Durham, London, Duke University Press, 2010, 338 pp.
The result of an initiative by Angela Leung and Charlotte Furth, who has written the introduction, this book contains ten articles written by Taiwanese (6), mainland Chinese (2), and American (2) researchers. It concludes with an afterword by Warwick Anderson, professor at the University of Sydney, whose contribution seeks to enlarge perspectives by replacing the general problematic in the framework of historiographic changes in recent decades. The high representation of Chinese and in particular of Taiwanese scholars in this collection indicates the importance that health problems have assumed in historiographic reflection and social sciences in general in this region over recent decades, a trend that owes much to Leung’s pioneering work in this field over the past 30 years.
As Furth writes in the introduction, the book’s aim is to clarify the “science and politics of public health policy making and action” (p. 3) in a part of East Asia that has long been under China’s influence in the areas of language, intellect, and culture as well as in economics and politics. The period covered begins roughly a century and a half ago, from the introduction of the first “modern” notions of hygiene and public health in this region under the influence of European colonial expansion in the second half of the nineteenth century. At the heart of the reflection lies the notion of public health, rendered by the twin concepts of eisei in Japanese and weisheng (衛生) in Chinese, which Ruth Rogaski, author of one of the contributions in this volume, has popularised in the milieu of Anglo-Saxon Sinology through the expression hygienic modernity,referred to as such throughout the book.
Furth, Leung, and the other authors step back from the English language historiographic tradition which was long dominated, especially in its approach to the case of India, by the colonial enterprise and the close links it had to the concept of nation and the discourse developed around the rise of modern medicine. They attempt to “complicate” the picture as a whole without ignoring the colonial dynamic and its claim to “civilising” influence. Through a series of detailed studies of limited scope, the authors try to shed light on multiple levels of interaction that were juxtaposed in a crucial transition period during which public health was extended in East Asia. In addition to the national and colonial spheres, there was also the transnational one, with international organisations – governmental or otherwise – taking pride of place. Such diversified levels of analysis help especially in reconsidering the normally attempted chronology of the process. In the “science” domain – especially medical here – the studies in this volume attest to a complex form of adaptation and transformation, rather than pure and simple disappearance, of so-called traditional knowledge that was clearly threatened by the formidable challenge of modernity and triumphalist discourse of the era. The writers ably challenge the habitual and radical separation of so-called scientific knowledge from traditional (if not superstitious) practices.
Reflecting these concerns, the collection is divided into three parts. The first, entitled “Tradition and Transition,” contains three articles that trace, each in its own way, the major lines of adaptation of traditional conceptions under the influence of new inputs. At the outset, Leung explores the Chinese notion of contagion (chuanran傳染), retracing both the way in which it was conceptualised quite early in traditional Chinese medicine (right from the twelfth and thirteenth centuries) and the minor role long attributed to it in the passage to the pathological stage. This conceptual framework, which lasted until the early twentieth century, also influenced the way in which the great Manchurian pneumonic plague of winter 1910-1911 was perceived by some traditional practitioners. This is brought out very well in Sean Hsiang-lin Lei’s article, devoted specifically to this well-known epidemic episode. Thought incurable at the time, the pulmonary plague that spread in the Qing empire’s northeast from the autumn of 1910 highlighted the therapeutic ineffectuality of both traditional and modern medicine. While traditional practitioners sought – futilely, and sometimes sacrificing their own lives – to save the victims, practitioners of modern medicine could identify the cause of the disease using a microscope, and they persuaded the authorities to impose strict quarantine and isolation of patients. Despite the cruelty suffered by some of those concerned, the measures helped contain the spread of the disease and finally snuffed it out. The authorities were converted to the measures favoured by modern medicine of the period, while the foundations of traditional knowledge faced a challenge, forcing practitioners to reconsider their positions in light of new information.
The third article (second in order of presentation) by Yu Xinzhong is concerned with cleanliness and urban sanitation. The author seeks to present an overall picture of traditional waste disposal in cities in the Chinese empire and goes on to examine the influence of Western expansion on this process in the countryside. One of the few essays in the book to regard China as a whole, the article suffers from the author’s juggling of sources vastly different in nature and relating to periods more than a century apart, resulting in generalities that unfortunately fail to do justice to an otherwise fascinating subject. It is also regrettable that in tackling the passage to modernity, the author limits his focus mostly to the foreign concessions of ports open to foreign trade starting from the mid-nineteenth century, and often overestimates the “gains” of this gradual modernisation, the limits of which were exposed in many works of the era, as well as the still unstable scientific foundations, reflected in turbulent debate in the West and Japan throughout the second half of the nineteenth century around notions of contagion, infection, and micro-organism that are accepted unanimously today.
The book’s second part is entitled “Colonial Health and Hygiene.” The three articles it contains transport readers to the singular world of colonised societies, where traditional and imported novelties confront and merge with each other. Shang-jen Li looks at China’s open ports in the second half of the nineteenth century and the issue of indigenous food regimes as described by foreign “observers,” in this case all British doctors. The second article, by Ruth Rogaski, turns to Manchuria under Japanese domination, describing sanitary arrangements for the population during the 1930s, whereas the third article, written by Wu Chia-ling, focuses on the role and training of midwives in Taiwan, again during Japanese colonisation. The underlying theme here is represented through relating to the other or otherness in a general context in which, in a way more or less pronounced depending on the situation, the superiority of the colonising power, its knowledge, and its practices are taken for granted. It is interesting to note, as the authors do, that the confrontation between the expertise of one side and the “ancestral” practices of the other, though always provoking a form of symbolic if not physical violence, also created a space for mediation, even in Manchuria – which concerns Rogaski – where the word “occupation” would perhaps be most appropriate, as the Kwantung Army controlled the annexed territory.
The third part, “Campaigns for Epidemic Control,” catches up with the present. The four articles therein deal with the efforts made from the twentieth century to the present to eradicate diseases endemic to the region or to control others that have appeared recently. First, Lin Yi-ping and Liu Shiyung tackle the classic case of malaria in Taiwan, retracing several eradication drives undertaken from the beginning of Japanese colonisation to the mid-1960s, when the island saw the last of the disease. The second contribution, by Li Yushang, is concerned with mainland China, especially the Jiangnan region, where bilharzia (or schistosomiasis) was endemic until the 1980s. Li examines an eradication campaign launched in the 1950s that illustrates the eagerness as well as the inability of new communist authorities to properly manage the effort at a time when over-mobilisation of the “masses” was afoot towards the end of the decade.
The last two texts, by Marta Hanson and by Tseng Yen-fen and Wu Chia-ling, deal with the SARS (Severe Acute Respiratory Syndrome) epidemic that gripped East Asia in 2003. Hanson looks at the role of Chinese traditional medicine in mainland China among possible treatments for the atypical disease, this therapeutic input being generally coupled with solutions sought in modern medicine. Rather than a return to favour of the principles and concepts underlying traditional Chinese medicine, Hanson sees their eventual marginalisation, as practitioners themselves talk of the “scientific” dimensions proving the validity of their system rather than basing their justification on traditional theoretical fundamentals. Tseng and Wu analyse the reactions of authorities faced with the epidemic, especially focusing on Taiwan and Singapore. They note the confusion in both places and the difficulties of reacting to an unknown pathology. They also note the faltering international cooperation and coordination at this level by the World Health Organisation. Inevitably, the outbreak of a disease that is difficult to cure using modern medicine confronts us with our humanity, mortality, and vulnerability, and revives age-old anxieties that the rise of public health and modern medicine during the twentieth century had relegated as relics of the past.
There is a great deal more to be said about a collection that will doubtless be read by anyone concerned with the themes of public health and modernisation of the Chinese world over the past two centuries. Leung and Furth are to be thanked for putting together this volume, which, among its numerous merits, demonstrates the virtue of publishing conference papers when they are well organised.
Traduit par N. Jayaram
Luca Gabbiani is a researcher at l’École française d’Extrême-Orient (French School for East Asian Studies) and Director of the School’s Beijing Centre (email@example.com).
 See Ruth Rogaski, Hygienic Modernity: Meanings of Health and Disease in Treaty-Port China, Berkeley, London, University of California Press, 2004.