Florence Bretelle-Establet, La santé en Chine du sud (1898–1928), Collection Asie orientale, Paris, CNRS Editions, 2002, pp. xv, 239, illus., €30.00 (paperback 2-271-06010-9).

Abstract

This French volume on health in southern China offers a valuable insight into the health matters of a little studied area of China during a period of great chaos. It traces the decay of the Qing empire from 1898 to its collapse in 1911, followed by some years of warlord rule until a centralized Chinese government was reinstated under the Nationalist Party in 1928. It also chronicles how rapacious imperial powers carved out areas of preferential trading rights across Chinese territory. While never ceding direct rule to any foreign power, by the turn of the twentieth century the disintegrating Qing empire had granted France concession areas in six major Chinese cities in the three southern provinces of Yunnan, Guangxi and Guangzhou. Bretelle-Establet focuses in particular on the south-western province of Yunnan, where the French imperialist effort was concentrated because of its juxtaposition to Indochina. After the outbreak of bubonic plague in Guangdong and Hong Kong in 1894, it became obvious to the French colonial authorities that the health situation in China needed to be carefully monitored if its settler population was to be protected and if disease was to be prevented from travelling along the expanding trade routes to Indochina. After the First World War, however, France's strength as an imperial power waned and those medical officers who remained in China had to turn from charitable medical activities to more lucrative private practice. This meant that their role shifted from one of observation of Chinese medical practices to a degree of participation with them. Bretelle-Establet is keen to point out that the type of doctor entering China in the late nineteenth century was, unlike his predecessor whose movements were confined to the coasts, a graduate of the Pasteurian school and of the scientific sort. She juxtaposes his viewpoint with the state of medicine and health relief in southern China at that time. Here Bretelle-Establet offers a thorough account of the diseases prevalent in the region, the way in which local doctors approached them and the state institutions in place to deal with them. While stopping short of providing a distinctive Chinese medicine of the south-west, mainly due to a lack of comparison with medicine in other areas, Bretelle-Establet is successful in displaying some general trends in regional medical practice which will be of interest to other historians of Chinese medicine of the period. Bretelle-Establet bases her study on a number of original primary sources. These include the sanitary correspondences of French medical officers, held mainly in the archives of overseas records in Aix-en-Provence, complemented by reports from medical missionaries based in the south-west. She also uses a variety of local Chinese prefectural gazetteers along with a handful of high-profile medical writings by doctors of the south-west. Bretelle-Establet displays a clear understanding of nineteenth- and early-twentieth-century history of European medicine as well as a good command of the classical Chinese sources. If I do have a criticism it is that this history is perhaps too French in its orientation. Alphonse Laveran plays a centre role in the background to the history of malaria, but there is no mention of Patrick Manson, a man who spent some twenty years researching in south-east China. There are also a number of English-language works that would have assisted in the analysis of trends in nineteenth-century Chinese medicine but which appear to have gone unnoticed, such as Chao Yuan-ling's study of physicians in Suzhou and Ruth Rogaski's work on health and hygiene in treaty port Tianjin over a similar time period. There is no doubt that this is a welcome contribution to the recent history of medicine in China. Well-researched and well-illustrated with a number of helpful tables and maps, Bretelle-Establet does a masterful job of uniting French and Chinese viewpoints on health and disease.