Nation Work
Asian Elites and National IdentitiesThe University of Michigan Press
Copyright © 2000University of Michigan
All right reserved. ISBN: 978-0-472-11032-2 Contents
Introduction: Nations and Identities in Asia Timothy Brook and Andre Schmid......................................................1Constructing the National Body: Public Health and the Nation in Nineteenth-Century Japan Susan L. Burns..........................17Discourses of Empowerment: Missionary Orientalism in the Development of Dravidian Nationalism V. Ravindiran......................51Decentering the "Middle Kingdom": The Problem of China in Korean Nationalist Thought, 1895-1910 Andre Schmid.....................83Two Kinds of Nation, What Kind of State? R. Bin Wong.............................................................................109Chen Gongbo and the Construction of a Modern Nation in 1930s China Margherita Zanasi.............................................125Collaborationist Nationalism in Occupied Wartime China Timothy Brook.............................................................159The Incoherent Nation: An Exploration of Chinese "Postnationalism" Xiaoping Li...................................................191Nation and Postnation in Japan: Global Capitalism and the Idea of National History Thomas Keirstead..............................219Bibliography......................................................................................................................241Contributors......................................................................................................................263Index.............................................................................................................................265
Chapter One
Constructing the National Body: Public Health and the Nation in Nineteenth-Century Japan Susan L. Burns
The Body in Question
In 1883, Nagayo Sensai, who headed the Board of Hygiene within the Home Ministry of the Japanese government, wrote a short article entitled "Correcting the Mistaken Understanding of Hygiene." In this work, Nagayo attempted to clarify the meaning of the term eisei, which, while usually translated as "hygiene," is also part of the compound koshu eisei, or "public health." He had chosen the compound eisei from the Chinese classics a little more than a decade before to translate the German term Gesundheitspflege, and it had quickly become one of the most popular of the Meiji neologisms, appearing in the titles of a host of health handbooks and in the advertisements of patent medicines. Nagayo, however, was not pleased with the popular understanding of this term. Throughout his short piece, he emphasized the social benefits, rather than the individual pleasures, of hygienic practices. Hygiene, he asserted, did not refer to the pursuit of "easy living, delicious foods, or luxury," as many people seemed to think. Rather, its aim was "to discipline the body," "to strengthen the soldiers' vitality," and "to make the flesh able to withstand bad weather and humble living" (Nagayo 1883, 32-33).
Nagayo's concern for the public understanding of eisei, which had come to signify a wide range of "healthy" practices from brushing one's teeth to quarantining the sick, is revealing of the Japanese government's interest in the bodies of its citizens, an interest that was intimately tied to the pursuit of the new national goals of "Increase Production and Promote Industry" and "Rich Nation, Strong Military," as popular slogans of the day put it. A subordinate of Nagayo's made this relation even more explicit when he declared, also in 1883, that "healthy bodies and active spirits are the single great foundation of Japan's wealth and power" (Matsuyama 1883, 2).
This essay explores the place of the body in the Japanese government's project of nation building in the last decades of the nineteenth century. Soon after its establishment in 1868, the new government of the Meiji emperor made improving the health of its citizens a state priority, and to that end it began not only to exercise its authority over medical knowledge, practice, and institutions but also to create a system of public health. Bureaucrats in charge of state medical policy such as Nagayo Sensai viewed sickness and disease as threats to the well-being of the "national body"-the literal rendering of the Japanese term kokutai, or "national polity," which had a central place in the ideology of the emperor-centered state (Gluck 1985, chap. 5). The medical system that emerged in the 1870s and 1880s was organized around the principles of policing and confinement, as the primary means of dealing with the "danger" that disease posed to the creation of a large healthy population of potential workers and soldiers. The process of constructing the new medical and public health system was, however, not easy. The government in articulating state medical policy made reference to notions of social benefit and national necessity, but popular contestation greeted attempts to implement the new public health policies, which suggests that the notion of an easy metonymic relationship between the "national" and individual bodies was one not shared by all Japanese. The debate over the nature of the relation between individuals and the national body is the subject of this essay.
I begin by exploring the rise of public health as idea, policy, and administrative system and then turn to examining how the concept of public health was applied to two very different diseases, syphilis and mental illness. I have chosen these two diseases out of the many that were addressed by public health policy in the nineteenth century for several reasons. First, in early modern Japan the "culture" of both diseases differed dramatically from the understanding of them that emanated from the Meiji state. By examining them, we can catch a glimpse of how the new medical policy entered into popular culture and with what consequences. Second, the two allow us to explore how public health discourse intersected with other discursive forms that also emanated from the state. For example, as we shall see, public health discourse on syphilis was never purely "medical" but was also implicated in and ordered by notions of sexuality and gender roles. Finally, the different natures of the diseases themselves make them useful for purposes of comparison and contrast. Proceeding in this way, I hope to expose the terms and the limits of the debate on the nature of the body. By the end of the Meiji period, the concept of "public health" had to some degree been naturalized but not in ways that clearly confirmed the relation between the individual and national bodies that the state envisioned.
The Meiji State and Medicine: Rendering Health "Public"
The new Japanese government's first statement on medical policy was issued in December 1868, only two months after the emperor's triumphant entry into his newly renamed capital of Tokyo. A proclamation of the Council of State announced that because of his "benevolence and affection" the emperor could no longer ignore the abuse of human life that characterized much of contemporary medical practice and thus he had decided to regulate the practice of medicine (Koseisho imukyoku 1955, 1). The evocation of the emperor's interest and concern is significant because throughout the Meiji period the government legitimated reform efforts by identifying them with the imperial will-and by extension with the national good. But what this early proclamation also reveals is the extent to which concern about health and disease was shaped by the political dynamics of the last decades of Tokugawa rule. While the leadership of the Meiji government looked to Europe for models of how to construct a modern medical and public health system, the impetus for such reforms was quite different.
In Europe, public health became the object of popular and political discourse in the early nineteenth century, articulated in response to a rising concern about the poor health, sickness, and diseases that resulted from industrialization, urbanization, and the rise of capitalist economies. The leaders of the public health movement were social reformers, including physicians, lawyers, clerics, and bureaucrats, many of whom saw the prevention of disease in ethical terms: it was part of a larger humanitarian program for ending poverty and despair. This was also the moment when campaigns to regulate prostitution and for prison reform and workplace improvements were taking place. The social reformers in Great Britain, France, and the German states were in agreement that health should be a right of citizens of modern states, but there was profound disagreement about what role the government should play in regulating and policing matters of health. In the case of France, the strong tradition of political liberalism mitigated against central government control of medical and sanitary matters, so that much authority remained in the hands of local and civic leaders. In Great Britain in the first half of the nineteenth century, there was a similar debate over the question of how and to what degree the state should concern itself in medical matters. The period from 1848 to 1871 has been characterized as the heyday of state medicine, but parliamentary and professional critiques of governmental intervention in matters deemed "local" and "medical" led to its gradual eclipse in the 1870s. Even in the German states, some of which had made use of a system of medical police from the 1760s on to regulate sanitation, the nineteenth century saw the rise of civil reformers, many of them physicians, who worked to take power over medical matters away from government bureaucrats (Rosen 1993, 135-38, 253-59; Weindling 1994).
In Japan, in contrast, public health discourse predated industrialization and its attendant health problems, and it emanated not from civil society but from the new central government. If public health discourse in Europe emerged in response to industrialization, in Japan it took form in response to concerns about imperialism. In the early 1850s, the Bakufu, the government of the Tokugawa shogun, reluctantly signed a series of treaties with Western nations, "opening" Japan to foreign contact after more than two centuries of a Bakufu-imposed policy of limiting foreign trade to a single country, Holland, and a single port, Nagasaki. These treaties gave rise to what has been termed a system of "informal imperialism" through the creation of a number of so-called treaty ports in which citizens of the Western powers had special rights and privileges, in particular freedom of entry and extraterritoriality, which compromised the sovereignty of the non-Western countries where the ports were located. The outcry that greeted the opening of the country strengthened the growing anti-Tokugawa movement, which coalesced around the cry "Revere the Emperor, Expel the Barbarians."
The creation of the treaty ports in Japan brought not only political and economic turmoil but also an epidemiological crisis. In 1858, the American naval ship Mississippi sailed into Nagasaki, one of the new treaty ports, with seamen infected with cholera aboard. It was not long before cholera broke out among the Japanese population of that city and then spread through Kyushu and Shikoku to Kyoto, Osaka, and Edo, eventually reaching as far north as Hakodate in Hokkaido. During the three years of the epidemic, an estimated 280,000 people died; there were more than 100,000 dead in Edo alone. Contemporary accounts of the epidemic paint a chilling picture of the social havoc and human suffering that the outbreak of the acute infectious disease brought. Funeral processions filled the streets, the air was thick with the smoke of crematory fires and the stink of decaying bodies, and coffins were stacked as high as mountains. In their desperation to ward off the evil spirits that many thought had brought the disease, people beat drums, fired guns, and carried out other exorcising rituals.
As these activities suggest, the infectious nature of cholera was then poorly understood. The contemporary Japanese conception of disease derived from Chinese medical theory, which held that the main cause of illness was an imbalance in the body's ki, the "fundamental energy" that flowed through channels within the body. This imbalance was seen as having both endogenous and exogenous causes. The former included the failure to moderate the desires of the body-to overeat, overdrink, or partake excessively in sexual pleasures; all had the potential to upset the body's ki. The latter referred to environmental causes, such as bad air or water, that were specific to certain locations. Regional outbreaks of disease were often explained in this way by those knowledgeable in medical theory. But for many in early modern Japan it was neither immoderate habits nor bad air that caused disease but rather the dangerous presence of supernatural spirits, who had to be placated or frightened away for health to be recovered. Thus, a common response of domainal officials to epidemics was to require the distribution of amulets and to order shrines and temples to conduct rituals to ward off the spread of the disease.
In the aftermath of the 1858 epidemic, after the threat posed by infectious diseases such as cholera was recognized, the Bakufu would press for the right to deny foreign ships entry into the ports if it was thought that they might be carrying infected people-a request that the European nations would resist by citing their treaty rights. But even in the absence of an understanding of the principle of infection, almost immediately the cholera outbreak of 1858 was linked in the minds of many Japanese to the unwanted foreign presence in Japan. Katsu Kaishu, the Bakufu official who negotiated the end of Tokugawa rule ten years later, was in Nagasaki in 1858 and wrote later of the popular theory that "officers from British ships had come ashore, sought out wells, and poisoned the water within them," thereby causing the epidemic (1971, 174). A Dutch naval officer in Nagasaki recorded a similar theory of origin: "it was rumored that Buddhist priests had declared that the disease of the sick was caused by poison that had been dumped into the wells and used this to inspire among the people the notion of expelling all foreigners" (Tatsukawa 1979, 184). It was in the context of this kind of cultural tension that a critical rethinking of notions of health and disease began to take place. At the center of this set of transformations was a group of medical practitioners who became extraordinarily influential in the Meiji period. These were the students of the medical school (Igaku denshujo) attached to the Bakufu naval training school in Nagasaki, the Kaigun denshujo, which had been created in 1855 to strengthen Bakufu defenses against the West by training retainers of the Bakufu and the various domains in navigation and other forms of maritime technology.
The medical school, like the Kaigun denshujo itself, brought together bright and ambitious young men from around the country for training in Nagasaki, a city where the unequal relations of power-political and technological-that shaped Japan's contact with the West were clearly on display. Their teacher was Pompe Van Meedervort (1829-1908), a Dutch naval medical officer. During the five years he remained in Japan, Pompe, as he became known in Japan, taught medicine to a total of 133 students, one of whom was Nagayo Sensai. His classmates included Matsumoto Ryojun, who later became surgeon general of the armed forces and an official in the Central Hygiene Society; Ogata Koreyoshi, later founder of the first public hospital in Osaka and the head of the army's medical school; Seki Kansai, who was to head the Naval Hospital; and Iwasa Jun, who would serve as the personal physician to the Meiji emperor for thirty years.
In his memoirs of his years in Japan, Pompe wrote at some length of the cholera epidemic of 1858 and his efforts to instill in his students the concepts of contagion and sanitation, principles that he noted with pride were well understood in "my home land which is known to be a civilized country." In contrast, he stated, he had great difficulty in conveying both ideas to his students because "in Japan the horror of infectious disease seemed to be completely unknown. ... As for the people of the city, they were at a loss to deal with this kind of disease." As a result, as cholera swept through Nagasaki, the Japanese "began to say that the cause of the disease was that Japan had been opened by the foreign countries, and soon they even regarded foreigners like myself as the enemies." According to Pompe, he lectured extensively on theories of public health and also took his students on walking tours of Nagasaki, during which he tried to point out examples of a bad sanitary practice such as contaminated water supplies, poor waste disposal, and so on. At last, he believed he had conveyed to his students the basic concepts of public health:
I explained many times the importance of hygienic principles and during the time of the cholera epidemic I lectured on hygiene, and gradually they began to understand the importance of these ideas. At last the students came to recognize that the cause of much human suffering was infectious disease and that the cure for this lay in the progress and principles of hygienic science. (Numata and Arase 1968, 59)
A tone of self-satisfaction pervades this section of the memoirs, and Pompe presents his lectures on the "civilized" and "progressive" concept of hygiene as an easy counter to the theories of the origin of the epidemic that some Japanese embraced. But another perspective of Pompe's achievement is offered up by his student Matsumoto Ryojun, who dealt with the cholera epidemic at some length in his own memoirs. Among the students at the Naval Training School, Matsumoto figured prominently, in part because of his status as a Tokugawa vassal and Bakufu official but also because he, unlike many of his fellow students, had some knowledge of Dutch and thus was responsible for taking notes of Pompe's lectures and translating them for his fellow students.
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