Twentieth-Century China

In the global history of disease control, China and the movement of Chinese people play an important role. This statement is as true of today's pandemics as of the El Tor cholera epidemic, which broke out in Wenzhou and its surrounding counties in Zhejiang Province in 1962, after the famine following the Great Leap Forward. Xiaoping Fang makes an extremely timely contribution to the history of epidemics by examining how this pandemic became an integral component of China's social restructuring in the early 1960s. Fang bases much of his meticulous analysis upon local-level—e.g., district, county, and prefectural—archival documents and oral history interviews. The volume will particularly appeal to historians and other social scientists who are interested in how governmental actors, such as epidemic control teams, reach members of the population for public health interventions and data collection. Given the ongoing COVID-19 pandemic, this book is likely to have wider appeal, including to "armchair epidemiologists" who are interested more generally in the history of epidemics.

The book is organized into three sections, each of which examines a set of fundamental questions about how disease was influenced by and affected social structures. The first section highlights the close relationship between social upheaval and disease outbreaks. Fang pinpoints the origin of China's outbreak to the repatriation of overseas Chinese from Indonesia, where El Tor cholera broke out in Makassar in 1961. Additionally, interprovincial fishing, military mobilization, and domestic migration within China drove the epidemic, as tens of thousands of people were on the move, including would-be urban dwellers who were sent back to the countryside following the Great Leap famine and prior to the implementation of population stabilization measures, such as the resident-permit system. The idea of migrants as "suspected" disease carriers puts this work in conversation with other scholarly works and media reports examining the tendency of societies to blame outsiders or outgroups for infectious disease, including recent accounts of COVID-19.

The second section investigates the relationship between social hierarchy and disease outbreaks, how borders affected susceptibility, and quarantine and illness experience. Among these social hierarchies, rural residents were more vulnerable to cholera, due to water and sanitation infrastructure development in cities. Urban areas also had better medical infrastructure and health insurance, which affected compliance with recommendations regarding isolating cases. Another of the hierarchical social divisions was the gendered division of labor. Fang highlights how Communist insistence on women's liberation prompted their participation in agricultural work, increasing their vulnerability to cholera. A third social division was that between the young, healthy soldiers being deployed to coastal Zhejiang to prepare for potential military conflict with Taiwan and [End Page E-21] civilians, who lacked the same access to nutrition and healthcare. As has been the case in the current COVID-19 pandemic, persons with mild and asymptomatic cases contributed to the spread of disease, while a few privileged individuals, such as government officials, were able to evade quarantine measures.

The third section turns to inoculation, as well as to advances in the production of statistics as a political process, which allowed the government to consolidate social control over the population. With respect to inoculation and other health campaigns, Fang chronicles that communication and cadre attitudes played an especially important role, given the short history of inoculation in rural China. Although the initial emergency inoculation efforts in 1962 were not properly integrated with the agricultural production calendar, eventually rural cadres recognized that improved health of commune members could increase production. The inoculation register then became a means of improving upon epidemiological data and consolidating the state's biopower. At the same time, rural cadres struggled regarding data transparency and how data might reflect negatively upon their commune. The government eventually decided to suppress coverage of the campaign, developing a coded system for talking about infectious diseases and labeling reports discussing cholera as "secret" or...