 18-19
5. Horn, ibid. p. 31
6. Horn, ibid. p. 123
7. Horn, ibid. p. 30
8. Horn, ibid. p. 129
9. Horn, ibid. pp. 135-136
10. Horn, ibid.  p. 94-97
11. Horn, ibid. p. 98
12. MSH on healthcare, NPR on barefoot doctors, Monkey Smashes Heaven, February 21, 2010
13, Horn, ibid. p. 76
14. Horn, ibid. p. 45
15. Horn, ibid. p. 178