Xiaoping Fang. China and the Cholera Pandemic: Restructuring Society under Mao. Pittsburgh: University of Pittsburgh Press, 2021. 312 pp. $55.00 (cloth), ISBN 978-0-8229-4662-5; $35.00 (paper), ISBN 978-0-8229-6683-8.
Reviewed by Wee-Siang M. Ng (The College of Wooster)
Published on H-Sci-Med-Tech (May, 2022)
Commissioned by Penelope K. Hardy (University of Wisconsin-La Crosse)
The El Tor cholera outbreak started in Makassar on the island of Sulawesi (Celebes), Indonesia, in 1961, and arrived in Guangdong, China, by June of the same year. Fang Xiaoping’s book examines the responses of the Communist government under Mao Zedong to contain the El Tor cholera epidemic in Wenzhou and its surrounding counties in Zhejiang Province in 1962. Fang provides meticulous details of local efforts that successfully contained the disease and contextualizes the complex public health response against the larger tumultuous social and political transformation in China.
The book consists of three parts. Part 1 (chapters 1 and 2) presents the theme of mobility of diseases and migrants, drawing attention to the relationship between epidemic outbreaks and social instability, at the local, regional, and transnational levels. Chapter 1 lays out the path of the El Tor cholera outbreak in Sulawesi, Indonesia, which Fang argues probably made its way to Guangzhou via the repatriation of overseas Chinese during civil unrests fueled by anti-Chinese violence. The disease also spread to Hong Kong and later to Manila, Philippines, resulting in an epidemic affecting much of the Asia-Pacific region. Chapter 2 shifts the focus back to China and describes the mobility of the disease through interprovincial fishing people, the mobilization of military men, and various migrant populations seeking out livelihoods.
Part 2 examines how urban and rural divisions changed within the context of the epidemic and how public health policy responses affected various social statuses. Chapter 3 discusses how substantial resources channeled to urban areas and used to renovate waterways and deliver potable water corresponded to lower cholera infection rates. In contrast, rural areas experienced higher rates of infection as a result of contamination, absence of potable water, and poor sanitary environment. Another rural health policy Fang examines is women’s liberation and women’s increased participation in agricultural work. Subsequently, many of these rural women reportedly experienced increased incidence of gynecological illnesses, revealing the complex consequences of reforms. The author also examines the healthy and well-cared for soldiers deployed to Wenzhou to defend Communist China against the Nationalist army’s “Reclaim the Mainland” campaign. Their robust health within an almost cholera-free bubble was an exception in the badly stricken area along the coastal areas. Chapter 4 describes how different forms of quarantine and isolation affected and interfered with social restructuring campaigns in rural and urban China. The urban or privileged experienced the epidemic very differently than those with fewer resources or access to power. (That particular phenomenon could arguably also be observed in the current COVID-19 pandemic.)
Part 3 lays out how local and top-level responses to the cholera epidemic strengthened the restructured administration through the integration of data, gathered and produced for epidemic responses. Chapter 5 describes the detailed accounting system set up and used by local practitioners and health-care workers during the epidemic for the inoculation campaigns. The collection and assessment of household and individual information in every area significantly strengthened the new rural social system in Communist China, with the emergence of political units deployed for various campaigns. Chapter 6 details the medicalization of the administrative system and the authoritative nature of biostatistics. Chapter 7 reveals the clandestine and politically charged nature of epidemiological information and data in Communist China, which affected China’s positionality in transregional tensions, global power politics, and international organizations like the World Health Organization, which did not recognize China as a member until 1972. The isolation of China in the 1960s from the world stands in sharp contrast to a global China today.
Fang’s book contains gems for those interested in the local history of Wenzhou prefecture, in Zhejiang Province, and the ways its geographic location shaped epidemic responses. Fang pays meticulous attention to Wenzhou’s geography, terrain, ecology, and local practices. Like other ethnographers, such as the famous anthropologist who pioneered the field of anthropology in China, Fei Xiaotong, Fang describes how the cholera epidemic intersected with rural life, funerals, weddings, and the continued use of the lunisolar calendar for farming, which would in turn be interwoven into contemporary biomedical public health campaigns. Fang consulted local and regional archives and local gazetteers to contextualize the cholera epidemic in the larger context of China’s tumultuous Great Leap Forward campaign (1958-60) and the subsequent famine (1959-61), which resulted in an estimated death toll of between fifteen and fifty-five million. Fang moves adroitly between the local and the larger contexts throughout the themes of “disease and mobility,” “social divisions and borders,” and “data and social structure.” With China being so huge and covering a wide range of geographic terrain, I wonder however if Wenzhou’s case would be an exception and other parts of China would have had different experiences of how to respond to epidemics.
The most interesting and useful aspects in Fang’s book might be the meticulous descriptions of how local practitioners and administrators gathered household information. That data was then used to administer vaccines or process accounting information, which made up much of the statistics used by higher levels of government to formulate strategies and policies. It was fascinating to read about the resistance and the adaptability of locals. This back and forth between the local and the higher levels of governments provides evidence for understanding how a different political system works, especially in terms of how power is diffused within different strata of society.
Fang could have said more about how the Communist government’s responses differed from the Nationalist government's in the early twentieth century and also in the subsequent epidemics in China. How did the public health structure set up to respond to the cholera epidemic in 1961 hold up in the subsequent years? Why did the Communist government move from the local anti-epidemic stations to Centers for Disease Control and Prevention later in the 1990s? Other questions that arose when reading this book include those of regional comparisons. How did the Communist government’s response differ from that of the governments of Indonesia, or the Philippines, two nation-states that were also undergoing social and political restructuring in the postcolonial era? Was the Communist government less effective in dealing with the cholera epidemic than these other two governments? Another point that would have benefited from deeper analysis and critical interrogation is the assumption that the diasporic returnees from Indonesia to China were the carriers of the disease. If mobility of people facilitated the spread of the disease, what about the troops and people fleeing from wars moving through Southeast and East Asia during Vietnam’s War of Resistance, and wars of independence and revolutions in Laos, Cambodia, Burman, Indonesia, and Malaysia in that decade? It might be opportune to include scholarship on various aspects of changing ocean ecosystems affected by or related to cholera and the dynamic interactions of bacterial communities in various environments (microbiomes).
This is a valuable addition to the history of epidemics in China. Those interested in modern medicine and public health in East Asia will benefit from reading this book.
. Rital R. Colwell, "Global Climate and Infectious Disease: The Cholera Paradigm," Science 274.5295 (1996): 2025-31.
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Wee-Siang M. Ng. Review of Fang, Xiaoping, China and the Cholera Pandemic: Restructuring Society under Mao.
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