In this creative longitudinal study of a frightening disease, Angela Ki Che Leung uses leprosy as a vehicle from which to view the context and meanings of China's struggle to create its own modernity. The subject of the book is as much Chinese modernity as it is leprosy. As she says, “[f]or a civilization such as China, to appreciate its construction of a hybrid modern regime of health management requires not only the grasp of the nature of its unique political regime since the late nineteenth century, but, above all, an understanding of its long and complex medical, religious, and social traditions since antiquity” (p. 16).

Accordingly, she delves into the ancient medical literature to find skin diseases resembling leprosy, which were thought to be caused by flesh-eating worms, evil winds, and a combination of dampness and cold. After the Tang dynasty, mainstream Confucian doctors no longer associated disease causation with worms, but in popular culture, worm infestation was merged with the idea of gu magic, a concern that persisted in popular and Daoist texts. By the Song dynasty, many authors thought of li/lai/mafeng (the various renderings of leprosy-like diseases in Chinese) as caused by the toxic miasmas of southern China, and as contagious. In the Ming and Qing Dynasties, gu poisoning was also often associated with the south, and with bewitchment by minority women. Since the Song period, there was also a sense that the disease was a form of contamination of the body, perhaps a form of cosmic retribution for sin, which could be passed on to others (chuanran), initially within the family just as sins were also punished communally. Later, the idea of contagion became generalized. Moreover, there was a popular idea that the disease could be shed through intercourse – if a woman in the early stages of leprosy could seduce a healthy man into intercourse, she would be cured as he contracted the disease. There were many stories about southern women seducing strangers from northern provinces for this purpose, that persisted from the thirteenth century into the twentieth.

Popular remedies for leprosy included some toxic drugs such as viper wine, scorpions, blistering beetle, arsenics, calomel, and from the 13th century, chaulmoogra oil (da feng zi), a remedy that 19th-century Chinese scholars often mistakenly thought of as a Western drug brought by missionaries, even though it had been used for skin diseases in China and India for centuries.

In the 19th century, leprosy became an issue in globalization and modernization. Even after the identification of Hansen's bacterium in 1873–74, most western doctors thought of the disease as hereditary, a congenital susceptibility being necessary for the contraction of the disease. Westerners thought of this congenital weakness as being characteristic of inferior races dwelling in the tropics, an idea which meshed surprisingly well with the elite Chinese prejudice about leprosy being a disease of the miasmatic and less civilized regions of south China. Increased global trade and the mass emigration of Chinese coolies from southern Chinese ports led to hysterical fear of Chinese immigrants, which only worsened after the famous case of the Belgian missionary, Father Damien, who contracted leprosy while working in a Hawai‘ian leper colony and died from it in 1889. Oddly enough, this case finally turned the tide in modern medical minds in favour of the contagious nature of the disease, something that had been assumed in Chinese culture for several centuries. In fact there were leper asylums for the segregation of the sick and the protection of the health in China since at least the 16th century.

During the Republican era (1912–49), segregation and isolation of lepers was deemed a matter of national pride, one of the essential measures necessary for removing the shame to China's reputation of being a global source of contagion. The nationalist government generally lacked the manpower and the resources to run the necessary leprosaria, so they ran their public health campaign against leprosy in uneasy collaborative relationships with western missionary organizations. It was not until the Communist Party turned its attention to the debilitating chronic diseases of the rural poor after 1949 that leprosy (and schistosomiasis and venereal diseases) became the subject of co-ordinated eradication campaigns, and, with the advent of sulphonamide drugs and then multi-drug therapy, curable. Today, the rate of leprosy in China is so low as to be considered eradicated by the WHO, though Leung ends her study with alarming reports of the rise of early stage leprosy in poor rural villages, where the demise of communal health insurance during the market reforms since the 1980s has left a gaping hole in access to health care.

Using the history of disease to examine the complex battles over claims to territory, knowledge, modernity and civilization has been gaining in popularity in Chinese (and Western) history over the past couple of decades, and Leung's mastery of the sources and historiographical methodology are both impressive and suggestive. Her approach is finely nuanced, as for example when demonstrating that Western missionaries and Chinese elites shared some of the same (racist/classist) prejudices against the rural poor. Some of China's existing resources against leprosy – segregation, chaulmoogra oil, welfare support for disabled patients – may have anticipated Western medicine, but it was the exigencies of 19th- and 20th-century international politics that ultimately dictated the forms of the campaigns waged against leprosy in modern China.