This is an ambitious book both in terms of its scope and its approach. It covers the period between the early nineteenth century and the late twentieth century, and it deals with several important subjects relating to the history of medicine in modern China such as missionary medicine, early psychiatric asylums, urban and rural health care, and the conflict between Western medicine and traditional Chinese medicine (TCM). The book covers a long period and its chapters generally follow a chronological order; nevertheless, it eschews the dry, tedious listing of names and events that are all too common in general histories written by Chinese historians. In the introduction of his book, Yang criticizes these Chinese historians, who are also practitioners of TCM, for focusing their research on evaluating the “scientific content” of TCM (p. 4). He also explicitly rejects diffusionist accounts of Western medicine in China. His approach has thus departed from the kind of internal history of medical concepts and theories that is still dominant in Chinese historians' writing today. On the other hand, the book also differs significantly from Whiggish accounts of the introduction of modern Western medicine to China and the modernization of TCM. Yang's analysis of medicine in China during this turbulent period is characterized by detailed discussions of state policies and keen attention to popular culture. Furthermore, he has not shied away from using contemporary social theories and philosophy, such as the concepts championed by Michel Foucault, Anthony Giddens, Susan Sontag, and others, as analytical tools. The result is both refreshing and intriguing.
The first two chapters of the book are a study of missionary medicine in nineteenth and early twentieth century China. Some of the points made by Yang, for example, the observation that missionary medicine in general failed to convert any significant number of Chinese patients to Christianity and that instead of preaching medical missionaries increasingly devoted themselves to medical work, have been discussed in earlier works by other scholars. But chapter 1 includes an interesting discussion of how Chinese patients understood the efficacy of foreigners' charitable medicine in terms of Chinese folk religion, and chapter 2 contains an in-depth analysis of the connection between missionary medicine, antimissionary rumors, and the traditional Chinese belief in black magic related to the use of human body parts (採生折割). Yang rightly points out that Chinese families were not used to entrusting sick family members to the care of strangers, and consequently, missionary hospitals had to adapt their medical practice to the customs of family care and try to transform them. Lastly, there is also a brilliant analysis of how the spatial arrangement of missionary establishments, such as churches, hospitals, and orphanages, aroused fear in the Chinese people.
Chapters 3 and 5 should be read together. The former describes the efforts of some provincial and municipal governments to establish a professional, independent public health system in the 1920s and 1930s. Most of these attempts were short-lived and sanitary matters remained under the charge of the police department. It was an arrangement that bore striking similarity to that used in Japan, but the author has not explored this connection. The chapter also contains some interesting accounts of preventive measures implemented during cholera outbreaks, i.e., sending out teams of health care workers and soldiers to conduct forced vaccination on customers in tea houses and passengers disembarking from steamboats. Most of the chapter, however, is about the Peking Union Medical College professor John B. Grant's vision for the establishment of community health care in China as well as his cooperation with the Peking City government. Related to this, the first half of chapter 5 is written on Chen Zhiqian's famous experiment with establishing a community health care system in Ding County and includes a contrast between his project and that of his teacher, Grant. Unlike Grant whose work was supported by the Rockefeller Foundation and could draw on the resources of the Pecking Union Medical College, Chen had to adapt his plan to the conditions of a poor rural community. The pursuit of professional excellence championed by the Pecking Union Medical College, which modeled itself upon Johns Hopkins University, was replaced by improvised measures to make the most of limited resources. Chen recruited local people to work as primary health care providers after 2 weeks of elementary medical training. He argued that their familiarity with local conditions and the trust they could garner from their community more than compensated for their lack of professional qualifications. The second half of the chapter is about a similar rural project operated by Yenching University, but it focuses on the pivotal role played by an impoverished intellectual Xue Zhiming who became a health care worker. This section discusses the ways in which Xue demonstrated the efficacy of Western medicine and secured the trust of the rural peoples. Yang argues that people like Xue played an important role in promoting Western medicine and a modern health care system in rural China.
Chapter 4 describes the roles of traditional midwives and death ritual masters in the provision of maternity health care and the issuance of death certificates in Peking. Yang discusses the municipal government's measures for regulating and training midwives in the late 1920s and the 1930s and also explores the decline of death ritual masters by analyzing police records regarding the persecution of cases related to causes of death falsification. There is also an interesting discussion of the training program set up to “modernize” midwifery in Peking. Chapter 6 discusses the practices of religious healing that were associated with worship of local deities and animal spirits. At the end of the chapter, Yang briefly describes the state's efforts to root out these “harmful backward customs.” Chapter 7 begins by retracing the familiar story of the conflict between supporters of Western medicine and the practitioners of TCM and the controversy generated by Yu Yan's famous proposal to abolish TCM. The second half of the chapter, which describes the ways TCM practitioners integrated themselves into the state health care system in the 1950s by participating in epidemic prevention in rural areas, is more interesting and original. Yang points out that, by participating in epidemic prevention, TCM practitioners secured their place as part of the state health care system, but they also consigned themselves to play a subordinate role to practitioners of Western medicine. Mao Tse-tung, however, was not satisfied with a situation in which traditional practitioners were playing a rather inactive role in rural public health care while there was a serious shortage of health care workers. The author returns to this issue in chapter 9 where he discusses Mao's ideas of relying on barefoot doctors to solve the problems of rural health care. There is also a detailed analysis of the training program for these barefoot doctors in this chapter. Yang persuasively argues that, regardless of ideological facades, the functioning of barefoot doctors, in fact, depended on the particular economic and social arrangement of the commune. Many barefoot doctors chose the profession mainly for the purpose of securing a better income. One of the reasons that the system was destroyed so completely in the 1980s was because the economic incentive of working as a barefoot doctor no longer existed after Deng Xiaoping's reforms.
Chapter 8 discusses the campaign against the threats of American “germ weaponry” during the Korean War. Yang points out that propaganda created by Chinese authorities deliberately connected American “germ weaponry” with the atrocities committed by the Japanese military during the Sino-Japanese war. By evoking this bitter experience, the Chinese authorities tried to arouse the people's nationalist sentiment and to mobilize them. The book also argues that, after the end of the Korean War, the Chinese Communist Party continued to use similar slogans and rhetoric in the Patriotic Hygiene Campaigns. Under Mao's rule, treating sanitary work as a type of political campaign had been the rule rather than a wartime exception. Rumor of germ warfare, however, provoked unexpected responses in certain rural areas. Incidents of false alarms caused people to believe that they had been poisoned by American germs and they sought medical assistance desperately. Charlatanism thrived as people sought to secure antidotes to American germ warfare. A few of the victims of this charlatanism fell ill, and some of them eventually died after taking medicines of dubious provenance. People also sought protection by conducting religious rituals, and there was rumor that Mao gained immunity against American germs by worshiping certain deities. Some people even questioned why the People's Liberation Army failed to defend Chinese soil from the biological attacks of the “Paper Tiger.”
In the conclusion, Yang draws on the historiography of colonial medicine and argues that the tension between the institutionally controlled space of modern Western medicine and Chinese traditional space with its unique senses of place is the key to an understanding of the history of medicine in China in the nineteenth and twentieth centuries. This is an intriguing and probably valid point, but it is not well-connected with the rest of the book, which is more about exploring and comparing different medical practices and sanitary measures in urban and rural areas. The book is indeed about the politics of space in the conflicts between Western medicine, on the one hand, and traditional medical practices, such as folk medicine, religious healing, and TCM, on the other. A major contradiction that is repeatedly highlighted in each chapter, however, is not the contradiction between the colonizing universalism of Western medicine and a peculiar Chinese localism, but instead is the contradiction between the city and the country. The inconsistency between what Yang claims to be the framework of his analysis and what has actually been written is somewhat disconcerting.
For those who are not that familiar with modern history of China, this book is not easy to read. Biographical information relating to the physicians and officials being discussed is seldom provided, while many of these physicians and officials are not well-known. Political events are mentioned without supplying the readers with their context. The book also suffers from some structural problems. The richness of its content is not adequately supported by its organization. The transitions between chapters, even between sections within a chapter, are often abrupt and, as a result, the flow of the narrative and the structure of the argument are frequently interrupted and the book reads more like a collection of essays than a monograph. Considering the importance of Western medical texts translated by the Japanese and the significant role played by Japanese-educated Chinese practitioners of Western medicine, it is surprising that the book does not mention Japanese influences on modern Chinese medicine. The main title of the book is also slightly misleading; there is very little actually written about the transformation of Chinese patients. Indeed, Chinese patients appear elusive and recalcitrant in the book, and they seldom behaved as medical practitioners and policy makers suppose they will. Most of the book is about the ways in which Chinese practitioners, both practitioners of modern Western medicine and of TCM, were transformed by rural poverty, popular culture, and state policies. “Remaking Medical Practitioners” would be a more apposite title. It is also a great shame that the publisher's editing work is of poor quality. There are quite a few typos. The name of the famous missionary Timothy Richard is inexplicably misprinted as “R. Timoth”! (p. 3)
Compared with what Yang has achieved in this book, however, the above criticisms are but minor quibbles. The book has used a wealth of sources, is based on solid research, and is never short of fascinating details and insights. It has successfully broken away from the orthodox historiography of medicine that was still prevalent in China around the time of its publication. Yang has written a stimulating book that should be an essential reference for anyone working on the history of medicine in modern China.