Bridie Andrews's new book gives a spirited and compelling account of the long, complex struggles that went into making medicine modern in China. It is at once an engaging and mind-stretching introduction for undergraduates studying modern China, and a sophisticated, richly documented and provocative contribution to post-colonial history and history of science.
Many of us who teach on China will have taken medicine as a revealing case study, a lens to bring into focus the wider struggles over body, state, science and resources that marked China's growth into a nation that recognized itself, and that was acknowledged by others, as modern.
The basic story goes as follows. In the late 19th century, shocked by a series of humiliating defeats and territorial concessions, Chinese intellectuals and reformers diagnosed their country as the “sick old man of Asia.” This image superimposed the metaphorical and literal meanings of sickness: not only was Chinese society sick, weakened by noxious institutions and traditions as well as foreign incursions, but ordinary Chinese people were sick too, prey to disorders and epidemics that native Chinese medicine was incapable of curing.
Many of China's greatest patriots and revolutionary thinkers, including Sun Yat-sen and Lu Xun, trained in Western medicine and called loudly for a ban on Chinese medicine, which they were convinced was unscientific and positively harmful, an obstacle to China's progress towards modernity and national strength. The commitment to science in general, and to Western medicine in particular as an essential and effective instrument of modernization, informed government policy through the Republican era.
While biomedical expertise and institutions received official support, however, their outreach was largely confined to big cities in areas under Republican control. Chinese medicine meanwhile regrouped, adapted and survived: Chinese physicians fought back against campaigns to discredit their knowledge, claiming their field as an essential element of national heritage, distancing their text-centred skills from popular or religious healing, creating professional groups, selectively mobilizing the tools of modern science to develop scientific credentials for their drugs, therapies and theories, and maintaining a large patient base. Thus, when the People's Republic was established and Mao's government set to its socialist mandate of providing medicine for all, the ubiquity of practitioners of Chinese medicine, together with the sparsity of biomedical personnel, imposed the policy of “standing on two legs.” For the first time the state offered endorsement to Chinese medicine on more or less equal terms with biomedicine.
The story that Andrews tells follows this familiar outline, yet she throws down a gauntlet to anyone who might claim that this could be construed as a story of the triumph of reason: “No doubt few people spend much time questioning why Western medicine should spread to non-Western lands, but, if people were to consider it, their response would likely be that Western medicine works. Yet, the story of Western medicine in China shows that clinical practice was not the prime motivation for the Chinese to adapt it to their practice” (p. 213).
Andrews's chapters follow a roughly chronological sequence: the spectrum of Chinese healing practices previous to the encounter with Western medicine; missionary medicine; the influence of reforms in Japan; the place of public health in Chinese state-building; selected medical lives; new institutions; and the unfolding impact of the scientization of Chinese medicine on theory and therapeutic practice. In each carefully specified and contextualized case, Andrews identifies what was at stake ideologically, politically, socially or culturally in the complex interactions between Chinese and Western medicine, which she suggests functioned not as distinct Others but rather as twinned mirrors, each holding the image of the other and the other's view of itself. This metaphor should intrigue and engage students new to historical critique, and lead them to reflect more broadly on the claims of science. Another element of Andrews's analysis that will be particularly valuable to student readers is the discussion of conceptual genealogies. The idea of public health, for instance, emerged in 19th-century Western societies as a politically specific response to problems caused by rapid industrialization and urbanization. How, then, did this particular understanding of threats to the social order, of responsibility and agency translate into long-standing Chinese traditions of political or social obligations to succour the needy? At another level of interpretation, among Andrews’ many well-chosen examples of how to read between the lines of sources my favourite is her deep reading of the “scientized” rewriting of a “traditional” medical case (chapter eight).
In confronting Western medicine with its reflections and refractions in Chinese medicine, and vice versa, Andrews's account illuminates both. She thus meets her goal, laid out in her introductory and concluding chapters, of contributing fresh understanding to the meaning of modernity, and to the place of medicine in shaping its instantiations.
