This volume, which encompasses contributions from scholars of history, sociology, and public health, presents overlapping themes, shifting medical paradigms, and cosmopolitan approaches to medical history. To facilitate the reader’s understanding of the dialogue among the research works in the volume, the editors have arranged the essays in approximately chronological order, but they have also grouped them into three thematic sections: tradition and transition, colonial health and hygiene, and campaigns for epidemic control. All three sections provide a powerful exposition of embedded local practices and traditions together with their interactions with international and transnational influences as the shapers of public health policy and practice.
The first section of the volume assesses the change in conceptions of cleanliness, public order, and epidemic disease that drastically altered ideas about what is needed for a vigorous body and a healthy environment in the geographic region that the book covers. The issues addressed in this section remind students of medical history that philological treatment is necessary in the study of medical and public health systems. Change and progress required not only a linguistic transference but also a cultural transference and epistemic transference as indigenous understanding and concepts may not encompass certain basic ideas behind ‘modern’ public health introduced by the West.
In precisely this context Angela Leung undertakes an in-depth study of the evolution of the concept of chuanran (contagion) from ancient to modern times and discovers that the Chinese idea of chuanran is strikingly similar, epistemologically, to the English notion of infection. She argues that the new understanding of chuanran in late Qing traditional Chinese medical texts was crucial in fighting the 1910–11 Manchurian plague epidemic, although the term chuanran in fact both ‘facilitated and at the same time distorted’ the introduction of germ theory into China (p. 46). Also scrutinising the 1910–11 Manchurian plague, Sean Lei’s research in the same section demonstrates as well how the plague helped stage a ‘conceptual breakthrough’ (pp. 74–5) from the traditional term wenyi (epidemics) to the modern understanding of chuanranbing (infectious/contagious disease, meaning ‘an acute and widespread epidemic that was transmitted by direct and intimate human interaction’ ) as a new disease category (p. 89). Although YuXinzhong’s nuanced study in the same section does not directly discuss the changing meaning of any terms, it nonetheless sheds light on different stakeholders’ changing perceptions of night soil (human excrement) management, something which involved an epidemiological change. The traditional handling of night soil for agricultural production was transformed not only into a public health issue but also into a lucrative trade when the British-led Shanghai Municipal Council incorporated traditional Chinese practice into its modern public health management, an accomplishment which ‘satisfied both traditional agricultural needs and Western urban environmental norms’ (pp. 67–8).
The second section of this volume diagnoses the relationship between imperialist power, racial concepts, and medical discourses, thus outlining the multi-faceted nature of coloniality. The methodologies adopted in, together with the findings of, the papers in this section push scholars to think further about how the experience of twentieth-century East Asia can subvert the prevalent critical studies on colonialism in Africa and South Asia.
By indirectly juxtaposing different colonies (China and India) under the rule of one colonial power (Britain), Shang-jen Li’s work on the diverse reactions of British medical practitioners in China to the health values in Chinese diets uncovers the roots of colonial behaviour in two legacies: (1) the European ethnographies, which contribute to the depiction of the so-called colonial ‘Other’; and (2) the differences between the nature of the British imperial presence in China and India, as the practitioners in China relied heavily on ‘the conceptual frame work and theoretical resources provided by tropical hygiene, especially the work of their colleagues in India’ (p. 127). The other two papers in this section deal with the experience of two Japanese colonies, Manchuria and Taiwan. Ruth Rogaski’s investigation into the Japanese perception of colonial Manchuria as backward and disease-ridden exposes the complexity in coloniality by confirming the history of colonial medicine and public health simultaneously as a history of ‘health and violence, cleanliness and coercion, religious benevolence and scientific objectification’ (p. 156). This thrilling chapter also highlights an important note in historiography: the legacy of the notorious Military Medical Unit 731, where Japanese scientists conducted lethal experiments on human subjects, which points to ‘problems of representation and truth, history and justice’ (p. 143).
Turning to the case of colonial Taiwan under Japanese rule, Wu Chia-Ling uses oral histories to challenge the Japanese colonial stereotype of Taiwanese birthing women and their lay birth attendants. The claim of male elites that these women were ‘backward, irrational, and insufficiently educated’ (p. 175) was biased because these women indeed exercised considerable autonomy in making their choice for traditional birthing practices based on extensive Chinese medical knowledge, personal skills, and life experiences.
The third section of the volume illuminates the interconnected web of medical systems, socioeconomic shifts, and the roles politics can play in epidemic control efforts. This process is signified by national governments’ efforts to mediate between a universalising biomedical enterprise and entrenched localisms.
By revisiting Taiwan’s malaria control campaigns, Li Yi-ping and Liu Shiyung focus on Japanese efforts to combat the disease in the early twentieth century and the war against mosquitoes in the 1950s and 1960s sponsored by America and the World Health Organisation which involved island-wide DDT sprayings. The authors showed the Taiwanese case as a local manifestation of global health policy projects, combining scientific knowledge and an extensive network of local health centres. In addition to political efforts, economic activities such as colonisation, urbanisation, industrialisation, and agricultural development were important in making Taiwan malaria-free today, despite the frequent downplaying of their contribution to the effort. While Lin and Liu’s story confirms the significance of extra-political efforts in combating epidemics, Li Yushang’s work serves as an interesting contrast. By focusing on the fight to combat schistosomiasis in the shadow of political mobilisation in the People’s Republic of China, Li argues that strong interest in the progress of the effort from leaders like Mao Zedong and the lack of effective medicine available made local cadres exaggerate the success of treatment out of ambition and pride, when the health issue was turned into a political mission. The other two chapters in this section study the case of SARS in 2003. Marta Hanson examines the Chinese medical interpretation and treatment of SARS coupled with integrated knowledge of biomedicine and Chinese herbal medicine. She accounts for the Western media’s ‘blind spots and blindfolds’ (p. 231) around the Chinese medical response that prevented Western journalists and analysts from ‘seeing the fuller, more compelling story of the interactions between biomedical and traditional Chinese medical institutions, researchers, and practitioners’ (p. 235). This blindness, which had a long historical bias that stretched beyond a biomedical framework, consequently laid a media blindfold over the eyes of the public. Also, by studying the case of SARS with close scrutiny on the roles of the World Health Organisation and national governments, Tseng Yen-feng and Wu Chia-Ling conclude that public health authorities at both the national and transnational levels overrated the risk of this disease in the name of ‘good governance’. This attitude reflected the ‘decision-making processes of health authorities’ (p. 255) which were underpinned by the irrationality of ‘treating national borders as meaningful lines for locating a virus’ (p. 258) because the decision-making process of the health authorities was often based on subjective risk assessment and political priorities cloaked in the name of scientific knowledge.
The only question left behind in the reader’s mind after finishing the book is what interesting issues could have been raised if the lacuna of the Sino-Japanese War of 1937–45 were covered in this volume. This under-researched period not only saw the establishment of important medical systems when simple survival was at stake, but also altered traditions and their interactions with transnational influences, since what medicine meant to people and how efficacy was evaluated changed. This deficiency aside, Health and Hygiene in Chinese East Asia offers the reader a great deal of information for thought and the means to evaluate the various public health issues that it covers.
