Zhongguo jindai jibing shehuishi 中國近代疾病社會史 [A Social History of Disease in Modern China] (review)

Thanks to three scholarly developments—the emergence of France’s Annales School of historiography in the 1930s, the rise of the sociology of medicine in the 1940s, the appearance of the anthropology of medicine in the 1960s—the 1970s gave rise to the social history of disease. In recent years this branch of the history of medicine has won adherents around the world. The novelty of the social history of disease lies in a new paradigm that integrates medical history with social history. This synthesis between internal history and external history also involves an ontological synthesis: the integration of its dual attributes (biological and sociological) frames disease as a hybrid of nature and society.

Since the publication of Chen Bangxian’s Zhongguo yixueshi (中国医学史 The History of Chinese Medicine) in 1919, a series of studies has been carried out on the history of disease in China. Only in the 1980s did some historians begin to investigate the social history of disease; examples include Liang Qizi’s Yufang tianhua cuoshi zhi yanbian (预防天花措施之演变 Changes in the Prevention of Smallpox and Medical Care, 1987), Mingqing yiliao zuzhi: Changjiang xiayou diqu guojia he minjian de yiliao jigou ( 明清医疗组织：长江下游地区国家和民间的医疗机构Medical Institutions in the Ming and Qing Dynasties: Imperial Medical Institutions and People’s Clinics in the Yangzi Delta, 1987), Du Zhengsheng’s Yiliao shehui yu wenhua: Linglei yiliaoshi de sikao (医疗、社会与文化—另类医疗史的思考 Medicine, Society and Culture: An Alternative History of Medicine, 1997), Cao Shuji’s Shuyi liuxing yu huabei shehui bianqian (1580–1644) (鼠疫流行与华北社会变迁 Plague and Social Change in North China [1580–1644], 1997), and Yu Xinzhong’s Qingdai Jiangnan De Wenyi Yu Shehui (清代江南的瘟疫与社会 Plague and Society in Qing Jiangnan, 2003). Most of these offer theoretical discussions in addition to case studies that place disease within concrete social institutions, economic situations, and customs.

In Zhongguo jindai jibing shehuishi, Zhang Daqing traces the social history of disease through the complex institutionalization of Western medicine in modern China. Treating modern Western medicine as a foreign culture, Zhang uses the tools developed by recent historians to present a social history of disease. The main topics of his study are disease’s composition (chapter 1), changes in the perception of disease (chapter 2), disease control and establishment of the Western medicine system (chapters 3 and 4), understanding disease and the socialization of Western medicine (chapters 5 and 6), and the doctor–patient relationship and the establishment of Western professional norms (chapter 7).

The author first expounds the intrinsic connection between disease and society from the angle of disease’s composition. A large volume of historical documents are used to show that infectious diseases, parasitic diseases, diseases arising from nutritional deficiency, and endemic diseases were the biggest health problems in China. The author picks out the social factors at work, including political turbulence, poverty, and folk customs.

Ideas from modern Western medicine changed the attitudes of many. The intelligentsia accepted the new medicine as a central constituent of modern scientific knowledge and set about translating books, publishing periodicals, setting up associations, and improving education. Deploying the intellectual resources of the new medical order, politicians and doctors described their goals of social transformation as “saving the nation by medicine.”

The author dates the beginning of the institutionalization of this new system from efforts to stem the spread of epidemics. Among the steps taken were laws governing the treatment of contagious disease, the professionalization of epidemic control, and the establishment of protocols administered by central and local governments. As the author writes, “The successful introduction of strategies for epidemic prevention did much to elevate Western medicine to a position of dominance in our country’s medical and health care system” (78). The object of disease control shifted from the individual to society, completing the transition from traditional to modern medicine.

The popularization of modern hygiene and community health practice attached Western medicine to the Chinese social matrix. Crucial to this process were mass education and the rural construction movement. Thanks to the propaganda disseminated...