From Sick Man of Asia to Sick Uncle Sam

PERSPECTIVE From Sick Man of Asia to Sick Uncle Sam M ARTA H ANSON 1860, the New York Times published “Sick Man of America,” an editorial focused on the US government’s failure to solve the “great Mexican question” at the end of Mexico’s War of Reform (1857–60). For the most part, though, the term was used in an Orientalist way to denigrate Eastern empires (see Figure 1). But the provocative suggestion that the United States was itself a “sick man” would turn out to be prescient 160 years later. EAST–WEST ROLE REVERSAL Among all these variations on the theme, the racist “Sick Man of Asia” trope may have been the one that had the greatest long-term impact on the Figure 1. MARTA HANSON is an associate professor of the history of medicine at Johns Hopkins University. 241 “Another Sick Man,” by Sir John Tenniel, published in the British magazine Punch, 1898. Here the “Sick Man of Europe” (Turkey) consoles the “Sick Man of Asia” (China). Downloaded from http://online.ucpress.edu/currenthistory/article-pdf/119/818/241/410067/curh.2020.119.818.241.pdf by guest on 07 September 2020 L ike a lot of other people, I’ve had to adjust to working from home during the COVID-19 pandemic. My medical-historian colleagues and I, however, have been kept busy by high demand for putting this crisis in historical perspective. As soon as the American Association of the History of Medicine agreed to cancel its May 2020 annual conference, members began to organize a virtual meeting to respond to the coronavirus crisis. The resulting two-day webinar on the theme “Creating a Usable Past: Epidemic History, COVID-19, and the Future of Health” sought to mine history for critical insights about our pandemic present. During the closing discussion on “Pandemic Legacies and the Future of Health,” Ruth Rogaski, a historian of China, provided a valuable perspective. The current pandemic could not be understood without integrating the historical legacies of East Asia’s past epidemics into the analysis, she argued. Not only did epidemics accompany foreign invasions of China starting with the Opium Wars (1839–60), but experiences with epidemics also fundamentally shaped all modern Asian nation-states. Over the transition from the late nineteenth to the early twentieth century, the Qing dynasty (1644–1911) proved incapable of defending itself from either foreign incursions or epidemic diseases. European observers and Chinese reformers alike began to cast China as the “Sick Man of Asia” or the “Sick Man of the Far East.” They borrowed the image from the earlier trope of the “Sick Man of Europe,” allegedly inspired by Tsar Nicholas I when he referred to the Ottoman Empire, just before the Crimean War (1853–56), as “a sick man on our hands, a man gravely ill.” Of course, the “Sick Man” label was not only slapped on Turkey and China; even a rising new power, the United States, was not immune. In 242  CURRENT HISTORY  September 2020 Downloaded from http://online.ucpress.edu/currenthistory/article-pdf/119/818/241/410067/curh.2020.119.818.241.pdf by guest on 07 September 2020 nation that it mocked. For most of the twentieth Asian history and the region’s modern health care century, the label haunted Chinese rulers and systems. people alike. Now, however, as the public health The author neglected, however, to take account consequences of America’s structural racism and of national policies across East Asia that to varying lack of universal health coverage have been redegrees integrate traditional medical therapies vealed by COVID-19, on top of working-class “deaths with modern biomedicine. In Europe and the of despair,” the roles have been completely United States, these approaches are generally sepreversed. How did this happen? arated into incommensurable spheres. Western The recent experiences of China, Taiwan, press coverage of the Chinese government’s topSingapore, and Vietnam in dealing with the SARS down support for integrating Chinese medicine epidemic (caused by the coronavirus now called with biomedicine to treat COVID-19 patients has SARS-CoV-1) in 2002–3 and South Korea’s experilargely been disparaging. Salmon’s report altoence with MERS in 2015 certainly provided lessons gether ignored such integrated medical decisionthat helped them respond more effectively to the making in hospitals across China as well as in present SARS-CoV-2 (the virus that causes COVID-19) clinics of Korean medicine and Japanese Kampo pandemic. But a longer-term perspective shows across East Asia. that East Asian nations much earlier were forced Just over a month later, most reasonable US analysts agreed with Salmon’s assessments as COVID-19 to strengthen their state, medical, and public case numbers began sharply rising again across the health infrastructures in order to survive the invacountry. On June 23, the director of the federal sions, wars, epidemics, and national humiliations Centers for Disease Control and Prevention (CDC), of the twentieth century. Paying attention to such Dr. Robert Redfield, testified before a congressiohistorical legacies clarifies the geopolitical context nal committee: “We have all done the best that we of these countries’ collective success in controlling COVID-19 , despite distinctly can do to tackle this virus different languages, cultures, and the reality is that it’s national histories, and health brought this nation to its Using illness as a metaphor allows care systems. knees.” By June 30, the Euroone to make a diagnosis that can That context was well pean Union blocked travel then be acted upon. explored by Andrew Salmon from the United States as well in a two-part May 15–16 report as Brazil and Russia, while alfor the Asia Times titled, “Why lowing the resumption of East Beat West on COVID-19.” Salmon sought to flights from countries that had more effectively explain how “East Asia has handled and contained responded to COVID-19. the pandemic far better than the West on nearly all As I finish writing this essay, the Republicanmetrics.” Here, East meant China, Japan, South run states that ended shutdowns earlier than the CDC guidelines recommended are now leading the Korea, Taiwan, and Vietnam; West meant the Euronationwide US surge in COVID-19 infections. No pean Union and the United States. state has been able to build the four-step publicThe first part of the report examined differhealth infrastructure necessary to render the epiences in culture and communalism, attitudes demic sufficiently visible to implement effective toward authority, rights to privacy, and divercontrol measures: 1) widely test, 2) isolate the ingences in recent historical and epidemic experifected, 3) trace all their contacts, and 4) selectively ence that may have contributed to the more quarantine all contacts for 14 days. effective COVID-19 response by East Asian nationstates, whether authoritarian (China, Singapore, While most East Asian states have fully inteVietnam) or democratic (Japan, South Korea, Taigrated these four steps into their health care infrawan). The second part compared leadership, polstructures, US states remain blind, unable to see their mutual enemy. Even more alarming, the cynicy responses, vaccination policies, travel and ical Trump regime considers everything that makes geographic integration, manufacturing capacity, viral variations, genetic vulnerabilities related to the pandemic visible to experts and the public alike—from testing and masking to shelter-inrace, and differences in weather and climate. place orders—contrary to its political interests. Finally, it cited a pervasive Western sense of culExacerbated by myriad failures of federal-level tural superiority that contributes to arrogance leadership, the United States now leads the world toward Eastern models and ignorance of both East From Sick Man of Asia to Sick Uncle Sam  243 “Uncle Sam with La Grippe,” by Edward Williams Clay, printed and published by Henry R. Robinson of New York City, 1837. with more than 3.9 million positive cases. Epidemiologists advise that we should multiply this figure by ten to arrive at a rough estimate of total infections, given the limited reach of testing and the related inability to follow through on the next three essential steps of isolating, tracing, and selective quarantining. This means that about 39 million have likely been exposed to COVID-19—just over 10 percent of the country’s total population of roughly 330 million. The current accounting of more than 136,000 COVID-19 deaths in the United States is about to surpass the twentieth-century US fatalities of World War I (53,402), the Vietnam War (58,220), and the Korean War (36,574) combined. Still worse, we could be heading toward the estimated 600,000 American lives lost after World War I, when the 1918 influenza pandemic spread across the country. Historically reconstructed global estimates of influenza deaths from 1918 to 1920 range much higher. The already hard-to-fathom conservative estimate of 50 million, some scholars argue, may be more accurately doubled to 100 million. State and medical infrastructures were pushed beyond their capacity to care for the sick, much less to fully account for the dead. Postwar fatigue, as well as historians largely focused on Anglo-American and European rather than global consequences of the influenza pandemic, together contributed to historical amnesia regarding its massive toll, until Laura Spinney’s long overdue reckoning in her 2017 book Pale Rider: The Spanish Flu of 1918 and How It Changed the World. POWERFUL DISCOURSES OF WEAKNESS While the West has struggled, China and the other East Asian nations overall have controlled the COVID-19 pandemic within their borders. Although the multiple and divergent reasons for East Asia’s overall success and European and American failures will take at least the next decade to work out, anyone paying attention can clearly see that the tables have turned. China’s old reputation as the “Sick Man of Asia” has indisputably shifted to the United States. “Sick Uncle Sam” is now the new focus of the world’s concern over a clearly declining superpower. Downloaded from http://online.ucpress.edu/currenthistory/article-pdf/119/818/241/410067/curh.2020.119.818.241.pdf by guest on 07 September 2020 Figure 2. 244  CURRENT HISTORY  September 2020 Figure 3. “The Novel Corona King,” by Kelly Burke, March 2020. Thus, the “Sick Man of Asia” trope pejoratively positioned China as inferior to its East Asian neighbors as well as its European counterparts. Yet among Chinese reformers, it also constituted a broader “discourse of weakness,” one that Iwo Amelung, a historian of modern Chinese science, has argued included the concepts of “national salvation” and “saving the country by science.” Closely linked to social Darwinist interpretations of the rise and fall of nations, these discourses of weakness motivated the Chinese government to pursue the long-term aim of not only regaining national strength, but also rising above all others on the global stage. Now that Uncle Sam has been rendered an invalid by the misrule of Trump, the virusspreading Novel Corona King (see Figure 3), the humiliating labels “Sick Uncle Sam” and “Sick Man of North America” could not be more apt. They are also as potentially transformative for the United States as the “Sick Man of Asia” slur was for China. A regime change would be needed, however, for Uncle Sam to acknowledge being sick, diagnose his illnesses and comorbidities, and effectively mobilize the wider range of treatments available from East Asian experiences, models, and even medicines, all of which he currently scorns. & Downloaded from http://online.ucpress.edu/currenthistory/article-pdf/119/818/241/410067/curh.2020.119.818.241.pdf by guest on 07 September 2020 That’s not necessarily a bad thing. The power of the “sick man” label is that using illness as a metaphor allows one to make a diagnosis that can then be acted upon. And the staying power of the “Uncle Sam” moniker relies on metonymy, using the name of one thing to represent something related—such as “the press” for journalists. It often lends human scale, through personification, to an otherwise unwieldy institution. Uncle Sam, as a metonym for the US government, also draws power from history and myth. In September 1861, the US Congress formally recognized Sam Wilson, a meat-packer from Troy, New York, as the model for America’s national symbol. The story was that Wilson, during the War of 1812, had supplied “US”-stamped, beef-filled barrels that Army soldiers called “Uncle Sam’s grub.” This proved apocryphal, but Uncle Sam nonetheless has been a fixture ever since in the national imagination. Twenty-five years after Uncle Sam’s supposed war exploits, artist Edward Williams Clay engraved a lithograph of “Uncle Sam Sick with La Grippe” (see Figure 2). In this political satire, Clay used the “grippe” (influenza) as a metaphor for the severe recession of 1837. Sick Uncle Sam sits splayed in a chair, holding a sheet of paper listing the millions of dollars lost by US banks. Standing from left to right, President Andrew Jackson blames overeating (economic overexpansion), Jackson’s ally Senator Thomas Hart Benton prescribes “mint drops” (coinage), and Jackson’s vice president and successor Martin Van Buren (feminized as elderly “Aunt Matty”) diagnoses “over-issues” of paper money. The Sick Uncle Sam trope is as effective today as it was back then for diagnosing what ails the US government. It has recently resurfaced in the title of an article about Washington gridlock, “Uncle Sam Is Very Sick: Here’s What Can Be Done,” which appeared in June 2019 in an online magazine, The Bulwark, and in The Economist’s assessment from mid-March, “Uncle Sam v the Coronavirus.” Anticipating these examples by several years was foreign policy analyst John Feffer’s commentary, “The Sick Man of North America.” The “sick man” trope, whether applied to Europe, Asia, North America, or even Africa, also does geographic work by drawing national distinctions within the handful of metageographical concepts that divide up the world’s major landmasses into regions. It wields its power by clarifying a diagnosis of illness within that regional body politic.