Reproducing Women: Medicine, Metaphor, and Childbirth in Late Imperial China (review)

Childbirth in most societies has been a strictly female affair. The woman giving birth was attended by female relatives and a midwife; men kept their distance from the messy business, which was often considered polluting as well as distressing and dangerous. While male experts might be called in to prescribe drugs or perform rituals, the hands-on physical business was left to women. In Europe in the eighteenth century this began to change, as "man-midwives" armed with forceps, anatomical training, and formal certification took control of obstetrics, pushing women, their skills, and their hitherto privileged understanding of the female body to the margins.

In early modern China, too, male physicians and medical writers developed claims to a superior, authoritative understanding of women's bodies and reproductive processes. Unlike in Europe, however, male experts did not attempt to displace midwives in the birthing chamber. Instead, they declared themselves masters of the methods that would enable women, their families, and midwives to avert problems during and after pregnancy, and to prepare for a naturally easy birth. Profound understanding of cosmo-physiological principles, honed diagnostic skills, and virtuosity in prescription were the tools of their trade and the sources of their status.

In this wonderfully rich and sophisticated study, vividly illustrated with case histories, Yi-Li Wu explains how and in what context theories and practices of "medicine for women" [fuke] evolved between about 1600 and 1900. Wu draws a fascinating and convincingly complex picture of how late imperial medical specialists thought and reasoned about reproductive processes as well as individual cases. They and their clients negotiated decisions about diagnosis and treatment within a pluralistic mosaic of concepts and beliefs: formal cosmology and its medical interpretations; astrology and geomancy; Buddhist notions of karma; or beliefs in ghosts and possession. Vying for the custom of the well-to-do families that could afford health care were doctors learned in medical theory, physicians trained as apprentices by their fathers, fortune tellers, shamans, acupuncturists, and midwives. Even poorer clients might come armed with information from cheaply printed handbooks on childbirth distributed by charitable individuals or government offices. These popular works were often composed in simple verse to make them accessible even to the illiterate. Meanwhile, as in Europe during the same period, many educated men were well versed in medical theory and would confidently diagnose and prescribe within the family circle, dispute a doctor's decisions, or publish a treatise of their own.

While most physicians and almost all medical writers were men, some interesting records of the achievements of respected female physicians were published (see Charlotte Furth's 1999 work, A Flourishing Yin: Gender in China's Medical History, 960-1665). But theories of the body were such that women were not considered to possess any privileged understanding of the female body. As expert expounders of the cosmological principles underlying natural processes, scholarly men claimed authority over gynecological knowledge.

There has been considerable debate about how the gestational female body was theorized in late imperial medicine. Charlotte Furth proposes a tension between an androgynous body, the explanandum of classical medical theory, and a gendered childbearing body, the object of fuke. Wu, however, argues that there was no such tension. Rather than an androgynous body with both male and female attributes, she sees both general theory and fuke practice as addressing "an infinitive body, one that serves as the basis for all human bodies, to be conjugated into male and female, young and old, robust and delicate, Southern and Northern, depending on circumstance" (232; emphasis added). Furthermore, unlike the great medical masters of the past who saw childbearing as innately pathological, the root of a multitude of inevitable female weaknesses and diseases, late imperial medical thinkers argued that pregnancy and childbearing were naturally easy, and should cause no problems as long as the pregnant woman exercised care, was not distressed, and avoided harmful behavior. Husbands could use the new books on successful childbirth to guide their...