restricted access 3. Medical Encounters and Divergences
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3 Medical Encounters and Divergences Of the whole preceding process of civilization, nothing remains in their consciousness except a vague residue. Its outcome is taken simply as an expression of their own higher gifts. . . . And the consciousness of their own superiority, the consciousness of this “civilization,” from now on serves those nations which have become colonial conquerors, and therefore a kind of upper class to large sections of the nonEuropean world. norbert elias, The Civilizing Process The year 1842 was an important one in British history. That year saw the signing of theTreaty of Nanking,which ended the OpiumWar,opened Hong Kong,Shanghai,and other Chinese ports to British Settlement,and signaled the beginning of Great Britain’s military dominance over Asia’s largest empire, the Great Qing. It was also the year Edwin Chadwick published his monumental Report on an Inquiry into the Sanitary Conditions of the Labouring Population of Great Britain. In his report the lawyer, reformer, and utilitarian sought to demonstrate the primary importance of environmental factors in disease. He proclaimed through numbers and powerful prose that the shamefully high mortality rates among Great Britain’s poor were caused first and foremost by dirt, stagnant water, and bad air, conditions that the nation’s government had the obligation to detect and to eliminate . Within the next few decades the health of cities became a centerpiece of European definitions of their “advanced” civilization. For many Europeans , superiority in medical theory and disease control became the main characteristic that distinguished the “West” from the “Orient.” European confidence in such a “great divergence” in medicine was misguided and premature. I draw the phrase “great divergence” from Kenneth Pomeranz’s work of the same title, The Great Divergence: Europe, China, and the Making of the ModernWorld Economy.1 Pomeranz argues that economic differences between China and Europe were minimal until the nineteenth century, when parts of Europe began to reap the full benefits from accessible fossil fuel sources and armed imperialism. Until that moment of divergence,both sides of the Eurasian land mass labored under the same demographic and environmental constraints and developed equally successful strategies to address those constraints. Although Pomeranz’s theory has stirred considerable debate, such questions of similarity and divergence can 76 meaningfully be applied to other areas where Europe claimed an early advantage . Theories of disease causation and disease prevention in China and Europe did not manifest great divergence for most of the nineteenth century , in spite of the congratulatory self-evaluation of Europeans as they established their military superiority over the Qing empire. What did differ was the political and social organization of disease prevention, and this very recent divergence fueled the most contentious medical encounters between Chinese and Europeans at midcentury. A sanitary revolution was sweeping Britain’s cities, but this recent interest in government-organized methods of disease prevention was not the result of medical innovation. It was instead the product of a unique set of trends in the economy, society, and philosophy of England in the mid– nineteenth century.Reforms in the political organization of health and medicine were reactions to shocking deficiencies that were revealed in the course of battling epidemics at home and fighting wars abroad. Great Britain’s successful simultaneous prosecution of industrial production and imperial expansion rested on the health of its two national forces: labor and the military . Trial and error in the laboratories of the city and the empire produced meaningful divergences between Europe and China that emerged later in the nineteenth century, divergences that would fuel the creation of a discourse of Chinese deficiency centered on hygiene.2 Arriving only a few years after the publication of Chadwick’s report and the contentious beginnings of national public health reform in Great Britain, the British soldiers and civilians who came to Tianjin in 1858 nevertheless brought with them a well-established sense of medical and sanitary superiority . Once they landed on Qing soil, British military officers and civilians seemed to forget that their home country still had high infant mortality rates, increasing rates of tuberculosis and dysentery, and was still susceptible to devastating epidemics of cholera and typhus.The Industrial Revolution that had produced the military might needed to defeat the Qing and other foreign powers had brought disease to an increasingly impoverished domestic populace. The British medical profession was experiencing a period of uncertainty about the efficacy of their therapies,and British practitioners possessed diverse ideas about what...