A Review of Chasing Snails: Anti-Schistosomiasis Campaigns in the People’s Republic of China, by MIRIAM GROSS.
At the heart of Miriam Gross’ investigation there lies a curious paradox concerning the relationship between the practice and the collective memory of mass mobilizations in China during the 1950s and 1960s. Gross focuses exclusively upon the anti-schistosomiasis campaigns, but her analysis and conclusions will shape how we understand other public health campaigns from that same period. The PRC’s anti-schistosomiasis campaigns are generally deemed to be powerful examples of state success against the scourge of endemic disease. Indeed, many observers, both Western and Chinese, have gone so far as to locate 1958 as the year when the PRC defeated the disease, and the campaigns as the model for public health work (including the most recent SARS and bird flu campaigns).
And yet, as one might guess, such claims were exaggerated, if not hyperbolic. Schistosomiasis was not eliminated in 1958, and it continues to effect populations living in China’s key rice growing areas. But as Gross explains, what makes the anti-schistosomiasis campaigns historically interesting is not the disjunction alone, but rather how this constructed memory of the campaigns’ success obscures a far more complex and intriguing story about the CCP’s ability to consolidate power in local areas during its first two decades of existence, and the multifaceted forms of popular resistance and assimilation provoked by the party’s public health efforts. In the first instance, the CCP managed to establish itself as the arbiter of political life and scientific knowledge, despite a persistent lack of funding and other material resources; irregular, even non-existent, local leadership on campaign matters; and sometimes overly ambitious treatment regimes that either failed to properly cure the disease and or imperiled the patient’s life. As for the second, although the anti-schistosomiasis campaigns of the 1950s failed to eliminate the disease and encountered stiff resistance from target populations, the campaigns of the 1960s, which introduced free treatment schemes and used the flexibility of labor organization in the newly established communes, succeeded in saving lives and eventually changing both beliefs and daily practices.
Gross’s dissertation is an extraordinary work of sharp acumen and deep research. To date, there are only a handful of other scholastic treatments of the anti-schistosomiasis campaigns of the 1950s: John Harland Reed’s unpublished dissertation, Brass Butterflies of the Thoughts of Mao Tse-tung: The Sociology of Schistosomiasis Control in China, and David Lampton’s two books, Health, Conflict, and the Chinese Political System (University of Michigan, 1974) and Politics of Medicine in China: The Policy Process, 1949-1977 (Boulder: Westview Press, 1977). None of these works, however, can match the archival depth and nuance achieved here. Gross has mined municipal, provincial, and county-level archives to startling effect. Her analysis of the grassroots dynamics of these campaigns and her thoughtful examination of the epistemological stakes involved in conflicting conceptions of health and disease makes her dissertation an exciting addition to the growing body of work that takes the convergence of health and medicine with state and society as its focal point.
Gross structures her dissertation about three case studies: Yujiang, a rural county in Jiangxi province; Qingpu, a suburban county in Jiangsu province; and the metropolis of Shanghai. Although each of these locations were model sites for the campaigns, the differences in approach, strategy, and execution gives us tremendous insight into the practical realities facing even non-model sites. Part 1 (ch. 1) provides the reader with a description of the disease background, etiology, and symptoms of schistosomiasis, as well as a consideration of schistosomiasis’ place within the history of tropical medicine and parasitic diseases. Gross also sketches the entire scope of the campaigns and situates it within the high politics of the period (ch. 2).
In Part 2 (ch. 3-5), Gross pursues the local dynamics of the campaigns through a back-and-forth comparative analysis of the three model sites. These three chapters form the empirical heart of the dissertation. Gross extrapolates from the diversity of experiences in Yujiang, Qingpu, and Shanghai to draw persuasive conclusions about how model and non-model sites addressed a variety of problems. Local differences in built environment and geographies played a critical role in the spread and intensity of disease occurrence (ch. 3-4). Poor, mountainous Yujiang county had a fraction of the medical and educational resources available to Shanghai, and even its suburban neighbor, Qingpu. Nevertheless, it was able to control dissemination of the disease, because its access to water and elimination/fertilizer management tactics (a feces cellar versus commode and vat-based system) were more amenable to disease containment. For all three sites, the campaigns struggled to overcome passive resistance or apathy on the part of populace. Communicating the concept of prevention was especially difficult, as successful prevention was by definition an affair of absence. For communities that viewed health in terms of one’s ability to accomplish the requisite necessities of life (“eat, void, and lift heavy burdens,” p. 402), engaging in prevention, and even receiving treatment, was simply avoiding the real work that had to be done each and every day (ch. 5).
In Part 3, Gross takes a metaphorical step back to evaluate the bigger picture. Having detailed all the various ways in which the anti-schisotomiasis campaigns were stymied by the lack of resources, leadership, and popular consent, she shows how the CCP was nonetheless able to use the campaigns to consolidate its power at the local level. We see this consolidation most vividly through the feedback loop created between formation of higher-level cooperatives and communes and the anti-schistosomiasis campaigns. Mass health campaigns enabled the new government to gain entry into local communities and conduct accurate census and detailed cadastral mapping activities, which in turn, facilitated the CCP’s reorganization of rural life (ch. 6). Communal work and living made it easier for the government to promote fundamental changes in behavior by using group pressures to insure compliance, e.g., prohibiting villagers from relieving themselves wherever outside, as well as gain control of local nightsoil economies. Gross then interrogates the various meanings of “science” operative throughout the campaigns and challenges the popular perception of the PRC as anti-science (ch. 7). From an emphasis upon gathering quantitative data to popularizing the use the microscope to encouraging village-level innovation and experimentation, the CCP placed science at the heart of its endeavors to combat superstitious thinking and create a modern citizenry.
Gross’ insightful analysis of the complex dynamics of resistance and assimilation experienced by those most intimately connected with the campaigns (e.g., the local cadre, the sent-back physician, the villager turned activist, the recalcitrant patient, etc.) demonstrates how crucial health campaigns were to the early PRCs consolidation of power and establishment of popular credibility. Collective memory got it right. These campaigns did succeed, but not in the ways people think.
Wendy Jia-Chen Fu
Department of History
Case Western Reserve University
Second Historical Archive
Shanghai Municipal Archive
Jiangsu Provincial Archives
Jiangxi Provincial Archives
Qingpu Area Archives
Wenshi ziliao (National Memoir Project)
University of California, San Diego. 2010. 749 pp. Primary Advisor: Joseph Esherick.