Nationalistic history tends to swing back and forth between pride and humiliation. In one mode, it fosters solidarity among a varied populace by tracing the lineage of a nation to a single glorious tradition that has persisted, unaltered and continuous, to the present. At its other extreme, nationalistic history narrates the humiliation that people have suffered in order to rouse them to resist foreign encroachment. The metaphor of the “Sick Man of Asia” often evoked in modern Chinese literature, emerged after the crushing defeats that the Chinese endured for much of the modern age; it refers to the politically and physically sick constitution that made them unfit for life on the international stage. Cultural critics have exploited this discourse since the late nineteenth century to criticize all sorts of old and “feudal” cultural and hygienic practices. The formation of this stigma constitutes the central theme of Heinrich's book.
Heinrich focuses on Martial Cibot's study of smallpox vaccination, Lam Qua's paintings of Peter Parker's Chinese patients, photographs of Chinese patients in English medical journals published by medical missionaries, Benjamin Hobson's anatomical book, and Lu Xun's reception of that anatomy as examples of how the “Sick Man of Asia” was forged. She argues that for the most part, the Chinese absorbed this image through medical discourses—above all, through medical images transmitted into China during the eighteenth and nineteenth centuries. Heinrich considers the coinage of the image of the sick Chinaman largely a project of “Orentalism” through which Westerners and, to a certain extent, Chinese collaborators such as Lam Qua, pathologized the Chinese. But she temporarily abandons an otherwise chronological narrative on medical images to dwell on the new, objective, and cold anatomical gaze that Hobson brought to China. This newly imported visual culture allowed Lu Xun to see his own morbid culture with a fresh eye, rendering him a literary “physician” who treated not patients but a culture and her people. In his hands, the image of the sick Chinaman spread.
Fascinating as the story told in the book is, the reader may wonder to what extent the Chinese pathologized themselves through the channels that the author has described. While the writings of Hobson and Lu Xun were well known, few had access to Cibot's French report, Lam Qua's oil paintings, or the photographs in English medical journals. Heinrich is certainly aware of this problem and makes a great effort to persuade her readers that these artifacts had a tremendous impact. For instance, she mentions that some of Lam's paintings were hung in Parker's hospital, where they were seen by Chinese patients, many of whom were from the lower class. Even if some people did see these pictures, the reader may still wonder how such a small Chinese audience formulated and spread the stereotype of the “Sick Man of Asia.” Furthermore, it is worth wondering whether Westerners really did pathologize the Chinese people, even as we take seriously foreign descriptions of the Chinese physical conditions.
Western missionaries considered China a “tropical” zone where the Caucasian easily fell prey to the hazards of a volatile climate. To these observers, upper-class Chinese seemed meek and effeminate, while those from the lower classes and from northern China struck them as strong with a remarkable capacity for enduring great pain and hardship (Li Shang-jen 李尚仁 2005). Even Japanese physicians, writing before the Sino-Japanese War, ranked the physical constitution of the northern Chinese above their own.1
A Chinese scholar named Jin Anqing added his voice to the chorus of foreign observers. As part of a plan for national defense that he drew up in the late nineteenth century, Jin compared the Qing army to those of the West. He concluded that one of the advantages held by the former lay in brute strength: the Chinese could physically overpower the Westerners. As long as no guns were involved, his country's army could easily defend itself in land combat (Jin Anqing 金安清 1997). Missionaries often employed categories such as “character” or “custom” to describe the physical condition of the Chinese but rarely attributed health problems to an allegedly inferior physical constitution. The complicated relations among character, custom, health, and the Chinese body in military, political, and medical literature has yet to be carefully scrutinized.
The concept of the “Sick Man of Asia” has a complicated textual history which goes beyond images and medical discourse. It was first used around 1895 by a Western journalist to refer to a country he saw as governed by an incompetent court. The referent was the ruling dynasty, not the physical characteristics of the Chinese people. At this early stage of the metaphor, no specific medical conditions were implied. The main source for this metaphor derived from the political situation of the Turkish empire. Ironically, it was late Qing intellectuals like Liang Qichao, not Westerners, who projected this sick-man image onto the Chinese people in order to inspire political reforms and self-strengthening. As the image was adopted by those it described, the “Sick Man of Asia” gained ideological weight and bestowed the newly formed Chinese state with power over the health of her subjects (Yang Ruisong 楊瑞松 2005). When taking all these complexity into consideration, readers have to evaluate Heinrich's arguments with caution.
In the process of discussing the discourse of the “Sick Man of Asia,” Larissa Heinrich raises various questions of interest to scholars of science and technology studies. For instance, did existing technology assist or compete with newly imported techniques in cases such as inoculation against smallpox? What is the relation of medical images, their mechanical reproduction, and the context in which they were situated? How did reader read a text accompanying an image? Can images serve a visual aid to a text, or does text undermine the meaning of an image? How did Western sciences transform Chinese visual culture in the modern age through instruments and other visual practices? Heinrich's book thus marks a new beginning to a field which needs more close examinations.
Email discussion with Chang Che-jia 張哲嘉, whose paper on this subject will be published shortly.