Organized medicine in Mingqing China: state and private medical institutions in the lower Yangzi region.

Abstract

��� Between the fourteenth and the nineteenth centuries the people of China, like those of Europe, experienced periodic outbreaks of epidemic disease, as well as a high rate of mortality from endemic smallpox, measles, influenza and dysentery-chronic killers in early modern society. Indeed, factors of urbanization and population growth facilitating serious public health problems from a wide variety of infections probably had been established in China well before the Ming dynasty. From the beginning of the imperial era, instances of epidemic were regularly reported to the throne by local officials as omens reflecting upon the state of the Heavenly Mandate. Denis Twitchett has shown us the close relation between pestilences and demographic decline in the Tang era.1 During the Yuan dynasty a sharp and mysterious drop in population occurred; some suspect that plague may have played an important role.2 Helen Dunstan, in her preliminary survey of late Ming epidemics, suggests that great human losses occurred at this time as well.3 In this situation, the idea of the state's responsibility in matters ofpublic health benefited from the development of a rational classical medical system whose therapeutics was based on a sophisticated materia medica. Learned medicine, although it did not replace or even seriously challenge ritual healing and religious propitiation of the gods as popular means of