2005 Annual Meeting: Border-Crossing Sessions


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Session 116: Medicine and Social Transformation in Early-Twentieth-Century China

Organizer: Tina Phillips, University of Pittsburgh

Chair: Bridie J. Andrews Minchan, Harvard University

Discussant: Hugh L. Shapiro, Princeton University

Keywords: China, history, medicine, hygiene, hospitals, tuberculosis, midwifery.

This panel aims to elucidate the complex interconnections between emerging medical paradigms and broader social and political discourse in early-twentieth-century China. To this end, the papers first analyze shifts in the management of public health, in the diagnosis and treatment of ailments afflicting mind and body, and in the definitions of what constitutes patients and caregivers. The papers then aim to link these changing notions of medicine, hygiene, and patient-caregiver roles to broader non-medical transformations occurring in the cultural life of Republican-era China.

Sean Lei analyzes alternative conceptions of weisheng (literally, "guarding life"), arguing that the discourse of weisheng contributed to changing notions of body, psyche, and life, especially in relation to controlling tuberculosis. Stefani Pfeiffer’s study examines how social workers at PUMC, negotiating between medical practices then conceptualized as traditional and modern, redefined the role of patients as care-receivers in an unpredictable bureaucratic environment. Michelle Renshaw’s paper focuses on the problem of dietetics, explicating the course by which American hospitals in China negotiated with patients and their families regarding dietetics, even as the patient’s support network ran counter to the hospitals’ philosophies. Tina Phillips’s research on the professionalization of modern midwives illuminates issues of social and political change for women, growing interest in maternal and child health, and the importance of women and their bodies in nationalist discourse.

The papers draw upon a wide array of sources, including detailed case histories from hospitals, such as the Peking Union Medical College (PUMC).

Habituate Individuality: Framing of Tuberculosis and Its Material Solutions in Republican China

Sean Hsiang-lin Lei, National Tsing Hua University

One of the most entrenched enigmas of modern China is the perceived prevalence of tuberculosis during the Republican era. How did a disease that was largely associated with industrialization and urbanization in Western countries become such a perceived affliction in an agricultural society such as China? In their efforts to solve this enigma, public health advocates eventually framed tuberculosis into a question about the individuals’ unhygienic habits, particularly those cultivated within the extended but intimate Chinese family. For them, the issue of tuberculosis did not symbolize the pathology of modernity but rather the weight of traditional habits and family, a burden which, in turn, prevented China from becoming an individualist society.

Focusing on the so-called unhygienic habits and the selective acceptance, abandonment, and innovation of household utensils (such as family kang, individual cups, and a hygienic table), this paper traces the process by which tuberculosis as a health issue ultimately contributed to the making of a modern Chinese body by way of habituating individuality.

The Place of Chinese Dietetics in an American Hospital in China

Michelle Renshaw, University of Adelaide

This paper examines one aspect of patient care that emerged when the "modern" hospital was introduced into China by Protestant missions at the end of the Qing dynasty. Due to a confluence of forces—lack of money for staff, Chinese cultural norms which made it inappropriate for women to nurse male patients, the Chinese custom of family taking an active role in caring for the sick, and the missionaries’ desire to attract Chinese patients into a strange environment to undergo unfamiliar procedures—family members accompanied patients when they entered the hospital. Family and friends offered more than just reassurance and nursing; they were often responsible for the patient’s nutrition. They collected fuel and brought, prepared, cooked, and served their meals.

In China, providing food was one tangible way that families could demonstrate concern for their sick relatives. Also nutrition, or more specifically dietetics, had always been a distinct but integral component of Chinese medical theory and the knowledge of its use as medicine was widespread in the community. Thus patients in mission hospitals benefited both physically and psychologically: family members could choose foods based on their knowledge of dietetics and the patient’s symptoms, patients would believe that the food was doing them good and complementing any medical treatment, and they would feel cared for and valued. In contrast, in a hospital in America, "invalid" food was prepared in the hospital kitchen, and visitors were forbidden to bring food in. This paper will examine the negotiations between patients, their friends and families, and hospital staff over the issue of dietetics.

Epistemology and Etiquette: Bargaining, Self-Disclosure, and the Struggle to Define the Patient Role at PUMC Hospital, 1921–1941

Stefani Pfeiffer, Rutgers University

When the Peking Union Medical College officially opened its doors in 1921, the hospital was confronted with patients whose conceptions of their role challenged the institution’s ability to carry out therapeutic treatments in practice. In China’s more pluralistic medical culture, patients were accustomed to a wide range of therapeutic choices and assumed greater authority over medical decision-making than their counterparts in the United States, where scientific medicine had achieved a near monopoly on cultural authority and control of resources. Disagreements over price, diagnosis, and definition of cure could result in incomplete treatment, sometimes with fatal consequences. Medical social workers attempted to shape the ways patients related to the institution, as well as to inculcate the Chinese public with a "modern" mindset and behavior. The hospital offered a model of modern bureaucratic organization, data collection, and record keeping to extend scientific authority and institutional control into the lives of patients beyond the hospital. PUMC social workers deployed an institutional ethos of collecting evidence to establish truth, which they used to confront patients in attempts to compel truthful self-disclosure and deference toward a new style of public bureaucracy. This paper is part of a larger project about the role of scientific authority in globalization, exploring how encounters between different medical worldviews played out in a clinical setting such as PUMC. Case records from PUMC’s social work department provide a basis for inquiry into the ways differently situated individuals negotiated for medical care at the bureaucratic, American-style hospital in Beijing.

The Professionalization of Midwives in Early-Twentieth-Century China

Tina Phillips, University of Pittsburgh

China’s nation-building agenda in the early twentieth century embraced the causes of women’s rights and medical modernization. Reformers promoted new medical practices and legislation to produce more fit children and women, thereby improving the nation. Amid growing interest in maternal and child health, women entered the western medical profession as midwives, nurses, and obstetrician/gynecologists (ob/gyns). Local and national governments in China supported midwife training and research for the health of the future generations. China’s central government established a National Midwifery Board in 1929 to oversee training programs and enact laws to regulate modern midwives and physicians. These medical personnel created professional organizations that had enough political clout to transform public health policy. Medical professionals and associations successfully lobbied for legislation and actively advocated western medicine for women.

These professionals challenged traditional Chinese notions of female passivity and seclusion and helped transform women into dynamic actors mobilized for a new China. The creation of feminized occupations like nursing and obstetrics/gynecology reinforced women’s roles as healers and caretakers during this nationalist phase. This paper will demonstrate that women gained new public respect and influence as China developed the fields of midwifery, nursing, and ob/gyn. Furthermore, they launched new professional associations to further these medical specialties.