Bubonic Plague in Nineteenth-Century China (review)

In this excellent, clearly written book, Carol Benedict charts the history of an epidemic of bubonic plague that broke out of its endemic reservoir in peripheral Yunnan province in the early eighteenth century, spread to that province’s core areas later in the century, and then progressively afflicted much of south and southeastern China during the nineteenth century. She adds for comparative purposes an account of the celebrated outbreak of pneumonic (not bubonic) plague in Manchuria in the early 1900s.

The book falls into two halves, which are linked by general subject but only loosely by thematic coherence. In the first half—an etiology of the bubonic plague epidemic—the author argues for a multistage process in which the principal engine of spread was commercial development. She argues, in other words, that contrary to Western denigrations of China as plague-ridden because of its “backwardness,” plague in China was a by-product specifically of prosperity and economic expansion. Developing a model of disease diffusion that seeks to mediate between existing theories (which, in Benedict’s presentation, appear somewhat reductionist), she invokes central-place theory as elaborated for the Chinese case by G. William Skinner. In so doing, it might be added, she makes a new case for the importance of Skinner’s work to an audience of China scholars that, after a period of infatuation with it in the seventies and eighties, has tended to move on to other schemes of interpreting socio-historical data.

The second half of the book deals with evolving Chinese responses to plague. The progression that Benedict charts is from minimal official interest and only ad hoc elite reaction to plague throughout most of the imperial period, to a much more systematic civic (not governmental) response in the later nineteenth century, to a full-blown dedication to principles of state medicine in the early twentieth. The last was part and parcel of the sweeping “late Qing reforms” (xinzheng), which witnessed a qualitatively greater level of state intervention in society across the spectrum of policy areas. Despite her sophisticated discussion of indigenous medical theories and their areas of overlap with the evolution of the germ theory in the West (a discussion that constitutes one of the most interesting contributions of the book), the author argues that the shift in response owed less to changing Chinese understandings of contagion, or indeed to any indigenous factors, than it did to urgent Chinese desires to emulate Western public health practices out of essentially nationalist motives.

Students of the history of medicine and disease will certainly find this book both interesting and accessible, but it is clearly addressed above all to an audience of historians of China. As a practitioner of the latter discipline, with minimal familiarity with the problematics of the former, I found the book provocative for the way it so clearly wrestles with two linked historiographic issues. First is the inescapable problem of authorial viewpoint on what measures the Chinese of each era ought to have taken, and the implications of this for one’s general political outlook. Benedict readily acknowledges that the “well-ordered police state” (to use Marc Raeff’s phrase) that the late Qing sought to create, in plague-prevention as well as other areas, deeply partook of elements of cultural elitism and class repression. Nevertheless, she cannot help but reveal her judgment that the late Qing statist response was the “right” one, and that less authoritarian responses, however well-intentioned, were in effect counterproductive, contributing to great and unavoidable loss of human life (see especially pp. 163–64).

The second, related issue is that of teleology. In chronicling the evolving Chinese understandings of and responses to plague, how appropriate is it to adopt a “scientistic” frame of reference, treating contemporary Western medical knowledge as an absolute, unproblematized standard against which past or alternative belief systems are to be judged? Benedict struggles with admirable candor to stake out an intermediate authorial stance between an unreflectively “positivist” and an uncritically relativist “cultural...