Farewell to the God of Plague: Chairman Mao's Campaign to Deworm China / Edition 1 available in Hardcover
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Farewell to the God of Plague
Chairman Mao's Campaign to Deworm China
By Miriam Gross
UNIVERSITY OF CALIFORNIA PRESSCopyright © 2016 The Regents of the University of California
All rights reserved.
Chairman Mao Weighs In
THE HIGH POLITICS OF THE CAMPAIGN
IT WAS THE END OF May 1949, and the People's Liberation Army had just liberated Shanghai from the Nationalists. Looking ahead, the CCP was focused on completing Communist control of China by taking Taiwan. There was only one impediment. The thirty-seven thousand crack troops from Northern China had no idea how to engage in water-based skirmishes. On August 1, the troops were sent to Shanghai's suburban counties of Songjiang and Qingpu to gain aquatic invasion skills. A couple of weeks later, the swimming soldiers came down with skin rashes. Some were sick enough to be hospitalized. Since the source of the problem was unclear, doctors slowly gathered data and did experimental treatment and education. Two months later, the troops were ordered to stop swimming, but it was too late. Troops were heavily infected with worms. Over fourteen thousand troops, or 38 percent of the top soldiers in China, were incapacitated due to snail fever. Additionally, about 50 percent of the troops had hookworm, 50 percent had roundworm, and 27 percent had whipworm. Treatment by the twelve hundred medical personnel, organized in part by the snail fever expert, Dr. Su Delong, and requisitioned from medical institutions in Shanghai, Hangzhou, and Nanjing, took four months, lasting until April 30, 1950. It is unknown whether this affected the decision to delay attacking Taiwan. However, by June 1950, only two months after the last treatment of the decimated soldiers, the window of opportunity had been lost. China's involvement in the Korean War prompted the United States to move from an unaligned position to protecting Taiwan with its Seventh Fleet.
When Mao Zedong and the Communist Party took over China in 1949, epidemic and endemic diseases were rampant, life expectancy low, infant mortality high, and most people outside cities had never seen a physician or been vaccinated. The military emergency resulting from troops infected with snail fever may have contributed to the decision to dedicate capital and resources toward fighting the disease. However, it is still baffling, given the multitude of problems facing the regime, that the CCP chose to expend enormous resources fighting snail fever, an unknown rural disease that generally took decades to kill its victims. This chapter examines why the national government and Mao Zedong made snail fever a priority and then provides an overview of the campaign's wider political context from 1949 to 1976.
SNAIL FEVER: A PRIORITY?
Initially identified as a threat to military and economic security, and then as an ideological issue, snail fever was a Party health priority from the CCP's very earliest days in power, garnering the personal interest of several top Party members. Except for SARS, this is the only disease campaign labeled as a political rather than a health campaign.
The top Party leadership realized that this disease was a significant impediment to military fitness after the aquatic training debacle. Reinforcing this perception, the disease devastated early recruitment efforts throughout south and central China. Due to the disease, in Jiangsu's hard-hit Songjiang Prefecture (where Taiwan-intended troops learned aquatic skills), 73.6 percent were unfit for duty in 1953; in Greater Shanghai, 33 percent of enlistees could not fight for the same reason in 1954, and Jiangxi Province had similar problems. In the early 1950s, CCP concerns over military fitness and procuring healthy recruits were at an all-time high, as the Party was simultaneously trying to take control of the countryside and participate in the Korean War, where an estimated 700,000–900,000 troops died.
The disease also had a large impact on agricultural productivity. After fifteen years of war, with few remaining factories, agricultural production was the major source of government income and key to obtaining the capital required for the Soviet model of heavy industrial development. Snail fever was endemic in rice-growing regions, negatively influencing the productive capacity of land, labor, and even capital (in the form of oxen and water buffalo). Land with high disease intensity became known as death traps, causing locals to flee. The most frequently abandoned land was also extremely productive prime farmland, generally with a growing season of more than three hundred days, making it amenable to multicropping. According to campaign propaganda, forty-six thousand hectares of deserted, snail-laden land in Hubei, Fujian, and Guangdong Provinces were reclaimed by August 1958, leading to large provincial surpluses. In addition to killing 400,000 people per year (4 percent of an estimated 10 million sick), snail fever decreased productivity of those with mid- to late-stage disease by up to 40 percent. One report estimated that curing 3.5 million people added the equivalent of a million men's labor power to the labor force by 1959.Finally, cattle studies in Jiangxi's Yujiang County found that oxen and water buffalo with snail fever plowed only half as much as healthy animals and had higher miscarriage rates. Given a skyrocketing population and very slim agricultural margins for building heavy industry, the Party felt that ridding the country of this disease was a matter of economic security.
The new Chinese government was not alone in enacting health campaigns for reasons that were advantageous to its agenda. According to Ralph Croizier, particularly for new nations with limited resources, there is often a tension in government-supplied health care. Is public health enacted for humanitarian reasons to relieve individual suffering, or is it a mechanism to increase national strength economically and militarily? There seems little doubt that most health work in China was done to strengthen the country. At an important meeting in Yujiang in January 1956 to launch major campaign work, the government listed four ways that snail fever had an impact, including production, population growth, energetic participation in political activities, and army recruitment. Nowhere mentioned were the human costs of the disease or improving people's well-being. Instead, the government emphasized the military, economic, and political ways the campaign would help the government. This focus was incorporated into assessment of campaign success. When communities demonstrated rising production rates and grain surpluses, and when enlistment numbers and population climbed post-treatment, then the campaign must be achieving its goals. Even Chinese medicine was evaluated based on how much labor power it rescued. This tendency was also true of colonial public health efforts, which were almost entirely focused on improving subjects' working potential. This emphasis became even more pronounced after World War II, when international public health was envisioned primarily as a handmaiden to economic development.
Similar to other health campaigns, the initial ideological rationale for counteracting snail fever was to refute late nineteenth-century descriptions of China as the sick man of Asia. Possibly influenced by ideas stemming from social Darwinism that connected racial fitness, physical prowess, and victory on the world stage, the CCP incorporated rural health and sanitation as a core platform even before taking power in 1949. As early as April 1917, the future Chairman Mao wrote "A Study of Physical Education," where he connected national strength and military spirit to physical education. Upon joining the CCP's Public Health Commission in the 1930s, he identified hygiene as a core Party responsibility in the Jiangxi Soviet in 1934. Mao insisted on medical care and hygiene instruction for all regular and guerrilla military units. Mao also established and directed a committee on public health in Yan'an, the Shaanxi-Gansu- Ningxia Border Region, and held both individual and group-level public health contests among Red Army groups. At Yan'an, the CCP allocated an impressive 6 percent of the budget to health care.
Once in power, the CCP rhetoric made public health a yardstick for measuring progress toward modernity. Curing age-old endemic diseases validated Party leadership and ensured that advantages of the new society were experienced in people's healthy new bodies. Likewise, creating a cleaner living space would make villagers conscious of the new society and empowered to control nature, their age-old enemy. As Chairman Mao explained in his August 30, 1956, speech for the preparatory meeting for the Eighth National Congress: "China used to be stigmatized as a 'decrepit empire,' 'the sick man of East Asia,' a country with a backward economy and a backward culture, with no hygiene, poor at ball games and swimming, where the women had bound feet, the men wore pigtails and eunuchs could still be found. ... But after six years' work of transformation we have changed the face of China. No one can deny our achievements."
Upon realizing that snail fever helped trigger poverty and infertility, the Party made the campaign a symbol of fighting everything that was holding society back. A 1956 Jiangxi Province report explained: "Socialism will bring a happy new society — how can we have big belly disease in it? If people are lying flat on their backs in bed, how can they be happy?" Newspaper articles repeatedly reported on the campaign and an entire generation memorized Chairman Mao's famous 1958 commemorative poem. In popular memory, eradication of snail fever was seated as a foundational campaign of the era, a symbol of Party success at stamping out intractable ills, and a patriotic demonstration of the power of the people.
The great success of the campaign made it an ideal ideological platform for asserting China's scientific expertise globally. Although possibly a questionable strategy internationally, it was used domestically to legitimate Party rule. Campaign leaders explained that developed nations, including "American scientists," "up till now had no way of dealing with it [snail fever] and could only shake their heads and heave a sigh." In contrast, CCP success demonstrated that the Party could wield science competitively and proved that socialism could provide benefits unavailable in a capitalist system. The Party asserted that China was the "the first place in the world to eliminate snail fever," a historic achievement with "huge international significance," a sort of medical Sputnik symbolizing China's triumphs on the world stage. This also bolstered China's claim to leadership of developing countries. As a 1955 Shanghai report explained: "Egypt has already been treating and preventing snail fever for fifty years without any result. We have experience. We can do a cultural exchange which is of great use to politics."
The personal attention of Premier Zhou Enlai, Vice Premier Chen Yun, and Chairman Mao help account for the success, prominence, and longevity of this campaign. These leaders represented a wide spectrum of political opinion, which helped the campaign to weather the tempestuous politics of the Maoist era. In March 1952, Zhou Enlai became chair of a new central epidemic prevention committee that established the CCP's initial policy toward public health and started China's Patriotic Public Health Campaigns in response to the 1952 germ warfare affair, discussed below. Zhou's specific interest in snail fever is not easy to determine, but it is clear he was actively engaged. When Japanese physicians came to China in November 1955 to convey information available through the World Health Organization (which had yet to accept China as a member), Sasa Manabu, professor at the Institute for Infectious Disease at Tokyo University, met personally with Zhou. Zhou knew enough about the campaign to detail the snail fever situation in south and central China and facilitate the Japanese doctors' visit to the field. When Yujiang's Party secretary came to a Beijing conference on rice production in 1966, Zhou personally rewrote his talk to highlight snail fever and link it to Yujiang's increased productivity. Zhou's precise role needs further research, but he kept actively informed about campaign progress.
Vice Premier Chen Yun was born in Qingpu County, Jiangsu Province, which had some of the highest rates of disease in the country. He grew up surrounded by people suffering from snail fever. In 1957, he paid a special visit to Qingpu to investigate its campaign work and offer his support. Information he learned in Qingpu was conveyed to the State Council and reportedly influenced its decisions about the campaign.
Chairman Mao spent his childhood in Shaoshan Village, Hunan Province, fifty miles from Dongting Lake, a center of regional economic interchange (fishing, cattle raising, and green reed fertilizer collection) and a reservoir for snail fever. The lake disseminates the disease during its annual flooding cycle, when its borders expand greatly. It is very likely that growing up, Mao encountered people with the disease or heard stories about hard-hit areas. Mao also passed through highly infectious areas in Jiangxi in the 1920s and 1930s when fighting against the Nationalists. According to Su Delong, a top snail fever expert and Mao's campaign advisor, Mao had dealt with so many ill villagers and soldiers that when the crack troops were discovered to have the disease in 1949, he became particularly interested in it. After deciding that the Ministry of Public Health (MPH) was doing an inadequate job in 1955, Mao created a dedicated nine-person leadership small group (LSG), directly under the Central Committee, to run future campaign activities (discussed below). Mao was also personally involved in early national snail fever conferences. In Mao's December 1955 "Circular Requesting Opinions on 17 Articles on Agricultural Work," a key document for determining agricultural priorities, snail fever topped the list of diseases slated for elimination in Article 12. In "Second Preface to Upsurge of Socialism in China's Countryside," written at the same time, Mao repeated injunctions to wipe out diseases, with snail fever as his only specific example. While in Shanghai in 1957 and the 1960s, Mao consulted with Su Delong about the campaign, and in 1958 while in Anhui, Mao visited a provincial museum exhibit about snail fever (see figure 2). Finally, upon hearing that Yujiang County, Jiangxi Province, was the first to eliminate the disease, Mao was reportedly so excited that he stayed up all night and wrote his famous poem, "Farewell to the God of Plague" (see this book's epigraph). Chairman Mao's decades-long attention elevated the campaign until it was politically impossible for it to fail.
Perhaps because of linkages to military security, economic development, and Chairman Mao, the snail fever campaign was designated as a political campaign. As Wei Wenbo, deputy director of the nine-person LSG put it, "Elimination of snail fever impacts on whether our people survive or perish; it is related to the existence of our nation; to thrive or wither depends on it." The campaign's unprecedented place in the political arena would have a crucial effect on grassroots work, organizational independence, and resource acquisition. These advantages made the campaign one of the most important models in the health field.
Beginning in 1949 and continuing, albeit intermittently, to the present, the snail fever campaign is one of the longest health campaigns in the history of the People's Republic of China. The campaign had two peaks of activity coinciding with the Great Leap Forward (1958) and the Cultural Revolution (1966–71) and a third in places participating in the 1990s World Bank project. The remainder of this chapter provides an overview of the campaign.
THE MINISTRY OF PUBLIC HEALTH UMBRELLA, 1949–1955
The Ministry of Public Health listed snail fever as a key target as early as 1952. However, acknowledging the disease's significance did not mean MPH could actually accomplish this or most other grassroots work in the vast hinterland. The First National Health Conference in 1950 defined MPH's portfolio as "1. Attention to the health of workers, peasants, and soldiers; 2. Emphasis on preventative medicine; and 3. Cooperation among doctors practicing in Chinese and Western medicine." A fourth goal of "enlisting the broad masses of the people and actively participating in the health campaign with them" was added at the Second National Health Conference in 1952. Although given the mandate to fight diseases, MPH lacked resources to do so and faced formidable obstacles. In addition to shortages in funding, MPH lacked personnel, materials, infrastructure, and medication. With only cursory disease surveying during the Republican era (1911–49), disease location was also unknown. Following fifteen years of war, local people had many diseases but little understanding of public health, making a focus on preventative medicine and popular participation difficult to achieve. Finally, the Party encouraged reliance on Soviet rather than Western European and American medical experts. A Chinese medical delegation duly presented a paper on snail fever at a September 1954 conference in Tashkent. However, because snail fever is a southern disease, Soviet experts had no experience with the illness. Russian prescriptions were vague and depended on resources, both material and professional, that China lacked.
Excerpted from Farewell to the God of Plague by Miriam Gross. Copyright © 2016 The Regents of the University of California. Excerpted by permission of UNIVERSITY OF CALIFORNIA PRESS.
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Table of Contents
List of Illustrations xi
Part I From The Eyes at the Top: Overview of the Campaign
1 Chairman Mao Weighs In: The High Politics of the Campaign 15
Part II The Campaign Nobody Wanted: Structural and Economic Underpinnings to Rural Resistance
2 Dodging Leadership in an Era of Decentralization: Structural Problems of the 1950s 43
3 Denying Economic Responsibility While Brandishing an Empty Purse 61
Part III The three arms op the campaign: Education, Prevention, and treatment
4 Building the New Scientific Socialist Society: Educating the Masses 87
5 Preventing the Unpreventable 115
6 The Challenges of Treatment 145
Part IV Government Benevolence? The Nonhealth Benefits of Health Campaigns
7 Doing the Unthinkable: Scientifically Legitimating Party Intrusion in the 1950s 181
8 Scientific Consolidation in the Late 1960s and 1970s 203