352  Journal of the History of Medicine

Bridie Andrews. The Making of Modern Chinese Medicine, 1850–1960. Vancouver,

British Columbia, University of British Columbia Press, 2014. xvi, 294 pp., illus.
$32.95 (paper).

Sean Hsiang-lin Lei. Neither Donkey nor Horse: Medicine in the Struggle over
China’s Modernity. Chicago, Illinois, University of Chicago Press, 2014. x, 382
pp., illus. $35.00 (cloth).

K E Y W O R D S : scientism, missionary medicine, Japan, imperialism,

nationalism, acupuncture

It may seem strange to a contemporary observer in the West that “complementary

and alternative medicine” (CAM) has not lost its appeal, but has in fact acquired a
growing measure of popularity in developed countries in the twenty-first century.
The root of this impression exemplifies what Charles Rosenberg identifies in Our
Present Complaint: American Medicine, Then and Now (Johns Hopkins University
Press, 2007) as one of the two possible outcomes in the encounter between Western
biomedicine and alternative healing practices. The slighting of Chinese medicine, to
single out one genealogy of CAM, supports a triumphalist narrative of scientific bio-
medicine according to which mainstream, learned medicine always has the capacity
to integrate those seemingly valuable elements of the alternative into its normative
and regulatory foundations. Over time, however, Rosenberg observes a different
trend displacing the total disdain of CAM. The hegemony of scientific medicine rests
on its indifferent awareness of and willing coexistence with “other” health-care para-
digms, acknowledging the abiding necessity of alterity presence rather than genuine
“epistemological egalitarianism or relativist pluralism” (Rosenberg, 126).
The two books reviewed here turn Rosenberg’s insight on its head by steering our
attention to a different side of the world where, before the rise of industrial global-
ism, “Chinese medicine” had been the dominant tradition (of course, which medical
tradition appears “dominant” depends on where and how one looks). In fact, as both
authors point out, this statement is a misnomer, because before the twentieth cen-
tury, there was a plurality of medical and healing conventions in China, not all of
which we would identify as what is called (traditional) Chinese medicine today. A
notable example contributing to the changing definition of medicine in China is the
maneuvering of those reform-minded physicians who intentionally construed
“superstitious” religious practices as the antithesis of a scientific and modern version
of Chinese medicine in the early twentieth century. As such, the key question that
Sean Hsiang-lin Lei sets out to tackle in his study is this: “How was Chinese medi-
cine transformed from the antithesis of modernity to one of the most potent symbols
for China’s exploration of its own modernity?” (3) Similarly, Bridie Andrews asks, in
what ways have “the values associated with modernity (including science, democracy,
linear time, and the commitment to progress in human history) [come] to be equally
important in Chinese medicine?” (12) Both books therefore share the ambition to
 Book Reviews  353

throw light on the mutual imbrication of modernity, scientificity, and nationalism in

China’s medical development.
For a long time, historians of Chinese medicine have been divided into two
groups, distinguished by whether one’s focus is on the period before or after the rise
of Western biomedicine. While concluding immediately prior to the onset of modern
challenges serves the strategic purpose of certain analyses, we also know that what
we call “traditional Chinese medicine” is a relatively recent invention that found its
most definitive articulation in the Maoist period. This crucial pillar of contemporary
CAM emerged in a Cold War context that witnessed the state-wide promotion of an
epistemic syncretism, which attempted to absorb elements of Western biomedicine
into the foundations of a kind of medicine that is at once nationalistic and Chinese.
If this narrative appears strikingly mimetic of Rosenberg’s depiction of medical
hegemony in the West, Andrews’s and Lei’s studies provide a sober and timely
reminder about the alterative agency of Western biomedicine in the modern transfor-
mations of Chinese medicine, representing not its enemy but its midwife.
By putting the spotlight on the Republican period (1912–49), the two books
present a number of astute insights that promise to remain authoritative in the field
for years to come. Both authors share the view that Western biomedicine had gained
an uneven footing in China whereby its influence on different domains of health care
varied significantly since the mid-nineteenth century. The expansion of public health,
for example, exemplifies where Western biomedicine penetrated most deeply. Wu
Liande’s success in containing the Manchurian Plague in 1912 epitomized the begin-
ning of a series of targeted efforts to merge medical reform with state interest. These
efforts not only culminated in the establishment of the North Manchurian Plague
Prevention Service, China’s first attempt at a public health service, but they also
brought into sharp focus some of the lingering difficulties that physicians of tradi-
tional medicine faced, especially their weakness in dealing with the contagious nature
of certain infectious diseases. When Yu Yan proposed to abolish Chinese medicine
altogether in 1929, its practitioners came together and learned from physicians of
biomedicine to connect their professional development to the interest of the state by
rebranding their work as “national medicine” (guoyi) in tune with the then prevalent
ethos of anti-imperialism. Faced with mounting pressure, the Nationalist government
quickly forsook Yu’s proposal, and physicians of Chinese medicine grabbed onto the
new language of science to legitimate the efficacy of some of their longstanding phar-
macopeia. This move, therefore, highlights an important area of their expertise least
threatened by the intrusive nature of Western biomedicine. In short, not only is the
conventional wisdom about the absolute triumph of Western medicine over Chinese
medicine untenable, the confrontation between the two styles of medicine pushed
advocates of modern biomedicine in China to re-strategize and learn from it as much
as it stimulated Chinese-style physicians to take action to bring about an unprece-
dented collectivism among themselves.
In showing that the introduction of modern biomedicine helped strengthen rather
than curtail the development of Chinese medicine, Andrews and Lei stress the
354  Journal of the History of Medicine

incoherent nature of Western medicine itself. In the nineteenth century, argues

Andrews, “missionary medicine turned out to be not so much a marker of cultural
difference as a tool for reducing the perception of alterity” (55). Striving to persuade
the Chinese public, Western doctors downplayed the spectrum of problems con-
fronting their work by appropriating and accommodating Chinese medicine in order
to generate a sense of commensurability. This had the unintended effect of reinforc-
ing the status of Chinese medicine, especially the value of Chinese pharmacy. By the
early twentieth century, the western medical community in China was still far from
unified. Although the attempted merging of the China Medical Association (for mis-
sionaries, secular doctors, and Chinese graduates of foreign or approved Far Eastern
medical schools), the National Medical Association (for Chinese graduates of
British- and American-run medical schools), and the Chinese Medical and
Pharmaceutical Association (for graduates of Japanese-run medical schools) into a
single Chinese Medical Association in 1932 gave the Western medical profession in
China a seemingly unifying voice, these mergers were in many ways a reaction to the
increasing solidarity of their rivalry. In fact, as Lei demonstrates, when the
Nationalist government committed itself to forming a Ministry of Health in 1928,
one of its key objectives was to strike a delicate balance between the Japanese-
German faction and the Anglo-American faction. However, a direct consequence of
the Rockefeller Foundation’s intervention, among other variables, was that “over the
course of the Republican period, the Anglo-American faction gradually acquired a
dominant position in both medical administration and the medical profession as a
whole” (129).
Despite these similarities, the two books have different strengths. Andrews’s study
is especially illuminating in explaining Japan’s influence on medical reforms in China.
As a result of Japanese imperialism in China, many Chinese physicians have been
reluctant to acknowledge the Japanese impact on their profession. This often leads
to the singular perception of Japan’s significance in terms of mediating the transmis-
sion of Western biomedicine to modern East Asia, especially since the direction of
knowledge acquisition reversed between Japan and China after the First Sino-
Japanese War (1894–95). However, Andrews shows that by the time Chinese stu-
dents arrived in Japan, they encountered a mixed situation in which the state sup-
ported the development of Western medicine and a concurrent movement for
preserving kanpo (Sino-Japanese medicine) flourished as an attempt to maintain cul-
tural identity by way of “scientizing” traditional medicine. A mirror image developed
in Republican China: the Nanjing government convened its first Health Commission
in 1929, which is often seen as the opening salvo of a series of attacks on Chinese
medicine. In response, Chinese-style doctors, like their kanpo predecessors, mobi-
lized themselves into forming a coherent National Medicine Movement, launched
initiatives to defend their status, and consolidated a professional identity in ways that
correlated with anti-imperialist nationalism. Andrews shows that the application of
scientific methods to uncover the active principles in traditional pharmacopeia, a
major innovation in Chinese medicine in the 1920s and 1930s, can be traced back
 Book Reviews  355

historically to the pharmacological research into Chinese drugs in the kanpo revival
movement.
Lei’s study, on the other hand, provides the best account to date of the role of the
state in transforming medicine in China. In his words, “the historic confrontation did
not take place directly between the two styles of medicine but between Chinese
medicine and the modernizing Chinese state” (5). Lei depicts the year 1929 as a piv-
otal turning point for both Western medicine and Chinese medicine as their practi-
tioners redefined the nature of their competition in terms of their alliance with the
state, as opposed to fighting for patients, for instance. The same year that witnessed
the government’s intention to abolish Chinese medicine saw the rise of the National
Medicine Movement. Whereas the evidence for the state’s alliance with Western
medicine runs across the North Manchurian Plague Prevention Service and the
Ministry of Health, Chinese medicine’s alliance with the state culminated in the
establishment of the Institute of National Medicine. Lei refines his argument, how-
ever, by showing that this is not merely a matter of political struggle, but one with
epistemological consequences. Specifically, he calls the creation of modern Chinese
medicine a process of speciation, out of which a new “mongrel” form of medicine sud-
denly emerged (making Chinese medicine “neither donkey nor horse”). “The impor-
tant point,” writes Lei, “is that the desirability, the derogatory connotation, and the
dangerous potential of mongrel medicine were all inseparable from . . . the project of
Scientizing Chinese Medicine” (163). The spirit of scientism first found its most
explicit pronouncement during the May Fourth Era, but it became, according to Lei,
a key motto embraced by Chinese physicians in response to Yu’s proposal a decade
later. Although notable efforts to integrate the two styles of medicine existed before
1929 (Tang Zonghai’s work springs to mind), this moment marked the first time
when Chinese-style physicians were forced to cope collectively with the concept of
science. Having succeeded in acquiring the necessary state capital for establishing the
Institute of National Medicine, they began to marginalize those peers who refrained
from engaging with the project of scientization.
It is impossible to do justice to these two meticulously researched and clearly
written monographs in a single review essay, but certain elements do stand out as
especially interesting and path-breaking. Andrews’s discussion of the advent of scien-
tific acupuncture provides a sorely needed historical explanation for its contemporary
survival and popularity. After all, the practice was shunned by elite doctors in China
before the twentieth century, so how did it become such an important icon of
Chinese medicine today? The answer, according to Andrews, lies in the effort of
those medical thinkers who attempted to give acupuncture a modern scientific basis.
Here, the work of the physician Cheng Dan’an (1899–1957) is remarkable in that he
mapped Western anatomy and physiology—such as the physical structures and func-
tional systems of nerves, blood vessels, and lymph glands—onto the meridian tracts
of acupuncture (jingluo). For a similar experiment in the scientization of Chinese
medicine, Lei’s chapter on the birth of the new antimalarial drug changshan (dichroa
root) reveals the political nature of this discovery. Among other things that made
356  Journal of the History of Medicine

this an anomalous event, participating researchers violated the basic protocol for con-
ducting scientific research on Chinese drugs, but it was only because of this violation
that they were able to show the antimalarial efficacy of changshan as efficiently and
quickly as they did. This chapter in the history of Chinese medicine therefore not
only dispels the longstanding myth that Chinese medicine is ineffective in treating
infectious diseases, but it also sheds light on the intertwined nature of experimenta-
tion, laboratory science, and actor-network that turned a research design into a politi-
cal strategy—a story familiar to critical scholars of science but told with a brand-new
cast.
Whereas previous studies have tended to shy away from delving directly into the
encounter between Chinese-style and Western-style medicine, these two books rep-
resent the most innovative and magisterial treatment to date of the transformation of
Chinese medicine in the first half of the twentieth century. They show that although
Chinese physicians have struggled with medical hegemony in myriad ways, genuine
interests in “epistemological egalitarianism or relativist pluralism”—however volatile
in becoming the most obvious end product of history—have nonetheless served as a
key catalyst in medicine’s global past.

Howard Chiang, Ph.D.

Department of History, University of Warwick,
Coventry CV4 7AL, UK
doi:10.1093/jhmas/jrv054
Advance Access Publication: January 7, 2016

Anne Hardy. Salmonella Infections, Networks of Knowledge, and Public Health in

Britain, 1880–1975. Oxford, Oxford University Press, 2015. ix, 249 pp., $99.00
(cloth).

K E Y W O R D S : epidemiology, bacteriology, food poisoning, germ theory

“A large family . . . with a beautiful name but most unpleasant habits.” Such is a force-
ful description of the bacterial genus, Salmonella, the subject of Anne Hardy’s new
monograph. The group was confounded in the late nineteenth century by the nebu-
lous monikers enteric fever, typhoid, and summer diarrhea, yet a century later, micro-
biologists recognized over two thousand and five hundred specific zoonotic
serotypes of Salmonella, the most virulent being Salmonella typhi, the causative organ-
ism of typhoid fever. Hardy’s goal—formidable in chronology and scope—is the
weaving of three narratives; the modern history of how Salmonella became a public
health problem, the laboratory research that unraveled the Salmonella family of bac-
teria, and public health attempts to curb food poisoning Salmonella outbreaks.
Following her longstanding interest in Victorian public health, and presaged by a
series of signpost journal articles on typhoid fever, food poisoning, and veterinary