Health and Hygiene in Chinese East Asia: Policies and Publics in the Long Twentieth Century (review)

This book should be of interest to scholars who want to see a more cosmopolitan approach to the history of medicine. The history of medicine in East Asia is a rapidly growing field, but as Warwick Anderson points out in his Afterword, East Asia has not seen the kind of critical studies of colonial public health as Africa and South Asia, and this volume, the result of a working group of scholars at the Academia Sinica in Taiwan, fills some of this gap. The editors have put together ten chapters covering approximately the mid-nineteenth to the early twenty-first centuries. This book departs from earlier scholarship on public health in East Asia in two important aspects. First is the shift in focus to geographical regions that are far from the center of state power, such as Manchuria and the Pearl River delta, as well as the focus on the countryside rather than urban centers. Second, studying the embedded local practices and traditions and their interactions with international and transnational influences allow the authors to break out of the narrative based on imperialism or nation-building as the shaper of public health. The chapters are arranged under three roughly chronological parts, though many of their themes intersect.

Part I, “Tradition and Transition,” highlights how ideas embedded in traditional medical and social discourse and cultural practices helped to shape modern policies and institutions. Angela Ki Che Leung explores this transition on the evolution of the term chuanran, the standard translation for contagion. The term developed multiple layers of meanings since it first emerged in the tenth century, of which “transmission by contact” became the most significant. The sick body as contagious became subjected to segregation, and death did not end its polluting power as it caused the epidemic qi. Furthermore, southern physicians also distinguished between contagious and noncontagious qi. But the term also embodied the belief that members of the family were more vulnerable to contagion and that disorders that were chuanran in nature were more deadly. Chuanran, however, was only one of the causes for the spread of diseases. Therefore, although the term chuanran was adopted to translate the modern biomedical notion of contagion, its multiple layers of meaning both facilitated as well as complicated early efforts in public health. The adaptation of traditional ideas and institutions to modern needs is further explored in Yu Xinzhong’s chapter on the changing treatment of night soil and waste. In traditional China, the commodification of night soil as a valuable source of fertilizer was evidenced by developments such as night soil markets and professional bodies that collected and sold night soil. This ensured the effective removal of waste materials from the cities in traditional China and maintained an equilibrium between the urban and rural ecosystems. But as sanitation and public health came to be closely associated with national character and strength, and when Western ideas of sanitation and institutions were first introduced in the treaty ports, they had to accommodate the existing traditional Chinese practices and social organizations. Yu examines this process in the treaty port of Shanghai. Sean Hsiang-lin Lei’s chapter, “Sovereignty and the Microscope,” shows how the Manchurian plague of 1910, a highly fatal pneumonic form, allowed modern doctors to introduce a new category of disease called chuanranbing (infectious disease), the identity of which was determined by microscopic tests and the germ theory. This fundamentally challenged the authority and conceptualization of traditional Chinese medicine on contagious diseases.

The three chapters in Part II, “Colonial Health and Hygiene,” examine medicine and health practices in colonial and semicolonial settings. They deal with the colonial powers of Britain in the treaty ports and imperial Japan in Manchuria and Taiwan. Li Shang-Jen’s chapter, “Eating Well in China,” examines British expatriate views of the connection between diet and...