title: Triage

text: Triage always follows the modern interpretation of the Hippocratic oath, but otherwise there is plenty of leeway in interpretation, leading to more than one simultaneous idea of its nature. The best settled theories and practical scoring systems used in here come from the area of acute physical trauma in an emergency room setting; a broken bone obviously counts for less than uncontrolled arterial bleeding, apt to lead to death. But no current principle carries too well over to mental health, reproductive health (such as abortion), chronic medical conditions, geriatrics, or palliative care (including euthanasia). This is because triage needs to balance multiple and sometimes contradictory objectives simultaneously, most of them being fundamental to personhood: likelihood of death, efficacy of treatment, patients' remaining lifespan, ethics and religion of them all.


title: Triage

text: "Structured triage" was introduced by Holy Roman Emperor Maximilian I. It was in his armies that the wounded were first categorized and treated according to an order of priority – in times of war, higher priority was given to military personnel over civilians, and the higher-ranked over the lower-ranked. The practice spread to other armies in the following centuries and was coined "triage" by the French.


title: Triage

text: Modern medical triage was invented by Dominique Jean Larrey, a surgeon during the Napoleonic Wars, who "treat[ed] the wounded according to the observed gravity of their injuries and the urgency for medical care, regardless of their rank or nationality", though the general concept of prioritizing by prognosis is foreshadowed in a 17th-century BCE Egyptian document. Triage was used further during World War I by French doctors treating the battlefield wounded at the aid stations behind the front. Those responsible for the removal of the wounded from a battlefield or their care afterwards would divide the victims into three categories:


title: Triage

text: For many emergency medical services (EMS) systems, a similar model may sometimes still be applied. In the earliest stages of an incident, such as when one or two paramedics exist to 20 or more patients, practicality demands that the above, more "primitive" model will be used. However, once a full response has occurred and many hands are available, paramedics will usually use the model included in their service policy and standing orders.


title: Triage

text: As medical technology has advanced, so have modern approaches to triage, which are increasingly based on scientific models. The categorizations of the victims are frequently the result of triage scores based on specific physiological assessment findings. Some models, such as the START model may be algorithm-based. As triage concepts become more sophisticated, and to improve patient safety and quality of care, several human-in-the-loop decision-support tools have been designed on top of triage systems to standardize and automate the triage process (e.g., eCTAS, NHS 111) in both hospitals and the field. Moreover, the recent development of new machine learning methods offers the possibility to learn optimal triage policies from data and in time could replace or improve upon expert-crafted models.


title: Triage

text: Simple triage is usually used in a scene of an accident or "mass-casualty incident" (MCI), in order to sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries. This step can be started before transportation becomes available.


title: Triage

text: Upon completion of the initial assessment by physicians, nurses or paramedical personnel, each patient may be labelled which may identify the patient, display assessment findings, and identify the priority of the patient's need for medical treatment and transport from the emergency scene. At its most primitive, patients may be simply marked with coloured flagging tape or with marker pens. Pre-printed cards for this purpose are known as a triage tags.


title: Triage

text: A triage tag is a prefabricated label placed on each patient that serves to accomplish several objectives:


title: Triage

text: Triage tags may take a variety of forms. Some countries use a nationally standardized triage tag, while in other countries commercially available triage tags are used, and these will vary by jurisdictional choice. The most commonly used commercial systems include the METTAG, the SMARTTAG, E/T LIGHT tm and the CRUCIFORM systems. More advanced tagging systems incorporate special markers to indicate whether or not patients have been contaminated by hazardous materials, and also tear off strips for tracking the movement of patients through the process. Some of these tracking systems are beginning to incorporate the use of handheld computers, and in some cases, bar code scanners.


title: Triage

text: In advanced triage, specially trained doctors, nurses and paramedics may decide that some seriously injured people should not receive advanced care because they are unlikely to survive. It is used to divert scarce resources away from patients with little chance of survival in order to increase the chances for others with higher likelihoods.


title: Triage

text: The use of advanced triage may become necessary when medical professionals decide that the medical resources available are not sufficient to treat all the people who need help. The treatment being prioritized can include the time spent on medical care, or drugs or other limited resources. This has happened in disasters such as terrorist attacks, mass shootings, volcanic eruptions, earthquakes, tornadoes, thunderstorms, and rail accidents. In these cases some percentage of patients will die regardless of medical care because of the severity of their injuries. Others would live if given immediate medical care, but would die without it.


title: Triage

text: In these extreme situations, any medical care given to people who will die anyway can be considered to be care withdrawn from others who might have survived (or perhaps had less severe disability from their injuries) had they been treated instead. It becomes the task of the disaster medical authorities to set aside some victims as hopeless, to avoid trying to save one life at the expense of several others.


title: Triage

text: If immediate treatment is successful, the patient may improve (although this may be temporary) and this improvement may allow the patient to be categorized to a lower priority in the short term. Triage should be a continuous process and categories should be checked regularly to ensure that the priority remains correct given the patient's condition. A trauma score is invariably taken when the victim first comes into hospital and subsequent trauma scores are taken to account for any changes in the victim's physiological parameters. If a record is maintained, the receiving hospital doctor can see a trauma score time series from the start of the incident, which may allow definitive treatment earlier.


title: Triage

text: There are a number of concepts referred to as Reverse Triage, the first is concerned with the discharge of patients from hospital. This makes resources available within a healthcare or hospital for incoming patients. The second concept of Reverse Triage is utilised for certain conditions such as lightning injuries, where those appearing to be dead may be treated ahead of other patients. The third is the concept of treating the least injured, often to return them to functional capability. This approach originated in the military, where returning combatants to the theatre of war may lead to overall victory (and survivability).


title: Triage

text: Usually, triage refers to prioritizing admission. A similar process can be applied to discharging patients early when the medical system is stressed. This process has been called "reverse triage". When a major wave of patients arrive to a hospital, such as immediately after a natural disaster, many hospital beds will be already occupied by regular non-critical patients. To accommodate a greater number of the new critical patients, the existing patients may be triaged, and those who will not need immediate care can be discharged until the surge has dissipated, for example through the establishment of temporary medical facilities in the region.


title: Triage

text: Undertriage is underestimating the severity of an illness or injury. An example of this would be categorizing a Priority 1 (Immediate) patient as a Priority 2 (Delayed) or Priority 3 (Minimal). Historically, acceptable undertriage rates have been deemed 5% or less.


title: Triage

text: Overtriage is the overestimating of the severity of an illness or injury. An example of this would be categorizing a Priority 3 (Minimal) patient as a Priority 2 (Delayed) or Priority 1 (Immediate). Acceptable overtriage rates have been typically up to 50% in an effort to avoid undertriage. Some studies suggest that overtriage is less likely to occur when triaging is performed by hospital medical teams, rather than paramedics or EMTs.


title: Triage

text: In telephone triage, decision makers over the phone must effectively assess the patient's symptoms and provide directives based on the urgency. This should be done in a timely fashion while meeting standard guidelines in order to prevent symptoms from worsening.


title: Triage

text: For patients that have a poor prognosis and are expected to die regardless of the medical treatment available, palliative care such as painkillers may be given to ease suffering before they die.


title: Triage

text: Alternative care facilities are places that are set up for the care of large numbers of patients, or are places that could be so set up. Examples include schools, sports stadiums, and large camps that can be prepared and used for the care, feeding, and holding of large numbers of victims of a mass casualty or other type of event. Such improvised facilities are generally developed in cooperation with the local hospital, which sees them as a strategy for creating surge capacity. While hospitals remain the preferred destination for all patients, during a mass casualty event such improvised facilities may be required in order to divert low-acuity patients away from hospitals in order to prevent the hospitals becoming overwhelmed.


title: Triage

text: In advanced triage systems, secondary triage is typically implemented by emergency nurses, skilled paramedics, or battlefield medical personnel within the emergency departments of hospitals during disasters, injured people are sorted into five categories.


title: Triage

text: Some crippling injuries, even if not life-threatening, may be elevated in priority based on the available capabilities. During peacetime, most amputation injuries may be triaged "Red" because surgical reattachment must take place within minutes, even though in all probability the person will not die without a thumb or hand.


title: Triage

text: During the early stages of an incident, first responders may be overwhelmed by the scope of patients and injuries. One valuable technique is the Patient Assist Method (PAM). The responders quickly establish a casualty collection point (CCP) and advise, either by yelling or over a loudspeaker, that "anyone requiring assistance should move to the selected area (CCP)". This does several things at once: it identifies patients who are not so severely injured that they need immediate help, it physically clears the scene, and it provides possible assistants to the responders. As those who can move do so, the responders then ask, "anyone who still needs assistance, yell out or raise your hands"; this further identifies patients who are responsive yet may be unable to move. Now the responders can rapidly assess the remaining patients who are either expectant or are in need of immediate aid. From that point, the first responder is quickly able to identify those in need of immediate attention while not being distracted or overwhelmed by the magnitude of the situation. Using this method assumes the ability to hear. Deaf, partially deaf, or victims of a large blast injury may not be able to hear these instructions.


title: Triage

text: S.T.A.R.T. (Simple Triage and Rapid Treatment) is a simple triage system that can be performed by lightly trained lay and emergency personnel in emergencies. It is not intended to supersede or instruct medical personnel or techniques. It has been taught to California emergency workers for use in earthquakes. It was developed at Hoag Hospital in Newport Beach, California for use by emergency services. It has been field-proven in mass casualty incidents such as train wrecks and bus accidents, though it was developed by community emergency response teams (CERTs) and firefighters after earthquakes.


title: Triage

text: The JumpSTART pediatric triage MCI triage tool is a variation of the S.T.A.R.T. model. Both systems are used to sort patients into categories at mass casualty incidents (MCIs). However, JumpSTART was designed specifically for triaging children in disaster settings. Though JumpSTART was developed for use in children from infancy to age 8, where age is not immediately obvious, it is used in any patient who appears to be a child (patients who appear to be young adults are triaged using START).


title: Triage

text: Within the hospital system, the first stage on arrival at the emergency department is assessment by the hospital triage nurse. This nurse will evaluate the patient's condition, as well as any changes, and will determine their priority for admission to the emergency department and also for treatment. Once emergency assessment and treatment are complete, the patient may need to be referred to the hospital's internal triage system.


title: Triage

text: For a typical inpatient hospital triage system, a triage nurse or physician will either field requests for admission from the ER physician on patients needing admission or from physicians taking care of patients from other floors who can be transferred because they no longer need that level of care (i.e. intensive care unit patient is stable for the medical floor). This helps patients flow more efficiently in the hospital.


title: Triage

text: This triage position is often done by a hospitalist. A major factor contributing to the triage decision is available hospital bed space. The triage hospitalist must determine, in conjunction with a hospital's "bed control" and admitting team, which beds are available for optimal utilization of resources in order to provide safe care to all patients. A typical surgical team will have their own system of triage for trauma and general surgery patients. This is also true for neurology and neurosurgical services. The overall goal of triage, in this system, is to both determine if a patient is appropriate for a given level of care and to ensure that hospital resources are utilized effectively.


title: Triage

text: In an advanced triage process injured people are sorted into categories. Conventionally there are five classifications with corresponding colors and numbers although this may vary by region.


title: Triage

text: The "Australasian Triage Scale" (abbreviated "ATS" and formally known as the "National Triage Scale") is a triage system that is implemented in both Australia and New Zealand. The scale has been in use since 1994. The scale consists of 5 levels, with 1 being the most critical (resuscitation), and 5 being the least critical (nonurgent).


title: Triage

text: In the mid-1980s, The Victoria General Hospital, in Halifax, Nova Scotia, Canada, introduced paramedic triage in its Emergency Department. Unlike all other centres in North America that employ physician and primarily nurse triage models, this hospital began the practice of employing Primary Care level paramedics to perform triage upon entry to the Emergency Department. In 1997, following the amalgamation of two of the city's largest hospitals, the Emergency Department at the Victoria General closed. The paramedic triage system was moved to the city's only remaining adult emergency department, located at the New Halifax Infirmary. In 2006, a triage protocol on whom to exclude from treatment during a flu pandemic was written by a team of critical-care doctors at the behest of the Ontario government.


title: Triage

text: For routine emergencies, many locales in Canada now employ the Canadian Triage and Acuity Scale (CTAS) for all incoming patients. The system categorizes patients by both injury and physiological findings, and ranks them by severity from 1–5 (1 being highest). The model is used by both paramedics and E/R nurses, and also for pre-arrival notifications in some cases. The model provides a common frame of reference for both nurses and paramedics, although the two groups do not always agree on scoring. It also provides a method, in some communities, for benchmarking the accuracy of pre-triage of calls using AMPDS (What percentage of emergency calls have return priorities of CTAS 1,2,3, etc.) and these findings are reported as part of a municipal performance benchmarking initiative in Ontario. Curiously enough the model is not currently used for mass casualty triage, and is replaced by the START protocol and METTAG triage tags.


title: Triage

text: Triage at an accident scene is performed by a paramedic or an emergency physician, using the four-level scale of   Can wait, Has to wait, Cannot wait, and Lost.


title: Triage

text: This triage is performed by a physician called "médecin trieur" (sorting medic). This triage is usually performed at the field hospital (PMA–"poste médical avancé", i.e. forward medical post). The absolute urgencies are usually treated onsite (the PMA has an operating room) or evacuated to a hospital. The relative urgencies are just placed under watch, waiting for an evacuation. The involved are addressed to another structure called the CUMP–"Cellule d'urgence médico-psychologique" (medical-psychological urgency cell); this is a resting zone, with food and possibly temporary lodging, and a psychologist to take care of the brief reactive psychosis and avoid post-traumatic stress disorder.


title: Triage

text: In the emergency department of a hospital, the triage is performed by a physician called MAO–"médecin d'accueil et d'orientation" (reception and orientation physician), and a nurse called IOA–" infirmière d'organisation et d'accueil" (organisation and reception nurse). Some hospitals and SAMU organisations now use the "Cruciform" card referred to elsewhere.


title: Triage

text: France has also a Phone Triage system for Medical Emergencies Phone Demands in its Samu Medical Regulation Centers through the 15 medical free national hot line. "Medical Doctor Regulator" decides what is to be the most efficient solution = Emergency Telemedecine or dispatch of an Ambulance, a General Practitioner or a Physician+ Nurse + Ambulance Man, Hospital based MICU (Mobile Intensive Care Unit).


title: Triage

text: Preliminary assessment of injuries is usually done by the first ambulance crew on scene, with this role being assumed by the first doctor arriving at the scene. As a rule, there will be no cardiopulmonary resuscitation, so patients who do not breathe on their own or develop circulation after their airways are cleared will be tagged "deceased". Also, not every major injury automatically qualifies for a red tag. A patient with a traumatic amputation of the forearm might just be tagged yellow, have the bleeding stopped, and then be sent to a hospital when possible. After the preliminary assessment, a more specific and definite triage will follow, as soon as patients are brought to a field treatment facility. There, they will be disrobed and fully examined by an emergency physician. This will take approximately 90 seconds per patient.


title: Triage

text: The German triage system also uses four, sometimes five colour codes to denote the urgency of treatment. Typically, every ambulance is equipped with a folder or bag with coloured ribbons or triage tags.


title: Triage

text: In Hong Kong, triage in Accident & Emergency Departments is performed by experienced registered nurses, patients are divided into five triage categories: "Critical", "Emergency", "Urgent", "Semi-urgent" and "Non-urgent".


title: Triage

text: In Japan, the triage system is mainly used by health professionals. The categories of triage, in corresponding color codes, are:


title: Triage

text: All public hospitals in Singapore use the Patient Acuity Category Scale (PACS) to triage patient in Emergency Departement. PACS is a symptom-based differential diagnosis approach that triages patients according to their presenting complaints and objective assessments such as vital signs and Glasgow Coma Scale, allowing acute patients to be identified quickly for treatment. PACS classifies patients into four main categories: P1, P2, P3, and P4.


title: Triage

text: Some autonomous communities in Spain, like Navarre and the Valencian Community, have created their own systems for the community hospitals.


title: Triage

text: In the UK, the commonly used triage system is the Smart Incident Command System, taught on the MIMMS (Major Incident Medical Management (and) Support) training program. The UK Armed Forces use this system on operations. This grades casualties from Priority 1 (needs immediate treatment) to Priority 3 (can wait for delayed treatment). There is an additional Priority 4 (expectant, likely to die even with treatment) but the use of this category requires senior medical authority.


title: Triage

text: In the UK and Europe, the triage process used is sometimes similar to that of the United States (see below), but the categories are different:


title: Triage

text: Triage in a multi-scale destruction, disaster, catastrophic, casualty event, such as following a tornado or an explosion in a populated area, first responders follow a similar triage category scale as the US military. The civilian medical industry uses a similar system for triage. Normally medical personnel aren't immediately available on scene. First responders are usually the first to arrive on scene. They could be police, fire rescue, paramedics, or community individuals with disaster training (CERT certified). They are trained to perform first aid, basic life saving and rescue techniques while performing the greatest good, for the greatest number of people. They will rapidly classify victims and sort them into 4 categories, treating quickly as they go. This system is intended to rapidly identify and classify victims for arriving transport or advanced care medical personnel such as doctors and nurses. The local National Guard and other military units responding would be using the military system of triage rather than civilian.


title: Triage

text: A battlefield situation, however, requires medics and corpsmen to rank casualties for precedence in MEDEVAC or CASEVAC. The casualties are then transported to a higher level of care, either a Forward Surgical Team or Combat Support Hospital and re-triaged by a nurse or doctor. In a combat situation, the triage system is based solely on resources and ability to save the maximum number of lives within the means of the hospital supplies and personnel.


title: Triage

text: In a "naval combat situation", the triage officer must weigh the tactical situation with supplies on hand and the realistic capacity of the medical personnel. This process can be ever-changing, dependent upon the situation and must attempt to do the maximum good for the maximum number of casualties.


title: Triage

text: Field assessments are made by two methods: primary survey (used to detect & treat life-threatening injuries) and secondary survey (used to treat non-life-threatening injuries) with the following categories:


title: Triage

text: Notions of mass casualty triage as an efficient rationing process of determining priority based upon injury severity are not supported by research, evaluation and testing of current triage practices, which lack scientific and methodological bases. START and START-like (START) triage that use color-coded categories to prioritize provide poor assessments of injury severity and then leave it to providers to subjectively order and allocate resources within flawed categories. Some of these limitations include:


title: Triage

text: Research indicates there are wide ranges and overlaps of survival probabilities of the Immediate and Delayed categories, and other START limitations. The same physiologic measures can have markedly different survival probabilities for blunt and penetrating injuries. For example, a START Delayed (second priority) can have a survival probability of 63% for blunt trauma and a survival probability of 32% for penetrating trauma with the same physiological measures – both with expected rapid deterioration, while a START Immediate (first priority) can have survival probabilities that extend to above 95% with expected slow deterioration. Age categories exacerbate this. For example, a geriatric patient with a penetrating injury in the Delayed category can have an 8% survival probability, and a pediatric patient in the Immediate category can have a 98% survival probability. Issues with the other START categories have also been noted. In this context, color-coded tagging accuracy metrics are not scientifically meaningful.


title: Triage

text: Poor assessments, invalid categories, no objective methodology and tools for prioritizing casualties and allocating resources, and a protocol of worst first triage provide some challenges for emergency and disaster preparedness and response. These are clear obstacles for efficient triage and resource rationing, for maximizing savings of lives, for best practices and National Incident Management System (NIMS) compatibilities, and for effective response planning and training.


title: Triage

text: Inefficient triage also provides challenges in containing health care costs and waste. Field triage is based upon the notion of up to 50% overtriage as being acceptable. There have been no cost-benefit analyses of the costs and mitigation of triage inefficiencies embedded in the healthcare system. Such analyses are often required for healthcare grants funded by taxpayers, and represent normal engineering and management science practice. These inefficiencies relate to the following cost areas:


title: Triage

text: Because treatment is intentionally delayed or withheld from individuals under this system, triage has ethical implications that complicate the decision-making process. Individuals involved in triage must take a comprehensive view of the process to ensure fidelity, veracity, justice, autonomy, and beneficence are safeguarded.


title: Triage

text: Ethical implications vary between different settings and the type of triage system employed, culminating in no single gold-standard approach to triage. Emergency departments are advised to preemptively plan strategies in attempts to mitigate the emotional burden on these triage responders. While doing so, standards of care must be maintained to preserve the safety of both patients and providers.


title: Triage

text: There is widespread agreement among ethicists that, in practice, during the COVID-19 pandemic triage should prioritize "those who have the best chance of surviving" and follow guidelines with strict criteria that consider both short-term and long-term survivability. Likewise, the triage of other health services has been adjusted during the pandemic to limit resource strain on hospitals.


title: Triage

text: Under the utilitarian model, triage works to maximize the survival outcomes of the most people possible. This approach implies that some individuals may likely suffer or die, in order for the majority to survive. Triage officers must allocate limited resources and weigh an individual's needs along with the needs of the population as a whole.


title: Triage

text: Some ethicists argue the utilitarian approach to triage is not an impartial mechanism, but rather a partial one that fails to address the social conditions that prevent optimal outcomes in marginalized communities, rendering it a practical but inadequate means of distributing health resources.


title: Triage

text: There is wide discussion regarding how VIPs and celebrities should be cared for in the emergency department. It is generally argued that giving special considerations or deviating from the standard medical protocol for VIPs or celebrities is unethical due to the cost to others. However, others argue that it may be morally justifiable as long as their treatment does not hinder the needs of others after assessing overall fairness, quality of care, privacy, and other ethical implications.


title: Triage

text: A variety of logistical challenges complicate the triage and ultimate provision of care in conflict situations. Humanitarian actors acknowledge challenges like disruptions in food and medical supply chains, lack of suitable facilities, and existence of policies that prohibit administration of care to certain communities and populations as elements that directly impede the successful delivery of care. The logistical realities of humanitarian emergencies and conflict situations threatens the bioethical principle of beneficence, the obligation to act for the benefit of others.


title: Triage

text: To address the ethical concerns that underpin triage in conflict situations and humanitarian crises, new triage frameworks and classification systems have been suggested that aim to uphold human rights. Scholars have argued that new frameworks must prioritize informed consent and rely on established medical criteria only in order to respect the human rights considerations set forth by the Geneva Convention of 1864 and the Universal Declaration of Human Rights, but no comprehensive triage model has been adopted by international bodies.


title: Triage

text: Emergency veterinarian Jessica Fragola wrote in 2022 about the ethics of animal triage. She said that pressures on veterinarians having been exacerbated by staffing shortages that resulted from the Covid pandemic, coupled with growth in spending on veterinary care and on pet insurance.


title: Susannah Fielding

text: Susannah Glanville-Hearson known professionally as Susannah Fielding is an English actress who has worked in theatre, film, television and radio. She won the 2014 Ian Charleson Award for her portrayal of Portia in "The Merchant of Venice" at the Almeida Theatre. She also starred in the CBS sitcom "The Great Indoors". Since 2019, she has co-starred with Steve Coogan in "This Time with Alan Partridge".


title: Susannah Fielding

text: Fielding was born in Poole, England, and grew up in Havant, near Portsmouth, before spending two years boarding at Christ's Hospital school in Sussex, where she developed an interest in acting. She also attended Dynamo Youth Theatre, a youth theatre for 11- to 18-year-olds in Havant. She trained at the Guildhall School of Music and Drama; her performances there included Trinculo in "The Tempest" (directed by Patsy Rodenburg) and Myrrah in "Tales from Ovid" (directed by Christian Burgess). She graduated from Guildhall in 2006.


title: Susannah Fielding

text: Fielding's first four professional roles in theatre were in four productions at the National Theatre: "The Rose Tattoo" (2007), "Philistines" (2007), "Much Ado About Nothing" (2007) and "The Hour We Knew Nothing of Each Other" (2008). She received an Ian Charleson Award Commendation for her role as Pietra in Ibsen's "An Enemy of the People" at the Sheffield Crucible in 2010 alongside Antony Sher.


title: Susannah Fielding

text: In 2011 she played Portia in Rupert Goold's production of "The Merchant of Venice" for the Royal Shakespeare Company alongside Sir Patrick Stewart as Shylock, reprising the role in the production's transfer to the Almeida Theatre in 2014. In 2012, she was cast as Kim for the UK run of "All New People", a black comedy play written by and starring Zach Braff. The play's UK run included Manchester and Glasgow before culminating in a 10-week run in London's Duke of York's Theatre. Fielding played the role of Evelyn Williams in the musical "American Psycho" at the Almeida Theatre in December 2013.


title: Susannah Fielding

text: Fielding won the 2014 Ian Charleson Award for her reprised portrayal of Portia in "The Merchant of Venice" at the Almeida Theatre. Michael Grandage, one of the four judges, said of her performance in the production, set in a Las Vegas casino, that she had made the familiar role her own, with a "faultless American accent and a huge intelligence in her acting choices".


title: Susannah Fielding

text: In 2008 she appeared in "Firewall", the second episode of the BBC TV series "Wallander". 2009 saw Fielding as a guest on "The Bill", playing Rochelle Chapman. In 2010 she appeared in the "Doctor Who" episode "Victory of the Daleks", as well as an episode of "Midsomer Murders" and "Comedy Lab". She played Chloe in the Channel 4 sitcom "Pete versus Life". In 2016 Susannah played Emma (Murray's colleague who has a crush on him) in "I Want My Wife Back". In 2016, she appeared in "Nosedive", an episode of the anthology series "Black Mirror". She had a recurring role in 2016–2017 in the American sitcom "The Great Indoors" as Brooke, the ex-girlfriend and current boss of Jack (Joel McHale), who must help him transition from an adventurous reporter to an office worker.


title: Susannah Fielding

text: In 2019, she co-starred with Steve Coogan in "This Time with Alan Partridge". A second series of the show aired in 2021.


title: Susannah Fielding

text: Fielding appeared in the 2010 films "4.3.2.1." and "1st Night" (originally titled "Cosi"), for which she learned to sing opera in Italian. In 2011 she starred in "Kill Keith", a comedy horror film featuring Keith Chegwin. She appeared in the 2012 romantic comedy "The Knot" alongside Mena Suvari and Noel Clarke. She played the beautiful Katherine, Poirot's deceased former lover in the film "Death on the Nile" (2022).


title: Susannah Fielding

text: Fielding dated English actor Tom Hiddleston from 2008 to 2011. They met while filming the series "Wallander".


title: Osteomyelitis

text: Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children e.g. the femur and humerus, while the feet, spine, and hips are most commonly involved in adults.


title: Osteomyelitis

text: The cause is usually a bacterial infection, but rarely can be a fungal infection. It may occur by spread from the blood or from surrounding tissue. Risks for developing osteomyelitis include diabetes, intravenous drug use, prior removal of the spleen, and trauma to the area. Diagnosis is typically suspected based on symptoms and basic laboratory tests as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).This is because plain radiographs are unremarkable in the first few days following acute infection. Diagnosis is further confirmed by blood tests, medical imaging, or bone biopsy.


title: Osteomyelitis

text: Treatment of bacterial osteomyelitis often involves both antimicrobials and surgery. In people with poor blood flow, amputation may be required. Treatment of the relatively rare fungal osteomyelitis as mycetoma infections entails the use of antifungal medications. In contrast to bacterial osteomyelitis, amputation or large bony resections is more common in neglected fungal osteomyelitis, namely mycetoma, where infections of the foot account for the majority of cases. Treatment outcomes of bacterial osteomyelitis are generally good when the condition has only been present a short time. About 2.4 per 100,000 people are affected each year. The young and old are more commonly affected. Males are more commonly affected than females. The condition was described at least as early as the 300s BC by Hippocrates. Prior to the availability of antibiotics, the risk of death was significant.


title: Osteomyelitis

text: Symptoms may include pain in a specific bone with overlying redness, fever, and weakness and inability to walk especially in children with acute bacterial osteomyelitis. Onset may be sudden or gradual. Enlarged lymph nodes may be present.


title: Osteomyelitis

text: In fungal osteomyelitis, there is usually a history of walking bare-footed, especially in rural and farming areas. Contrary to the mode of infection in bacterial osteomyelitis, which is primarily blood-borne, fungal osteomyelitis starts as a skin infection, then invades deeper tissues until it reaches bone.


title: Osteomyelitis

text: In children, the metaphyses, the ends of long bones, are usually affected. In adults, the vertebrae and the pelvis are most commonly affected.


title: Osteomyelitis

text: Acute osteomyelitis almost invariably occurs in children who are otherwise healthy, because of rich blood supply to the growing bones. When adults are affected, it may be because of compromised host resistance due to debilitation, intravenous drug abuse, infectious root-canaled teeth, or other disease or drugs (e.g., immunosuppressive therapy).


title: Osteomyelitis

text: Osteomyelitis is a secondary complication in 1–3% of patients with pulmonary tuberculosis. In this case, the bacteria, in general, spread to the bone through the circulatory system, first infecting the synovium (due to its higher oxygen concentration) before spreading to the adjacent bone. In tubercular osteomyelitis, the long bones and vertebrae are the ones that tend to be affected.


title: Osteomyelitis

text: Bloodstream-sourced osteomyelitis is seen most frequently in children, and nearly 90% of cases are caused by "Staphylococcus aureus". In infants, "S. aureus", Group B streptococci (most common) and "Escherichia coli" are commonly isolated; in children from one to 16 years of age, "S. aureus", "Streptococcus pyogenes", and "Haemophilus influenzae" are common. In some subpopulations, including intravenous drug users and splenectomized patients, Gram-negative bacteria, including enteric bacteria, are significant pathogens.


title: Osteomyelitis

text: The most common form of the disease in adults is caused by injury exposing the bone to local infection. "Staphylococcus aureus" is the most common organism seen in osteomyelitis, seeded from areas of contiguous infection. But anaerobes and Gram-negative organisms, including "Pseudomonas aeruginosa", "E. coli", and "Serratia marcescens", are also common. Mixed infections are the rule rather than the exception.


title: Osteomyelitis

text: Systemic mycotic infections may also cause osteomyelitis. The two most common are "Blastomyces dermatitidis" and "Coccidioides immitis".


title: Osteomyelitis

text: In osteomyelitis involving the vertebral bodies, about half the cases are due to "S. aureus", and the other half are due to tuberculosis (spread hematogenously from the lungs). Tubercular osteomyelitis of the spine was so common before the initiation of effective antitubercular therapy, it acquired a special name, Pott's disease.


title: Osteomyelitis

text: The "Burkholderia cepacia" complex has been implicated in vertebral osteomyelitis in intravenous drug users.


title: Osteomyelitis

text: The area usually affected when the infection is contracted through the bloodstream is the metaphysis of the bone. Once the bone is infected, leukocytes enter the infected area, and, in their attempt to engulf the infectious organisms, release enzymes that lyse the bone. Pus spreads into the bone's blood vessels, impairing their flow, and areas of devitalized infected bone, known as "sequestra", form the basis of a chronic infection. Often, the body will try to create new bone around the area of necrosis. The resulting new bone is often called an involucrum. On histologic examination, these areas of necrotic bone are the basis for distinguishing between acute osteomyelitis and chronic osteomyelitis. Osteomyelitis is an infective process that encompasses all of the bone (osseous) components, including the bone marrow. When it is chronic, it can lead to bone sclerosis and deformity.


title: Osteomyelitis

text: Chronic osteomyelitis may be due to the presence of intracellular bacteria. Once intracellular, the bacteria are able to spread to adjacent bone cells. At this point, the bacteria may be resistant to certain antibiotics. These combined factors may explain the chronicity and difficult eradication of this disease, resulting in significant costs and disability, potentially leading to amputation. The presence of intracellular bacteria in chronic osteomyelitis is likely an unrecognized contributing factor in its persistence.


title: Osteomyelitis

text: In infants, the infection can spread to a joint and cause arthritis. In children, large subperiosteal abscesses can form because the periosteum is loosely attached to the surface of the bone.


title: Osteomyelitis

text: Because of the particulars of their blood supply, the tibia, femur, humerus, vertebrae, maxilla and the mandibular bodies are especially susceptible to osteomyelitis. Abscesses of "any" bone, however, may be precipitated by trauma to the affected area. Many infections are caused by "Staphylococcus aureus", a member of the normal flora found on the skin and mucous membranes. In patients with sickle cell disease, the most common causative agent is "Salmonella", with a relative incidence more than twice that of S. aureus.


title: Osteomyelitis

text: The diagnosis of osteomyelitis is complex and relies on a combination of clinical suspicion and indirect laboratory markers such as a high white blood cell count and fever, although confirmation of clinical and laboratory suspicion with imaging is usually necessary.


title: Osteomyelitis

text: Radiographs and CT are the initial method of diagnosis, but are not sensitive and only moderately specific for the diagnosis. They can show the cortical destruction of advanced osteomyelitis, but can miss nascent or indolent diagnoses.


title: Osteomyelitis

text: Confirmation is most often by MRI. The presence of edema, diagnosed as increased signal on T2 sequences, is sensitive, but not specific, as edema can occur in reaction to adjacent cellulitis. Confirmation of bony marrow and cortical destruction by viewing the T1 sequences significantly increases specificity. The administration of intravenous gadolinium-based contrast enhances specificity further. In certain situations, such as severe Charcot arthropathy, diagnosis with MRI is still difficult. Similarly, it is limited in distinguishing avascular necrosis from osteomyelitis in sickle cell anemia.


title: Osteomyelitis

text: Nuclear medicine scans can be a helpful adjunct to MRI in patients who have metallic hardware that limits or prevents effective magnetic resonance. Generally a triple phase technetium 99 based scan will show increased uptake on all three phases. Gallium scans are 100% sensitive for osteomyelitis but not specific, and may be helpful in patients with metallic prostheses. Combined WBC imaging with marrow studies has 90% accuracy in diagnosing osteomyelitis.


title: Osteomyelitis

text: Diagnosis of osteomyelitis is often based on radiologic results showing a lytic center with a ring of sclerosis. Culture of material taken from a bone biopsy is needed to identify the specific pathogen; alternative sampling methods such as needle puncture or surface swabs are easier to perform, but cannot be trusted to produce reliable results.


title: Osteomyelitis

text: Factors that may commonly complicate osteomyelitis are fractures of the bone, amyloidosis, endocarditis, or sepsis.


title: Osteomyelitis

text: The definition of OM is broad, and encompasses a wide variety of conditions. Traditionally, the length of time the infection has been present and whether there is suppuration (pus formation) or osteosclerosis (pathological increased density of bone) are used to arbitrarily classify OM. Chronic OM is often defined as OM that has been present for more than one month. In reality, there are no distinct subtypes; instead, there is a spectrum of pathologic features that reflects a balance between the type and severity of the cause of the inflammation, the immune system and local and systemic predisposing factors.


title: Osteomyelitis

text: OM can also be typed according to the area of the skeleton in which it is present. For example, osteomyelitis of the jaws is different in several respects from osteomyelitis present in a long bone. Vertebral osteomyelitis is another possible presentation.


title: Osteomyelitis

text: Osteomyelitis often requires prolonged antibiotic therapy for weeks or months. A PICC line or central venous catheter can be placed for long-term intravenous medication administration. Some studies of children with acute osteomyelitis report that antibiotic by mouth may be justified due to PICC-related complications. It may require surgical debridement in severe cases, or even amputation. Antibiotics by mouth and by intravenous appear similar.


title: Osteomyelitis

text: Due to insufficient evidence it is unclear what the best antibiotic treatment is for osteomyelitis in people with sickle cell disease as of 2019.


title: Osteomyelitis

text: Initial first-line antibiotic choice is determined by the patient's history and regional differences in common infective organisms. A treatment lasting 42 days is practiced in a number of facilities. Local and sustained availability of drugs have proven to be more effective in achieving prophylactic and therapeutic outcomes. Open surgery is needed for chronic osteomyelitis, whereby the involucrum is opened and the sequestrum is removed or sometimes saucerization can be done. Hyperbaric oxygen therapy has been shown to be a useful adjunct to the treatment of refractory osteomyelitis.


title: Osteomyelitis

text: Before the widespread availability and use of antibiotics, blow fly larvae were sometimes deliberately introduced to the wounds to feed on the infected material, effectively scouring them clean.


title: Osteomyelitis

text: There is tentative evidence that bioactive glass may also be useful in long bone infections. Support from randomized controlled trials, however, was not available as of 2015.


title: Osteomyelitis

text: Hemicorporectomy is performed in severe cases of Terminal Osteomyelitis in the Pelvis if further treatment won’t stop the infection.


title: Osteomyelitis

text: The word is from Greek words ὀστέον "osteon", meaning bone, μυελό- "myelo-" meaning marrow, and -ῖτις "-itis" meaning inflammation. In 1875, American artist Thomas Eakins depicted a surgical procedure for osteomyelitis at Jefferson Medical College, in an oil painting titled "The Gross Clinic".


title: Osteomyelitis

text: Evidence for osteomyelitis found in the fossil record is studied by paleopathologists, specialists in ancient disease and injury. It has been reported in fossils of the large carnivorous dinosaur "Allosaurus fragilis". Osteomyelitis has been also associated with the first evidence of parasites in dinosaur bones.


title: Chinese Communist Revolution

text: The Chinese Communist Revolution, officially known as the Chinese People's War of Liberation in the People's Republic of China (PRC) and also known as the National Protection War against the Communist Rebellion in the Republic of China (ROC), was a period of social and political revolution in China that culminated in the establishment of the People's Republic of China in 1949. For the preceding century, China had faced escalating social, economic, and political problems as a result of Western imperialism and the decline of the Qing Dynasty. Cyclical famines and an oppressive landlord system kept the large mass of rural peasantry poor and politically disenfranchised. The Chinese Communist Party (CCP) was formed in 1921 by young urban intellectuals inspired by European socialist ideas and the success of the Bolshevik Revolution in Russia. The CCP originally allied itself with the nationalist Kuomintang party against the warlords and foreign imperialism, but the Shanghai Massacre of Communists ordered by KMT leader Chiang Kai-shek in 1927 forced them into the Chinese Civil War.


title: Chinese Communist Revolution

text: Early Nationalist military dominance forced the Communists to abandon their strategy of appealing to the urban proletariat, instead basing themselves in the countryside as advocated by Mao Zedong. Mao rose to become the Chairman of CCP during the Long March while the CCP narrowly avoided complete destruction. The Communists led by Mao once again formed a United Front with the Kuomintang to fight the Japanese occupation of China beginning in 1936. The CCP made effective use of situation to rebuild their movement around the Chinese peasantry. Following the Japanese surrender in 1945, China became an early hot spot in the Cold War. The United States continued to funnel large amounts of money and weapons to Chiang Kai-shek, but corruption and low morale fatally undermined the Nationalist army. The Soviet Union's decision to let the CCP take control of Japanese weapons and supplies left behind in Manchuria, on the other hand, proved decisive. The Communists were able to mobilize a massive army of peasants with their program of radical land reform and gradually began winning open battles against the KMT. In 1948 and 1949 the Communist People's Liberation Army won three major campaigns that forced the Nationalist government to retreat to Taiwan. On 1 October 1949, Mao formally proclaimed the creation of the People's Republic of China.


title: Chinese Communist Revolution

text: The Communist victory had a major impact on the global balance of power: China became the largest socialist state by population, and, after the 1956 Sino-Soviet split, a third force in the Cold War. The People's Republic offered direct and indirect support to communist movements around the world, and inspired the growth of Maoist parties in a number of countries. Shock at the CCP's success and fear of similar events occurring across East Asia led the United States to intervene militarily in Korea and South East Asia (e.g. Vietnam). To this day, the Chinese Communist Party remains the governing party of mainland China and the second-largest political party in the world.


title: Chinese Communist Revolution

text: Many historians agree with the Chinese Communist Party official history that the Chinese Revolution dates to the founding of the Party in 1921. A few consider it to be the latter part of the Chinese Civil War, since it was only after the Second Sino-Japanese War that the tide turned decisively in favor of the Communists. That said, it is not entirely clear when the second half of the civil war began. The earliest possible date would be the end of the Second United Front in January 1941, when Nationalist forces ambushed and destroyed the New Fourth Army. Another possible date is the surrender of Japan on August 10, 1945, which began a scramble by Communist and Nationalist forces to seize the equipment and territory left behind by the Japanese. However, full-scale warfare between the two sides did not truly recommence until June 26, 1946, when Chiang Kai-Shek launched a major offensive against Communist bases in Manchuria. This article is focused on the political and social developments that contributed to the Revolution, rather than the military events of the Civil War, so it begins with the founding of the Communist party.


title: Chinese Communist Revolution

text: The exact end of the Revolution is also a bit unclear. The most common date used, and the one used here, is the Proclamation of the People's Republic of China on October 1, 1949. Nonetheless, the Nationalist Government had not evacuated to Taiwan until December, and significant fighting (such as the conquest of Hainan) continued well into 1950 and the takeover of the de facto state of Tibet in 1951. Although it never posed a serious threat to the People's Republic, the Kuomintang Islamic insurgency continued until as late as 1958 in the provinces of Gansu, Qinghai, Ningxia, Xinjiang, and Yunnan. ROC soldiers who had fled into the mountains of Burma and Thailand worked with the CIA and Kuomintang to finance anti-Communist activities with drug trafficking well into the 1980s. Because no formal peace between the Republic of China and the People's Republic was ever negotiated, a formal conclusion to the civil war has never been reached.


title: Chinese Communist Revolution

text: Historians disagree on the fundamental causes of the Chinese Communist Revolution. One explanation offered is the extreme exploitation of the Chinese peasantry by the landlord system. Prior to the revolution, the majority of agricultural land in rural China was owned by a class of landlords and wealthy peasants, with the between 50 and 65 percent of peasants owning little or no land and thus needing to rent additional land from landlords. This disparity in land ownership differed by region, and was more extreme in southern China where the commercialization of agriculture was more developed. For example, in Guangdong more than half the rural population owned no land at all. Poor peasants owned an average of only .87 "mu" (about .14 acres) and so spent most of their time working rented land. Even in north China, where most peasants owned at least some land, the plots they owned were so small and infertile that they remained on the edge of starvation. Periodic famines were common during both the Qing Dynasty and the later Chinese Republic. Between 1900 and the end of WWII, China experienced no less than six major famines, costing tens of millions of lives.


title: Chinese Communist Revolution

text: Depending on the system of tenancy, peasants renting land might have been expected to pay in kind or in cash, either as a fixed amount or as a proportion of the harvest. Where a share of the harvest was paid, as in much of north China, rates of 40%, 50%, and 60% were common. A system of sharecropping prevailed in much of Shanxi where landlords owned all agricultural capital and expected 80% of the harvest as rent. The amount of fixed rents varied, but in most areas averaged about $4 a year per "mu". Proponents of peasant exploitation as a cause of the Chinese Communist Revolution argue that these rents were often exorbitant and contributed to the extreme poverty of the peasantry. Agricultural economist John Lossing Buck disagreed, arguing that landlords' return on investment was not especially high in comparison to the standard rates of interest in China at the time.


title: Chinese Communist Revolution

text: According to William H. Hinton, author of a case study on how the Revolution impacted a village in north China:


title: Chinese Communist Revolution

text: The land held by the landlords and rich peasants, while ample, was not enough in itself to make them the dominant group in the village. It served primarily as a solid foundation for other forms of open and concealed exploitation which taken together raised a handful of families far above the rest of the inhabitants economically and hence politically and socially as well.


title: Chinese Communist Revolution

text: Landlords utilized forms of exploitation such as usury, corruption, and the theft of public funds to enrich themselves and their families. They ran side businesses with the profits from farming to shore up their finances and isolate themselves from the effects of bad harvests. On holidays, funerals, and other important events, landlords had they right to demand their tenants act as servants, reinforcing the social divide and engendering resentment from the peasants. Agnes Smedley observed how even within a short distance from Shanghai, rural landlords operated essentially as feudal lords, paying for private armies, dominating local politics, and keeping numerous concubines.


title: Chinese Communist Revolution

text: Some historians emphasize the role of anti-imperialism in the Chinese Communist Revolution. Richard Harris argues that that imperialist pressure by the Western powers and the Japanese led to a "Century of Humiliation" that stoked nationalism, class consciousness, and leftism.


title: Chinese Communist Revolution

text: The French historian Lucien Bianco, in "Origins of the Chinese Revolution, 1915–1949", is among those who question whether imperialism and "feudalism" explain the revolution. He points out that the CCP did not have great success until the Japanese invasion of China after 1937. Before the war, he argues that the peasantry was not ready for revolution; economic reasons were not enough to mobilize them. More important was nationalism: "It was the war that brought the Chinese peasantry and China to revolution; at the very least, it considerably accelerated the rise of the CCP to power." The Communist revolutionary movement had a doctrine, long-term objectives, and a clear political strategy that allowed it to adjust to changes in the situation. He adds that the most important aspect of the Chinese communist movement is that it was armed.


title: Chinese Communist Revolution

text: In the first decade of the twentieth century, young Chinese intellectuals such as Ma Junwu, Liang Qichao, and Zhao Bizhen were the first to translate and summarize socialist and Marxist ideas into Chinese. However, this happened on a very small scale, and had no immediate impacts. This would change following the 1911 Revolution, which saw military and popular revolts overthrow the Qing Dynasty. The failure of the new Chinese Republic to improve social conditions or modernize the country led scholars to take a greater interest in Western ideas such as socialism. The New Culture Movement was especially strong in cities like Shanghai, where Chen Duxiu began to publish the left-leaning journal "New Youth" in 1915. "New Youth" quickly became the most popular and widely distributed journal amongst the intelligentsia during this period.


title: Chinese Communist Revolution

text: In May 1919, news reached China that the Versailles Peace Conference had decided to give German-occupied province of Shandong to Japan rather than returning it to China. The Chinese public saw this not only as a betrayal by the Western allies, but also as a failure by the Chinese Republican government to properly defend the country against imperialism. In what became known as the May Fourth Movement, large protests erupted in major cities across China. Although led by students, these protests were significant because they included the first mass participation by those outside the traditional intellectual and cultural elites. Mao Zedong later reflected that the May Fourth Movement "marked a new stage in China's bourgeois-democratic revolution against imperialism and feudalism...a powerful camp made its appearance in the bourgeois-democratic revolution, a camp consisting of the working class, the student masses and the new national bourgeoisie." Many political, and social leaders of the next five decades emerged at this time, including those of the Chinese Communist Party.


title: Chinese Communist Revolution

text: Many of the May Fourth protests were led and organized by students, who had become increasingly radical in the past few years. The October Revolution in Russia had inspired many of them to join study groups centered on Marxist theory. Soviet Russia offered a unique and compelling model of modernization and revolutionary social change in semi-colonial nation. One of the most influential study groups was led by Li Dazhao, head librarian at Peking University. His study group included Mao Zedong and Chen Duxiu, the latter of who was now working as dean at the university. As the editor of "New Youth", Chen used his journal to publish a series of Marxist articles, including an entire issue devoted to the subject in 1919. By 1920, Li and Chen had fully converted to Marxism, and Li founded the Peking Socialist Youth Corps in Beijing. Chen had moved back to Shanghai, where he also founded a small Communist group.


title: Chinese Communist Revolution

text: By 1920, "skepticism about <nowiki>[study groups']</nowiki> suitability as vehicles for reform had become widespread." Instead, most Chinese Marxists had determined to follow the Leninist model, which they understood as organizing a vanguard party around a core group of professional revolutionaries. The Chinese Communist Party was founded on 23 July 1921 in Shanghai, at the 1st National Congress of the CCP. The dozen delegates resolved to affiliate with the Communist International (Comintern), although the CCP would only formally become a member at its second congress. Chen was elected in absentia to be the first General Secretary. The Chinese Communist Party grew slowly in its first few years. The party had 50 members at the beginning of 1921, 200 in 1922, and 2,428 in 1925. In contrast, the Kuomintang had 50,000 members already in 1923. The CCP continued to be dominated by students and urban intellectuals living in China's large cities, where exposure to Marxist ideas was strongest: three of the first four party congresses were held in Shanghai, the other in Guangzhou. One exception was Peng Pai, who became the first CCP leader to seriously engage with the peasants. In Haifeng County in rural Guangdong, he organized a powerful peasant association that campaigned for lower rents, led anti-landlord boycotts, and organized welfare activities. By 1923, it claimed a membership of about 100,000, or one-quarter of the population of the entire county. Later that year, Peng worked with the KMT to establish a joint "Peasant Movement Training Institute" to train young idealists to work in rural areas, which slowly increased both parties' awareness of and engagement with the peasants and their issues.


title: Chinese Communist Revolution

text: At the same time as CCP was developing in Shanghai, in Guangzhou the seasoned revolutionary Sun Yat-sen was building the Chinese Nationalist Party, or Kuomintang (KMT). Although not a communist, Sun admired the success of the Russian Revolution and sought help from the Soviet Union. The Sun–Joffe Manifesto issued in January 1923 formalized cooperation between the KMT and the Soviet Union. The CCP's Third Party Congress was held in Guangzhou later that year, and the Comintern instructed the CCP to disband and join the KMT as individuals. This was justified in view of the "two-stage theory" of revolution, which postulated that "feudal" societies such as China's needed to undergo a period of capitalist development before they could experience a successful socialist revolution. Although the CCP did agree to allow members to join the KMT, it did not disband. Sun encouraged this decision by offering praise for Vladimir Lenin and calling his principle of livelihood "a form of communism".


title: Chinese Communist Revolution

text: This was the basis of the First United Front, which in effect turned the CCP into the left-wing of the larger KMT. The KMT ratified this United Front at its First National Congress in 1924. The Soviets began sending the support the KMT needed for its planned expansion out of Guangdong. Military advisors Mikhail Borodin and Vasily Blyukher arrived in May to oversee the construction of the Whampoa Military Academy, financed with Soviet funds. Chiang Kai-shek, who the year prior had spent three months in the Soviet Union, was appointed commandant of the new National Revolutionary Army (NRA).


title: Chinese Communist Revolution

text: On 30 May 1925, Chinese students in Shanghai gathered at the International Settlement, and held demonstrations in opposition to foreign interference in China. Specifically, with the support of the KMT, they called for the boycott of foreign goods and an end to the Settlement, which was governed by the British and Americans. The Shanghai Municipal Police, largely operated by the British, opened fire on the crowd of demonstrators. This incident sparked outrage throughout China, culminating in the Canton–Hong Kong strike, which began on 18 June, and proved a fertile recruiting ground for the CCP. Membership was catapulted to over 20,000, almost ten times what it had been earlier in the year. Concerns about the rising power of the leftist faction, and the effect of the strike on the Guangzhou government's ability to raise funds, which was largely dependent on foreign trade, led to increasing tensions within the United Front. When Sun Yat-sen had died on 12 March, his immediate successor as chairman was the moderate Liao Zhongkai, who supported the United Front and the KMT's close relationship with the Soviet Union. On August 20 Hu Hanmin's far-right faction likely orchestrated Liao's assassination. Hu was arrested for his connections to the murderers, leaving Chiang and Wang Jingwei—Sun's former confidant and a leftist sympathizer—as the two main contenders for control of the party. Amidst this backdrop, Chiang began to consolidate power in preparation for an expedition against the northern warlords. On 20 March 1926, he launched a bloodless purge of hardline communists who were opposed to the proposed expedition from the Guangzhou administration and its military, known as the Canton Coup. The rapid replacement of leadership enabled Chiang to effectively end civilian oversight of the military. At the same time, Chiang made conciliatory moves toward the Soviet Union, and attempted to balance the need for Soviet and CCP assistance in the fight against the warlords with his concerns about growing communist influence within the KMT. In the aftermath of the coup, Chiang negotiated a compromise whereby hardline members of the rightist faction, such as Wu Tieh-cheng, were removed from their posts in compensation for the purged leftists. By doing so, Chiang was able to prove his usefulness to the CCP and their Soviet sponsor, Joseph Stalin. Soviet aid to the KMT government would continue, as would co-operation with the CCP. A fragile coalition between KMT rightists, centrists led by Chiang, KMT leftists, and the CCP managed to hold together, laying the groundwork for the Northern Expedition.


title: Chinese Communist Revolution

text: By 1926 the Kuomintang (KMT) had solidified their control over Guangdong province enough to rival the legitimacy of the Beiyang government based in Beijing. After purging his opponents in the KMT leadership, Chiang Kai-shek was appointed Generalissimo of the National Revolutionary Army and set out to defeat the warlords one at a time. The campaign saw massive success against Wu Peifu in Hunan, Hubei, and Henan. Sun Chuanfang put up a stronger resistance, but popular support for the KMT and opposition to the warlords helped the National Revolutionary Army (NRA) make inroads into Jiangxi, Fujian, and Zhejiang. As the NRA advanced, workers in the cities organized themselves into left-leaning trade unions: in Wuhan, for example, more than 300,000 had joined trade unions by the end of the year. The All-China Federation of Labor (ACFL), founded by the Communists in 1925, reached 2.8 million members by 1927.


title: Chinese Communist Revolution

text: At the same time as workers organized in the cities, peasants rose up across the countryside of Hunan and Hubei provinces, appropriating the land of the wealthy landowners, who were in many cases killed. Such uprisings angered senior KMT figures, who were themselves landowners, emphasising the growing class and ideological divide within the revolutionary movement. CCP leader Chen Duxiu was also upset, both from doubt in the peasants' revolutionary capabilities and fear that premature revolt would wreck the United Front. The KMT-CCP leadership dispatched prominent CCP cadre Mao Zedong to investigate and report on the nature of the unrest. Mao had returned from a previous visit to his rural home town personally convinced that the peasantry had revolutionary potential, and over the course of 1926 had established himself as an authority on rural issues while lecturing at the Peasant Training Institute. Mao spent just over a month in Hunan and published his report in March. Rather than condemning the peasant movement, his now-famous Hunan Report made the case that a peasant-led revolution was not only justified, but practically possible and even inevitable. Mao predicted that:


title: Chinese Communist Revolution

text: In a very short time, in China's central, southern and northern provinces, several hundred million peasants will rise like a mighty storm, like a hurricane, a force so swift and violent that no power, however great, will be able to hold it back. They will smash all the trammels that bind them and rush forward along the road to liberation. They will sweep all the imperialists, warlords, corrupt officials, local tyrants and evil gentry into their graves. Every revolutionary party and every revolutionary comrade will be put to the test, to be accepted or rejected as they decide. There are three alternatives. To march at their head and lead them. To trail behind them, gesticulating and criticizing. Or to stand in their way and oppose them. Every Chinese is free to choose, but events will force you to make the choice quickly.


title: Chinese Communist Revolution

text: After the capture of Wuhan, the Central Committee of the Koumintang voted to move to their government to this more central location. Headed in Chiang's absence by Minister of Justice Xu Qian, the executive committee was a mix of liberals and conservatives who had not been subject to Chiang's purge of leftists. They included Minister of Finance Sun Fo, Minister for Foreign Affairs Eugene Chen, and banker and industrialist T. V. Soong. When they arrived in Wuhan on December 10, the Nationalists found a city gripped by enthusiasm for the revolution. The rapidly-expanding, Communist-led labor movement staged near-constant demonstrations in Wuhan itself and across the nominally KMT-controlled territories. Although still prevented from participating in the KMT government, the CCP established parallel structures of administration in areas liberated by the NRA.


title: Chinese Communist Revolution

text: The Wuhan government proved its competency when, in January 1927, violent protests broke out in the British concession at Hankou. Eugene Chen successfully negotiated its evacuation by the British and handover to the Chinese. The Wuhan administration gradually drifted away from Chiang, becoming a center of leftist power and seeking to reassert civilian control over the military. On 10 March, the Wuhan leadership nominally stripped Chiang of much of his military authority, though refrained from deposing him as commander-in-chief. At the same time, the Communist Party became an equal partner in the Wuhan government, sharing power with the KMT leftists.


title: Chinese Communist Revolution

text: Chiang Kai-shek declined to join the rest of the KMT in Wuhan, wary of the influence the CCP had there. Instead, he stayed at his military headquarters in Nanchang and began to rally anti-Communist elements in the KMT and NRA around him. In February 1927, he launched an offensive on the last and most important cities under Sun Choufang's control: Nanjing and Shanghai. While two of Chiang's columns advanced on Shanghai, Sun was confronted with the defection of his navy and a communist general strike. On 22 March, NRA General Bai Chongxi's forces marched into Shanghai victorious. But the strike continued until Bai ordered its end on 24 March. The general disorder caused by the strike is said to have resulted in the deaths of 322 people, with 2,000 wounded, contributing to KMT feelings of unease with its rising Communist allies. The same day the Shanghai strike ended, nationalist forces entered Nanjing. Almost immediately after arrival of the NRA, mass anti-foreigner riots broke out in the city, in an event that came to be known as the Nanjing Incident. British and American naval forces were sent to evacuate their respective citizens, resulting in a naval bombardment that left the city burning and at least forty people dead. He's forces arrived on 25 March, and on the next day, Cheng and He were finally able to put an end to the violence. Although it was a mix of both Nationalists and Communist soldiers within the army who had participated in the riots, Chiang Kai-shek's faction accused Lin Boqu of planning the unrest in order to turn international opinion against the KMT. Lin, a member of both the CCP and the KMT, had been serving as political commissar of the Sixth Army, part of the forces that captured Nanjing. Whatever was responsible, the Nanjing Incident represented the culmination of tensions within the First United Front.


title: Chinese Communist Revolution

text: On April 12, 1927, Chiang Kai-shek and his right-wing faction of the KMT massacred the Communists in Shanghai. The White Terror spread nationwide and the United Front collapsed. In Beijing, 19 leading Communists were killed by Zhang Zuolin. That May, tens of thousands of Communists and those suspected of being communists were killed, and the CCP lost approximately of its members. Only in Wuhan, where leftist sympathizer Wang Jingwei split from Chiang and proclaimed a rival nationalist government, were the Communists safe to hold their Fifth National Congress. However, under pressure from Chiang, Wang eventually purged Communists from his government and declared his loyalty to the right-wing government in Nanjing.


title: Chinese Communist Revolution

text: In 1927, immediately after the collapse of Wang Jingwei's leftist Kuomintang government in Wuhan and Chiang Kai-shek's suppression of communists, the CCP attempted a series of uprisings and military mutinies in Guangzhou, Nanchang and Hunan. Despite initial success they were unable to withstand direct pressure from the KMT's National Revolutionary Army (NRA). The immediate effect was to make it clear to CCP leaders that a formal military apparatus was needed, and during the flight from Nanchang they founded the Chinese Red Army.


title: Chinese Communist Revolution

text: The defeat left an opening for machinations within the party leadership. In late 1927, Xiang Zhongfa was sent as the CCP's representative to celebrations of the Bolshevik Revolution's 10th Anniversary. While in Moscow, Xiang was able to convince the Soviet leadership to hold the


title: Chinese Communist Revolution

text: CCP's 6th Party Congress there, rather than in China. With the help of the "28 Bolsheviks" (Chinese students studying Marxism at the Moscow Sun Yat-sen University), Xiang replaced Chen Duxiu as general secretary to the dismay of CCP leaders back in China. Upon his return to Shanghai, Xiang attempted several bureaucratic changes to consolidate centralized power, with mixed success. In 1930, the Comintern began pressuring the CCP to conduct more "anti-rightist" actions and Li Lisan was promoted to propanganda chief. Li grew to become the effective paramount leader with support from Xiang and advocated for an immediate armed uprising in the cities. This was attempted in July 1930, but failed and again led to heavy losses.


title: Chinese Communist Revolution

text: Under pressure from Zhou Enlai and many others in the party, the Comintern sent Soviet functionary Pavel Mif to replace Li Lisan and Xiang Zhongfa with members of the 28 Bolsheviks. Bo Gu became nominal party secretary while Wang Ming became the de facto paramount leader. Under the influence of Moscow, the strategy of direct confrontation with the KMT by organizing urban uprisings continued until 1933, when party leadership was finally forced to evacuate to the countryside. They fled to Jiangxi, where Mao Zedong had had considerable success in setting up the Chinese Soviet Republic. Established in November 1931, the Soviet had helped expand CCP membership to over 300,000 and supported 100,000 Red Army soldiers. Mao's guerilla tactics had successfully repulsed three KMT encirclement campaigns. The CCP leadership quickly took over from Mao when they arrived from Shanghai. Following the advice of Otto Braun (communist), they replaced cautious guerilla tactics with a more traditional military strategy. The subsequent fourth encirclement campaign was a disaster for the Communists, and forced them to abandon South China altogether. They began the Long March, a 9,000 kilometer retreat to Northern China, where Chiang Kai-Shek's authority was weaker. In January 1935, the CCP paused the march to hold a conference in Zunyi. Here, Mao Zedong denounced the party leadership for its dogmatic adherence to urban revolution in the face of repeated defeats. He also criticized Otto Braun's conventional tactics. Instead, Mao put forward a strategy based on rural guerilla warfare that prioritized winning peasant support. This was controversial because it conflicted with traditional party doctrine and the line endorsed by the Comintern. But with the support of Zhou Enlai, Mao defeated the 28 Bolsheviks and Otto Braun, becoming chairman of the Politburo and de facto leader of the party. Although the party survived the Long March, it had lost about 90% of its membership and was on the brink of destruction. The Communists' new base in Yan'an might indeed have been destroyed, but the outbreak of the Second Sino-Japanese War gave them a reprieve.


title: Chinese Communist Revolution

text: In 1931, the Japanese army had occupied Manchuria, which had nominally been under Chinese sovereignty. This triggered debates inside China on whether the Nationalist Government of Chiang Kai-Shek, the administration with the strongest claim to national leadership at the time, should declare war on Japan. Chiang, despite popular disapproval, wanted to continue to focus on wiping out the Chinese Communist Party before moving on to Japan. In 1936, two of Chiang's generals arrested him in Xi'an and forced him to form the Second United Front with the Communists against Japan. In return for the ceasefire, the Communists agreed to dissolve the Red Army and place their units under National Revolutionary Army command. This arrangement did not end tensions between the CCP and KMT. In January 1941, Chiang Kai-shek ordered Nationalist troops to ambush the CCP's New Fourth Army, one of the Communist armies that had been placed under Nationalist command, for alleged insubordination. The New Fourth Army Incident effectively ended any substantive co-operation between the Nationalists and the Communists, although open fighting between the two sides remained sporadic throughout the war.


title: Chinese Communist Revolution

text: The war with Japan and the Second United Front created an enormous opportunity to expand CCP influence, but also created tensions within the party's leadership. The Nationalists' image had been tarnished by Chiang's original reluctance to the take on the Japanese, while the Communists willingly adopted the rhetoric of national resistance against imperialism. Using their experience in rural guerilla warfare, the Communists were able to operate behind the front lines and gain influence among the numerous peasant resistance groups set-up to fight the Japanese. In contrast with the Nationalists, the Communists undertook moderate land reform that made them extremely popular among the poorer peasants. Communist cadres worked tirelessly to organize the local population in each new village they arrived, which had the dual benefits of spreading Communist ideas and allowing for more effective administration. In the eight years of war, the CCP membership rose from 40,000 to 1,200,000. According to historian Chalmers Johnson, by the end of the war the CCP had also won the support of perhaps 100 million peasants in the regions where they had operated. The temporary truce with the Nationalists also made it possible for the Communists to once again target the urban proletariat, a policy advocated by the "internationalist" faction of the party. Led by Wang Ming, this faction advocated mobilizing labor not for revolution, but rather to support to Nationalists (at least until the war was won). Mao, in contrast, advocated continued focus on the peasantry, and ultimately managed to consolidate his position during the Yan'an Rectification Movement.


title: Chinese Communist Revolution

text: The impact of the war on the social and economics conditions of China had been brutal. An estimated 20 to 25 million Chinese were killed in fighting, massacres, and man-made natural disasters. By 1946, Chinese industries operated at 20 percent capacity and had 25 percent of the output of pre-war China. The influx of cheap American goods forestalled any recovery. In order to coordinate the war effort, the Nationalist government had taken over more than 70% of Chinese industry, a dramatic increase from the 15% it owned before the war. This consolidation of wealth in the regime's hands contributed to the pervasive problem of corruption. The Nationalist currency had been undergoing hyperinflation since the beginning of the war. By 1945, retail market prices had reached 3,000% of their 1937 levels. This problem was compounded by the presence of numerous other currencies printed by the Japanese, Communists, and other local authorities. The Nationalist Government failed to curb inflation after the Japanese surrender and continued to print more currency to pay for the civil war. Hyperinflation reduced the real wages of peasants, workers, and especially soldiers, and destroyed the savings of the upper-middle class that was Chiang's base of support.


title: Chinese Communist Revolution

text: The power of the CCP had grown considerably by the end of the Second Sino-Japanese War. The Eighth Route Army and New Fourth Army—officially still part of the Nationalist NRA but in reality under independent Communist command—counted between 1.2 and 1.27 million men. An additional 1.8 to 2.68 million militia brought the total Communist forces to between 3 million and 4 million. When the Japanese surrendered, the Communists' "Liberated Zone" grew to contain 19 base areas (mostly in north China), making up one-quarter of the country's territory and one-third of its population. In the south, the New Fourth Army had recovered from the attempted massacre of its forces and established a serious Communist presence along the banks of the Yangtze. Nonetheless, the CCP's forces were still numerically inferior to the rest of the NRA, which excluding the Communists counted around 4 million regulars and 1 million militia in its ranks. This was compounded by the Communists' lack of war material like trucks, artillery, and other heavy weaponry. For most of the war the Communists had operated in rural areas without factories or support from the Allies, which the Kuomintang received in abundance. As Mao Zedong said to an American Colonel David D. Barrett, the Communists had an army based on "millet plus rifles."


title: Chinese Communist Revolution

text: The international situation for the Communists was unfavorable in 1945. At Yalta, the Allies had agreed to recognize Russia's claims in the Far East in exchange for a Soviet declaration of war on Japan. These claims included control of Port Arthur and joint control over the Chinese Eastern Railway, which Chiang reluctantly accepted in return for Soviet recognition of the KMT as the sole legitimate government of China. In that way, the Communists appeared to have lost their most likely ally. The American Dixie Mission had investigated the possibility of American support for the Communists, but although its findings were favorable, cooperation was stubbornly blocked by American Ambassador Patrick J. Hurley. Hurley and the powerful pro-Nationalist China Lobby orchestrated the recall or dismissal of American "China Hands" who favored cutting ties with the Nationalists or supporting the Communists, including John Service, Joseph Stilwell, and David Barrett. By mid-1945, the United States was firmly committed to supporting Chiang. According to William Blum, American aid included substantial amounts of mostly surplus military supplies, and loans were made to the KMT. In the two years following the Sino-Japanese War, the KMT had received $4.43 billion from the US—most of which was military aid.


title: Chinese Communist Revolution

text: On August 8, 1945, the Soviet Union invaded Manchuria, immediately altering the military situation in China. The Soviet invasion, among other contemporary developments, made Japan's defeat inevitable. Both the Kuomintang and the Chinese Communist Party immediately ordered their forces to take as much territory from the Japanese as possible, which would yield not just land, but also weapons and equipment from the defeated Japanese units. Although Chiang Kai-Shek was confident that he was in a strong position to win a civil war against the CCP, he also knew that if the Communists gained control of Japanese war material, the balance of power would change. In order to buy time, and under American pressure to negotiate, Chiang Kai-shek reached out to Mao Zedong with a request that the latter fly to Chongqing to negotiate. At first, Mao demanded that Chiang grant the CCP certain conditions, but sustained pressure from Joseph Stalin made him realize the extent of the CCP's international isolation. On August 23, Mao told the Politburo that without Soviet backing, the CCP would have to make concessions to Chiang.


title: Chinese Communist Revolution

text: Meanwhile, military forces on all sides continued their maneuvers. On the 20th, the last Japanese units in Manchuria surrendered to the Soviet Red Army. On the 26th, the CCP authorized army units and cadres to begin infiltrating the Manchurian countryside (a move tolerated by the Soviets). CCP dominance in northern China seriously concerned Chiang, who was not in a position to stop the CCP from taking Beiping or Tianjin. Chiang Kai-shek ordered the Japanese troops to remain at their post to receive the Kuomintang and not surrender their arms to the Communists. Chiang called on the Americans for assistance, and the United States landed more than 50,000 marines in northern China to occupy the major cities until the Nationalists could arrive. Although greeted with enthusiasm, incidents such as the rape of a Chinese student quickly turned the population against the Americans and contributed to growing support for the Communists. The Americans were anxious to have the Nationalists take over their duties, and so General Wedemeyer further ordered the airlifting of 100,000 Nationalist troops into Northern China. As Nationalist troops moved in to formerly occupied territories, looting and large-scale corruption were common. Under the pretext of "receiving the Japanese surrender," business interests within the KMT government occupied most of the banks, factories and commercial properties, which had previously been seized by the Imperial Japanese Army. They also conscripted troops at an accelerated pace from the civilian population and hoarded supplies, preparing for a resumption of war with the Communists. These harsh and unpopular measures caused great hardship for the residents of cities such as Shanghai, where the unemployment rate rose dramatically to 37.5%. The Communists abstained from trying to take and hold any major cities (with the exception of Chinchow), focusing instead on gaining control over the countryside. Nevertheless, as Mao left for negotiations he simultaneously ordered the Shangdang Campaign to defeat as many KMT units in Shanxi as possible and thereby gain a stronger hand at the negotiating table.


title: Chinese Communist Revolution

text: During negotiations, Chiang's main offer was to move from the second stage of Sun Yat-Sen's stages of unification (KMT tutelage) to the third stage (constitutional government). Mao and Zhou Enlai, on the other hand, were willing to recognize Chiang as "de jure" President of China in return for "de facto" autonomy in the provinces of Shanxi, Shandong, Hebei, Rehe, and Chahar. They would be willing to join and support a KMT-led coalition government, but wanted to maintain separate armed forces in their provinces. Both sides criticized the other as unreasonable. Chiang viewed the degree of local autonomy requested by the Communists as a regression to the Warlord Era, and was not willing to sacrifice his goal of reunification. The Communists, on the other hand, suspected they would be massacred if they laid down their arms. Both sides eventually signed the Double Tenth Agreement, but this was mostly for show and the major issues were left unresolved. Negotiations between Chiang and Zhou would continue in Nanking, but Mao returned to Yunnan.


title: Chinese Communist Revolution

text: The outbreak of fighting in Manchuria (see next section) proved to Ambassador Hurley that negotiations had failed, and he resigned in disgust. He was replaced by General George Marshall, who arrived in China on 20 December 1945. The goal of the Marshall Mission was to bring both parties into a coalition government, with the hope that a strong, non-Communist China would act as a bulwark against the encroachment of the Soviet Union. Marshall drew both sides into negotiations which would drag on for more than a year. No significant agreements were reached, as both sides used the time to further prepare themselves for the ensuing conflict.


title: Chinese Communist Revolution

text: By the time that Nationalist units had been able to arrive in the major cities of Manchuria, Communist forces commanded by Lin Biao were already in firm control of most of the countryside and surrounding areas, including the city of Chinchow. On 15 November 1945, the Nationalists began a campaign to roll back these gains. Chiang Kai-shek's forces pushed as far as Chinchow by 26 November 1945, meeting with little resistance. Rather than confront the advancing Nationalists head on, Lin Biao avoided decisive confrontations, and in doing so was able to preserve the strength of his army. The Nationalist advance also prompted Stalin, who did not want the CCP entirely crushed, to command Marshal Rodion Malinovsky to give most captured Japanese weapons to the CCP. This was decisive; from this point onwards the Communist forces were no longer just an army of "millet plus rifles".


title: Chinese Communist Revolution

text: In March 1946, despite repeated requests from Chiang Kai-Shek, the Soviet Red Army under the command of Marshal Rodion Malinovsky continued to delay pulling out of Manchuria, while Malinovsky secretly told the CCP forces to move in behind them. Mao quickly seized the opportunity, ordering Lin Biao and Zhu De to begin taking key cities, including Siping and Harbin. These favorable conditions also facilitated many changes inside the Communist leadership: the more radical faction who wanted a complete military take-over of China finally gained the upper hand and defeated the careful opportunists. By May 3, all Soviet troops had withdrawn, and fighting between local Communist and Nationalist forces had broken out in earnest. The conflict would escalate to the scale of a nation-wide civil war over the summer, as Chiang Kai-shek launched a large-scale assault on Communist territory in North China with 113 brigades (a total of 1.6 million troops).


title: Chinese Communist Revolution

text: Knowing their disadvantages in manpower and equipment, the CCP adopted a "passive defense" strategy. It avoided the strong points of the KMT army and was prepared to abandon territory in order to preserve its forces. In most cases the surrounding countryside and small towns had come under Communist influence long before the cities. The CCP also attempted to wear out the KMT forces as much as possible. This tactic seemed to be successful; after a year, the power balance became more favorable to the CCP. They wiped out 1.12 million KMT troops, while their strength grew to about two million men. In March 1947 the KMT achieved a symbolic victory by seizing the CCP capital of Yan'an. The Communists counterattacked soon afterwards; on 30 June 1947 CCP troops crossed the Yellow River and moved to the Dabie Mountains area, restored and developed the Central Plain. At the same time, Communist forces also began to counterattack in Northeastern China, North China and East China.


title: Chinese Communist Revolution

text: In late 1948, the CCP and the newly rechristened "People's Liberation Army" (PLA) launched the decisive Liaoshen Campaign. The PLA finally captured for good the northern cities of Shenyang and Changchun and consolidated control of the Northeast. The New 1st Army, regarded as the best KMT army, was forced to surrender after the CCP conducted a brutal six-month siege of Changchun that resulted in more than 150,000 civilian deaths from starvation.


title: Chinese Communist Revolution

text: The conscripted peasants who filled the Nationalist ranks also were beginning to defect to the PLA in larger and larger numbers, drawn by the promise of land and much better treatment by Communist officers. The defection and capture of large numbers of well-trained KMT troops finally gave the PLA material superiority over the Nationalist army. Manpower continued to grow as well; during the Huaihai Campaign alone the CCP was able to mobilize 5,430,000 peasants to fight against the KMT forces.


title: Chinese Communist Revolution

text: Now with tanks, heavy artillery, and other combined-arms assets, the PLA was prepared to execute offensive operations south of the Great Wall. In April 1948 the city of Luoyang fell, cutting the KMT army off from Xi'an. Following a fierce battle, the CCP captured Jinan and Shandong province on 24 September 1948. The Huaihai Campaign of late 1948 and early 1949 secured east-central China for the CCP. The outcome of these encounters were decisive for the military outcome of the civil war. The Pingjin Campaign resulted in the Communist conquest of northern China. It lasted 64 days, from 21 November 1948 to 31 January 1949. The PLA suffered heavy casualties while securing Zhangjiakou, Tianjin along with its port and garrison at Dagu and Beiping. The CCP brought 890,000 troops from the northeast to oppose some 600,000 KMT troops. There were 40,000 PLA casualties at Zhangjiakou alone. They in turn killed, wounded or captured some 520,000 KMT during the campaign.


title: Chinese Communist Revolution

text: After achieving decisive victory at Liaoshen, Huaihai and Pingjin campaigns, the CCP wiped out 144 regular and 29 irregular KMT divisions, including 1.54 million veteran KMT troops, which significantly reduced the strength of Nationalist forces. Stalin initially favored a coalition government in postwar China, and tried to persuade Mao to stop the CCP from crossing the Yangtze and attacking the KMT positions south of the river. Mao rejected Stalin's position and on 21 April, began the Yangtze River Crossing Campaign. On 23 April they captured the KMT's capital, Nanjing. The KMT government retreated to Canton (Guangzhou) until 15 October, Chongqing until 25 November, and then Chengdu before retreating to Taiwan on 7 December. By late 1949 the People's Liberation Army was pursuing remnants of KMT forces southwards in southern China, and only Tibet was left. A Chinese Muslim Hui cavalry regiment, the 14th Tungan Cavalry, was sent by the Chinese government to attack Mongol and Soviet positions along the border during the Pei-ta-shan Incident.


title: Chinese Communist Revolution

text: The founding of the Central People's Government of China was formally proclaimed by Chairman Mao Zedong on October 1, 1949, at 3:00 pm in Tiananmen Square in Beijing, the new capital. The new national flag of the People's Republic of China (the Five-starred Red Flag) was officially unveiled and hoisted to a 21-gun salute. The ceremony was followed by a PLA military parade. Commanded by Nie Rongzhen, the Commander of the Northern China Military Region and inspected by Zhu De, the Commander-in-Chief of the PLA, the parade involved around 16,000 PLA officers and personnel. The parade, which was approved in June 1949, was the first large-scale and modern Chinese military parade, with the country having never done a public review of troops before under previous governments. Liu Bocheng proposed to parade directors Yang Chengwu and Tang Yanjie be organized in the Soviet format, having personally witnessed a military parade on Red Square in Moscow. The Northern Military Region Band (now the Central Military Band of the PLA) provided musical accompaniment which included the "Military Anthem of the People's Liberation Army" and new national anthem of China, the "March of the Volunteers".


title: Chinese Communist Revolution

text: On October 1, 1949, Chairman Mao Zedong officially proclaimed the founding of the People's Republic of China at Tiananmen Square. Chiang Kai-shek, 600,000 Nationalist troops and about two million Nationalist-sympathizer refugees retreated to the island of Taiwan. After that, resistance to the Communists on the mainland was substantial but scattered, such as in the far south. An attempt to take the Nationalist-controlled island of Kinmen was thwarted in the Battle of Kuningtou.


title: Chinese Communist Revolution

text: In December 1949 Chiang proclaimed Taipei, Taiwan the temporary capital of the Republic, and continued to assert his government as the sole legitimate authority of all China, while the PRC government continued to call for the unification of all China. The last direct fighting between Nationalist and Communist forces ended with the Communist capture of Hainan Island in April 1950, though shelling and guerrilla raids continued for several years.


title: Chinese Communist Revolution

text: Starting from June 1950, the outbreak of the Korean War led the American government to place the United States Seventh Fleet in the Taiwan Strait to prevent either side from attacking the other, the cold war era of Taiwan Strait has begun. However, the CCP and Kuomintang kept clashing in Southeast Asia during the cold war.


title: Chinese Communist Revolution

text: The Kuomintang also made several last-ditch attempts to use Khampa troops against the Communists in southwest China. The Kuomintang formulated a plan in which three Khampa divisions would be assisted by the Panchen Lama to oppose the Communists. Kuomintang intelligence reported that some Tibetan tusi chiefs and the Khampa Su Yonghe controlled 80,000 troops in Sichuan, Qinghai and Tibet. They hoped to use them against the Communist army.


title: Composite number

text: A composite number is a positive integer that can be formed by multiplying two smaller positive integers. Equivalently, it is a positive integer that has at least one divisor other than 1 and itself. Every positive integer is composite, prime, or the unit 1, so the composite numbers are exactly the numbers that are not prime and not a unit.