Medicine & Public Health in Southwest China, 1937-1945

A review of Protecting the National Body: Gender and Public Health in Southwest China during the War with Japan, 1937-1945, by Nicole Elizabeth Barnes.

Nicole Barnes’ dissertation, Protecting the National Body, is an ambitious and engaging study that tells three previously untold stories: the importance of the war years for the formation of China’s hybrid and indigenized medical system; the centrality of the Sick (Wo)man of Asia to biomedical projects disciplining Chinese bodies into citizens; and the centrality of China (and Sichuan province in particular) to the global advancement of biomedicine. Barnes’ dissertation fits into a larger field of studies focused on the fundamental social and institutional changes wrought by China’s war against Japan, 1937-1945. Barnes’ work also adds to our understanding of the history of medicine in China by challenging previous studies of Chinese medical history that either skip the war years entirely or view the war as a period of stagnation or disintegration. The dissertation’s focus on the public health and medical systems in China’s wartime capital of Chongqing identifies new opportunities for expansion, collaboration, and reform in China’s medical system engendered by the war. The dissertation pays particular attention to the gendered nature of public health and the social values expressed in this system. Barnes argues that the expansion of public health provided new opportunities for women’s social and political participation, but the system also reinforced gender hierarchies and expressed gendered notions of citizenship in significant ways.

The introduction situates wartime concerns with public health within a Social Darwinist pre-occupation with rehabilitating China from having become the “Sick Man of East Asia” in the wake of the first Sino-Japanese War (1895), a status that justified Japan’s suzerainty over the region (p. 3). This study adds to the scholarship of gender and the war by introducing the Sick (Wo)man of Asia as central to the biomedical dimensions of disciplining bodies into citizens. In her introduction Barnes explains the importance of nomenclature to her argument, interrogating terms such as “Western medicine” that are “anachronistic and imprecise” and replacing these with new terms of analysis such as “scientific biomedicine” that she uses consistently throughout her dissertation (pp. 15-16). Barnes divides the dissertation into two parts: the first part (Chapters 2 through 5) examines the quality and scope of public health under the Nationalist regime; the second part (Chapters 6 and 7) takes up the social changes in public health and medicine that occurred in wartime Sichuan.

Chapter 2 introduces the work of three Nationalist health administrations that transformed the wartime capital and its residents: the newly-formed Nationalist Chongqing Bureau of Public Health (CBPH), the National Health Administration, and the Sichuan Provincial Health Administration. Barnes identifies three important changes brought about by the CBPH in particular: first, an increased governmental presence in the lives of ordinary citizens through the regulation of venues and practices such as toilets, street vendors, trash disposal and burials; second, the loss of autonomy of local leaders in relief and charity work who were often supplanted by central government staff arriving from eastern power centers; and third, a push towards biomedicine in city’s health practices (p. 67).  Although the deprivation and chaos of the war impeded many public health initiatives, Barnes argues that the war marked a period of significant expansion of the central government’s public health projects that touched people’s daily lives and brought new medical services to the region. The increase in numbers of trained medical professionals to the region, the establishment of new hospitals and clinics, including trauma centers for air raid victims, and the establishment of vaccination campaigns against infectious diseases, and the recruitment of volunteers to county health centers affected the lives of “hundreds of thousands of Sichuan residents” who “experienced new medical services” (p. 114).

Chapter 3 examines the “indelible links between public health, national strength and state sovereignty” (p. 116). Barnes’ analysis of the roles that police and neighborhood association (baojia) leaders played as staff, eyes and ears in the Chongqing Bureau of Public Health fits into a larger body of scholarship on the Qing, Nationalist and Communist state’s regulations of public life. Scholars such as Rebecca Nedostop, Frederic Wakeman, Janet Chen, Zwia Lipkin and Ruth Rogaski have looked at various ways in which the state has policed the public as a means of demonstrating political sovereignty (p. 117). Barnes argues that the Nationalist Party used its public health administration to try to shape Chongqing into a modern city modeled after Shanghai and Nanjing. Baojia heads engaged in “policing … organizing the cleaning of public toilets, inspecting local food and drink stalls, assisting with vaccination campaigns and participating in public health exhibits” (p. 125). Police constables worked with baojia leaders to prevent “crimes against public health” (p. 129). Though the Nationalists aimed to establish their party’s legitimacy in the local population, Barnes argues that local conditions, as well as fiscal and political challenges, often impeded their efforts to legitimize their political sovereignty over the region’s residents (p. 120). Barnes also argues that, although the policing of disciplining of bodies is often read by scholars as “Western,” China played an important role in the globalization of germ theory, “adopting these practices in accordance with their own sense of governmentality and modernity” (p. 132). This chapter also includes a comprehensive review of the growing scholarship on Chinese medical and social histories that apply Michel Foucault’s theories of biopower to studies of the Chinese nation and race.

Chapter 4 addresses another arena of hygienic policing in Chongqing: sanitation and the associated meanings of contaminants (p. 147). After a comprehensive review of multi-disciplinary scholarship that theorizes the meanings and import of dirt and disgust, the chapter is then divided into sections examining categories of “trash” that were managed by the CBPH: garbage, vermin, excrement, beggars and corpses. Barnes observes that public health officials were not just concerned with preventing the spread of infectious diseases. Informed by colonial practices of foreigners in Hong Kong and in China’s eastern cities, they were also concerned with “the city’s appearance”  as a marker of modernity (pp. 147-148). As such Chongqing became a kind a “stage” where Nationalist officials could showcase a political sovereignty rooted in modernity (p. 150). Barnes provides a gendered analysis of urban reform, arguing that the version of modernity promoted by male public health reformers and officers was “a specifically masculine modernity” that sought to tame a more “unruly and ‘feminine’ city with its overflowing piles of loose refuse, excessive tolerance toward vagrants and quacks, and secret doorways tucked behind yin shadows” (p. 212).

Chapter 5 provides a comparative analysis of two populations in wartime Chongqing who were differently affected by health care and disease: soldiers and recruits; and civil servants and non-government workers. Barnes finds that gender, social status, civil status and location of residence were important variables in protecting and maintaining the health of these subjects during the war. In terms of gender, health officials prioritized the prevention and treatment of disease in soldier populations while almost exclusively focusing on maternal health for women, overlooking women in vaccination campaigns (p. 229). In terms of social status, the Chinese not only had access to better medical care, but could also procure such advantages as motorized transport for evacuations and private air raid shelters to increase their odds of surviving the vicissitudes of the war (pp. 240-246). Barnes argues that despite the lack of agreement among top health administrators as to the relative importance of protecting the lives of soldiers versus civilians, public health administrations were able to promote reform agendas benefiting civilian populations during the war years by linking health issues with the strength the war effort and nation building (p. 221). This study finds that the war also opened an opportunity for the expansion of government agencies into new provincial regions previous outside of the central government’s apparatus. The final section of the chapter compares key differences in medical and public health services in Chongqing and Chengdu, as well as four rural Sichuan counties, arguing that location was as much of a determinate for wartime survival as status and wealth.

Chapters 6 and 7 of the dissertation focus on social change as an outcome of wartime public health. Chapter 6 provides a gender analysis of women’s involvement in medicine and public health, and the treatment of sick women and sick men as patients. Following the career trajectories of two women health professionals, Barnes argues that as advocates and agents of public health, women were expected to care for Chinese citizens as laborers working as home economists, public health workers and nurses while not supplanting the established authority of male leaders (pp. 263-264). The gendered expectations of women as maternal caregivers is also apparent in the treatment of women as patients. Government funds prioritized maternal and children’s health clinics, while health agents remained silent on the staggering inability of vaccination campaigns to reach the female population in Chongqing (p. 276).

Chapter 7 looks more broadly at wartime changes in Chinese medicine, the establishment and indigenization of scientific biomedicine, and the formation of a hybrid medical system in China. Barnes traces the important role that both politics and modern state building played in creating China’s unique hybrid medical system from the beginning of the Nationalist era through the creation of Traditional Chinese Medicine (TCM) in the 1950s by the post-war Communist state (pp. 313-324). The contingencies of the war hastened an elevation in the status of scientific biomedicine, but the wartime need for medicine and physicians also contributed to incorporation of Chinese medicine into the state bureaucracy (p. 312). Barnes makes a further argument that medicine became an important export from China during the war. The migration of medical researchers and personnel to China’s southwest combined with the wartime conditions of disease, battle field injuries, and shortages of medicine created a unique opportunity for the global advancement of science (pp. 311-312, pp. 329-332).

Barnes’ centering of Chongqing and Sichuan in the history of Chinese medicine and public health in China reveals a strikingly different view of both the war and of Chinese medicine, compared to previous studies of the war that focus on Shanghai and Nanjing or studies of Chinese medicine that skip the war years altogether. Rather than identifying failures in state building and stagnation in modernization processes, Barnes identifies an expansion of public health administration and advances in research that were made possible by the dislocations and contingencies of war. She also identifies ways in which reformers and activists deftly utilized state ideologies and newly-formed bureaucracies to promote their agendas and establish firm footholds in China’s changing medical system. This dissertation will be of great interest to anyone exploring the complex ways in which scientific biomedicine was adopted and adapted within China’s unique historical circumstances. It makes a significant contribution to our understanding of the history of gender and war and of gender and public health with its identification and interrogation of differential treatments of the Sick Woman and Sick Man of Asia. Barnes’ dissertation also elevates the importance of public health and hygienic modernity in the establishment of the Nationalist state by determining that the Nationalists used the mechanisms and discourses of hygienic modernity to establish political legitimacy.

M. Colette Plum
Johns Hopkins University
Lecturer, Hopkins in Nanjing
realprofplum@gmail.com

Primary Sources

Internal records of state agencies and affiliated organizations held at The Chongqing Municipal Archives and Chongqing Municipal Library in Chongqing.
Records of local and foreign philanthropic organizations.
Chinese medical journals, such as The Chinese Medical Journal, issues, 1937-1945.
Personal memoirs of Chinese public health activists and memoirs, letters, and journal articles from foreign missionary doctors and associations,  especially from the collections at Columbia University Burke Union Theological Seminary Library.
The Sichuan Provincial Archives in Chengdu, Sichuan.
Kuo Ting-yee Library of the Institute of Modern History at Academia Sinica.

Dissertation Information

University of California, Irvine. 2012. 406 pp. Primary Advisors: Kenneth L. Pomeranz and Jeffrey Wasserstrom.

 

Image: From the Archives of the American Bureau for Medical Aid to China, held at Columbia University’s Rare Books and Manuscript Library. Photograph by Nicole Barnes.

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