Leprosy, or Hansen's disease, is one of the few human maladies whose history can be traced in cultures with radically different medical traditions and disease nosologies. Although its exact mode of transmission remains unclear even today, the disfiguring skin lesions, numbness, and progressive debilitation caused by the Mycobacterium leprae microorganism made leprosy a particularly dreaded disorder in many societies. Leprosy has long attracted the attention of medical historians of other world regions. Angela Ki Che Leung's exquisitely researched monograph is the first to examine the centuries-long history of this disease in China.
The book has two goals. First, the author analyzes changes and continuities in Chinese medical ideas, religious beliefs, and social practices surrounding leprosy over the longue durée, from the second century bce to the present. Second, she places the modern history of Chinese leprosy within the global context of colonialism and the international politics of race. Each of the five substantive chapters is supported with an impressive array of primary sources, including classical Chinese medical works, Buddhist and Daoist texts, local gazetteers, Ming-Qing novels and plays, missionary journals, Chinese newspapers, and collected oral histories. The author also mined Ming-Qing documents and Republican-era archives to excellent effect. For example, she employs Qing judicial cases (xingke tiben) involving persons with leprosy to establish popular attitudes toward lepers in the eighteenth century (pp. 87–95).
In the first three chapters, Leung maps out significant diachronic transformations in Chinese conceptions of disorders suggestive of leprosy, beginning with the earliest written records of a category of diseases (dafeng or li/lai) that physicians later reanalyzed as mafeng (numb Wind). She is careful not to equate dafeng, li/lai, or mafeng with the disease that biomedicine identifies as Hansen's disease, preferring instead to analyze classical Chinese disease categories on their own terms. Nonetheless, many classical medical texts described ailments with symptoms similar to leprosy, suggesting that the disease was very likely present in ancient China. From the mid-Ming period onward, mafeng was associated primarily with the “miasmatic” southern regions and with promiscuous women. The late imperial classification of leprosy as a contagious venereal disease endemic to lascivious people living along the borders of the Chinese empire enhanced its stigmatization and gave rise to government-sponsored asylums (mafeng yuan) designed to remove lepers from society. Leung's discussion of Ming-Qing theories of contagion (pp. 38–51) constitutes one of the book's significant contributions.
In the fourth and fifth chapters, Leung emphasizes the deep historical roots of modern social and political practices, arguing that twentieth-century strategies for dealing with leprosy were informed more by Chinese tradition than by imported foreign models. She posits that Ming-Qing conceptualizations of leprosy as a disease of the “other” facilitated elite acceptance of the predominant racist discourse of leprosy that circulated globally at the end of the nineteenth century. She further argues that the policy of compulsory segregation, first attempted by the Guomindang regime in the 1920s and perfected by the Chinese Communist Party after 1949, was dictated as much by the prior existence of mafeng yuan as it was by the examples provided by leper colonies in Japan, Hawaii, Australia, or Louisiana.
Leung is to be applauded for underscoring indigenous sources of Chinese modernity and also for highlighting Chinese agency in the construction of modern regimes of health management. However, her continued emphasis on the “weight of tradition” (pp. 139, 176, 270 n. 78) leads her to overstate certain continuities between late imperial and Republican government policy. The Guomindang's use of soldiers to forcibly round up and detain the sick in leprosaria differed substantially from the Qing practice of paying leprosy patients to voluntarily remove themselves from society (pp. 102, 164). Whereas mafeng yuan residents could roam freely (p. 100), those swept up in Republican-era dragnets were detained under heavy guard (p. 164). To be sure, the Nationalist regime lacked the resources to fully implement such draconian measures and many proposals, such as the one (following Hitler's example) urging the sterilization of people with leprosy (p. 283 n. 84), were never carried out. Indeed, the Chinese Communist Party was only able to move large numbers of patients into “leper villages” (mafeng cun) in the 1950s after it adopted strategies that combined Qing-style financial incentives with penalties for noncompliance (pp. 186–92). Although the policies of the Guomindang and the Chinese Communist Party were clearly informed by tradition, as Leung argues, the modern state's aspiration to intern all lepers, by force if necessary, nonetheless appears to be a phenomenon entirely new to the twentieth century.
While not everyone will agree with the relative emphasis that Leung places on continuity over change across the late imperial and modern divide, this is an important and persuasive book that offers fascinating insights at every turn. It deserves the careful attention of historians who are interested in the global history of disease, colonial and postcolonial medicine, and public health, as well as specialists in the history of imperial and modern China.
