Remaking Patients—Space Politics Under the Conflict Between Chinese and Western Medicine (1832-1985)

1 Introduction: The History of Medicine in Another Narrative Framework

Historians are supposed to be good storytellers, but we have to admit many historians today are less and less able to tell stories. The place where stories are supposed to be told is full of the debris of the so-called history fragmented by modern ideas. But by chance, I was convinced that an ordinary story may only change a person’s mood, but a story told on a specific occasion can change the way a person looks at history.

Here’s an example that touched my heart. In 1995, my friend, an anthropologist, told me a story about temple restoration. He said a temple was like a “body,” as if it had a cycle of life, death, illness and senility, as well as a historical memory. It was a Confucius temple in a village in Gansu, which was demolished in the 1950s when a reservoir was built. In the 1980s, some old people simply restored it from their memory of etiquette, including many things that took place in the space. The restoration is like a process of constantly arousing history to resist cruel reality, thus realizing a complete cycle of life. He said, “Look! Isn’t this temple like a ‘body’ ”?¹

The “Confucius temple” as a body is of course a symbolic statement, which shows that a temple not only has a visual outline in the architectural sense, but once it is connected with a certain scene in history and reality, such as a series of events that took place in the process from destruction to restoration, it will ←1 | 2→become a metaphor for modern changes like a “body” that experiences birth, death, illness and senility.

The mysterious space in the early churches and hospitals once aroused the Chinese people’s numerous imaginations about “cutting” the human body for medicine, which even continued into the political discourse after the founding of the new China. In Cao Yu’s first play, “Clear Days,” after the founding of the new China, the office of Yanren Medical College, which symbolized the American cultural aggression, was filled with an uncomfortably gloomy atmosphere. “The room is full of people, but it can’t give them a warm feeling. When people come in, they immediately feel a kind of gloomy and threatening air, as if they can only talk about illness and death here.”² The authenticity of this imagination, which follows the idea of “cutting human bodies” in hospitals, seems to have been quickly confirmed by the development of the plot. The wife of an old worker who got rickets was quietly tested by a seemingly benevolent American doctor, and she died inexplicably and miserably. The cause of death was that her arm was tied to a box full of lice and became a victim of typhus fever test. With the constant ←2 | 3→appearance of “evidence of crime,” the intellectuals awakened quickly. An old professor in the hospital found that the voles used for research and cultivation were covered with poisonous bacteria after being brought to the United States, and were airdropped to North Korea again by the U.S. plane, which became new evidence for launching “germ warfare”; thus, the old professor recognized the true face of U.S. imperialism.³ In this way, the original story of “cutting” was finally transformed into the passionate imagination of modern nationalism by the revolutionary romantic literature.

The Western medical missionaries who came to China in the early days all believed that the Chinese people’s diseases were a reflection of the failure to establish a moral order similar to Christianity in the West; therefore, physical illness actually implied that the ugliness and inferiority of some Chinese customs were affecting the life state of the Chinese people. Only through salvation of the soul can physical illness be truly cured and can regeneration be achieved. Western missionaries’ ideas originated from the following Western concepts in medieval times: illness as a metaphor has the meaning of moral exhortation and punishment. The deepest fears of all kinds of things such as corruption, decay, pollution, abnormality and weakness are equated with epidemic diseases. The disease itself becomes a metaphor, and then in the name of the disease, these fears are displaced to other things; and the disease becomes an adjective, with the widest possibility of being used as a metaphor, and is used to describe things that are socially and morally incorrect.⁴

As a metaphor carrier of culture, the connotation and boundary of the sick body have been expanded more and more, and it even implied that China’s territorial boundaries were frequently violated. Through the treatment practice of Western medicine, the “body” disease has gradually become a place for various national politicians, modern intellectual elite, local gentry and ordinary people to exert their imagination. The intellectual elite, in the process of restoring and rebuilding the Chinese people’s bodies through Western medicine, painfully felt the fate of being humiliated and imagined that China was being insulted, discriminated against and trampled like a “sick body,” and then imagined the cured sick body as a symbol of “national regeneration.” A newspaper writer in the second year of the Republic of China wrote, “Since our society communicated with European and American societies, the external situation has changed a lot. The exploitation of rights and the loss of power are diseases of external infringement. External aggression is often caused by internal weakness. Therefore, for diseases within the society, we should study their causes and examine their pathological conditions to determine treatment methods.”⁵

Social governance became a “medical” behavior, although this “regenerative” treatment was obviously a result of imitation. The cure of a single sick body was magnified to the action of a group or even a country, which directly extended from receiving Western medical treatment to all things in contact with Western civilization, and whether or not to accept these things became almost the only criterion for evaluating the merits of this behavior. Even the “revolution” became a metaphor for “treatment,” as someone said at the beginning of the founding of the Republic of China, “I heard historians talk about the nature of the revolution, saying that the revolution in state politics is like a major surgical operation on the human body.”⁶

Throughout the 19th and early 20th centuries in the West, the metaphor of disease became more vicious, absurd and demagogic, and any situation that was not approved was called a disease. Diseases that were supposed to be part of nature like health have become synonyms for “unnatural” things.⁷ Even the “natural” aesthetic objects in the eyes of the Chinese people may be classified as morbid and be transformed; the attitude toward “Food-binding” is an example. Western medical missionaries’ judgment of the unnatural state of “Food-binding” changed the Chinese people’s understanding of “beauty” and “ugliness” in their daily life. “Food-binding” was understood as ugly based on pathological anatomy. The composition of aesthetic experience of “Food-binding” is often related to touch and vision, and the food-binding cloth is a mediator in the transition from vision to touch. Anatomically, the foot-binding cloth just obscures the ugliness of feet and must be removed. The perspective method in anatomy removed the food-binding cloth by violence, which was a process of destroying the aesthetic balance established by “food-binding” between touch and vision.⁸

The disappearance of “food-binding cloth” can thus be seen as a metaphorical act by which the body is relieved from an ugly state. At the same time, the sick Chinese people, especially women, would also become healthy; the Chinese people’s bodies have become the objects of medical discourse production, and “metaphors” attached to the Chinese people are the results of this production. The discussion on whether the national physique was good or bad has gradually expanded to the discussion on national temperament and character, which has become the standard to determine whether the Chinese images are modern and good.⁹

The metaphorical discourse of “national character” spread like pervasive bacteria, and the studies of medical history in China were strongly affected by such “bacteria.” Perhaps because of their medical background, many researchers unconsciously judged the advantages and disadvantages of TCM and Western ←4 | 5→medicine by whether they are “scientific” or not. Under the control of this metaphor, TCM also has to take responsibility for the inability to cure physical diseases with scientific methods, and in turn, the defense of TCM is convincing only when it’s scientific.

For example, a medical cultural historian from a medical background said that in the course of historical development, TCM can transform decadence into magic, of course, first of all because of the scientific nature in its connotation. The historian added that the scientific connotation of TCM culture needs further refining. Science doesn’t belong to a specific country or nation and is not limited to a certain cultural circle. It is a big mistake to overemphasize the dependence of TCM culture on Chinese culture and overlook the scientific nature of TCM and its compatibility with world culture.¹⁰

Of course, this process of accepting disease metaphors without thinking is more than an abstract discourse practice but the result of the increasingly politicized large-scale expansion of Western imperialism after the 19th century. In the 19th century, epidemiologist Rudolf Virchow had a famous saying, “Medicine is politics and politics is just bigger medicine.”¹¹ The emergence of modern medicine and science as a process of imperial expansion stemmed from the “standardization” strategy. In the early stage of “ecological imperialism” expansion in the 18th century, the colonial power of Western medicine was quite limited, and it was not until the 19th century that it had the colonial character of institutional expansion. This is also verified by China’s experience. It was not until the early 20th century that the Rockefeller Foundation standardized the “Union Hospital Model” in Chinese cities through demonstration effects.

Another perspective of studying “medical imperialism” is to focus on its connotation, which includes not only conquering new diseases but also expanding the “bio-medicine” model to non-medical fields, including extending Western cultural values to the non-Western world.¹²In the analysis of the expansion of imperial standardization in the history of modern Chinese medicine, the research on the “union model” is the most mature and detailed.¹³

Since modern times, both colonial and semi-colonial countries have attempted to use and imitate the scientific medical resources after the expansion of “imperialism” and tried their best to turn these resources into a basis for competing with imperialism, and medicine has become a tool for nationalism to seek self-defense and development in the late 19th and early 20th centuries. This perspective mostly emphasizes the complex mentality of the intellectual elite in colonies from imitation to wrestling but simplifies the screening and adaptation processes of imperial resources after they enter the local cultural system.

After Western medicine entered China, it once urged the Chinese society to redefine the concepts and behaviors of the body, disease and health. This process is often intertwined with the political situation, cultural thoughts, social forms, national identity and national concepts. Obviously, such a cut-in angle is more difficult than a simple internal study of the history of Chinese medicine. Therefore, some scholars criticized that the discussion of the history of modern medicine paid too much attention to the process of introducing modern medicine into the local society and the dominant role of Western churches, and there was no common problem structure among the various studies.¹⁴

Only a few scholars tried to break through the research framework of the traditional history of diseases and its transmission path; for example, instead of viewing imperialism as merely a source of radiation and testing its effect of spreading modern science through the so-called objective description, they re-evaluated the internal anxiety of imperial colonists after they entered a foreign country, thus evaluating the self or the source of such anxiety and the resistance measures taken by the foreign country.¹⁵ In this way, studies on imperial colonization have gone beyond the path of transmission; or, the traditional pattern of “doctor-patient relationship” has been re-examined and it’s found that, in the Republican Period, patients who chose doctors and doctors who chose patients began to be replaced by the new identities of “responsible doctors and patients with faith.”¹⁶For another example, in the Republic of China, there have been different perspectives from those of the West. The exploration of these perspectives will help us understand whether there is still a possibility of maintaining the subjectivity in Chinese medical concepts and behaviors in the siege of Western medicine.¹⁷Adding a perspective of gender analysis to the identity observation of medical caregivers in ancient China is also a new trend that has just emerged recently and can help us understand the traditional division of medical work within the family atmosphere.¹⁸

In addition, some researchers began to observe the difference between the “national” temperament of Chinese patients who are not patient enough and the cultivation of endurance in the acceptance of modern medicine. Some medical historians have even noticed that from the Yuan Dynasty to the Qing Dynasty, Chinese doctors’ investigation of the relationship between the environment and diseases has many similarities and differences with Western environmentalism. However, although the East and the West had similar views on the environment as a pathogenic factor in the same period, there were basic differences in the specific application of research results, such as the governance of environmental sanitation in the West and the establishment of public health institutions, all ←6 | 7→of which became manifestations of behaviorism. These comparable aspects may have paved the way for the so-called modernization of Chinese society in medicine and health.¹⁹

This book benefits from the above studies but hopes to further synthesize the reasonable parts of the above arguments, trying to build more clearly relationships among these seemingly scattered research topics.

First of all, about “metaphors of diseases,” Susan Sontag discovered how disease was used as a metaphor through her own experience with cancer.²⁰Kojin Karatani even suggested that the difference between “physical diseases” and “diseases as metaphors” should be distinguished; in other words, the disease has nothing to do with physical reactions and exists in a system of classification tables and symbols, which is a social system that is divorced from patients’ consciousness.²¹ The treatment of “disease” as a metaphor has been reflected in the historian circle. For example, Gail Hershatter once thought when studying prostitutes in Shanghai that the voice of a prostitute can’t be produced by her but must be created or highlighted by the modern atmosphere. In other words, even if prostitutes (all women?) have subjectivity, they may only be victims of construction.²²This view is rather controversial. Joseph W. Esherick criticized that most worrying of all, such cultural studies can easily mislead people to think reality is composed of culture and symbols, not society, thus simply attributing the power of changes in the Chinese society to the authoritative discourse itself, or imagining that some vague colonial or modernist elites in the state or capitalist enterprises have promoted the authoritative discourse and given it power, regardless of why these phenomena occur.²³

In fact, there is no conflict between treating “disease” as a metaphor and treating “disease” as a constituent element of modern system production, but both need to be taken into consideration in the research process. In my opinion, “disease” has experienced a shift from “symbolic value” to “technical rule” in modern China. On the one hand, “disease” as a metaphor is increasingly permeating the discourse expression of the Chinese intellectual elite, and is transformed into a cultural practice. Lu Xun’s abandonment of medicine for literature is a very sharp demonstration of this transformation. Lu Xun regards those seemingly disease-free Chinese people in films as bodies beyond cure, which is a symbolic transfer of imagination.

However, it is obviously not enough to analyze the complex relationship between the Chinese people and medical practice at this level alone. “Disease” as a metaphor not only shapes the way that the Chinese people imagine themselves and the world, but also constructs China’s behavioral technology and system in ←7 | 8→building a modern country. For example, the understanding of the power of bacterial infection has shaped the nationalism of the “state” against Western foreign enemies, and the infiltration of the “state” into the civil space, which is often talked about by academic circles, has actually been accomplished through the political imagination and social mobilization mechanism of the ability of bacterial “infection,” which is proved by the study of 1952 anti-germ warfare in this book. Therefore, in commenting on Sontag, Kojin Karatani said that the problem lies not in explaining the metaphor of disease, but in the modern medical knowledge system, which regards disease as a pure disease and objectifies it. As long as this knowledge system is not questioned, the more modern medicine develops, the more difficult it will be for people to be liberated from diseases and therefore from the metaphorical use of diseases.²⁴

Therefore, the word “patients” in the title of this book Remaking “Patients” is in quotes because the “patients” in modern China are very different from those in the ancient sense, and more importantly, the “patients” in modern China bear not only the original biological meaning of suffering from diseases, but also the ideological and institutional connotations of the formation of nationalism in modern China. Meanwhile, those who are actively engaged in reform under the banner of treating “patients” in modern times often have become the objects of treatment at a certain point.

In this book, I am still convinced that the Chinese people’s bodies have become an integral part of the modern world as a result of the making and packaging of many Western-style discourses, including medical discourses, but I have added a perspective to analyze in detail the root of the internal tension caused by the dual roles of Western medical missionaries as “doctors” and “priests” in Western culture and the significance of this root in the construction of the Chinese body and disease metaphors (Chapter 2), especially the supporting role of institutional construction in body and disease metaphors.

It’s true that Western medical missionaries came to China in the hope that the light of Jesus would shine on this place where pagans gathered. They once believed that the change of the body from damage to recovery was only a channel for soul redemption. However, in the course of treatment, they found that the Chinese people didn’t accept God at the same time as they accepted the physical changes. What’s worse is these soul-saving engineers had to succumb to such a secular choice in the end, and the significance of humanitarian relief has unconsciously replaced the supreme goal of soul redemption. The intensification of the internal tension of Western missionaries in China stemmed from the confrontation between two spiritual traditions within Christianity, namely, the tension ←8 | 9→between the “spirit of prophecy” and the “spirit of order.” The core of the “spirit of prophecy” is to destroy the system of heresy and guide the ultimate experience and hope. The “spirit of order” encourages working in the secular world and tolerates the imperfections of the secular world.

This book tries to clarify that previous studies on the “spreading history” of medical treatment were not limited to the channels and processes of Western medicine spread but also purified the connotation of such spread as if in any foreign space (including China), Western medicine can always stick to its original characteristics without change in terms of ideas and systems, and changes will ←9 | 10→only occur in a foreign society that is undergoing transformation. The mode of Western medicine spreading history presumes that the non-Western world only has the ability to passively accept Western influence but does not have the possibility to influence its role in the opposite direction, which obviously retains the trace of the “impact-response theory.” The study in this book proves that the spread of Western medicine is not a process of “purification,” but a result of balance after repeated interaction with local social culture (Chapter 3).

There is no denying that the experience of modern Chinese people often cannot break away from the “political” passion and memories of oppressive nightmare cycles. Some even say that the modern Chinese history is a plague. Many scholars have realized that it is a manifestation of political behavior that both the “state” and the “body” are surrounded by the metaphors of diseases. In recent years, historical studies have also taken the interpretation of these “metaphors” as their duty, from restoring the voice of prostitutes to combing the construction of “sex” consciousness.²⁵ The history of medicine is also considered as deliberately distancing from “political history” at this level, but it’s insisted that modern politics is interpreted from a new meaning.

At the same time, to avoid the simplistic “totalitarian” understanding of Chinese society from the traditional political history, it is also quite popular to interpret the orientation of state political behavior from the local context of “local history.” There is no doubt that from the interpretation of the infatuation with “metaphors” to the analysis of political operation from the perspective of “local history,” we can have a new insight into the Chinese people’s fate of being dominated in the power network and explore the ways that the grassroots society opposes the “politics” of violence in the form of “metaphors.” However, it is still not possible to satisfactorily understand the causes and motivations behind these “metaphors” and explain the prospect of cross-regional mobile forces under political domination.

In view of this, a chapter in this book is devoted to the key role of social mobilization in the transformation of the modern medical system, and analyzes how the local “germ warfare” incident in 1952 in North Korea and northeast China was effectively transformed into a national patriotic health campaign (Chapter 9).

In particular, the book points out that the core metaphor of the “1952 incident” is “bacteria,” as some scholars have realized, the accusation of “germ warfare” is actually to strengthen the recognition of the new China, so the accusation has dual metaphors, namely, China is the victim of imperialist aggression, while China is also the victim of nature, and the invisible and neglected “bacteria” are also threatening the survival of the new China.²⁶ However, it is obviously not ←10 | 11→enough to realize the existence and role of this metaphor; “anti-germ warfare” as a common event has finally become a key element in changing the historical process after political operation, and there are obviously more complicated motivations for the generation and maintenance of social mobilization ability behind the metaphor.