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POLICING THE SICK: PLAGUE AND THE ORIGINS OF STATE MEDICINE IN LATE IMPERIAL CHINA* Carol Benedict The New Policies period (1900-1911) saw the emergence of a modernist discourse in China, not only among Chinese intellectuals and local elites, but also among many reform-minded bureaucrats as well. The rhetoric of reform invoked by officials and extra-bureaucratic activist elites alike included ideas such as material progress, scientific development, and the need to build a fiscally and militarily strong state. As noted by a number of recent scholarly studies, these ideas served in turn as justifications for the expansion of state power into societal spheres as diverse as taxation, the suppression of popular religion, and the incarceration of mental patients.1 The first decade of the twentieth century also marked a shift in Chinese attitudes towards public health and state medicine. More specifically, the German idea that public health and disease prevention efforts should be directed by the police came to have widespread acceptance. From about 1902 onwards, new-style police departments in some Chinese cities began to implement Western-style disease control techniques such as quarantine and isolation hospitals for the treatment of infectious disease. The police-directed model of public health that emerged in China in the early twentieth century was thus driven by a state-oriented utilitarianist doctrine that was international in scope. One of the first municipalities to establish police-directed public health institutions was Fengtian city (now Shenyang) in southern Manchuria. These *A draft of this paper was first presented at a panel on early twentieth-century Chinese state-society interactions at the annual meeting of the Association for Asian Studies, 26 March 1993. I would like to express my appreciation to Prasenjit Duara, the panel discussant , and my two fellow panelists, Bryna Goodman and Kristin Stapleton. I also wish to thank Neil Diamant, Charlotte Fürth, Alison Case, Cathy Johnson, Paul Ashin, and three Late Imperial China referees for reading and commenting on earlier versions of this article. Special thanks are also due Trudi Abel. Prasenjit Duara (1988 and 1991) has documented state expansion in the realm of taxation and popular religion; Neil Diamant (1992) has written on state involvement in the institutionalization of insane asylums. Late Imperial China Vol. 14, No. 2 (December 1993): 60-77 60 Policing the Sick: Plague and the Origins of State Medicine61 institutional arrangements were severely tested when a virulent epidemic of pneumonic plague spread throughout the northeast in the winter of 1910-11. Although a lack of personnel meant that the goal of total police control went largely unrealized, the Fengtian police were active in managing anti-epidemic measures during the crisis. Furthermore, the involvement of the police in these activities laid the basis for the development of medical policing later in the century. State Medicine in Europe and the United States Public health was an area of key concern for nineteenth-century and early twentieth-century modernizing states.2 Rapid industrialization, urbanization, and their attendant social problems in the early nineteenth century had given rise to active public health movements in both Europe and the United States. Initiated largely by social reformers and non-professional lay people, public health issues were increasingly taken over by governmental authorities as the century progressed. The late nineteenth century saw the rise of the state medical movement, which took as its central tenets the notion that the state should have primary responsibility for protecting the public's health and the idea that the state had the right, even the duty, to impose upon individuals certain regulations of hygiene and sanitation for the public good. Given impetus by the revolutions in bacteriology and epidemiology that occurred in the 1880s and the 1890s, by the turn of the century, governments around the world increasingly felt compelled to intervene in public health emergencies. Although the concept of state medicine was becoming widely accepted in the United States and in many European countries, the public health reforms of specific nations followed very different trajectories. In the United States, protection of the public's health was initially directed largely by community groups, private philanthropists, and activist physicians. Local, state, and federal authorities only began to...
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