The History of Health and Hygiene in Chinese Society from the
Traditional to the Modern Periods.
Angela Ki Che LEUNG
ISSP, Academia Sinica.
The social history of medicine in China is a new area attracting
younger scholars in Taiwan, mainland China and in the West. Within this
large field, the history of health and hygiene, loosely defined as the
techniques for the prevention of illnesses and preservation of health, is
beginning to gain interest. Even though common sense would tell us that
such techniques should exist in all human societies in all times, no
systematic research on Chinese society has been done in this area. The
problem should involve several social levels of practices: personal,
familial, communitarian, regional, and national.
Some research, however, has been done on the personal and
national levels of hygiene practices, as printed sources on these are quite
abundant. Traditional personal hygiene, or the art of yangsheng, has
always been the interest of a number of medical historians1, though their
concern is more often on the art itself than on its significance for the
prevention of illness. On the other hand, hygiene practices at the national
level, often in the form of public health on the western model, are usually
studied as part of China’s “modernization” process 2. In other words, the
subject is typically understood as part and parcel of a modern political
process that roughly began in the mid-19th century through the
contemporary period. Between the personal and national levels of
hygiene practices little is known. We have very limited knowledge about
hygiene practices inside the family, within a local community and in
various regions, especially before the modern period. The lack of archival
materials on these is one main reason for the absence of interest. But
more important is perhaps the fact that the question of “life-preserving”
practices on these intermediate levels has not been perceived or
conceptualized as a proper problematique.
Among many studies in Chinese, a more recent one is by Zheng Jinsheng 鄭金生, Zhongguo gudai di
yangsheng 中國古代的養生. Beijing: Shangwu 1997. The Japanese scholar 板出祥伸 has also
compiled a number of works on the art of yangsheng in traditional China.
2
MacPherson, K., A Wilderness of Marshes. The Origins of Public Health in Shanghai, 1843-1893.
HK: Oxford University Press, 1987. More recently, in her study on the plague in the late 19 th century,
Carol Benedict also devotes a chapter on the origins of Chinese state medicine in the modern period,
see her Bubonic Plague in Nineteenth-Century China. Stanford University Press 1996, chapter 6.
1
Conditions have probably become ripe for a more systematic study
on the problem of health and hygiene practices on all levels. First of all,
the social history of medicine in China has become a productive field and
some of the findings are useful for the study of health and hygiene 3. This
development is particularly interesting in Taiwan. To this one must add
the important fact that there is already an extremely rich literature on
Western social history of medicine that inspires new perspectives for the
study of China. Secondly, recent progress in related fields, such as the
history of the body 4 and history of the environment 5 is also an
encouraging development for the history of health and hygiene. On top of
all these, many useful sources, such as medical classics and texts, archival
materials in legal cases, and archives of maritime customs, are easily
available in hard copy or microfilm form. Some are even accessible online. Last but not least, as local archives in mainland China are slowly
opening up, we could expect new sources for the topic, especially on
practices on the communitarian and regional levels in the modern period.
The study of the history of health and hygiene in Chinese society,
on the other hand, would necessitate new approaches to important issues
that have been under-studied so far. An example is the idea of illness or
disease in traditional China, and how these were related to the body and
to the environment. Comparative approaches with theories provided by
anthropologists are indispensable for a better and deeper understanding of,
for example, the causation of diseases. Another obvious question is the
idea of contagion. The classical term chuanran or jianran underwent
significant changes in meaning from the medieval to the pre-modern
periods, with the human body becoming increasingly more important as
an agent of transmission. 6 To understand these changes would be
indispensable for the analyses of hygiene practices of all levels in
different historical periods. The analysis of the ideas of contagion is also
indispensable in comprehending public measures in regard to epidemics
on which we have richer materials in the late imperial and modern
periods.
The series of conferences held by the research group on “Life and Medicine” of the Institute of
History and Philology, Academia Sinica since the late 1990s are good examples. They include
important topics like “The History of diseases”, “The History of Cleanliness” that are closely related to
the history of health and hygiene.
4
Works by Dorothy Ko, Charlotte Furth are obvious examples.
5
The conference volume edited by Elvin, M. & Liu, T.-j, Sediments of Time. Environment and
Sosciety in Chinese History. (Cambridge University Press 1998) is by far the most important work. A
second international conference on the environment was held in November 2002, and we may expect
more publications in this field. Diseases and environment is one of the main concerns of the project.
6
See my working paper “Leprosy in Ming-Qing China: Social Reactions” 2002.
3
Secondly, the perspective of “the preservation of life” provides
new angles to the study of the history of specific diseases, be they chronic,
endemic, or epidemic. Finer analyses of the nosology and etiology of
important diseases in history such as leprosy (or li/lai), tuberculosis (or
laobing), malaria (or zhangqi), beri-beri (or jiaoqi), cholera, dysentery,
plague, and so on would be necessary for the interpretation of private and
public health practices. For the pre-modern periods, it is hard to estimate
the actual effects of hygiene practices on morbidity and mortality caused
by various diseases. One could, however, analyze the rationale of such
practices in relation to the society’s understanding of diseases and
epidemics. In the modern period, available statistics would allow more
detailed study on the changes in mortality and morbidity of certain
diseases in relation to the implementation of health practices.
Thirdly, illness and health as social representations that have rarely
been studied in the case of China would be a central issue. As the French
sociologist Claudine Herzlich puts it, the language in which one
expresses health and illness, in which one interprets their causes and
consequences, is not a language of the body, but more often that of
relations between the individual and society. To be ill means the
interruption of one’s social activities and the modification of one’s social
identity. To be healthy is not merely a biological fact, but also implies the
capacity to be in control of one’s physical and social state 7 . The
individual’s and society’s efforts in the “preservation of health” could
thus better be understood in terms of social practices for the maintenance
of a “normative” state, or for the prevention of uncontrolled social
disruption in case of illness or epidemics. The study of legal cases
concerning the sick or dying is one of the interesting ways to look at the
problem. The organization of charitable and other institutions related to
the caring of “health”, including hospitals for the sick, or religious
practices in case of illness or epidemics could also be understood within
this framework of analysis.
Fourthly, comparative approaches would probably clarify some
aspects of the complex question of China’s modernity. The first
implementation of systematic public health measures in western Europe
was generally explained as an integral part of Europe’s emerging
modernity.8 China’s efforts in modernization from the late 19 th century
7
Philippe Adam, Claudine Herzlich, Sociologie de la maladie et de la médecine. Paris: Nathan 1994, p.
64-66, quoting Georges Ganguilhem.
8
The first general work on public health by Rosen published in 1958 already pointed out that public
health was integrated into national policy in the 17 th century in the West (pp. 114-119, 137), a period
of the emergence of European nation states. See George Rosen, A History of Public Health. Johns
Hopkins University Press 1993 (1958). Among numerous subsequent publications elaborating on this
onward clearly included the establishment of western style public health
institutions. However, one might ask how relevant China’s conditions
were to the principles of western hygiene practices. For example, while
public health essentially accompanied urbanization in the West, China’s
health problem did not seem to respect the rural-urban dichotomy in the
early modern period. While some questions were central to public health
in the modern West due to industrialization or their specific conceptions
of dirt and miasma, China had different sets of problems that were
already observed by contemporary foreign residents. The reception of
Western style public health measures even in the 20th century was never
total. How China received, rejected, or transformed Western ideas of the
healthy body, of illness, and of public health policies or hygiene practices
for her own purposes was a complex, but most interesting and important
subject. The question provides intriguing links between the issues of
nationalism, modern state-building, colonialism, science, and the body.9
The project is by definition an interdisciplinary one. Historians of
medicine, specialists of public health, sociologists, historical
demographers, anthropologists, or even medical doctors could have
valuable contributions. The results of the project should allow more
fruitful dialogues with Western colleagues who work on the history of
hygiene in the West and hopefully would provide a new perspective on
the question of modernity.
topic, one example is James Riley’s The 18th-century Campaign to Avoid Disease. (London: McMillan
1987). Scholarship in more recent years tends to take a more critical stand towards the progress thesis
and borrow more heavily on Michel Foucault’s social control theory, see Deborah Lupton’s The
Imperative of Health. Public Health and the Regulated Body. Sage 1995. But both put emphasis on the
relation between public health and modern state building.
9
The journal of cultural studies, Positions, has recently published a special issue “Empires of Hygiene”
with articles discussing several of these issues. See 6:3 (winter 1998).