The founding of the People's Republic in 1949 marked the advent of a series of massive-scale public health campaigns aimed at transforming hygiene practices, building a basic healthcare system, and strengthening the Chinese nation. The campaign against snail fever, a parasitic disease afflicting tens of millions of people in southern China, was one of the most influential public health events in the history of the PRC. Snail fever, also known as schistosomiasis, is a waterborne parasitic infection that causes chronic ill-health and various late-stage complications, especially abdominal swelling (hence the name “big belly disease” in Chinese colloquial language). With Mao at the helm, the PRC government launched a decades-long campaign to eliminate schistosomiasis. It was eventually able to control the disease thanks to the Communist Party's political mobilization strategies, the improvement of scientific education among rural youths, and the transfer of medical personnel and resources to rural area. Drawing on extensive local archives from multiple research sites, Miriam Gross's Farewell to the God of Plague provides the most comprehensive and thoroughly researched history of China's anti-schistosomiasis campaign.
Gross's groundbreaking research rests on her tremendous primary source base assembled from multiple local archives. Given the vast regional scope of the anti-schistosomiasis campaign, many provincial- and county-level archives could potentially have archival collections related to the topic. Gross selected her research sites judiciously. The campaign was well documented in all three of the locations where she conducted archival research, for different reasons: Shanghai was the national headquarters for the snail fever campaign, Qingpu County (in Jiangsu Province) was the national test site for the campaign, and Yujiang County (in Jiangxi Province) was the national model site highly lauded by Chairman Mao. The increasingly tight restrictions on access to post-1949 official historical archives across China in recent years makes Gross's archive-based research an all the more important contribution to the field of the PRC history.
Farewell to the God of Plague consists of eight chapters plus an introduction and conclusion. Chapter 1 provides an overview of the anti-schistosomiasis campaign, analyzing the top-down decision-making process at the beginning of the campaign, with an emphasis on Chairman Mao's personal involvement in fighting this particular disease. Chapters 2 and 3 discuss various forms of local resistance to the campaign, focusing on bureaucratic structural obstacles and funding conundrums respectively. Chapters 4 to 6 each address one of the three aspects of the campaign—scientific education, prevention efforts, and treatment practices. While previous scholarship assumes that mass prevention efforts during the early Mao years was the key to the success of the campaign, Gross effectively makes the case that it was the treatment efforts undertaken by rural educated youths and appointed medical professionals that played the decisive role in controlling schistosomiasis. Chapters 7 and 8 illuminate the notion of “scientific consolidation,” and discuss the ways in which the Chinese Communist Party utilized grassroots science and public health campaigns to consolidate its legitimacy in rural communities.
Farewell to the God of Plague is particularly effective in drawing on archival evidence to analyze grassroots resistance to the schistosomiasis campaign. According to Gross, the rural population resisted the campaign for two main reasons: the campaign disrupted agricultural production schedules and the villagers disliked the ways in which the campaign intruded into their everyday bodily practices. Peasants viewed farming as their first priority, but the campaign sometimes conflicted with seasonal agricultural work. Rural cadres and peasants considered it especially a waste of time and energy when they were mobilized to participate in prevention activities, such as eliminating snails, which had limited impact on controlling schistosomiasis. Gross further reveals that many peasants refused to cooperate with some aspects of the health campaign, particularly the examination of stool samples, which they found distasteful and suspicious.
The book's interventions are not limited to the scholarship on the PRC public health campaigns; it contributes substantially to studies of the Mao era from the grassroots perspective. Drawing on meticulous archival details, Gross offers a fascinating case study of the political dynamics, everyday life, and peasant survival strategies in rural China during the Mao era. The book provides vivid evidence of rural cadres’ complicated position between the state and the peasants. Village leaders faced enormous bureaucratic pressure from the upper-level government to implement policies, yet they were not simply loyal servants of the party-state. As demonstrated in the book, rural cadres in many cases acted on behalf of the interest of their own village communities, and especially resisted top-down policies that they deemed harmful to agricultural production. The book also provides a close analysis of the “Leadership Small Group” (LSG), a crucial grassroots leadership structure which was created in the early PRC and still exists today, which could either facilitate or hinder the Communist Party's policy implementation in rural China (Chapter 2). Gross further challenges the previous consensus that “rational bureaucracy” was absent during the era of High Socialism; she argues instead that even during the revolutionary peaks rural cadres were able to gain the scientific knowledge and technical capabilities needed to carry out health campaigns (p. 234).
Gross's examination of China's schistosomiasis campaign incorporates a comparative perspective as well. The book suggests that there are striking similarities between the global malaria campaign and the Chinese snail fever campaign, despite the fact that the former was implemented by the World Health Organization (WHO) and funded by the United States, while the latter was carried out in socialist China. She also compares the snail fever campaign to the 2003 SARS crisis in China, an episode when the Maoist medical model from the anti-snail fever campaign was rejuvenated. Gross acutely points out that the true Maoist medical model—a system that entails structurally embedded participation of the general population and government-funded treatment efforts undertaken by health specialists—can be a useful model for tackling global health issues in the contemporary world.
Overall, Farewell to the God of Plague offers an important contribution to two thriving fields in Chinese history—the history of medicine and public health in China, and the history of the PRC. The book is both highly informative and delightful to read. Anyone interested in PRC history or public health issues in China will benefit tremendously from these fully researched and beautifully written pages.
