As his lengthy career neared an end, Rockefeller advisor Frederick T. Gates made a bold and unsuccessful proposal to the trustees of the Rockefeller Foundation in 1924, asking them to invest $265 million in the China Medical Board. Founded in 1914, the China Medical Board (CMB) was one of the earliest ventures of the Rockefeller Foundation, the most prominent of the Progressive Era's giant secular philanthropic foundations. The CMB was also the last major philanthropic effort by Gates, the man most responsible for shifting the Rockefellers from denominational charity to international philanthropy. After a decade in existence, the CMB had not come close to realizing the hopes of its founder. Only with this massive, unprecedented infusion of capital, Gates explained, could his dream “spring into existence full panoplied.” This dream was never fully realized because of its astonishingly grandiose scale and complexity: its goal was to make Chinese medical care the finest in the world, and in the process close the chasm that he saw between denominational Christianity and the needs of the modern world. Although the story of the China Medical Board is the story of a failed vision, it also affords a glimpse of the cracks at the base of modern American philanthropy.