China and the Cholera Pandemic: Restructuring Society under Mao 0822946629, 9780822946625

Citation preview

CONTENTS

Acknowledgments vii Introduction 3

PART I. GLOBAL PANDEMIC AND MOBILIT Y 1. The Origins of the Epidemic: Migrants and Refugees in Cold War Asia 27 2. Mobile People, Mobile Disease 48

PART II. CONTAGION, SOCIAL DIVISIONS, AND BORDERS 3. Social Divisions, Epidemiology, and Disease Distribution 81 4. Quarantine and Isolation: The Rise of Multiple Borders 111

PART III. PANDEMIC EMERGENCY, DATA, AND SOCIAL S TRUCTURE 5. Comprehensive Inoculation, Rural Rhythms, and Compiling Registers 145 6. Stool Samples, Archiving Patients, and Statistical Politics 174

vi

Contents

7. “No. 2 Disease”: A National Secret 201 Conclusion 225 Glossary 237 Notes 241 Bibliography 269 Index 301

ACKNOWLEDGMENTS

M Y RE SE ARCH IN T ERE S T S IN T HE HIS T ORY OF CON T EMPOR ARY CHINA AF T ER 1949 originated from my childhood experience and memories in my home village in Zhejiang Province in the early 1980s. In the years of China’s transition, rural life still retained the political, economic, and social vestiges of Mao’s era. Meanwhile, those who lived in agrarian contexts in China started witnessing and experiencing radical changes in the postsocialist period. Soon families could afford to purchase a small black-and-white television, so watching television became a new part of rural life. In 1986, news of the space shuttle Challenger disaster in the United States and the televised images of people mourning the loss of the astronauts piqued my curiosity about the world beyond the mountains of Zhejiang Province. I also liked watching international news, and I admired the diplomats I saw on the news programs. But I realized that I might not be smart and handsome enough to be a diplomat. Nonetheless, I enjoyed liberal arts subjects very much during middle school. In particular, I was fascinated with the vivid lectures given by my history teacher. I told my deskmate that I wanted to become a historian. When I later rewatched the video clip of the space shuttle Challenger at the Newseum in Washington, DC, during the Christmas holiday of 2019, I shared my story with my wife and children. I was glad that I followed my heart to pursue the teenage dream of the country boy I was over the past decades. I have been working very hard, while many kind people have helped me in this long journey. For this book, I would like to sincerely thank all of the friends who offered generous assistance during my fieldwork in China from 2011 to 2019, including Zhou Baoluo, Wang Changming, Wang Jian, and Zhou Buguang in Wenzhou; Lang Youxing and Liu Hang in Hangzhou; Ding Lixing in Fuzhou; Shen Huifen in Xiamen; and Zhu Chongke and Chen Liyuan in Guangzhou. Their help was invaluable, particularly when fieldwork in China became increasingly difficult in recent years. I thank all the villagers, cadres of health bureaus, clinic doctors, and veterans who allowed me to interview them. To name just a few, I am especially grateful to Wei Shanhai, Ye Yuguang, Xu Zhijing, Han Yonggang, Sun vii

viii

china a nd the choler a pa ndemic

Fuzhi, Li Chengqin, Huang Suixing, Zhang Wenzhong, Gao Chunchai, Wang Jingfu, You Rongkai, and He Nangao for sharing their stories of life and work in Mao’s era. Even just a few sentences and words from my conversations with these interviewees inspired my analytical frameworks and the research questions that buttress the chapters of this book. I won’t forget the excitement at those moments of inspiration they provided. My archival materials came from many sites, including the Zhejiang Provincial Archives, the Wenzhou Prefectural Archives, the Rui’an City Archives, the Pingyang County Archives, the Yongjia County Archives, the Yangjiang County Archives, the Hangzhou Prefectural Archives, the Chun’an County Archives, the Fuyang District Archives and the Yuhang District Archives of Hangzhou City, the Keqiao District Archives of Shaoxing City, the archives of the World Health Organization Western Pacific Regional Office in Manila, the National Archives of Australia in Canberra, and the Rockefeller Archive Center in New York. All the local gazetteers used in this book were mainly found in the local document departments of the Zhejiang Provincial Library and the Wenzhou Prefectural Library. This book could not have been completed without the generosity of these archive and library staffs, who granted me access to their voluminous collections. I thank my research assistants Sinta Yowendra, Chen Weijie, and Tee See En at the Nanyang Technological University, Singapore, for assisting me in compiling original materials. I started this research at the China Research Center at the University of Technology, Sydney, continued it at the School of Humanities of the Nanyang Technological University, and completed the manuscript for publication at the National Humanities Center in North Carolina. At these institutions, I obtained intellectual stimulation, professional camaraderie, and administrative assistance from many colleagues, including Yingjie Guo, Maurizio Marinelli, Claire Moore, Mi Shih, Cui Feng, Els Van Dongen, Lee Lai To, Li Chenyang, Alethea Lim, Lim Ni Eng, Joseph Liow, Liu Hong, K. K. Luke, Uganda Kwan, Neil Murphy, Ng Bee Chin, Ong Soon Keong, Michael Stanley-Baker, Hallam Stevens, Shirley Sun, Joyce Tan, Ting Chun Chun, C. J. Wee Wan-ling, Yow Chuen Hoe, Zhou Taomo, Brooke Andrade, Ian Burney, Eugene Clay, Sarah Harris, Agnès Kefeli, Jacob Lee, Lynn Miller, Joe Milillo, Tania Munz, and Robert Newman. My thanks go out to the Australian Academy of Humanities, the University of Technology Sydney, the D. Kim Foundation for the History of Science and Technology in East Asia, the Singapore Ministry of Education Academic Research Fund Tier 1 (M4011572 RG146/15, NTU IRB-2016-12-004), and the

Acknow ledgments

Rockefeller Archive Center for providing generous funding to conduct fieldwork and attend international conferences. I thank the Henry Luce Foundation’s residential fellowship for my visit to the National Humanities Center in 2019–2020. Over the years of my research and writing of this work, many scholars have helped me in many different ways. Ng Chin Keong of the National University of Singapore, Louise Edwards of the University of New South Wales, Geoffrey Wade of the Australian Parliamentary Library, Bridie Andrews of Bentley University, Carol Benedict of Georgetown University, Kam Louie of the University of Hong Kong, Andrew Wear of University College London, and Francesca Bray of the University of Edinburgh read either the book proposal, main chapters, or the whole manuscript and offered me valuable suggestions for revisions. My research has also benefited from the assistance of Yongming Zhou of the University of Wisconsin–Madison, Liping Bu of Alma College, Theodore Brown of the University of Rochester, Naomi Rogers of Yale University, Gail Hershatter of the University of California at Santa Cruz, Danian Hu of the City College of New York, Ruth Rogaski of Vanderbilt University, Rachel Core of Stetson University, Raúl Necochea López of the University of North Carolina at Chapel Hill, Zhu Baoqin of Nanjing University, Xu Xiuli of the China Academy of Social Sciences, Yu Xinzhong of Nankai University, Yu Keping of Peking University, Xue Xiaojing of the Zhejiang University of Technology, Dong Guoqiang of Fudan University, Liu Shiyung of Shanghai Jiaotong University, Shen Yubin of Sun Yatsen University, Harry Wu of the University of Hong Kong, Aimee Dawis of the University of Indonesia, Mona Lohanda of the National Archives of Indonesia, Gregory Clancey and Jiwei Qian of the National University of Singapore, Carolyn Brewer of the Australian National University, Florence Bretelle of Paris Diderot University, Sanjoy Bhattacharya of the University of York, Mark Harrison of the University of Oxford, Vivienne Lo of University College London, Leonard Blussé of Leiden University, Lena Springer of Charité Medical University Berlin, Sam Brooks in Chapel Hill, and Victoria Patience in Argentina. At the University of Pittsburgh Press I am very grateful to the editor of the Histories and Ecologies of Health series, Robert Peckham, and acquisitions editor Abby Collier for accepting my book proposal and coordinating the review and publication process; to the five editorial board members for their constructive comments on the proposal and sample chapters; to the two anonymous reviewers for investing a great deal of time in reading the manuscript and giving me very encouraging and valuable suggestions for further revisions; to Amy Sherman and Alex Wolfe in the editorial and production team for their

ix

x

china a nd the choler a pa ndemic

meticulous work. Beyond the press, I wish to thank Maureen Creamer Bemko for her copyediting work and Hilary A. Smith of the University of Denver and Mary Augusta Brazelton of the University of Cambridge for their generous book endorsements. Thanks also go out to the editorial offices of Wenzhou Daily, the People’s Pictorial, and Overseas Chinese Affairs Newspaper; to Huang Ruigeng for permitting me to reproduce figures; to Zhang Jiayu for making the maps in this book; and to SAGE Publishing for granting me permission to reuse portions of my article “Mass Inoculation and Rural Rhythms: Local Agents, Population Data, and Restructured Social Systems during the Cholera Pandemic in China, 1962–1965,” published in Modern China (July 2020): 1–32, copyright © [2020] (Xiaoping Fang), https://doi.org/10.1177/0097700420935373. Like their fellow villagers of similar ages, my parents do not wholly understand the significance of academic studies of Mao’s China, though they have clear memories of and personal opinions about that era. They know my work is important and show their unfaltering support. In the busiest time of my writing process, my mother came to Singapore to take care of my family, which allowed me to concentrate on my research. I owe a great debt of gratitude to my wife, Huajuan He, for her sacrifices for our family and my work over the years. But we are delighted to see the growth of our two children and the publication of this book. I fulfilled my promise to my daughter, Xinlin Fang, when I dedicated my second book to both her and her little brother, Xinyi Fang, after he was born. When I finalized the manuscript for publication in the spring of 2020, the unprecedented COVID-19 pandemic was ravaging the world. I experienced quarantine, social panic, and the politics of epidemic information—the same things that I have analyzed in this book. As a historian who studies epidemics, I never imagined that I would have such a direct personal experience of these issues. I wish that I had not had such an opportunity. I have never before understood so profoundly the value of life and freedom as I do today. I wish all of you the best.

Map 1. Locations of Makassar, Indonesia, as well as Yangjiang County, Guangdong Province, and Wenzhou Prefecture, Zhejiang Province, in China

Map 2. Locations of Zhejiang Province and Wenzhou Prefecture in China

Map 3. Wenzhou Prefecture, Zhejiang Province, China, with inset map showing the whole of Zhejiang Province

China and the Cholera Pandemic

INTRODUCTION

O N J U N E 28, 19 6 2, S I X T Y-T H R E E -Y E A R - O L D C H E N A Z H U W E N T O U T S H O P P I N G , having said good-bye to her daughter-in-law, who was visiting the family from Shanghai Municipality. Chen and her husband lived a simple, lonely life at Xihetou Lane in Rui’an, a coastal county town in Wenzhou Prefecture, Zhejiang Province, China. Their days followed a predictable pattern: purchasing food from the nearby farmers’ market in the morning and staying at home in the afternoon, sometimes chatting with neighbors in the lane. Beyond their doors, however, Rui’an County, along with other parts of southeastern coastal China, was undergoing significant changes that month. The effects of the Great Famine still lingered, but the majority of internally displaced people had returned to their hometowns. With the end of the rainy season and the coming of high summer, the busiest agricultural season was about to begin—shuangqiang, or the quick harvesting and quick planting of rice crops. Grain production was especially important that year, as this fragile society had suffered hunger, disease, population flight, and death over the previous few years. Furthermore, Rui’an’s location on the southeast coast placed the county at the front lines of a new military threat. The Communist government had released an urgent circular calling on people to be prepared for war, to enhance their vigilance, and to step up the fight against the attempts by Chiang Kai-shek’s Nationalist government in 3

4

china a nd the choler a pa ndemic

Taiwan to, “Reclaim the Mainland,” per the title of a patriotic tune. In response, the People’s Liberation Army (PLA) was marching to the southeastern coastal front in unprecedented numbers. Although she lived in this fragile, frightened society, Chen Azhu was just an ordinary woman who never imagined that she would trigger a major social panic. However, on July 4, six days after her daughter-in-law left, Chen suffered serious abdominal pains and more than ten bouts of vomiting and diarrhea. She was admitted to the hospital on the second day of her illness with a preliminary and hotly contested diagnosis of suspected cholera. With the assistance of epidemiologists who had been urgently summoned from the Provincial Sanitation and Epidemic Prevention Station on July 16, it was finally confirmed that Chen was suffering from El Tor cholera (Vibrio cholerae El Tor), the first identified case in the area. In the days between her first symptoms and diagnosis, cholera had spread rapidly through Rui’an and its neighboring counties and cities within Wenzhou Prefecture. Her case was part of a global cholera pandemic. The disease broke out in 1961 in Makassar on Sulawesi Island (or Celebes), Indonesia. It quickly spread to Indonesia’s other islands, then to Sarawak and Sabah on the island of Borneo, and to other Southeast and East Asian countries. The outbreak had reached India and the Middle East by 1966 and then continued on to Europe, Africa, and the Americas, becoming the seventh global cholera pandemic in recorded history. It continues in many parts of the world today and is the same catastrophic disease that Nepalese United Nations peacekeepers brought to Haiti in 2010.1 In China, the disease first struck in Yangjiang County, Guangdong Province, in June 1961. Indonesian Chinese had returned to China during the archipelago’s pandemic to escape political, economic, and racial tensions between Indonesians and Chinese and were immediately suspected cholera carriers. Eight months later, in February 1962, cholera reemerged in Guangdong and from July 1962 onward affected southeastern coastal China, spreading rapidly through Zhejiang, Fujian, Shanghai, and Jiangsu. Following a large-scale but clandestine medical campaign, the pandemic had been contained by 1965. As a public health emergency, the 1961–1965 pandemic emerged and spread through southeastern coastal China in a very specific sociopolitical context. Before the pandemic hit, the Great Leap Forward of 1958–1960 had moved millions of peasants into communes in a misguided attempt to rapidly collectivize agriculture. It caused the catastrophic Great Famine of 1959–1961. The devastation of the Great Famine persisted into the early 1960s, while China’s

Introduction

paramount leader, Mao Zedong, appeared to have retreated somewhat from his “bullying and erratic leadership” that had directly produced the Great Leap debacle.2 In local politics, the Communist government committed itself to social restructuring in order to overcome the political crisis and reconsolidate its rule.3 Accordingly, the government undertook a number of crucial initiatives. It reformed and strengthened its control of population mobility through the household registration system (hukou) and the identification of all citizens with either a work unit (danwei) or a people’s commune. It reinvigorated social surveillance mechanisms, conducted more political indoctrination programs, and further implemented economic strategies and policies that it had initiated in the early 1950s. In so doing, it consolidated a strict division between rural and urban areas, which I refer to in this book as the “rural/urban duality.” This social restructuring in the early 1960s brought about a transition from the chaotic population movement that was characteristic of the Great Leap Forward years to orderly mobility in the more sedentary postfamine society. Rural people, who made up the vast majority of China’s total population, found their communities comprehensively and significantly restructured when the government formally downsized the People’s Commune system—a change that was further enhanced by new mechanisms for social control, payment, and welfare, such as letters of introduction, work points, and grain coupon schemes. The government also launched a series of rolling campaigns to target political, social, and ideological enemies while indoctrinating the people. Similar restructuring based on the work unit scheme also extended to nationalized factories, government-controlled bureaus, hospitals, and schools in urban society.4 In 1966, a year after the pandemic was brought under control, China’s most radical political campaign was launched: the Cultural Revolution. The state’s dominance in work, life, production, and consumption was brought about by social restructuring in the postfamine period under scrutiny in this book. It continued largely intact until the Reform and Opening Up era that commenced in December 1978. This sociopolitical change was complicated by the geopolitical position of the People’s Republic of China (PRC) within the international community at the peak of the Cold War. In the early 1960s, China’s contact with the outside was mainly confined to the socialist bloc and a few developing countries. China was isolated from the West and from major international institutions such as the World Health Organization (WHO). In this international context, China reshuffled its geopolitical and ideological interests and faced clashes and serious conflicts with its neighbors in Southeast and East Asia. These included the

5

6

china a nd the choler a pa ndemic

Indonesian Chinese nationality issue and Chiang Kai-shek’s military preparation for his “Reclaiming the Mainland” campaign. This external environment both challenged and reinforced the post–Great Leap social restructuring process. On the one hand, the absence of international coordination for health emergencies was problematic, and external affairs prompted the rise of a mobile society in coastal areas, including the arrival of PLA soldiers, interprovincial flows of fishermen, and visits from overseas Chinese. On the other hand, international responses also triggered further restructuring initiatives, such as political indoctrination, military mobilization, and propaganda campaigns justifying the ideology and legitimacy of Communist China. Under these circumstances, the global cholera pandemic and the restructuring process interacted reciprocally in the early 1960s. China and the Cholera Pandemic: Restructuring Society under Mao investigates the dynamics between disease and social restructuring in the significant transitional years of Mao’s China. It adopts an analytical framework that focuses on three major issues—disease and mobility (the movement of both people and pathogens), social divisions and borders (created by social reorganization and interventionist cholera prevention measures), and data and social structure (drawing on household registration, agricultural production figures, and epidemiological information)—and seeks to examine the following questions: Disease and mobility: How did transnational politics and domestic social restructuring lead to specific forms of population mobility and contribute to the outbreak and transmission features of the cholera pandemic? Social division and borders: How did the social divisions and borders created by the restructuring of society and politics that began in the 1950s and strengthened from 1961 onward shape epidemiology and facilitate quarantine and isolation? Conversely, how did control measures strengthen social restructuring during the pandemic? How did the consolidation of social divisions and the rise of multiple borders during the pandemic reflect the features and problems of social restructuring? Data and social structure: How did the integration of epidemiological information with household and production data (i.e., household registration and accounting books) contribute to the rise of the new comprehensive social order via a specific form of statistical politics in Mao’s China? What characteristics of the social restructuring process are revealed by the large-scale but clandestine anticholera campaign,

Introduction

which focused on comprehensive inoculation, disease surveillance, and pandemic information? This study argues that the global cholera pandemic was more than just a health incident in China—it was also, more importantly, a significant social and political exercise. Disease and its control were not only affected by the social restructuring that began in the 1950s and strengthened from 1961; they were integral components of it. And, to some extent, the disease and its control even prompted experimentation with possible alternative social structures. These sociopolitical changes facilitated the emergence of a sedentary rural society and, simultaneously, the rise of a mobile coastal society that would shape the features of cholera transmission and social epidemiology during the pandemic—namely, the emergence of rural/urban, male/female, and military/civilian divides. The interventionist prevention scheme to control the pandemic not only harnessed opportunities provided by the broader social restructuring initiatives but also directly contributed to them. The role of social, production, and epidemiological data in this reciprocal process further enhanced social control and political discipline and facilitated the formation and top-down imposition of a new, wide-reaching social structure via a specific form of statistical politics. This impacted government systems, local cadres, medical professionals, and the ordinary masses. The global cholera pandemic significantly contributed to the rise of an emergency disciplinary state in China through the integration of health governance and political governance. However, the efforts to contain and control the pandemic were plagued by problems resulting from the rural/urban divide and other gaps and hierarchies created by the broader social restructuring programs. Within the analytical framework of reciprocal interactions between disease and politics, this study of the cholera pandemic, with a specific focus on the Wenzhou area, advances both empirical and theoretical knowledge concerning disease and social restructuring in China studies and in the history of medicine. The book presents a nuanced and detailed sociopolitical, global, and medical history of a previously unexplored aspect of socialist China between the two most radical political events of the Maoist era: the Great Leap Forward and associated famine (1958–1961) and the Great Proletarian Cultural Revolution (1966–1976). Shifting from high politics to local politics, this research not only shows the sociopolitical history of grassroots society in the transitional and transformative years from 1961 to 1965 but also demonstrates the multifaceted and sophisticated

7

8

china a nd the choler a pa ndemic

relationship between Cold War politics, the transnational population movement, diasporic groups, and the global pandemic. It also sheds new light on Chinese Communist Party governance and social control/organization, which contributes to current scholarship in the fields of the sociopolitical history of China and Mao’s China in particular. From a medical history perspective, this study of the global cholera pandemic outbreak sheds light on the rise of health emergencies, the formation of health governance, and the development of pandemic surveillance under socialism in the context of public health, state medicine, and nation-building in China since the early twentieth century.5 This book also contributes to a growing body of medical history literature about the role of infectious diseases in the development of social and political structures in other locales, exemplified by studies of cholera in Europe and North America (mainly before 1900), colonial medicine in Asia from the nineteenth century to the early twentieth century, and cholera in Africa and South America since the 1970s.6 The study also presents a new understanding of epidemic history that is located at the intersections of sociopolitical, environmental, and economic histories.7

DISEASE AND MOBILIT Y Throughout the world, including China, population mobility and displacement resulting from wars, rebellions, and social and political chaos have often led to the outbreak of pandemics.8 The intensification of human interaction commenced in the early nineteenth century due to expanding global trade, warfare, pilgrimage, and migration, all facilitated by more rapid transportation methods, and together these increased the spread of diseases.9 The cholera pandemics in China from 1817 to the early 1900s occurred in a global context in which large parts of the world faced the full chaotic impact of Western imperial and colonial aggression. In 1817, the first global cholera pandemic emerged in the Gangetic Plain in India and spread throughout the world along the routes established via Western imperialist expansion. 10 According to Wu Lien Teh and Kerrie MacPherson, the first cholera pandemic reached China both by land—from India and the borders of Tibet and southwestern China—and by sea—carried to Burma by the British military in the British Burmese War in 1820. It then spread to Guangzhou via Bangkok and from there to the Yangtze delta areas by sea. By 1821, cholera had arrived in the capital, Beijing, which became the new center of cholera in northeastern Asia.11

Introduction

At the start of the twentieth century, further radical global disruptions caused large-scale population movement and resulted in the outbreak and spread of cholera. By 1932, there had been forty-six documented outbreaks of cholera of varying intensities, and there was no single year in which cholera was absent in China.12 Plague transmission is another representative case: after 1908, large numbers of rural coolies and migrant workers from Shandong migrated into Manchuria—which was contested by Japan, Russia, and the late Qing dynasty—to hunt the Tarbagan marmot for its fur. The migrants, who were “accused of neglecting anti-plague precautions taken by native hunters in harvesting marmot fur,” were believed to have triggered the outbreak of the great Manchurian pneumonic plague epidemic of 1910–1911.13 From the late 1930s onward, the movement of troops and armies caused by World War II and the Chinese Civil War led to cholera and other diseases spreading once again.14 After 1949, Mao’s China saw a new system of population mobility, one that shaped the specific features of the 1961 pandemic. It is generally argued that virtually no migration took place in China between the Communist victory in 1949 and the initiation of the Reform and Opening Up policies in 1978. Historians have called these three decades the “static decades” because of the household registration and work unit systems, which reduced population mobility to a minimum.15 However, this does not mean that there was no population mobility at all. Current scholarship has noted that the state directed and controlled substantial internal migration during those three decades for the purposes of economic development and transforming ideological beliefs; there were relocations and labor migration for industrial projects, migration to support the borders, and even migration as a form of punishment.16 In geopolitical terms, China, though isolated from the West, was committed to establishing partnerships and increasing its political, military, and ideological presence in developing and socialist countries.17 This engagement also brought about some degree of international population mobility. Mao’s China was generally characterized as being a sedentary society with limited and orderly population movement. However, some basic facts still should be noted about the features of this population mobility. In the 1950s, Chinese society experienced large-scale, uncoordinated population mobility mainly because of national industrialization projects and loose population management. Meanwhile, unorganized, uncontrolled, and spontaneous migrations still occurred, like peasants who made their way to cities, migrations between rural areas, famine-related migrations, and the movement of refugees.18 By the early 1960s, however, China had become an

9

10

china a nd the choler a pa ndemic

essentially immobile society. The transformation from large-scale and uncoordinated movements in the early 1950s to limited and orderly population mobility in the early 1960s is one of the most significant features of these crucial transitional years between the Great Leap Forward and its associated famine and the Cultural Revolution, when the cholera pandemic ravaged southeastern coastal China. As this study shows, the transformation of population mobility was entwined with the three thorny tasks that the Chinese government faced in the early 1960s—dealing with the postfamine crisis, restoring social order, and preparing for the war. Although the famine was approaching its end in late 1961 and early 1962, hunger, disease, and death were still affecting some areas of China. Rural migrant workers who rushed into urban areas for employment and drifters who had left their homes due to hunger during the Great Leap Forward and associated famine were “repatriated” to their places of origin, while some urban workers were sent to rural areas as part of economic reconstruction. In the process, the rural/urban divide was further reinforced. Meanwhile, the household registration and work unit systems were implemented in a more comprehensive manner and the People’s Commune system was adjusted so that the government could regain control of the economy and the vast rural society. The household registration system, which started in 1958, is an institutional exclusion scheme that assigns every Chinese citizen a geographically defined location and an associated sociopolitical status and identity, practically for life. The work unit system is a hierarchy of state-owned workplace allocations that provides economic benefits and implements political control. The People’s Commune system was a form of collective organization of agricultural production and life for peasants. These three systems were the basis of the sociopolitical structure in Mao’s China and effectively restricted the physical mobility of populations, confined the rural population to villages, and consequently formed an immobile and enclosed society.19 Limited, orderly population movement gradually emerged as a defining social feature of the consolidation of this rural/urban duality. In contrast to the largely static regular population, troop maneuvers along the coast opposite Taiwan meant that the PLA was highly mobile, and together with the visits of overseas Chinese and the interprovincial flow of fishermen, southeastern China had a relatively complex population mobility scenario. Internationally, the Cold War entered a new stage in the early 1960s. China’s geopolitical partnership with countries in the Non-Aligned Movement proved to be fragile. The radical change in Sino-Indonesian relations around the issue of

Introduction

the dual nationality of Indonesian Chinese unexpectedly caused transnational population movements between Indonesia and China in 1959–1961.20 One of the key factors behind this was the movement of Indonesian Chinese, who became suspected carriers of cholera, causing it to escalate from an endemic disease in Indonesia to a global pandemic that spread into southeastern coastal China in 1961. At this point, the population mobility modes described above and complicated by Chinese national politics shaped the spread of the new pandemic, at least in China.21 The impact of national and transnational political changes on disease and mobility in 1961–1962 comprises the first subtheme of this book.

SOCIAL DIVISIONS AND BORDERS The household registration, work unit, and People’s Commune systems were the three crucial, integrated parts of the social restructuring initiated in the 1950s. These systems were further significantly adjusted and strengthened in the early 1960s and became the cornerstones of the social structure in Mao’s China in the following two decades. This social restructuring brought about some immediate results, notably the rise of social divisions and borders, which had major impacts on social epidemiology, quarantine, and isolation during the cholera pandemic in southeastern coastal China in 1961–1965. As scholars in the field of the history of disease have argued, diseases reflect inequality in different social settings, including class, income, social geography, occupation, age, and gender. In particular, the distribution of diseases in infected areas is affected by social class, as people’s chances of getting an infection are shaped by living standards, housing conditions, and hygienic habits. The social distribution of diseases among different social classes has always been uneven.22 For example, the third global bubonic plague pandemic (1894–1950) struck hardest among the poor. In countries with large numbers of poverty-stricken people, plague broke out repeatedly, and mortality rates were usually very high.23 Cholera was another disease that was typically associated with the poor. In his studies of the cholera pandemic in Hamburg in 1892, Richard Evans argues, “Cholera, more than most diseases, indeed, was the product of human agency, of social inequality and political unrest.”24 As a waterborne epidemic disease, cholera usually spread among the lower social classes, who congregated in areas without clean water supplies and basic sanitation infrastructure. For instance, as Charles E. Rosenberg points out, “the majority of the 853 cholera victims in Baltimore in the summer of 1832 were of the ‘most worthless’ sort.”25 Similarly, Margaret Pelling finds that “the

11

12

china a nd the choler a pa ndemic

worst-conditioned parts of the population would be most subject to the disease [cholera]” in England during the mid-nineteenth century.26 This characteristic continued into the seventh cholera pandemic, in the twentieth century. As Oscar Felsenfeld pointed out in 1965, “the present El Tor outbreak is restricted to poor people inhabiting bustees and slums, to off-shore fishermen living under bad sanitary conditions and to boat dwellers with less than minimal sanitary facilities.”27 In China, there has been repeated criticism of the inequitable distribution of medical services under the rural/urban social structure because it tends to discriminate against peasants, who suffer disadvantages in terms of social class and income. The most representative of these criticisms are Mao’s 1965 critique of the Ministry of Health and, in more recent years, social commentators’ and scholars’ criticism of the extreme marketization of medical services at the turn of the millennium.28 However, to date there has been no empirical study of social epidemiology and disease distribution between the rural and urban sectors since 1949. Current scholarship is limited to broad critiques of the system’s unfairness toward rural dwellers. In fact, the inequities in the provision of medical services and the resulting social epidemiology and disease distribution are gradual processes. As this book indicates, there was little noticeable difference between rural and urban epidemiology and disease distribution as late as 1949. Among other things, medical resource distribution and sanitary environments were not dramatically different between rural and urban areas in China, except for treaty ports and major cities, such as Tianjin, Shanghai, Guangzhou, and Chongqing.29 However, from the mid-1950s onward, the distribution of medical resources, the implementation of the medical welfare scheme, and sanitary infrastructure projects gradually had an impact on social epidemiology and disease distribution, but urban residents were the primary beneficiaries. Moreover, the various administrative levels, such as prefectural city, suburban areas, county towns, and rural districts, demonstrated a hierarchy of morbidity rates, mainly due to differentials in their sanitary environments and medical resources. As this book shows, the incidence rates in urban areas were usually lowest, while rates of disease in rural areas were the highest. The cholera pandemic in 1961–1965 therefore showed both a widening divide and the increasingly hierarchical character of incidence rates between rural and urban areas. Government investment patterns played a crucial role in this process. The social restructuring that began in the 1950s and was strengthened from 1961 onward not only brought about social divisions between rural and urban areas but also gave rise to specific gender-based and military/civilian divisions.

Introduction

Women’s liberation, which was proclaimed and promoted by the government after 1949, contributed to the feminization of agricultural production in China and resulted in specific illnesses among women as a result of onerous labor undertaken since the Great Leap Forward of 1958–1960.30 However, the gendered impact of these agricultural production changes on the social epidemiology of disease outbreaks and pandemics has not yet been studied sufficiently, not to mention women’s participation in epidemic prevention and treatment campaigns. Cholera was one of the most common and most devastating acute infectious diseases to affect China, and the 1961–1965 pandemic arrived shortly after women began to participate in agricultural production on a large scale. Consequently, this pandemic is an excellent case for furthering our understanding of the dynamic relationship between gender and disease in Mao’s China, including women’s vulnerability to epidemics and their active roles as medical practitioners and health-care workers. The cholera pandemic is also an ideal case for analyzing social epidemiology and disease distribution in terms of military/civilian divisions. As this book shows, the conjunction of a disease pandemic with active troop mobilization in the same geographic locality enables us to see differentials between soldiers and citizens from a historical perspective. The cholera distribution in 1961–1965 was sharply divided between the military and civilians: strong soldiers on the one hand and weak civilians on the other. The differences were due to different physiques, nutrition, and medical care, all of which were significantly shaped by broader sociopolitical changes since the 1950s and strengthened by the “Preparation for War” campaign during the pandemic. In the meantime, it should be noted that environmental and ecological change had been another crucial factor in shaping rural/urban, gender-based, and military/civilian divisions during the cholera pandemic in 1961–1965. As Robert Peckham argues, epidemics are “environmental events produced by the stresses of these natural, economic, social, and political convergences.” He points out that, to some extent, epidemics should be understood as the outcome of environmental crises.31 As this book indicates, population pressures affected the environmental and ecological system in Wenzhou after 1949, which contributed to the outbreak of cholera and shaped its distribution. The environmental change brought by the new cropping system also increased women’s exposure to cholera. In contrast, military camps were protected from the contaminated environment and cholera. Furthermore, epidemics are “episodes that foreground the convergence of human and natural ecologies.”32 As this study shows, typhoons,

13

14

china a nd the choler a pa ndemic

rainstorms, and floods in the summer of 1962 also played a specific part in the transmission of cholera. While social restructuring brought about rural/urban, gender-based, and military/civilian divisions, it also created a system of internal borders. Social divisions combined with specific aspects of grassroots social organization to create an additional layer of borders within the new social structures. Production brigades and work units became China’s basic sociopolitical units in rural and urban areas, respectively. Commune members and their families were confined to this integrated grassroots organization of production and life, while urban residential spaces were characterized by individual and family dependence on work units.33 For example, the urban neighborhood—run by a work unit—was the hub of the redistributive network in the socialist urban economy. This neighborhood group performed crucial government functions, instituting social order in a spatial, administrative, and political formation.34 These rural and urban organization units therefore shared three key features—compositional homogeneity, economic egalitarianism, and political surveillance, as this book explores. These characteristics of the organizational units that emerged with China’s social restructuring contributed to the rise of the concept and implementation of internal borders between and among rural and urban residents. These borders further interacted reciprocally with disease quarantine and isolation processes. They were adopted to combat the cholera pandemic in 1961–1965 as two key components of classic interventionist approaches, though their effectiveness was called into question by the World Health Organization in April 1962.35 Nevertheless, the policing of new social borders created a dynamic relationship between quarantine, isolation, and social restructuring. The social structure of 1950s and 1960s China and the newly drawn borders within the country facilitated the implementation of quarantine by creating social homogeneity, economic egalitarianism, and political surveillance within these designated groups. Establishing a quarantine zone in the 1960s also helped consolidate the new borders created by the government. In her work on the role of quarantine in the formation of Australia as a nation in the early twentieth century, Alison Bashford argues, “Quarantine, more than any other government technology, is the drawing and policing of boundaries. Boundaries are required for the creation of nations in a modern Western sense, and quarantine is, in essence, the putting of these boundaries to a particular use by the administrative nation-state. Quarantine and national administration produce and monitor the same space: that is, the border of a nation has often been where a quarantine line was drawn. This

Introduction

same border might well have a military, political and economic significance.”36 Bashford further explains that the border of a quarantine zone contributed to a new Australian identity. Public health management, quarantine in particular, can shape and inform national identities. As she puts it, “the maritime quarantine line was one important way of imagining Australia as a whole, as the island-nation it was.” The new nation was further strengthened through the effective coordination and assessment of quarantine measures.37 In this sense, quarantine and isolation could be interpreted as a synchronized process of nation-state building. Under some circumstances, the border solidified by quarantine and isolation illustrates both the national and racial dimensions of implementing medical inspections and immigration regulations. As Alexandra Minna Stern points out in Eugenic Nation, a protracted and aggressive quarantine along the U.S.-Mexican border scrutinized and racialized the bodies of Mexican immigrants during the first half of the twentieth century. The medicalization and militarization of the borders under the authority of the U.S. Border Patrol created “a regime of eugenic gatekeeping on the U.S.-Mexican border that aimed to ensure the putative purity of the ‘American’ family-nation while generating long-lasting stereotypes of Mexicans as filthy, lousy, and prone to irresponsible breeding.”38 Bashford’s and Stern’s arguments lead us to understand quarantine and isolation in the cholera pandemic of 1961–1965 in the sociopolitical context of China. As this book reveals, quarantine and isolation symbolized the rise of multiple borders in both the cholera pandemic itself and the social restructuring that took place during the pandemic. During this process, natural, administrative, military, and quarantine borders overlapped or were reclassified and further strengthened. However, the practice of enforcing multiple borders also brought problems. In particular, quarantine and isolation procedures were unable to identify suspect cholera carriers as effectively as expected. Nonetheless, these two “intrusive intervention” approaches of infectious disease surveillance brought about coercion and interfered with personal rights and freedoms, which had already been constrained by the sociopolitical control schemes.39 As the most crucial element of public health emergency response, these interventionist measures also functioned as social control mechanisms and significantly contributed to the rise of an emergency disciplinary state during the cholera pandemic. In this way, quarantine and isolation played a part in the social restructuring process and then strengthened the borders that had been recently created and reclassified. In the meantime, the formation and strengthening of new borders was not a seamless process during the pandemic. Social class differences that formed

15

16

china a nd the choler a pa ndemic

during the broader social restructuring process introduced distinctions based on hierarchy, privilege, and status into quarantine practices and sometimes resulted in evasion. These hierarchies further complicated the implementation of quarantine and isolation in relation to these multiple borders and revealed the limit of the emergency disciplinary state during the pandemic. Social epidemiology and interventionist approaches to cholera prevention (i.e., quarantine and isolation) seen from the perspectives of social divisions and borders constitute the second subtheme of this book.

DATA AND SOCIAL S TRUCTURE The cholera pandemic of 1961–1965 gave rise to a new channel for strengthening the restructuring programs by integrating social and production data (i.e., household registration and accounting registers) with pandemic data. As this book shows, within the borders created by social restructuring and the quarantine and isolation schemes, the government faced the immediate, crucial task of implementing comprehensive inoculation programs and managing epidemic information, both of which involved large quantities of population data. In terms of comprehensive inoculation, effective control of disease in the population required, as Katherine Mason has argued, “accurate biostatistics that provided scientific truths about the population and a reliable means of sharing those statistics.”40 Both population data and local agents (for sharing information) are indispensable factors for successful inoculation efforts. Local administrative systems played a crucial role in these programs and determined their success or failure, which was illustrated by different cases in different sociopolitical settings in modern China and Asia. Typical contrasting examples of this occurred in Manchuria and Taiwan under Japanese colonial rule before the mid-twentieth century. In some Manchurian villages, because of the scarcity of adult men to serve as local agents, old, fragile women and children resisted the Japanese inoculation program.41 In contrast, on the island of Taiwan a similar public health intervention was much more successful because headmen and local police served as local agents and helped round up targeted populations for the Japanese sanitary police corps. 42 Similarly, as Warwick Anderson points out, American public health bureaucrats controversially attempted a Filipinization of health service to solve the passive resistance of Filipinos to the new order of colonial hygiene in the Philippines in the early twentieth century. 43 A similar situation occurred in China in the early twenty-first century. As

Introduction

Mason found in her fieldwork in Tianmai (her pseudonym for a large, cosmopolitan city), the lack of information on migrant workers and the absence of mechanisms with which health officials could engage with their communities posed serious challenges to disease control and inoculation. Medical professionals from the Municipal Center for Disease Control still needed to rely on traditional guanxi (i.e., a network of mutually beneficial relationships) to work with district- and street-level public health institutions and connect them indirectly to factory bosses and village leaders, who had communication channels through which to contact migrant workers.44 These examples of inoculation and public health practices led me to explore the comprehensive inoculation campaign launched during the cholera pandemic of 1961–1965 through population data and from the perspective of local agents during the integration of the medical and administrative systems. As this book shows, cadres, household registration, and accounting registers acted as local guides and sources of population data that would facilitate inoculation programs in villages during the pandemic. More significantly, the comprehensive inoculation campaigns also directly contributed to broader social restructuring by generating inoculation registers and certificates. These campaigns involved the administrative and medical systems while combining social, production, and epidemiological data in a reciprocal process. Comprehensive inoculation enabled social control, facilitated the imposition of a new top-down and far-reaching social structure, and contributed to the formation of an immobile society. The inoculation program also contributed to the broader social restructuring goals of the central PRC government by extending social control and performing political and social experiments. Thus, as a significant element of the public health emergency response, comprehensive inoculation effectively played the role of biopolitical and population control and greatly facilitated the rise of the emergency disciplinary state during the pandemic. However, it should be noted that, like quarantine, the effectiveness of cholera inoculation was called into doubt by the WHO as of April 1962.45 Nonetheless, the cholera inoculation campaign was launched throughout Mao’s China. In this sense, the inoculation campaigns of 1961–1965, presented as an exercise in public health protection, were instrumental in achieving the government’s goal of social and political reorganization. Like the comprehensive inoculation campaigns, the management of epidemic information also played a crucial role in the social restructuring by collecting data and controlling the public. Information about the epidemic was significant throughout the history of the state and government in the twentieth century.

17

18

china a nd the choler a pa ndemic

In his path-breaking book A Passion for Facts, Tong Lam argues, “We take it for granted that the gathering of social facts is indispensable to everyday life, and even more so when it comes to governance.” Lam regards the production of social facts as a crucial activity for China’s new nation-building process from the early twentieth century onward. In his opinion, such “investigative modalities,” which included censuses, ethnographic studies, sociological surveys, and similar modes of knowledge production, were all technologies of the modern state. They not only involved collecting empirical facts but also served governing purposes through the ordering, classification, calculation, preservation, and circulation of facts. By fundamentally transforming the nature of governance, the production of such facts aimed to make the complex human world appear knowable and manageable. As new governance technologies, social surveys symbolized China’s transformation from a dynastic empire to a nation-state.46 After 1949, statistical work gradually became an indispensable part of the nation-state building process in China. As Arunabh Ghosh argues, the midcentury statistics mainly developed in the context of the overwhelming drive toward the modernization of statecraft. There were two principal means of statistical data collection: the complete enumeration periodical report and the survey based on typical sampling.47 Moreover, the formation of preliminary and imperfect epidemic information management systems in the mid-1950s was significant in Chinese historical epidemiology because epidemics were recorded irregularly in Chinese medical history using vague terms like yi, wen, and zhang (referring to epidemic diseases). There were no standardized records of types, etiologies, and symptoms.48 Mirroring these deficiencies in epidemiological records in imperial China, there has been criticism over the intentional secrecy around epidemic statistics in contemporary China. In the discussion around the SARS pandemic in 2002–2003, scholars and social commentators attributed the outbreak and spread to the fact that, in the early stages, the Chinese government covered up information about the epidemic.49 Scholars have noticed that it is in the nature of authoritarian governments to control information because “Communist China had a long history of obsession with secrecy.”50 This does not mean that China is devoid of a mass communication system, but it is true that the government tends to keep epidemic information confidential. In fact, the Chinese government “often creates asymmetric information system[s], that is, top leaders have access to abundant information while ordinary people are provided with little information.”51 The many reasons for censoring epidemic information include fear of social panic and economic disaster.52

Introduction

However, the politics of epidemic statistics between imperial and twenty-first-century China are still unexplored. This study of the cholera pandemic in 1961–1965 addresses this vacuum because the epidemic statistics scheme and the politics established in this pandemic shaped the politics of pandemic information in Mao’s China and in subsequent decades. As this book argues, the establishment of a bottom-up epidemic information collection scheme integrated the grassroots medical and sociopolitical systems through the process of the broader social restructuring that was taking place simultaneously. This restructuring was in turn reflected in the institutionalization of the medical system, the medicalization of the administrative system, and the epidemiological categorization of populations. This finding contributes to the comparative understanding of epidemic statistics in other sociopolitical settings, both past and present. As Myron Echenberg argues, “statistics for cholera cases and deaths in the nineteenth century are impressionistic and serve only to provide a qualitative picture.”53 By the early twenty-first century, cholera cases were still being underreported everywhere due to their confusion with other cases of acute diarrhea, as well as denial and fear. According to WHO, “Annual global case and fatality rates [are] at least ten times higher than annual official reports indicate.” In particular, cholera is significantly underreported in Asia.54 My examination of epidemic statistics schemes in the cholera pandemic further explores the historical origins of the traditional secrecy around epidemic statistics in contemporary China. As this book shows, the term “No. 2 disease” was created to control cholera epidemic information from the top down in order to maintain social order, justify the CCP’s legitimacy, and prevent mass panic. More significantly, epidemic information was not simply biodata but was also endowed with the political functions of disciplining and indoctrinating local cadres, medical professionals, and the general public in the sociopolitical contexts of social restructuring. All these factors therefore shaped the politics of epidemic statistics in Mao’s China, which also functioned as an isolated nation in a global health community in the cholera pandemic of the early 1960s. In general, the politics of epidemic statistics, as the crucial component of the government’s public health emergency response, significantly contributed to the rise of the emergency disciplinary state through the collection and control of epidemic information. As a consequence, inoculation campaigns and epidemic information, viewed from the perspective of data and social restructuring, make up the third subtheme of this book.

19

20

china a nd the choler a pa ndemic

ME THODOLOGY, MATERIAL S, AND THE S TRUCTURE OF THIS BOOK This book traces the spread of the cholera pandemic from Makassar, Indonesia, to Guangdong Province, China, in 1961, before focusing on Wenzhou Prefecture, Zhejiang Province, in southeastern coastal China, for the duration of the 1962– 1965 outbreak there. I chose to center my study on Wenzhou Prefecture simply because the incidence of cholera in that area was the highest in southeastern coastal China, according to the statistical data available, and Zhejiang was also among the provinces with the highest incidence of the disease out of all those affected by cholera at the time (Guangdong, Fujian, Zhejiang, Shanghai, and Jiangsu).55 El Tor cholera first appeared in Rui’an County in Wenzhou Prefecture on July 5, 1962—this was the first cholera case in Zhejiang Province. By the end of 1962, there were 10,747 reported cases of El Tor cholera and 606 people had died in the Wenzhou area. The figures were much higher than those in Guangdong and Fujian Provinces, in which there were 8,666 and 3,975 reported cases, respectively. The cholera cases in Rui’an County, Pingyang County, and Wenzhou City accounted for 97 percent of the total number within Zhejiang Province.56 Wenzhou Prefecture is at the northern end of China’s southeast coast and is adjacent to the southern end of the Yangtze River region in terms of division of socioeconomic macroregions. Since the 1950s, Wenzhou’s large coastal regions and extensive river and delta access have endowed it with specific geopolitical significance. The Nationalist government based in Taiwan regarded it as the bridge across which it would “Reclaim the Mainland,” while the Communist government identified Wenzhou as the frontier of anti-imperialism and anti– Chiang Kai-shek groups. The military confrontation between the Nationalists and Communists reached its peak in 1962, precisely when the cholera pandemic was ravaging Wenzhou Prefecture. In this sense, Wenzhou functioned as a front line in the Nationalist-Communist conflict amid the wider Cold War in Asia. To further complicate this situation, many overseas Chinese were from Wenzhou and Zhejiang, though the latter was nowhere near as significant in that regard as Guangdong and Fujian Provinces. People who had migrated to Hong Kong, Macau, and Indonesia from Wenzhou came back periodically to visit throughout the 1950s and 1960s. The ways that cholera affected Wenzhou, as the center of the epidemic, and the ensuing emergency response scheme came to be reflected throughout other areas of southeastern coastal China, through illness itself or the cascading social and economic impacts.57 Any study of the history of disease and epidemics in China after 1949 faces

Introduction

immediate difficulties and challenges related to accessing original materials of any sort, not to mention those on pandemics. The Communist government recorded in official internal files all disease and epidemic information, including minutes of meetings, investigation reports, work reports, and policy documents kept by different levels of the party committees and governments from 1949 onward. As this book shows, when cholera swept into China in the early 1960s, files concerning this pandemic were classified as top secret, confidential, or secret. This rule was also applied to other diseases and epidemics in Mao’s China. It was impossible for researchers both in and outside of China to access to reliable information on the extent of the pandemics and the nature of the responses to them. Access to original archival documents concerning diseases and epidemics improved in China thanks to the changes that have occurred since the 1990s and the country’s opening up to the academic world but then became more difficult again a few years ago, particularly at the central level. However, reliable information on cholera pandemics is available at some Chinese archives at the provincial and county levels. These sources are particularly fruitful because they include detailed, relatively loosely managed records of real situations at the grassroots level. Archival documents of this type, mainly from each of the county archives in Wenzhou Prefecture, form the core materials of this book. Archival documents, when used in conjunction with other sources, can illuminate many of the dark corners of PRC politics.58 Some local gazetteers describing medicine, health care, and epidemic prevention from 1949 onward and published since the late 1980s made up for the limited access to archival documents at the central and provincial levels. In the 1990s, the compilation boards for these gazetteers, organized by either health bureaus or sanitation and epidemic prevention stations, were authorized to read these original archival documents and cited some of them in their works. These gazetteers provide a lot of references and clues when searching through archival documents. Furthermore, like other counties in Zhejiang Province, each county in Wenzhou Prefecture published its own newspaper from the outbreak of the Great Leap Forward to 1962, when the Great Famine basically ended. The Wenzhou Prefecture newspaper, Zhenan dazhong (Masses of southern Zhejiang), was published from the very beginning of the new regime to the middle of the Cultural Revolution, in 1972. Issues of these newspapers provided original material on the social and political history of local society in official discourses. In-depth interviews with the dwindling population of witnesses and survivors of this global pandemic were another core source of material for this book. I

21

22

china a nd the choler a pa ndemic

mainly conducted interviews in Rui’an County, Pingyang County, and Wenzhou City because these three areas saw the highest morbidity rates in southeastern coastal China in 1962. These local narratives from the perspectives of individual and collective memories include interviews with former medical doctors and epidemic prevention staff at sanitation and epidemic prevention stations, county health bureau cadres, production brigade and team cadres, and ordinary villagers. Sigrid Schmalzer argues that interviews “emerge from specific contexts of production and are transformed through specific contexts of circulation,” like diaries, memories, biographies, and academic publications. These oral history materials, mediated by some political and social motivations, require careful, critical analysis.59 However, informants in this study recounted their memories half a century after the pandemic, and their commentary was not arranged by the government and had few sociopolitical and ideological constraints. As this book indicates, interviewees narrated their suffering, complaints, and resistance at the grassroots level. Thus, scrutiny of these narratives can rectify and supplement original archival records and local gazetteers that were written under the guidelines of the official historiography. This book has three parts. The first, “Global Pandemic and Mobility” (chapters 1 and 2), analyzes the global and local cholera pandemics in Southeast Asia and China in the context of transnational politics and domestic social restructuring. Chapter 1 explores the Chinese diaspora and the global cholera pandemic in the transnational politics surrounding Indonesia and China from the late 1950s onward, including the outbreak of the pandemic, its spread from Indonesia to China, and the movement of Indonesian Chinese as suspected carriers. Chapter 2 examines how the dynamics of population mobility from the 1950s onward contributed to the emergence of a generally sedentary rural society simultaneous with the rise of a mobile coastal society. It also traces how population mobility further shaped the spatial and temporal distributions of the cholera pandemic, together with human ecology and social customs in Wenzhou Prefecture in summer 1962. The second part, “Contagion, Social Divisions, and Borders” (chapters 3 and 4), discusses social epidemiology and interventionist cholera prevention methods (i.e., quarantine and isolation) within the social divisions and borders created by the social restructuring process. Chapter 3 examines how the social divisions that had gradually formed since 1949 and were strengthened in 1961–1962 resulted in specific social epidemiology features and the distributions of cholera cases along rural/urban, male/female, and military/civilian divides.

Introduction

Chapter 4 addresses how quarantine and isolation redrew and interwove multiple borders (including natural, administrative, militia, and quarantine borders) and explores how the problems these practices encountered in preventing the spread of cholera reflected key features of the restructured social system. The third part, “Pandemic Emergency, Data, and Social Structure” (chapters 5, 6, and 7), examines the reciprocal integration of the anticholera campaign and social restructuring through the combining of social, production, and epidemiological data (i.e., household, accounting, and inoculation registers and certificates). Chapter 5 explores how the restructured rural social systems facilitated the entry of comprehensive inoculation emergency programs into vast rural areas by providing local agents and household and accounting information, as well as how the inoculation campaign adjusted, improved, and finally strengthened the recent social restructuring process through the compiling of inoculation registers and certificates. Chapter 6 explores how the epidemic statistical politics based on the institutionalization of the medical system, the medicalization of the administrative system, and the epidemiological categorization of populations strengthened the social structuring process. It also looks at how all these systems suffered institutional dysfunctions during this process. Chapter 7 investigates why the cholera pandemic was highly politicalized as the “No. 2 disease” and how information about it was endowed with the political functions of disciplining and indoctrinating local cadres, medical professionals, and the general public in the domestic and international politics of China in the early 1960s. The concluding chapter examines the significance of the global pandemic as a sociopolitical event in the crucial transitional years between the Great Leap Forward and its associated famine and the Cultural Revolution. The book ends with a discussion of the rise of the emergency disciplinary state and its far-reaching impact on public health emergency response in the changing sociopolitical contexts of the decades following the cholera outbreak, including the cerebrospinal meningitis epidemic in 1966–1967, the SARS pandemic in 2002–2003, and the ongoing COVID-19 pandemic.

23

PART I GLOBAL PANDEMIC AND MOBILIT Y

1 THE ORIGINS OF THE EPIDEMIC Migrants and Refugees in Cold War Asia

ON THE MORNING OF FEBRUARY 29, 1960, THE FIRST OF FOUR FOREIGN OCEAN LINERS hired by the Chinese government to carry more than twenty-one hundred returning Indonesian Chinese sailed slowly into Huangpu port in Guangzhou City, China. The ships docked after a twenty-day journey from Jakarta, Indonesia. The Guangzhou municipal government organized four thousand people from all walks of life to welcome these returning overseas Chinese. Amid the applause, flowers, firecrackers, and lion dancing, the Indonesian Chinese disembarked smoothly within an hour. In the grand rally held immediately afterward, Liao Chenzhi, director of the Overseas Chinese Affairs Committee for the People’s Republic, criticized the Indonesian government for “launching large-scale and comprehensive Chinese exclusion and anti-Chinese movements.” He further proclaimed to the masses at the rally, “There are still many of our fellow countrymen and women who want to come back but haven’t done so. We’ll dispatch a second, third, and fourth batch of ocean liners. If necessary, we’ll arrange more boats to pick up those fellow countrymen and women who want to come back to the motherland.”1 In the following year and a half, the numbers of returning Indonesian Chinese reached their peak—around one hundred thousand Chinese left Indonesia and returned to mainland China by ship.2 However, this large-scale transnational 27

28

china a nd the choler a pa ndemic

migration became unexpectedly entangled with a global El Tor cholera pandemic originating in Makassar on the island of Sulawesi (Celebes), Indonesia. Around 1960 and 1961, Makassar was experiencing huge population movements, including troops in the area to suppress local rebellions, unprecedented large-scale Chinese emigration from Indonesia, and unsupervised smuggling via small boats.3 Of these movements, that of Indonesian Chinese is believed to have been particularly important. Because of the anti-Chinese campaigns, Indonesian Chinese started leaving Makassar for Java in December 1959 to board the ocean liners going to mainland China.4 This outward migration reached its peak in the summer of 1960 and continued into 1961, which coincided with the outbreak of cholera in Makassar in January 1961. In the broader context of transnational politics and population mobility in the early 1960s, this group of Indonesian Chinese had triple identities: they were fleeing aliens, they were a returning diaspora, and they were suspected cholera carriers in an outbreak of the disease that would soon spread across Southeast Asia, China, and the world. This chapter traces the origin of El Tor cholera and examines the mobilities of the global pandemic and Indonesian Chinese between Indonesia and China from the late 1950s onward. It further discusses mainland Chinese refugees heading to Hong Kong and Macau after the debacle of the Great Leap Forward and the spread of cholera in southern China and Southeast Asia. This chapter thus aims to narrate and analyze the epidemic, migrants, and refugees in the contexts of transnational politics and nation-building in Cold War Asia.

THE PILGRIMAGE TO MECCA AND EL TOR CHOLERA For centuries, groups of Southeast Asian Muslims had voyaged between the Indian Ocean and the Hejaz (the Red Sea and the Arabian and Yemeni coasts) on their pilgrimage to Mecca to perform the hajj. The voyage included stopping at the Red Sea port city of Jeddah on a journey their communities had been making annually since the fourteenth century as a gesture of religious devotion.5 By the nineteenth century, the rapid circulation of information and the increasing scale of population movements was contributing to the formation of multiple Muslim diasporas in Asia. The opening of the Suez Canal in 1869 and advances in transportation further expanded the scale of the annual pilgrimage from Southeast Asia to Mecca.6 In fact, by 1902 Southeast Asian pilgrims annually numbered nearly 40,000.7 Pilgrim numbers from Southeast Asia reached their peak in the

The Or igins of the Epidemic

late 1920s. As the world’s most populous Muslim country, Indonesia sent more devotees annually to Mecca than any other nation in the Muslim world. For example, a total of 132,109 pilgrims arrived in Jeddah by sea in 1927, of which 29.6 percent were from Indonesia, 19.7 percent from India, 22.4 percent from Malaya, and 14.2 percent from Egypt.8 However, religious voyages provided fertile ground for the transmission of disease among Muslims throughout Southeast Asia. As Eric Tagliacozzo puts it, “a long sea voyage with passengers in close proximity, as was the case with pilgrims coming from Southeast Asia by sea to Jeddah, was almost tailor-made for cholera to thrive and then spread.”9 The pilgrimage routes between Muslim nations in South Asia and Southeast Asia and Mecca became one of the key arteries for the spread of the first cholera pandemic, which originated in India in 1817.10 In 1821, cholera spread to the Arabian Peninsula from India via the Persian Gulf. In 1831, it spread to the key pilgrimage destination, the Hejaz region, where it killed twenty thousand people. By 1859, there had been five more outbreaks of cholera in the Hejaz.11 The transmission of cholera along transoceanic pilgrimage routes in the late nineteenth and early twentieth centuries made the hajj a dangerous and sometimes fatal devotional practice, and the fight against cholera on the hajj became a global concern.12 Beginning in the 1850s, international sanitary agreements were implemented for pilgrims from Southeast Asia traveling to Mecca. A quarantine station was established at Qamaran Island, Yemen—the first stop for pilgrims before arriving at Jeddah—as the first key epidemic prevention tactic.13 In the north, another quarantine station was established in El Tor, on the Sinai Peninsula, 120 miles south of Suez on the eastern shore of the Gulf of Suez.14 As the sole gateway into Egypt for returning pilgrims, the El Tor quarantine station aimed to prevent the spread of cholera into Egypt by pilgrims traveling on Arab coast– hugging vessels.15 Detachments of cyclists, camel guards, and infantry patrolled the banks of the canal from Port Said in the north to Kosseir in the south, while camel guards patrolled the more southerly shores of the Gulf of Suez and the Red Sea to ensure that no one evaded these quarantine practices.16 Despite these preventive measures, a hemolytic strain of Vibrio cholerae emerged, a new one that differed from the classical, nonhemolytic V. cholerae discovered by the German physician and microbiologist Robert Koch in 1884.17 The new strain came to Mecca with South Asian pilgrims before 1900 and then was transmitted to El Tor and other areas in the Middle East by other pilgrims.18 However, this new biotype of V. cholerae initially existed in a mild form, and for a

29

china a nd the choler a pa ndemic

30

Table 1.1 El Tor cholera in Sulawesi, Indonesia, 1937–1958 Outbreak No.

Dates

Affected Areas

Cases

1

Aug. 1937–April 1938

Makassar

48

2

Oct. 1939–July 1940

Around the east shore of southwest Sulawesi

63

3

1944

East and west shore of southwest Sulawesi

7

North shore of Makassar

27

Neighboring areas of Makassar

81

Jakarta (Java)

2

4

Jan. 1957–Feb. 1958

Sources: Kamal, “Seventh Pandemic of Cholera,” 1; Shanghaishi weishengju gongzuozu, “Fuhuoluan liuxingbingxue jianggao,” 1962, WZA, Vol. 118-10-140; MacPherson, “Cholera in China,” 492.

number of years there was no associated epidemic.19 The situation would change in 1905, when German physician Felix Gotschlich first identified six such strains of Vibrio cholerae from dead pilgrims at the El Tor quarantine station, and this strain thus obtained its current name: El Tor cholera (V. cholerae El Tor).20 Southeast Asian pilgrims returning from the Middle East brought El Tor cholera to the Indonesian port of Makassar (renamed Ujung Pandang in 1971), on the island of Sulawesi, in 1925, and there it gained its foothold and developed various potent mutations.21 After 1937, cholera broke out around Makassar, with patients showing clinical signs of the hemolytic (El Tor) biotype of V. cholerae.22 By 1958, there had been four major outbreaks of cholera in Indonesia, but all were basically confined to Makassar.23 However, Makassar soon became the starting point for new El Tor strains resulting from twelve additional mutations.24 From there, El Tor cholera evolved into a pandemic; in 1961, the disease would commence its spread to other parts of Indonesia, Asia, and the world.25

IDEN TIT Y DILEMMAS AMONG INDONESIAN CHINESE As Southeast Asian pilgrims made their voyages between the Hejaz and the Indian Ocean in the nineteenth century, another group of mobile people were heading to Southeast Asia and other parts of the world via the South China Sea and the Pacific. These were Chinese migrant workers. From the early nineteenth century on, millions of Chinese left southeastern coastal China for destinations

The Or igins of the Epidemic

around the world. Prompted by the hunger, famine, war, and chaos that plagued China, they sought to make their living elsewhere as coolies and indentured laborers.26 Southeast Asia was a key destination because of the huge demand for labor generated by rapid development of cities and plantations, and around 20 million people from China arrived there within the century after 1840.27 As in the case of Southeast Asian pilgrims, the history of the Chinese diaspora in Southeast Asia and elsewhere is accompanied by a parallel history of disease. These migrant workers, regardless of whether they traveled on sailing ships or steamships, were afflicted by disease throughout their miserable sea journeys. Voyages of Southeast Asian pilgrims and Chinese migrant workers are examples of population mobility and disease transmission across the Indian Ocean and the South China Sea, respectively, before the mid-twentieth century. However, Indonesian Chinese unexpectedly connected these two seemingly unrelated social and medical events in the early 1960s. Chinese interest in the Indonesian archipelago extended back two thousand years, but the numbers of Chinese actually living in Indonesia were small. After the Dutch East India Company was established in the seventeenth century, more Chinese came to Indonesia. Their numbers greatly increased in the late nineteenth century and in the following decades because of the economic changes brought by the expansion of plantation cropping. By 1951, the number of Chinese in Indonesia stood at around 2 million.28 Two distinct subgroups emerged within the Chinese community: the Peranakan and the Totok. The former were already partially assimilated into Indonesian society from the fifteenth to the seventeenth centuries, while the latter were descendants of immigrants who had arrived since the second half of the nineteenth century and still had close connections with China.29 Regardless of their origins or the extent of their assimilation, the history of Chinese collaboration with the colonial regime, their distinct racial and cultural practices, and the wealth of some community members mean that the position of Indonesian Chinese was and continues to be contested and redefined both by themselves and by others.30 Feelings of distrust and animosity toward the Chinese prevailed through much of the twentieth century.31 As Philip Kuhn puts it, “Among the postcolonial nations of Southeast Asia, Indonesia’s anti-Sinitism has been the most deeply ingrained; its political, religious, and ethnic structure, along with its colonial background, have sustained a particularly tenacious belief in a ‘Chinese problem.’“32 The Chinese were targeted “as capitalists, as infidels, as aliens, and as collaborators of the hated yet admired Dutch.”33

31

32

china a nd the choler a pa ndemic

The distinct features of the Chinese community in Indonesia were soon complicated by changes in the geopolitics between Indonesia and China during the Cold War. The first ambassador to Indonesia from the People’s Republic of China, Wang Renshu, arrived in Jakarta in August 1950.34 He had with him eighty Chinese diplomats, though it was less than a year after the founding of the People’s Republic of China. The first Communist diplomatic offices were opened in Jakarta, Medan, Makassar, and Banjarmasin in July 1951.35 Even though the two countries established diplomatic relations quite quickly after the formation of the PRC, they soon faced a dispute about determining the nationality of Indonesian citizens who were also Chinese nationals.36 The Indonesian government insisted that people of Chinese origin born in the Netherlands Indies and whose parents were domiciled under the Dutch administration automatically became Indonesian citizens following the principle of “right of the soil.” However, the Chinese government regarded Indonesian Chinese to be Chinese citizens according to the “law of blood” followed in China.37 After extensive negotiations, on April 22, 1955, in Bandung, the Chinese premier and foreign minister Zhou Enlai and the Indonesian foreign minister Sunario signed the Agreement on the Issue of Dual Nationality between the Republic of Indonesia and the People’s Republic of China. The agreement stipulated that “anybody with both the citizenship of the Republic of Indonesia and of the People’s Republic of China shall choose between the two citizenships on the basis of his or her own will.” It was further stipulated that the treaty should come into force after the documents were ratified and exchanged by the two governments.38 The citizenship problem was solved, but the ongoing and deep suspicions with which Indonesians regarded Chinese in their communities remained. Soon a series of factors combined to place Indonesian Chinese in mortal danger. The mid- to late 1950s were marked by the rise of Communist China’s political influence in Indonesia, which eventually led to suspicions that all Chinese were Communist sympathizers or left-wing agitators.39 This image of China was further complicated by changes in US-Indonesian relations during the Cold War that ramped up anti-left-wing sympathies; these were then translated into anti-Chinese feeling.40 As the Australian embassy in Jakarta reported in 1956, “in contrast to the international façade, relations within Indonesia between Indonesians and Chinese residents in this country are manifestly deteriorating at a rapid rate.”41 On the one hand, the Chinese symbolized the capitalist exploiter class within the Indonesian national economy, while on the other, there were Chinese agitators in the Indonesian Communist movement seeking to influence local politics via

The Or igins of the Epidemic

their motherland; many of them were political allies of the PKI (Indonesian Communist Party).42 Suspicion of China’s influence on the Indonesian political scene combined with local hostility to make the situation for Indonesian Chinese extremely unstable. This pressure began to build in 1958. Chinese economic interests were targeted when the Indonesian government nationalized Chinese-owned enterprises, industries, and schools or educational enterprises. 43 In 1959, the Indonesian government took strong action against rural traders of foreign nationalities, the vast majority of whom were Chinese. According to a survey conducted in July 1959, Indonesian Chinese operated 83,783 retail businesses, half of which were scattered in rural areas around the Indonesian islands.44 On November 3, 1959, Presidential Regulation No. 10 banned alien retailers in rural areas, except in the capitals of first- or second-tier autonomous districts.45 Following these decrees, each province hastened to monitor aliens in its jurisdiction. Military commanders in Java issued a series of regulations forcing the Chinese to move into cities and towns. This combination of policies affected at least 300,000 Indonesian Chinese and caused 100,000 of them to lose their livelihoods.46 In response, the Chinese government intervened on behalf of its citizens by protesting against the new regulations and by enabling citizens’ repatriation to China.47 Beginning in December 1959, Beijing Radio initiated a series of broadcasts inviting overseas Chinese “who either no longer wished to stay in Indonesia or who had suffered persecution from the Indonesian government” to return to the “warm bosom of the motherland” and “take part in the great work of socialist construction.”48 The Chinese government instructed its embassy and consulates in Indonesia to undertake recruiting primarily among those Chinese who had skills or trades useful for building socialism on the mainland. 49 Under this program, 802 Indonesian Chinese returned to China via Shenzhen on January 8, 1960.50 Twelve days later, on January 20, 1960, in Beijing, the Chinese and Indonesian governments exchanged the ratified Agreement on the Issue of Dual Nationality, which finally brought it fully into effect.51 The Chinese government then initiated a repatriation scheme for those ethnic Chinese who opted for PRC citizenship.52 On February 2, 1960, the Chinese State Council set up the Committee for Hosting and Accommodating Returning Overseas Chinese of the People’s Republic of China. The council designated Guangzhou, Shantou, Zhanjiang, and Haikou as host ports and required the People’s Commissions of Guangdong, Fujian, Guangxi, and Yunnan Provinces to arrange for the settlement of

33

Figure 1.1. Farewell party for all staff going to repatriate Indonesian Chinese, 1960. QWB, no. 2 (1960).

Figure 1.2. Ocean liners dispatched to pick up Indonesian Chinese, 1960. QWB, no. 2 (1960).

The Or igins of the Epidemic

Figure 1.3. Indonesian Chinese returning to China by boat, 1960. QWB, no. 3 (1960).

returning overseas Chinese.53 On February 5, 1960, the four foreign ocean liners dispatched to Indonesia by the Chinese government departed from the Huangpu port in Guangzhou City.54 They returned on the morning of February 29 with about twenty-one hundred Indonesian Chinese aboard.55 In addition, four smaller merchant ships from China traveled back and forth between China and Indonesia to pick up other returnees. Most of the passengers on the merchant ships arrived first in Hong Kong and from there were put on trains to China.56 By the end of 1960, approximately ninety-four thousand Indonesian Chinese had returned to mainland China.57 At the same time, roughly seventeen thousand Indonesian Chinese went to Taiwan.58

35

36

china a nd the choler a pa ndemic

Figure 1.4. “Returning Indonesian Chinese receive a warm welcome,” 1960. QWB, no. 3 (1960).

FLEEING ALIENS AND THE RE TURNING DIASPORA AS SUSPECTED CHOLERA CARRIERS Among these Indonesian Chinese who returned to China, some were from Makassar on the island of Sulawesi. The Chinese presence in Makassar dates to before 1669, when the Dutch East India Company conquered the island, at which time there were already around 20 Chinese there. They soon became influential as merchants and contributed to the rise of Makassar as a regional trading center. They purchased sugar, birds’ nests, sea slugs, pepper, tin, and timber in Southeast Asia and sold silk, porcelain, tobacco, combs, fans, ceramics, and ironware to locals. Commercial demand from China for three major marine

The Or igins of the Epidemic

products—seaweed, sea slugs, and tortoiseshell—revived Makassar as a regional center. However, with the rise of Singapore in 1819, Makassar lost this role in the 1820s.59 Nevertheless, by December 1959 the number of Indonesian Chinese on Sulawesi had reached 140,000, around 40,000 of whom were based in the coastal town of Makassar.60 As mentioned earlier, cholera had been endemic in Makassar, and its spread had largely been confined to that locality between 1937 and 1958. However, the disease would reach epidemic proportions in Makassar by January 1961, in an outbreak that was different from earlier episodes because the cholera spread beyond Makassar and quickly escalated into a global pandemic. Why did cholera spread outside of Makassar during this outbreak? According to epidemiological principles, the capacity for pandemics and epidemics to emerge rests on certain distinctive factors. For a disease like cholera, with humans being the key source-vector for the spread of infection, these factors include the degree of disease prevalence in the endemic area, the number of persons leaving the infected territory, and the susceptibility of the populations with whom these persons come in contact during the journey and at their destination.61 Around 1960 and 1961, Makassar was experiencing huge population movements. In particular, Indonesian Chinese started leaving Makassar for Java in December 1959 to board the ocean liners going to mainland China because of the anti-Chinese movement in Indonesia. This emigration coincided with the outbreak of cholera in Makassar in January 1961. Compounding the danger, El Tor cholera differs from classical cholera in a number of important ways. Because humans are the natural reservoirs of the bacteria, the disease is maintained by a cycle of transmission from person to person through the environment.62 An individual infected with classical cholera will usually excrete vibrio for only a few days, but asymptomatic infection with El Tor cholera extends throughout the cycle of transmission, as the carrier state can last for more than one thousand days. In some cases, a single individual was shown to have been infected for seven years. El Tor V. cholerae can also establish itself in the host’s gall bladder, further extending that host’s capacity to spread the disease. Even after the successful treatment of convalescent carriers with antibiotics, vibrio could in some cases still be excreted through vomiting or during spontaneous diarrhea that occurred while the person was sick with other illnesses.63 El Tor cholera often appeared in a mild clinical form and resulted in many symptomless carriers moving around while unaware that they were spreading

37

38

china a nd the choler a pa ndemic

the disease. Indeed, the majority of individuals infected with cholera either had no symptoms or just showed mild diarrhea. For classical cholera, the ratio of severe cases that require hospitalization to either mild or asymptomatic infection is 1:5 to 1:10. For El Tor cholera, this figure reached 1:25 to 1:100.64 Because of this feature, El Tor cholera presented as an “iceberg phenomenon,” one in which the asymptomatic vibrio infection was much more frequent than the clinical disease.65 Furthermore, there were two types of carriers of asymptomatic infection: “convalescent carriers,” who were in good health and may even have been discharged from hospital after having been “cured” of cholera, and “contact carriers,” who excreted V. cholerae after having been in contact with cholera cases or other carriers. The convalescent carrier rate was reported to be 3.5 percent in the general population.66 In the early 1960s, the World Health Organization Expert Committee on Cholera insisted that asymptomatic and convalescent carriers of El Tor cholera played a very important role in transmission.67 The cholera expert Robert M. Worth argued in 1964 that “it has been definitely shown that asymptomatic and convalescent carriers are important in spreading and maintaining community epidemics.”68 A large number of the Indonesian Chinese who left Sulawesi and other Indonesian islands for mainland China were suspected to be asymptomatic carriers of the disease.69 As Ahmed Mohamed Kamal argued in the 1970s, “the continued occurrence of the disease in the affected territories and the nonabatement of the already existing outbreaks triggered the pandemic through constantly providing infection at the threshold conducive to its invasion of new territories.”70 Meanwhile, endeavors in Makassar to enhance economic development by increasing trade and introducing mechanized high seas transportation and travel also facilitated the export of cholera and its diffusion to other islands in Indonesia. Cholera was first reported in Java in May 1961, in a seaside community near Kendal that had been visited by residents from Makassar.71 Spreading to Java, the cholera bacteria found ideal conditions in which to establish a foothold and flourish: a susceptible population and a below-par sanitary environment.72 Soon it spread to Semarang in Central Java and then infected Jakarta in June, and from there it was introduced to Bandung.73 At the same time, Sulawesi remained the center of the pandemic. Boats from Sulawesi participated in a regatta in Kuching, Sarawak, spreading cholera to that town in Malaysia in late June 1961. In Sarawak, the cholera epidemic lasted only about two weeks and involved 582 persons, with 79 deaths.74 As the boats made their way to Sarawak, they also anchored in the Javanese township of Surabaya,

The Or igins of the Epidemic

which had not experienced cholera since 1902, and introduced the disease there. From Makassar, cholera spread to North Borneo through fishermen and other seafarers across the old pirate-traveled waters of the Celebes and Sulu Seas.75 By August, cholera had broken out around North Sumatra, and Kalimantan became infected.76 In sum, the disease had spread far and wide, from Makassar to Java and then on to other outer islands of Indonesia. Simultaneously, Indonesian Chinese were still leaving for China in 1961, although the Chinese embassy had dropped its recruitment campaign in April 1960 and quietly begun to urge other potential repatriates to stay in Indonesia. The Chinese government’s cooling enthusiasm for the repatriation program resulted from the huge numbers of older and nonskilled working people who applied for return. The government considered them to be of little economic use and not easily able to acclimate to social conditions in mainland China.77 Nevertheless, repatriation continued into 1961, when the Chinese government purchased the Greek ocean liner Marianna, which, after renovation, was renamed Guanghua, which means “glorifying China.” The renamed ocean liner started its first voyage from Huangpu port in Guangzhou to Indonesia on April 28, arrived in Jakarta on May 3, and returned to Huangpu on May 17. After this voyage, the Guanghua undertook a further twelve voyages to bring Indonesian Chinese to the PRC. Between twenty thousand and thirty thousand returned to China in 1961.78 One of the destinations of Indonesian Chinese returning to Guangdong Province was Yangjiang County, in Zhanjiang Prefecture, which lies between Zhanjiang City and Guangzhou City, the provincial capital of Guangdong. Zhanjiang’s port had been designated as a disembarking point for returning Indonesian Chinese. For this reason, the Guangdong provincial government set up two state farms in Yangjiang County to accommodate these returnees. In 1960 and 1961, a total of 2,547 returned Indonesian and Malaysian Chinese settled in Yangjiang County, making it a geopolitically significant locale.79 Yangjiang County is a mountainous coastal area, with most of the inhabitants living along the coast and a minority scattered in the mountains. By the late 1950s, the county had 50 towns of different sizes and a population of 610,000. Conditions in both towns and rural areas had been extremely unsanitary for a long time. In 1958, a summary report about four-pest eradication work, written by the Yangjiang County Culture and Education Bureau, described Jiangcheng Town as follows: Even in this county town, the most centralized area of politics, economy, and culture in the whole county, environmental sanitation is very poor. [Residents] eat

39

40

china a nd the choler a pa ndemic

food everywhere in the street. Fruit peels and miscellaneous stuff are scattered everywhere. Poultry and livestock raised by residents run all through the streets. Children urinate and defecate everywhere. Urine and stools are all over the ground. When the winds blow, highly unpleasant smells fill the air and people’s noses. . . . Worse still are the toilets. Because of no appropriate management, toilets became hotbeds of breeding flies. In the summer, there are flies everywhere. They cover the food in restaurants. Customers always eat fly-infested food. . . . Because of the extreme lack of environmental sanitation in the county town, Yangjiang County was particularly criticized by the Ministry of Health of the People’s Republic of China and the Guangdong Provincial Health Department in 1954 and 1955.80

The summary also described how “in small rural towns, chamber pots are scattered everywhere, too. . . . Areas around villages and open spaces are overgrown with wild weeds. Marshlands and polluted ditches are intertwined. Rubbish is heaped everywhere, which breeds pests.”81 These were the conditions in which the cholera pandemic emerged in 1961. Around June 18–23, the “vomiting and diarrhea illness” emerged in the coastal communes of Pinggang, Dui’an, and Dongping. After June 29, the number of cases increased quickly, which attracted the attention of the county government. A medical team led by the county’s party chief arrived in the infected communes and investigated the etiology. It was found that “for most emergent cases, patients died within only a few hours of the outbreak of illness.” At a meeting of Chinese and Western medical practitioners convened by the county’s party committee and health bureau, the majority of Chinese medical doctors insisted this illness was cholera because the symptoms were the same as those of the cholera that had spread in 1943. However, Western medicine physicians disagreed with this diagnosis: some thought it was acute gastroenteritis, while others claimed it was toxic dysentery.82 Not until ten days later did the central government and Guangdong provincial government dispatch epidemiological experts to conduct examinations and confirm that the illness was El Tor cholera. By that point, El Tor cholera was ravaging the county: from June 22 to August 20 there were a total of 2,226 cases, and the death toll reached 150.83 On July 6 the central government, the Guangdong provincial government, and the Zhanjiang Prefectural Committee began dispatching a large number of staff to Yangjiang County to prevent the further spread of cholera. Simultaneously, the governments at different levels started to investigate the etiology of this pandemic and concluded in the end that returned Indonesian Chinese were

The Or igins of the Epidemic

the source of the outbreak. In view of the fact that cholera had not occurred in Yangjiang County for the past eighteen years, the investigations by the staff of the Guangdong Provincial Epidemic Prevention Headquarters first focused on external factors. Likewise, because cholera had first broken out in a few coastal communes, the investigation team conducted intensive interviews among coastal residents and fishermen. After repeated surveys, it was found that coastal fishing boats were only used in shallow waters and that no single fishing boat could travel several hundred kilometers from the coastline, though one or two fishing boats sometimes harbored stealthily in Hong Kong and Macau. However, as no cholera cases had been reported in Hong Kong and Macau before the outbreak in Yangjiang County, authorities eliminated the hypothesis that fishing boats had brought the cholera from foreign countries into China. At that point the epidemiological investigation team began to target returned Indonesian Chinese. In the epidemiology report on the cholera outbreak in Yangjiang County submitted to the party committee of Guangdong Province on August 24, the investigation team claimed, Because there had been outbreaks of this cholera in Indonesia, we conducted vibrio examinations among returned Indonesian Chinese who had settled on national farms. In order to prevent suspicion, we conducted a total of 462 vibrio tests on both Indonesian Chinese and local residents throughout the farms. No cholera vibrio was identified. . . . Although findings based on only one test are not reliable, no cholera cases were identified among overseas Chinese. Cholera did not first break out among local residents who were laboring with overseas Chinese and living around these state farms, and there were not even any cholera patients in these locations. Furthermore, the last batch of Indonesian Chinese arrived in Yangjiang in March. How would the cholera vibrio survive until June? From this point of view, it seems there is no possibility that vibrio carried by overseas Chinese could have triggered this outbreak of cholera.84

Nonetheless, the epidemiological investigation team admitted the limits to this test and were prudent about their findings: “However, V. cholera is very vibrant. We did identify some mild cholera patients and close contacts carrying vibrio during the pandemic. We therefore cannot exclude this possibility completely. Further observation is required.”85 The investigators’ twelve-page report issued in August did not explicitly confirm that returned Indonesian Chinese had spread cholera to Yangjiang

41

42

china a nd the choler a pa ndemic

County. In late October, the work team of the Guangdong Provincial Epidemic Prevention Headquarters wrote a fifty-six-page epidemiological report. Classified top secret, this document’s title appears in the catalog of the archival folder, but the file itself has been removed, although other documentation remains in the folder, which is housed in the Yangjiang County Archives. Still, the available local archival records in Yangjiang County do not point to the conclusion that Indonesian Chinese spread cholera to mainland China. The uncertainty at the local level was at odds with the views of the central government. The conclusion the Chinese government had reached at internal meetings of senior medical and health officials identified Chinese Indonesians as the source. In December 1962, Qian Xinzhong, deputy minister of the Ministry of Health from the mid-1950s to 1966, gave a speech at a cholera prevention and treatment meeting attended by many representatives from the southeastern coastal provinces: “This cholera pandemic must have been transmitted from overseas. However, the transmission paths are still not clear. There is a great possibility that returned Indonesian Chinese brought cholera to China.”86 By 1964, he had explicitly confirmed that “the cholera pandemic in Guangdong Province in 1961 was brought by cholera carriers from foreign countries. We first identified that suspected cholera patients were in areas where returning Indonesian Chinese congregated. . . . Epidemiological surveys indicate that mild patient cases and cholera carriers were the main spreaders of epidemic diseases from one province and one area to another province and another district.”87 The deputy minister of health’s speeches in December 1962 and 1964 were more credible and authoritative than the Guangdong Province party committee’s investigation report in 1961 because of the timing of the reports and the hierarchical features of the party system. More significantly, in the late 1950s and early 1960s returned overseas Chinese served important sociopolitical goals for the Communist government, making it difficult for them to be identified as a “problem.” The returned overseas Chinese not only represented the patriotism of the Chinese diaspora, but the party, in displaying benevolence to them in their hour of need, also promoted its own political and ideological legitimacy as the defender of Chinese people’s interests. Any allegations without solid evidence that returning diaspora were suspected disease carriers would jeopardize this political program. In this sense, the deputy health minister’s statement at the party’s internal meetings for senior officials was significant and must have had supporting medical evidence. Meanwhile, this internal, definitive statement that cholera was not endemic to mainland China also justified political legitimacy

The Or igins of the Epidemic

and maintained the national image, which took priority over the political expediency of promoting the return of overseas Chinese. As the Ministry of Health’s etiological investigation report is not open to the public for viewing in governmental archives, one cannot access the original medical evidence that led to this conclusion. Thus, this book still argues that returned Indonesian Chinese were suspected carriers during the cholera pandemic.

REFUGEES, TRADE, AND PANDEMIC IN GUANGDONG Regardless of whether the source of the outbreak was the returning Indonesian Chinese, cholera still ravaged Yangjiang County in the summer of 1961. In order to cut the cholera transmission pathways, the epidemic prevention headquarters closed the Guang–Zhan (Guangdong–Zhanjiang) Highway and blocked vehicular traffic. It then set up quarantine stations on neighboring county lines along the Guang–Zhan Highway and along the Yangjiang River within the county. It also prevented returning fishing boats from entering ports during the pandemic. Instead, they were ordered to stay out at sea, with food and water being delivered to them.88 Even though the government had launched this anticholera campaign quickly, the disease had already spread beyond Yangjiang County by early July.89 In the west, cholera infected Maoming County and Zhanjiang City. In the east, it spread to Taishan, Jiangmen, Nanhai, and Dongguan Counties. Soon the whole Pearl River delta area in Guangdong Province was stricken by cholera. Guangdong then became the hub of the pandemic for China and Southeast Asia because of its location.90 The province is of particular significance in the history of epidemics, from as early as the opening of the treaty ports in the mid-nineteenth century, because it makes up most of the Pearl River delta, which came to play a role of strategic geographic importance due to its extensive connections with the world. In this area, disease and epidemics spread in concert with the import and export of commodities like opium and tea, as well as migration. This mode of disease spread in Guangdong continued into the 1950s.91 In the weeks and months immediately after the Communist victory in October 1949, large numbers of people escaped from the People’s Republic of China, mostly to Hong Kong and Macau—the country’s only immediate neighbors that were not under Communist rule. In the first half of the 1950s, more than seven hundred thousand mainland Chinese refugees arrived in Hong Kong, as the British government there did not initially prevent their entry.92 By the early 1960s,

43

44

china a nd the choler a pa ndemic

Map 4. The spread of El Tor cholera in Southeast Asia and China, 1961

widespread and devastating famine in mainland China had prompted another large influx of Chinese refugees into Hong Kong and Macau from Guangdong. Many people were granted legal permission by the Chinese government to leave China as part of their attempts to expel malcontents and to reduce demand for scarce food supplies during these hard years.93 In this context, cholera quickly spread from Guangdong Province to Macau and Hong Kong. On August 11, 1961, Macau identified its first batch of cholera

The Or igins of the Epidemic

cases, in thirteen patients.94 Hong Kong’s government immediately instituted a massive immunization campaign and strict border quarantine in view of the epidemic situation in mainland China. Despite those efforts, cholera appeared in Hong Kong on August 15, first among fishing and smuggling villages near the Chinese border. It eventually spread into the metropolitan area in a spotty fashion that seems to be explained by asymptomatic carriers.95 Many of these carriers entered by train through the Luhu customs gate—several hundred people came into Hong Kong this way each day.96 When cholera spread in Hong Kong from August 15 to October 22, 1961, the highest morbidity rates were among boat dwellers, who constituted only 3 percent of Hong Kong’s total population, yet of the total seventy-two cholera cases, twenty-five were boat dwellers.97 The strict control of human movement required to contain the disease was basically impossible to enforce among the mobile boat people.98 Hong Kong soon came to play a role similar to Guangzhou’s in the epidemic. As a hub of free trade in East Asia, Hong Kong had long been a center for spreading disease. In early 1894, the plague reached Hong Kong from Guangzhou and then spread globally along the various networks that sustained the British Empire, including the intensifying and accelerating flows of labor, commodities, and capital between the colonies and continents.99 The same patterns marked the spread of cholera from Hong Kong to Manila in 1961. Cholera had once been a serious and devastating disease in the Philippines, where major epidemics occurred in an irregular but somewhat continuous fashion between 1812 and 1902. However, not a single cholera case had been reported since 1936.100 The first patient during this new pandemic was diagnosed on September 22, 1961, in a poor neighborhood of Manila. The family of this person and the second victim had close contacts with the northern port district of Manila, where ships from Hong Kong and many neighboring countries were frequent visitors. The infection then spread mainly southward through the islands of the Philippines. About fifteen thousand people contracted cholera in the Philippines, 13 percent of whom had died by March 1962. From Sulu Island, a second wave of cholera spread to North Borneo.101 In this way, cholera spread back into Southeast Asia. At almost the same time, in February 1962, the disease broke out again in Guangdong Province. From this point, the spread changed direction and moved up through the coastal areas of eastern Guangdong, reaching around fifty kilometers inland from the coast.102 It then moved eastward along the southeastern coastal areas of China.103 By April 7, 1962, the epidemic had resulted in around twenty thousand cases and caused

45

china a nd the choler a pa ndemic

46

three thousand deaths in the South China Sea area.104 The WHO’s Western Pacific Regional Office in Manila announced that the cholera epidemic in countries around the South China Sea had “entrenched itself in places from which we have no record of its presence previously.”105 By 1965, WHO had announced that cholera had spread to almost all Asian countries and was on the verge of reaching the Middle East and eastern Europe. By 1967, the organization was warning that “no country is safe from cholera.”106 Within just a few years, cholera had escalated from an endemic disease in Makassar on the Indonesian island of Sulawesi to a global pandemic.107

CONCLUSION The origin, outbreak, and spread of the El Tor cholera pandemic in Southeast Asia and China in 1961–1962 indicate the impact of changing transnational politics and national politics on disease and mobility since the early nineteenth century. As this chapter has shown, the war, turmoil, hunger, and famine caused by incompetent and chaotic politics in China prompted Chinese laborers to emigrate from southeastern coastal areas overseas in search of a living. To some extent, the history of Chinese migrants is a parallel history of disease, one that is usually entangled with racial and political issues in host countries.108 By the early 1960s, the Chinese diaspora had unexpectedly connected with El Tor cholera in Makassar, Indonesia, and the disease had been spread by Southeast Asian pilgrims traveling across the Indian Ocean to Mecca. The movement of Indonesian Chinese across the South China Sea during this period can be understood in the context of nation-building and international relations in Indonesia and China since the end of World War II. Chinese identity in Indonesia had been contested and redefined due to the political, economic, and racial tensions between local Indonesians and Indonesian Chinese over time, a situation that was quickly politicized after Indonesia’s independence in 1945. For China, the Chinese diaspora was a source of political legitimacy, national wealth, and production skills during the continuous sociopolitical campaigns and industrial construction initiatives of the 1950s. The returning diaspora also buttressed the legitimacy of the new CCP government and counterbalanced the large numbers leaving the PRC in these same years. As former colonial and semicolonial countries, both Indonesia and China took part in the Bandung Conference in Indonesia in 1955, which opposed colonialism and neocolonialism by any nation. These transnational politics were soon complicated by the Cold

The Or igins of the Epidemic

War, beginning in the late 1940s. These factors converged to form a three-part identity for Indonesian Chinese returning to China—they were simultaneously fleeing aliens, returning diaspora, and suspected cholera carriers in this global pandemic. They entered China at a time when the general health of the population was poor following years of agricultural reform, including the Great Leap Forward and the huge famine that resulted. The capacity of the population to withstand a new disease was extremely low. Another kind of population movement facilitated the spread of cholera back to Southeast Asia, namely that of refugees from mainland China heading to Hong Kong and Macau. In essence, the mobility of these Chinese refugees originated in the failure of the Great Leap Forward as a sociopolitical experiment. In this sense, the 1961 cholera pandemic involved the movement of two social groups (Indonesian Chinese and mainland Chinese refugees) caused by changes in both transnational and national politics in Cold War Asia that had begun in the 1950s. However, when cholera started spreading northward through southeastern coastal China in summer 1962, the Chinese government was in the process of committing to overcoming political crises produced by the Great Leap and famine and to consolidating its legitimacy by restructuring its entire social system. These reforms laid significant foundations for the organization of society in Mao’s China in the following decades. The simultaneous unfolding of the global pandemic and this social restructuring process gave way to specific, dynamic scenarios of disease and politics.

47

2 MOBILE PEOPLE, MOBILE DISEASE

ON JANUARY 1, 1962, THE PEOPLE IN WENZHOU PREFECTURE, ON THE SOUTHERN COAST of Zhejiang Province in southeastern China, welcomed the new calendar year on a cold, snowy day. As usual, the Masses of Southern Zhejiang, the mouthpiece of the Communist Party Committee of Wenzhou Prefecture, delivered a congratulatory New Year message on its front page. This message proudly summarized the achievements of 1961: “Over the past year, the people in the whole prefecture have waved the three red flags that are the Communist Party’s General Line for Socialist Construction, the Great Leap Forward, and the People’s Commune and have achieved a great and tremendous victory based on the three years of continuous leaping forward under the brilliant leadership of the Party Central Committee and Chairman Mao!” The congratulatory message then moved on to address some difficulties and challenges: “But we still need to make long, arduous efforts. Natural disasters in some areas were more serious than in 1960 and the impact of these over the past two years has been hard to erase. There will be temporary difficulties on our way to success!” Nevertheless, the text ended on an enthusiastic note: “The current situation is getting better by the day and objective conditions are getting more favorable. As long as we work under the brilliant leadership of the Party Central Committee and Chairman Mao, we will be able to overcome various difficulties on the socialist road to progress and make great strides forward.”1 48

Mobile People, Mobile Disease

However, the reality differed from the official rhetoric. Life and work were still very harsh for ordinary people and local cadres in this southeastern coastal prefecture. One month later, people would be celebrating the Spring Festival, as the Lunar New Year is referred to in China. Although the effects of the Great Famine were not as severe in the southeastern area as in some parts of China, hunger was still a serious concern, and many were worried that they would not have enough food to survive beyond the New Year. Local cadres were busy with the work of mobilizing migrant peasants to return to their hometowns and arranging work and life in general for the urban employees who had been sent out to live in rural areas. Hunger aside, on the first day of 1962, people in the area were not expecting a particularly unusual year. However, history would prove them wrong. Wenzhou Prefecture would host three important groups that year: first, the People’s Liberation Army (PLA) soldiers moved in to participate in the Preparation for War campaign on the coastal front, fishermen from Guangdong Province would cast their nets in Zhejiang Province, and overseas Chinese would return to visit their hometowns. More significantly, the people in Wenzhou would be stricken by a deadly cholera pandemic during the summer, with that prefecture becoming the most seriously affected area in southeastern coastal China. This combination of famine, returning peasants, relocated urban employees, soldiers, fishermen, and overseas Chinese visitors wove a complicated web of population mobility that became entangled with the outbreak and spread of cholera in the summer of 1962. This chapter aims to investigate the dynamics of population mobility from the 1950s onward and its impact on disease transmission during the cholera pandemic in 1962. As this chapter indicates, population mobility during this period demonstrated the seemingly contradictory processes of the making of a sedentary society and the rise of a mobile coastal society, which restructured the sociopolitical context and led to the epidemic. Sociopolitical changes, human ecology, and social customs interacted and further shaped the geographic and temporal distributions of cholera.

FRAGILE BODIES AND THE MAKING OF A SEDENTARY SOCIE T Y Grain has been a crucial factor affecting population mobility in China throughout history, and its importance continued beyond the Communist revolution in 1949. On May 7 of that year, the Communist guerrilla armies took over Wenzhou City and set up new governments in each county, appointing their own cadres for

49

50

china a nd the choler a pa ndemic

all administrative positions at the prefectural and county levels. On May 26, the first dispatch of the No. 21 Division of the Third Field PLA arrived in Wenzhou City, bringing six hundred cadres of the East China Southbound Cadre Columns (Huadong nanxia ganbu zongdui) for prefectural and county governments. As local historian Zhou Baoluo described the situation, it was like “two batches of guests attending just the one banquet table.”2 Organizing all these cadres was difficult, but the much more challenging problem the new government faced was how to provide grain for the approximately forty thousand PLA soldiers who soon moved in along with local staff, civilian workers, and revolutionary youth, as well as former Nationalist soldiers who now worked for the new government. By forcing rich merchants and landlords to donate grain, the new Communist government found temporary respite from the serious grain shortage.3 The grain issue continued to trouble local governments in Wenzhou Prefecture and other parts of China and to affect population mobility during the 1950s. In October 1953, the central government started its policy of unified state grain purchases and sales, through which it procured surplus grain (yuliang) from among rural households to provide to urban populations and rural populations who were suffering grain shortages, after peasants had submitted public grain (gongliang, an agricultural tax) and kept grain rations (kouliang) and seed for production. In April 1958, the Zhejiang Provincial People’s Commission implemented the grain procurement quota scheme, which fixed the quantities of crops that would be procured regardless of fluctuations in grain production. This scheme therefore affected the grain ration available for peasants. Furthermore, the quota increased steadily, so that the 1959 quantity was 27 percent higher than that of 1958.4 While state grain procurement increased, agricultural collectivization and national industrialization resulted in a steady drop in grain production because of labor shortages, low productivity, and insufficient fertilizer.5 High levels of state grain procurement meant that the quantities that remained for feeding the population in Wenzhou Prefecture between 1958 and 1961 fell short.6 The grain ration per capita in the whole prefecture dropped steadily from 242 kilos in 1955 to 176 kilos in 1961, which meant peasants were consuming less than 460 grams of grain per person per day. The famine began to seriously affect Wenzhou Prefecture in late 1960 and continued until the outbreak of cholera in the summer of 1962.7 The famine was devastating for peasants. One local doctor, Ye Yuguang of the Dongtou district in Wenzhou City, recalled, “When villagers cooked food, they usually put rice husks in the middle of the pot, and then added sweet potatoes and rice around this. Rice was usually reserved for the formal laborers in the

Mobile People, Mobile Disease

families, as they needed strength to participate in agricultural production. Other family members ate sweet potatoes and rice husks.”8 To purchase enough staples to survive, commune members had to sell furniture, production tools, clothes, clothing coupons, or livestock, borrow money, or dismantle their houses and sell the wood. In some communes of southern Pingyang County, some even sold their children and wives.9 Furthermore, strenuous physical labor worsened the condition of these fragile, malnourished bodies, leading to large-scale outbreaks of edema in each county of Wenzhou Prefecture in October 1959, reaching a peak in 1960 and 1961. Adult patients accounted for the majority of cases, as they were most affected by the demand for high-intensity labor during the Great Leap Forward. Edema triggered a vicious economic cycle, as it reduced the number of formal laborers who could participate in agricultural production, which caused further grain shortages, resulting in even greater numbers of edema patients. Meanwhile, the large-scale agricultural collectivization campaign that had been ongoing since the mid-1950s mobilized peasants to labor in rice paddies, which exposed them to direct contact with water, soil, and feces, causing many to fall victim to parasitic diseases, such as filariasis, hookworm infection, and malaria.10 For example, the incidence rate of filariasis and hookworm reached 5 percent and 8 percent, respectively, of the total population of Rui’an County in 1962, and approximately half the population of Wenzhou Prefecture suffered from malaria.11 Famine and disease resulted in an abnormally high number of deaths after 1960. For example, in the most seriously famine-stricken commune, Wanquan Commune, in Pingyang County, a total of 3,481 residents died of starvation, accounting for 4.92 percent of the total population in 1960.12 As a result of these factors, the population natural growth rate in Wenzhou Prefecture dropped from 22.01 per thousand in 1958 to 8.95 per thousand in 1961.13 Fleeing from famine and disease was an important survival strategy for peasants in Wenzhou Prefecture. Peasants from Pingyang County began to move to neighboring counties in Fujian Province, which had suffered labor shortages due to the long, devastating fighting between the Communist and Nationalist armies from the 1920s onward.14 Within Wenzhou Prefecture, people also fled famine in their home counties and went to other rural or urban areas where there was somewhat more food, such as Rui’an County and Wenzhou City. Some begged for food, while others attempted to buy some grain. Some did odd jobs, such as carrying sugar in exchange for scraps of cloth or pig and cow bones; their family members begged for food in the street.15

51

52

china a nd the choler a pa ndemic

Meanwhile, the recruitment of peasants for industrial projects also brought about large-scale population movement. With the expansion of industry in urban areas during the People’s Commune campaign in 1958, Wenzhou City recruited more than ten thousand peasants from its suburban areas and nearby counties. This recruitment drive facilitated the arrival of other peasants looking for a living in urban areas. As the party committee of Wenzhou Prefecture described in its internal report, “many migrants asked for food and money in public areas such as bus stations, ports, theaters, and hotels. Some even knelt down and begged for food from house to house. Some held bowls and went to collect food scraps from snack bars, while others fought over food.” Many rural communes even encouraged their members to migrate into cities and asked them to remit money to commune funds.16 As the famine worsened in 1960 and 1961, more and more rural inhabitants moved to the cities. The large-scale and chaotic population movements caused by the famine and the migration of peasant workers into urban areas became a source of concern to the government. As the Pingyang County People’s Commission pointed out, “free population movement not only wasted the country’s manpower, materials, and finance but also brought very negative impacts on production and social security.”17 As early as April 1959, Wenzhou City started to lay off peasant employees and send them back to their home villages.18 In August 1960, the Zhejiang Provincial Committee decided to send all workers hired after 1959 back to rural areas. Other people from rural areas who had settled in towns were also instructed to go home and participate in agricultural production.19 This effort continued through the peak of the People’s Commune campaign, though it was fraught by setbacks. Compared with the relocation of peasant workers employed in the industrial sector, shifting unemployed migrants was more daunting because of their numbers. In view of this, the Zhejiang provincial government set up “repatriation” stations in four cities—Hangzhou, Ningbo, Wenzhou, and Jinhua—in early 1960. Because long-term migrants from Wenzhou mainly went to Fujian Province, Wenzhou Prefecture organized cadres to go to Fujian and mobilize these migrants to return.20 Similarly, Pingyang County set up sixteen repatriation substations and dispatched a total of sixty-eight cadres to Fujian Province under the leadership of the county party secretary and county governor.21 This period marked the beginning of serious top-down efforts to restrict population mobility. In October 1961, the Ministry of Public Security and Internal Affairs instructed local authorities to hasten the process of returning migrants

Mobile People, Mobile Disease

and peasant workers to their places of origin: “Rural communes, production brigades, and teams must conduct serious resettlement work for mobile populations and solve any problems regarding grains, households, houses, and allocated household plots.” The ministry also gave orders that “railway department and transport departments should implement ticket check schemes to limit free population movement via railways and boats.” The instruction also authorized each public security department to detain all migrants and send them back to their rural hometowns.22 The effects of these efforts were immediate: the percentage of rural peasants among total migrants dropped from 90 percent in 1960 to 65 percent in 1961. Population movements became more localized, entailing short distances within the same province or other neighboring areas.23 One month later, in November 1961, the State Council issued its “Report on Resolutely Stopping Free Population Movement.” This required that homeless peasants be sent home and that arrangements should be made to facilitate this, such as the provision of housing and work assignments. Further arrangements were to be made for those who had been repatriated repeatedly but still refused to stay in rural areas and participate in agricultural production.24 Following this directive, Zhejiang and Fujian Provinces signed an agreement on February 7, 1962, to repatriate those who migrated to each province, which basically put an end to such internal migration.25 Together with the improvement of the economic situation, migrant numbers decreased significantly. In Zhejiang Province, there were only around fifteen hundred long-term migrants by the end of 1962. Meanwhile, as a crucial part of alleviating national economic difficulties and reducing urban populations, the government reduced the number of urban residents in government agencies, enterprises, and civil service units, as well as towns, in a process called “streamlining and laying off ” (jingjian xiafang). These laid-off urban employees and workers were encouraged to go back to their rural hometowns and participate in agricultural production.26 In 1962, Wenzhou Prefecture met its target for laying off urban employees and reducing the size of urban populations: a total of 81,845 persons were laid off, 70,399 (86 percent) of whom returned to their home villages. The prefectural party committee justified this by indicating that “this work adjusted urban/rural balances and worker/ peasant relationships while strengthening the agricultural front.”27 By the time the cholera pandemic had arrived in the region in the summer of 1962, the chaotic population movements caused by agricultural collectivization and urban industrialization in the 1950s had basically been controlled. More

53

54

china a nd the choler a pa ndemic

significantly, the 1961–1962 repatriation of migrant peasants and the relocation of peasant-workers from urban areas to rural locations created a clear separation between the rural and the urban. Urban residents went from accounting for 11.5 percent of the population in Wenzhou Prefecture in 1961 to 9.6 percent in 1962.28 In subsequent years, the size of the urban population was further reduced: in Zhejiang Province, it decreased by 520,000 from January 1962 to June 1963 and had dropped by a further 923,000 by September 1964.29 This rural/urban divide became the basic social structure of Mao’s China and was facilitated by the institutionalization of the People’s Commune system in rural areas, the work unit scheme in urban areas, and the implementation of the household registration (hukou) system. These schemes “erected strong walls between the city and the countryside” and contributed to the rise of an immobile society by “creating a spatial hierarchy of urban places and prioritizing the city over the countryside[,] by controlling population movement up and down the spatially defined status hierarchy, preventing population flow to the largest cities.”30 This divided rural/urban society was established before the advent of the cholera pandemic in the summer of 1962 and was the sociopolitical backdrop against which the disease spread and was controlled. Nevertheless, as we shall see below, there were elements of population mobility within what was in theory and largely in practice a sedentary society. Both population movement and a static society helped to spread cholera. Large-scale movements such as those of fishermen and smaller ones such as the gatherings for traditional ceremonies aided in the transmission of cholera. In the meantime, the static nature of rural life in the enclosed space of the village meant that people were in close and constant contact with the sources of cholera.

FEAR AND THE RISE OF A MOBILE COAS TAL SOCIE T Y Famine, hunger, disease, and migration during the Great Famine and the subsequent formation of an immobile society in Wenzhou Prefecture by the summer of 1962 reflected Chinese society as a whole during this period. However, Wenzhou also presented some more unique features because of its geographic location and the historical tradition associated with its coastal society. Located in the southeastern corner of Zhejiang Province, Wenzhou Prefecture contains three archipelagos in the East China Sea: Dongtou, Beiji, and Nanji. The East China Sea forms a crucial passageway between Zhejiang and southeastern China, including Fujian, Guangdong, and Taiwan. Due to its location, Wenzhou

Mobile People, Mobile Disease

was also separated from the north and interior of China by mountain ranges. Constrained by limited arable lands and heavy population pressure, many of the prefecture’s peasants turned to migration and fishing, which were just about the only options available to them.31 The changing sociopolitical context after 1949 further complicated these specifically coastal features of Wenzhou.

The Tension of the Coastal Front When the Communist armies took over the mainland of Zhejiang Province in the first half of 1949, Nationalist armies set up their military headquarters in the Dachen Islands and remained in control of the sea off the coast of eastern Zhejiang.32 On January 18, 1955, the Communist army launched a successful attack on the Nationalist garrison stationed on Yijiangshan Island, which was the gateway to the Dachen Islands. The Nationalist army withdrew from the islands of Dachen, Beiji, and Nanji on February 6, 1955. From then on, the PLA occupied the islands of southeastern coastal China, except for Quemoy (Jimen) and Mazu. Military confrontation across the Taiwan Strait led to the formation of the southeastern coastal front, in which the Wenzhou area came to be conceived as the “bridge” for Taiwan’s intended northward expansion into mainland China. Because of their locations, Pingyang County, Rui’an County, and Wenzhou City quickly became important coastal military fronts. Nanji Island in Pingyang County, located in the far south of Zhejiang, was only a few miles from the nearest Nationalist-occupied area, through which fleets from Taiwan could reach Wenzhou within three hours.33 The confrontation posed great challenges for Wenzhou Prefecture, whose coastline is three hundred kilometers long and was home to more than forty thousand fishermen and seven thousand fishing boats. Fear among local residents intensified with the escalation of military confrontation across the strait in the 1950s. With the completion of the Yingtan–Xiamen rail line in April 1957, Communist forces were able to relocate to the Fujian front in large numbers, while the Nationalist armies moved onto Jinmen Island in south Fujian.34 By 1961, the military confrontation across the Taiwan Strait had radically intensified. Chiang Kai-shek, prompted by the prospect of a shift in the Kennedy administration’s policies toward Taiwan, as well as the rise of opposition democratic forces inside Taiwan, launched a military campaign under the motto “Reclaim the Mainland.” Preparations for war began, with the aim of landing in Xiamen, setting up a military base, and then expanding to the north and south on the mainland.35

55

56

china a nd the choler a pa ndemic

Figure 2.1. Chiang Kai-shek (center, in black) visiting Nanji Island, Wenzhou, 1954. Personal collection of Huang Ruigeng.

On the Communist side, following the debacle of the Great Leap Forward and the ensuing Great Famine, the government also encountered serious external challenges, including border clashes with India in the southwest, the radically worsening relationship with its ally the Soviet Union in the north, and Chiang Kai-shek’s plans to attack in the southeast. That attack was deemed to be imminent. In view of this, the Communist government decided to launch the so-called Preparation for War campaign. Under these circumstances, the geopolitical importance of Wenzhou was greatly enhanced, as it was the northernmost point of entry in the Nationalist military strategy. In August 1961, following the urgent directive on the Preparation for War issued by the Nanjing military region, the Zhejiang provincial military subregion set up its front headquarters in Rui’an County in Wenzhou Prefecture.36 In 1962, the military confrontation across the Taiwan Strait further intensified and reached its peak in May and June.37 On June 5, the General Political Department of the PLA issued an urgent circular: “The remnants of Chiang Kai-shek’s bandits stationed in Taiwan will launch an expeditious attack and attempt to set up an antirevolutionary base in the southeastern coastal areas of our country and restore its regime through plots.” The circular went on: “We shall mobilize immediately, make all preparations for war, welcome

Mobile People, Mobile Disease

Figure 2.2. People's Liberation Army joint coastal defense and patrol, 1964. People's Pictorial, no. 8 (1964).

the glorious tasks of war, and resolutely, thoroughly, completely, and cleanly eradicate all of Chiang’s bandit armies, safeguard socialist construction, and safeguard the fruits of revolutionary victory.”38 The Communist government initiated its Preparation for War campaign, which designated Guangdong, Fujian, and Zhejiang Provinces as war zones.39 On June 19 and afterward, both Taiwanese and U.S. military intelligence monitored the large numbers of PLA reinforcements moving into the Fuzhou military region. By the end of June, four hundred thousand land forces, one hundred navy vessels, and three hundred warplanes had already moved to the Fujian front.40 Intelligence reports from

57

58

china a nd the choler a pa ndemic

Hong Kong also reported that PLA troops stationed south of the Yangtze River had started large-scale redeployment, which disrupted normal rail traffic for two weeks.41 The No. 27 Division of the PLA stationed in Jiangsu Province marched into Pingyang County in Wenzhou Prefecture on June 8 to participate in the Preparation for War efforts in southeastern coastal areas of Zhejiang Province. Mao Zedong arrived in Hangzhou City, the provincial capital, and gave directives on troop maneuvers in the Wenzhou area. 42 The army started to strengthen fortifications on Nanji Island in Pingyang County, and the local government mobilized local laborers to move strategic goods to the port for the army. The Communist army then started relocating the residents of Nanji Island to the Wenzhou mainland.43 Following the instructions of the Central Committee of the CCP, Zhejiang Province set up the Provincial Committee Supporting Front Work Leadership Team.44 The government tightened social controls and mass mobilization to enhance political vigilance. As the Yongjia County government report claimed, “with the coming of the war, class enemies have started new activities. ‘The Four Elements’ (landlords, rich peasants, antirevolutionary elements, and bad elements) mistakenly believed that it was time to make trouble. They started contacting each other in secret and organized antirevolutionary groups, [planned] rampant counterattacks [and] plots to kill cadres, and pasted antirevolutionary slogans and spread rumor to misguide the masses.”45 Local governments then strengthened their control over the “Four Elements” in communes, brigades, and households one by one. They focused particularly on areas seriously affected by enemies and spies; locations between mountains, rivers, and coastal areas; and areas with economic difficulties. Local governments convened rallies and organized cadres, party members, and masses to “engage in self-criticism about the carelessness and lack of awareness around the Preparation for War and the underestimation of their enemies in order to enhance vigilance.”46 Through material preparation, civilian relocation, and social control and mobilization, the Wenzhou area was fully mobilized into a coastal front. These measures further reduced population mobility and contributed to the increasing reduction of population movements—the exception being PLA troops who had been dispatched to this coastal area. Their presence greatly complicated the health emergency that arose during the cholera epidemic, as is discussed in chapter 3.

Mobile People, Mobile Disease

Interprovincial Flows of Fishermen While the PLA was moving on land, there was another mobile group in Zhejiang Province: fishermen. Wenzhou Prefecture was one of four major fishing grounds in Zhejiang Province, and fishing was an important local industry. With the opening of the free fishing market and the implementation of the contract-based payment scheme in the early 1960s, the fishing industry developed very quickly. As was expressed in a report from the Masses of Southern Zhejiang, fishing not only provided a source of food, it also greatly increased the incomes of production brigades and teams. Offshore fishing had the advantage of being a low-cost activity, requiring only simple tools and production techniques, while making the most of available labor.47 For this reason, some communes actively assisted production teams in handling the relationship between agricultural and fishing production and fully mobilized “the masses” to participate in fishing activities.48 In addition to offshore fishing, Wenzhou people fished near the coast to the north and south. In the north, they worked the Zhoushan fishing ground, the largest in China, located in the northeast of Zhejiang Province. There were winter and spring fishing seasons, with the latter more profitable. The spring season, the main catch of which was yellow croakers, began in April–May and lasted for just over three months. Wenzhou fishermen sailed to Zhoushan, where more than a thousand fishing boats carrying some ten thousand fishermen congregated during the fishing season.49 In order to increase fishing production, Rui’an and Pingyang Counties and the Wenzhou City government assigned cadres to follow these northbound fishing boats and coordinate work among all teams and brigades.50 When Wenzhou fishermen headed north, the now-vacant seas in Wenzhou attracted fishermen from neighboring provinces, notably Guangdong, who came to Wenzhou to use a specific fishing technique called qiaogu (beating fishing boats). This fishing technique first emerged in the Chaoshan area of Guangdong during the Jiajing reign (1522–1566 CE) in the Ming dynasty, and it was a closely guarded secret among boat people (danmin). In this fishing technique, two big fishing boats waited in a given location and threw fishing nets into the sea, then twenty to thirty smaller fishing boats formed a semicircle around them. In each small boat, one person rowed and two more beat the water with bamboo poles to shock the fish, which were then driven into the fishing nets. As the mesh of the nets had holes of only one to two centimeters, the catch of qiaogu was extremely

59

Figure 2.3. Sketches of fishing activities. ZNDZ, November 3, 1962.

Figure 2.4. Guangdong fishing boats. People's Pictorial, no. 4 (1963).

high, usually ten times that of conventional fishing methods. A large-scale collaborative technique, it required a few hundred to a thousand fishermen to execute but was both low in cost and as profitable as it was destructive for fish stocks.51 By the 1950s, offshore fishing in Guangdong Province had already started

Mobile People, Mobile Disease

encountering difficulties. Long-distance fishing involved cold storage and maintaining the engines of the fishing boats, which were challenges for fishermen. Given these circumstances, Guangdong fishermen also began heading north to the grounds in Fujian and Zhejiang. By 1956, the qiaogu technique had thus spread from Guangdong Province to Wenzhou in Zhejiang Province. Some fishing teams from Guangdong even signed long-term contracts with local fishing brigades in the Wenzhou area. The combination of the Guangdong fishermen’s techniques and technology and the Wenzhou fishermen’s familiarity with the local sea led to extremely large catches.52 However, as the local gazetteer of Pingyang County pointed out, “the yellow croaker resources suffered devastating destruction.”53 The Zhejiang provincial government and party committee regularly issued circulars forbidding this fishing technique in view of its destructive effect on aquatic resources and the long-term interests of fishermen. However, facilitated by free-market demand and high profits, more and more local fishing brigades in Wenzhou ignored these mandates and began to collaborate with fishermen from Guangdong Province. Soon fishermen from Fujian Province also joined in the qiaogu fishing in the Wenzhou area. In the spring fishing season of April 1961, it was estimated that around 6,750 fishermen from Pingyang County engaged in this fishing technique.54 The Wenzhou prefectural party committee released another circular banning the method, and it had as little impact as its predecessor. More fishermen from Guangdong and Fujian Provinces arrived in Wenzhou and continued to engage in qiaogu fishing in the spring fishing season of 1962. For example, Fuding and Huian Counties in Fujian Province dispatched more than 2,000 fishermen and 200 fishing boats to Dongtou Island near Wenzhou City in May and June alone.55 It was estimated that more than 1,500 production units and 17,000 fishermen fished in the area during this period.56 These fishermen would come to play an important role as cholera carriers in long-distance disease transmission from Guangdong to Zhejiang in 1962. Within Zhejiang Province, as the Provincial Cholera Technical Supervision Station pointed out in November 1962, “clinic examinations of all the first cases in each cholera-affected county and city found that more than half of them were associated with fishing activity.”57

Visits from Overseas Chinese While the Guangdong fishermen were converging in Wenzhou, another group from farther afield also descended on the area: overseas Chinese returning

61

62

china a nd the choler a pa ndemic

from Southeast Asia to visit their hometowns. As early as the late Qing dynasty (1644–1911), many people from Qingtian County in Wenzhou Prefecture had started migrating to Europe to escape the hardship caused by a huge population trying to eke out a living from largely barren land. These Qingtian natives made a living selling carved stone to Europeans and gradually became a significant proportion of the Chinese migrants living in Europe by the early twentieth century.58 Their migration to Europe affected those living in neighboring counties in the Wenzhou area, as more and more of them went abroad with the assistance of their distant relatives, and the destinations to which they traveled also expanded in scope. From the late 1920s to late 1930s, laborers from the Wenzhou area also started moving to Southeast Asia, mainly Singapore, Malaysia, and Indonesia.59 There, many worked as carpenters or as coolies on local plantations, ran Chinese restaurants, or, in the case of intellectuals, taught Chinese at local Chinese schools.60 By the 1930s, the Wenzhou area had become the place from which the largest number of people had emigrated out of Zhejiang Province.61 By 1949, there were around 39,000 Wenzhou natives scattered around the world.62 In the 1950s, overseas Chinese affairs became a major focus of ideological propaganda and of the United Front Work on the part of the Chinese Communist Party and the government. This work also involved practical economic needs because remittances from overseas Chinese were a key source of foreign currency for national industrialization projects. However, during the People’s Commune campaign after 1958, some local governments confiscated houses and furniture and opened locked houses owned by returned overseas Chinese. Some cadres confiscated other means of subsistence held by families of overseas Chinese and returned overseas Chinese and asked them to donate money, jewelry, and gold to local governments. As the Department of Overseas Chinese Affairs of Zhejiang Province pointed out in an internal report, “these local policies have seriously affected the activeness of the families of overseas Chinese in procuring foreign currency remittances. Some relatives of overseas Chinese and returned overseas Chinese have written letters to their families abroad asking them to stop sending money.”63 Remittances began dropping in late 1958 in key counties in Wenzhou Prefecture, decreasing by 30 percent compared with 1957.64 There was a corresponding drop in overseas Chinese visitors around this time (including those from Hong Kong and Macau): visitor numbers increased steadily from 551 in 1955 to 1,282 in 1960 but plummeted to 403 in 1961.65 It therefore became imperative for the government to enhance its image among overseas Chinese to boost remittances. In May 1959, the Zhejiang

Mobile People, Mobile Disease

provincial party committee dispatched a work team to oversee refunds and compensations for families of overseas Chinese and returned overseas Chinese who had been targeted by cadres.66 In August 1959, in view of the fact that overseas Chinese visitor numbers were likely to increase around the tenth anniversary of the founding of the PRC in October, Wenzhou City’s party committee instructed each locale to take the opportunity to publicize this event among overseas Chinese, in order to “help them set aside any doubts about the Great Leap Forward campaign and the People’s Commune, conduct patriotic education, and soothe their emotions.” The instructions stipulated that each visitor would be offered thirty jin of grain rations per month, along with specific grains and staple foods. When they visited their families, their family members should be offered time off from production work.67 In 1961, to further boost remittances from overseas Chinese, Zhejiang Province People’s Commission set up a work team.68 One of its key roles was to encourage and invite overseas Chinese to visit their hometowns and to publicize new policies to their families. To this end, the local government first conducted a survey, which indicated that more than five thousand overseas Chinese from Pingyang County were living in twenty-four countries, including Hong Kong, Macau, Malaysia, Singapore, and Indonesia. The county then convened meetings for overseas Chinese, their families, and returned overseas Chinese to clarify a few issues on grain allowances, market supply, and overseas remittance policies.69 In order to urge more overseas Chinese to visit their hometowns, local governments also organized visits for these groups to Hangzhou, Shanghai, and Suzhou to “show the great achievements of socialist constructions over the years.”70 To achieve this, the Wenzhou Prefecture overseas Chinese travel agent regularly placed tourism advertisements in the Masses of Southern Zhejiang to attract overseas Chinese visitors. State-owned enterprises and institution units, including those hotels where overseas visitors stayed during their visits to Wenzhou, usually subscribed to local newspapers like the Masses of Southern Zhejiang. Placing these tourism advertisements in local newspapers at least symbolized to the public the governments’ efforts to attract overseas visitors.71 And these efforts were successful: visitor numbers to Zhejiang Province soared, from only 403 in 1961 to 2,539 in 1962, a fivefold increase within a year, according to the statistical data provided by the Provincial Foreign Affairs Commission.72 Although these numbers are small in comparison with those of PLA soldiers and fishermen, the overseas visitors became potential cholera carriers and were significant enough to complicate prevention efforts during the pandemic, as will be discussed in chapter 4.

63

64

china a nd the choler a pa ndemic

As the above sections have described, a mobile coastal society formed in the Wenzhou area due to the specific sociopolitical events that took place at the time, including tensions around the Preparation for War campaign, the interprovincial flow of fishing activities, and the revival of overseas Chinese visits in the summer of 1962. These changes sparked long-distance mobility among three specific groups against a backdrop of a largely immobile society. This specific sociopolitical structure shaped the spatial and temporal spread of cholera because of its impact on human ecology and social customs.

THE DYNAMICS OF HUMAN ECOLOGY AND THE GEOGRAPHIC CHOLERA BELT As I described in the introductory chapter, sixty-three-year-old Chen Azhu was the first cholera patient to be identified in both Wenzhou Prefecture and Zhejiang Province during the mainland outbreak that began in Guangdong Province in February 1962. The Rui’an County Sanitation and Epidemic Prevention Station conducted a preliminary epidemiological survey on the etiology of her case immediately after the diagnosis of cholera was confirmed on July 16. The investigation found that Chen lived with her husband and had had little contact with the outside world in her daily life. She had not visited any other areas before contracting cholera, and the only vegetables she ate had been purchased from the local farm market. Her daughter-in-law’s visit from Shanghai on June 28 thus seemed to be the only factor that might have caused Chen to contract cholera. The investigation found that before visiting Chen, her daughter-in-law had stayed with her uncle, who was a fisherman on Beiji Island in Rui’an County. However, this uncle had not been fishing in June because of the PLA’s preparations for war on the island. Furthermore, stool samples from both the daughter-in-law and her uncle’s family members proved that they were not cholera carriers.73 Nevertheless, the epidemiological experts all agreed that external intrusion had to be the main reason for the outbreak of cholera in Rui’an County in Wenzhou Prefecture. Since Guangdong Province was the only cholera-affected area before the outbreak in Wenzhou Prefecture, the experts explored the activities of people from Guangdong who had come to Zhejiang. They soon found three major clues. First, on June 12, a member of a military family had returned from Guangdong and traveled via Wenzhou City and Rui’an County to Nanji Island in Pingyang County. Second, a few Indonesian Chinese had visited their hometowns in Rui’an County in mid-May. Third, according to the local clinic on Beiji Island, quite a few fishermen from Guangdong suffering from serious intestinal

Mobile People, Mobile Disease

problems had sought medical treatment there on June 10–11. Their fleet included four motorized boats, six rowboats, and 180 men. In the epidemiological report submitted to the Zhejiang provincial party committee, the Rui’an County experts concluded, “It was impossible to confirm which of these suspicious external factors—the military family members, overseas Chinese visitors, or Guangdong fishermen—spread cholera to Rui’an County. However, these mobile groups were the explanation for the long-distance, interprovincial transmission of this mild type of cholera, as they were healthy carriers.”74 Regardless of which external factor was to blame, Rui’an County became the gateway for the transmission of cholera into Wenzhou Prefecture in the summer of 1962. More significantly, the human ecology of coastal Wenzhou, where Rui’an County is located, shaped the specific features of disease transmission. As the accompanying map indicates, Wenzhou Prefecture is surrounded on three sides (to the north, west, and south) by mountains, and the remaining side faces the East China Sea. Each of the three major coastal counties—Wenzhou, Rui’an, and Pingyang—has its own major river flowing west to east through their territories: the Ou, Feiyun, and Ao Rivers, respectively. Within this geographical network, the seat of Rui’an County is located on the Feiyun River, between Wenzhou City and Rui’an and Pingyang Counties. In the north, Highway No. 104 basically runs parallel to the north–south Wenrui Canal (tanghe), which crosses the Wenrui Plain near Wenzhou City and northern Rui’an County. In the south, Highway No. 104 runs parallel to the north–south Ruiping Canal and Ping’ao Canal, which pass through the Wanquan Plain in southern Rui’an and Pingyang Counties. In this way, three rivers, one highway, and three canals wove a crisscross transport network across the area. Within this network, the seats of Rui’an and Pingyang Counties and Wenzhou City are all located at junctions of these rivers, the highway, and the canals. The canals were especially significant in the Wenrui and Ruiping Plains, which are crossed by hundreds of smaller rivers, streams, and brooks. These canals are natural rivers that have been modified through longterm irrigation projects.75 As the local historian Wang Changming described, “The main channels of these canals had been dug out and dredged, so to a great extent they had become man-made rivers. . . . Over history, local authorities constructed water gates along them to control water for irrigation, which was also a source of drinking water for local residents.”76 These canals also played an important role in transport. In the early years of the republican era, motorboat companies used them to access the three major rivers between Wenzhou City and Rui’an and Pingyang Counties. This route

65

Map 5. River and transport networks in Wenzhou Prefecture, 1962

Mobile People, Mobile Disease

greatly facilitated the development of southern Zhejiang and northern Fujian.77 Even though the road networks became more important after 1949, the river transport system still played an important role in residents’ daily lives. The fact that the coastal areas of Wenzhou City and Rui’an and Pingyang Counties were well connected contrasted sharply with the situation in the semimountainous and mountainous areas to the west. The intersections between road and river transport networks played a particularly important role in cholera transmission. Population dynamics further complicated the ecological system in Wenzhou Prefecture. Throughout history, Wenzhou had been a favorite destination for refugees fleeing war and chaos at the end of dynasties because it was surrounded by mountains, which functioned as geographical barriers.78 Wenzhou Prefecture has long been the most populous area in Zhejiang Province. By the late 1940s, population density in Rui’an County was the highest in Zhejiang Province, averaging 449 people per square kilometer.79 Pingyang County was the second most populous county in Zhejiang Province and accounted for one-third of the total population in Wenzhou Prefecture. As population movement stabilized after 1949, these numbers increased steadily after soldiers and migrants returned to their hometowns following the collapse of various Nationalist armies. Later the increased birth rate and falling death rate increased the population even more rapidly in the 1950s, although there was a small drop in 1961 during the Great Famine.80 Population density in Zhejiang Province increased from 205 people per square kilometer in 1949 to 266 in 1962. During the same period, the figure for Wenzhou Prefecture went from 293.2 to 419.6. By the outbreak of cholera in the summer of 1962, Wenzhou Prefecture was one of the most densely populated areas in Zhejiang Province. In particular, the population density in three coastal counties—Wenzhou, Rui’an, and Pingyang—was more than 2.3 times that of Zhejiang Province as a whole, while the population density in the mountainous counties (Yongjia and Taishun) was lower than the provincial average, 184 and 108 per square kilometer, respectively. Within the three coastal counties (Wenzhou, Rui’an, and Pingyang), the most densely populated area was the eastern coastal plain, where the land was more fertile and transport networks were better. As local historian Zhou Baoluo explained, “soils in plains areas are very fertile, as these are alluvial plains. Agricultural production from one mu [666.66 square meters] on plains is equivalent to ten mu in mountainous areas.”81 Furthermore, population movement along the counties’ roads and river systems was mainly short-distance travel, and the human ecology of the area made it ideal for cholera to spread. Rivers played a

67

68

china a nd the choler a pa ndemic

particularly important role during this process. Like their counterparts in the Yangtze delta areas, people in eastern Wenzhou lived along rivers, brooks, and ponds and usually collected river water for drinking; used the river to wash vegetables, clothes, chamber pots, and grain containers; and bathed in the waters. Feces used as fertilizer would ultimately flow into rivers, which were also polluted by industry and run-off from ditches. While daily living and production activities seriously contaminated rivers, boats and junks then spread this pollution. River pollution was particularly serious during the rainy season.82 Right after the outbreak of cholera in Rui’an County on July 4, 1962, short-distance population mobility quickly spread cholera along these transport and river systems in eastern coastal Wenzhou. The evacuation of urban residents and the movement of peasant laborers, rice-harvesting laborers, and hawkers were the most significant types of mobility. In the summer of 1962, the Preparation for War campaign activities were in full swing. Some township residents were evacuated to rural areas in Wenzhou Prefecture, and Rui’an and Pingyang Counties were required to construct a fifteen-kilometer national defense road. The Pingyang County government was also asked to mobilize a total of sixteen hundred peasant laborers for the project, eleven hundred of whom arrived on July 15, while the remaining five hundred arrived on August 5, 1962.83 Meanwhile, the suburban communes of Wenzhou City hired laborers from Rui’an and Pingyang Counties to participate in the rice harvest.84 Hawkers also played an important role in cholera transmission between the two locations. For example, the first cholera patient in Taoshan District in Rui’an County was a hawker who had contracted the disease in Xianjiang District but did not experience symptoms until the second day after he returned home.85 Both cholera patients and healthy carriers moving along the highway and river systems facilitated the spread of the disease. While the cholera epidemiological experts were discussing between July 5 and 16 whether Chen Azhu’s “diarrheal illness” was cholera, the disease had already rapidly spread south and north in Wenzhou Prefecture. On July 11, the first “diarrheal” patient was reported in Wanquan District, Pingyang County, which is located near the Rui’an County seat. On July 13 and 14, Yueqing County and Wenzhou City also reported that they had found “diarrheal” patients.86 Over the following days, Wenzhou Prefecture received more and more urgent reports from these counties and the city. Cholera is an acute infectious disease. As the Rui’an County People’s Hospital described in its clinical report, in this case, “the incubation period lasted

Mobile People, Mobile Disease

from three hours to six days. Among them, 82.2 percent of cases broke out within three to twenty-four hours, and the vast majority of serious patients need to be hospitalized within twelve to twenty-four hours.” Clinically, cholera patients showed a few major symptoms when admitted to hospitals: “Patients suffered serious diarrhea. Although they did not have many bouts of this, each one consisted of one to two thousand milliliters of diarrhea, the majority of which was painless. . . . Each patient had nine bouts of serious vomiting on average but did not feel nausea. Serious and relatively serious patients usually suffered 74 percent dehydration of their entire bodies, and then felt thirsty, lost their voice, lost skin elasticity, experienced muscle cramping, and their limbs felt cold.”87 Patients suffered from shock along with low blood pressure, pulse rates, and urine output. The afflicted included both peasants and urban residents, and while young and middle-aged adults between twenty and forty were the main victims, the mortality rates among the old and fragile, pregnant women, and children were the highest. The spread of cholera caused panic in society. As the Rui’an County party committee reported, “when cholera was spreading in some areas of our county, it happened to be when the harvest started for the first rice crop. Some cadres and the masses panicked, particularly in areas that were seriously affected, where people were very scared.”88 Within about a month, cholera had affected five counties and cities in Wenzhou Prefecture. During this process, as the accompanying map indicates, cholera spread along very noticeable geographical belts, where incidence rates reached 9 per thousand and above. Cholera spread east and west along the Feiyun River in Rui’an County, the Ao River in Pingyang County, and the Ou River in Wenzhou City.89 It was also distributed north and south along Highway No. 104 beside the Wenrui Canal and the Ruiping Canal; the outbreak was especially serious in districts located along major canals and the highway.90 For example, the incidence rate in Xianjiang District in Rui’an County was 14.12 per thousand, which was the highest district rate in Zhejiang Province in 1962, while Rui’an County as a whole (5.79 per thousand) saw the highest county rate. Although presumably biologically the same, the cholera that spread north and south was much deadlier than that spreading east and west.91 Cholera distribution belts formed their own networks but overlapped significantly with the transport and river networks in eastern coastal Wenzhou. These distribution belts across the plains also contrasted sharply with neighboring areas. For example, in Rui’an County cholera mainly spread across coastal waterway plains: a total of 81.15 percent of cholera cases were in these areas, where

69

Map 6. The cholera belt in Wenzhou Prefecture, 1962, with inset showing affected areas of Zhejiang Province

Mobile People, Mobile Disease

the average incidence rate was 6.6 per thousand. Some 18.3 percent of cases were in the adjacent hilly land between the semimountainous and plains areas, where the incidence rate was 3.3 per thousand. In the mountainous and semimountainous areas seventy-five kilometers away from the coastline, cholera did not spread widely and the average incidence rate was only 0.06 per thousand. This pattern was also reflected in Wenzhou Prefecture, where cholera incidence rates were highest on the plains (5.78 per thousand), followed by the hilly areas (2.62 per thousand) in the middle of the prefecture, and lowest on the islands and mountainous areas (0.18 and 0.38 per thousand, respectively).92 The human ecological system not only contributed to the geographical belts of cholera distribution in eastern coastal Wenzhou but also formed a hierarchical shape of incidence rates that largely reflected geographical features.

THE TENACIT Y OF SOCIAL CUS TOMS AND THE TEMPORAL RHY THM OF CHOLERA In 1962, the rising population mobility on the southeast coast was the key external factor that aided the transmission of cholera from Guangdong Province to Wenzhou Prefecture, Zhejiang Province. With the subsequent restrictions in mobility, there was increased stress within the human ecological system, and cholera spread along specific geographical belts. However, another factor contributed to the disease transmission. The months between early June and late September hold great significance for agricultural communities in southeastern coastal China. Farm production peaks and social customs that bring people together, such as festivals, banquets, and visiting relatives and friends, increase. This rhythm of social customs brought inhabitants together at a crucial time in the disease’s progress. Summer is the most important season for Wenzhou, as it is a rice production area. Rice crop harvesting and the planting of the next crop started in mid-July and ended in early August. After this busy, exhausting season came a few important festivals, the aims of which were to celebrate bumper crops, show reverence to ancestors, and strengthen family bonds and friendship. Wenzhou customs included changxin (tasting new grain), qing fengshou (celebrating bumper crops), and wangongjiu (celebrating the end of harvests). These customs usually entailed banquets, as well as sacrifices to ancestors. After the harvest, the peasants dried the new grains, processed them, and cooked them. They then placed a table or tea table in the middle of the courtyard and set a plate of eggplant, some cowpeas, and a bowl of rice on it, and a stick of incense and red candles were put into the

71

72

china a nd the choler a pa ndemic

rice. The household started offering sacrifices to heaven and earth and to their ancestors. After this worship, the whole family tasted the new rice. These meals traditionally included cakes, fish, pork, chicken, and duck.93 The ceremonies combined worship of heaven and earth and the god of rice, ancestors, and kinship, and they were important family gatherings. Some marriage ceremonies were held around this period because people now had time to host guests and had grain to offer them. After these gatherings, residents welcomed another important festival, the Hungry Ghost Festival (guijie), which is in mid-August. During this festival, peasants would hold a memorial ceremony for their deceased ancestors, burning ghost paper money on the road and at the corners of fields. One month later came another major festival for celebrating family reunions, the Mid-Autumn Festival, which falls in mid-September.94 These festivals were very important in Wenzhou. In its investigative report into cholera epidemiology, the Pingyang County Cholera Epidemiological Team pointed out, “The local masses take marriage, funerals, and sacrifices to ancestors very seriously, including wedding and funeral banquets, tasting the new rice, the Hungry Ghost Festival, and the Mid-Autumn Festival. People like these customs, particularly on the plains and along the coast.” The festivals were an occasion for social gatherings. As this investigative report pointed out, “the masses loved to see performances in the quiet season after the harvesting of the first rice crop. They invited a group of performers from different areas to perform and also organized performances themselves.”95 Meanwhile, as the key element of these festivals, inviting guests to attend banquets was so commonplace in the villages of Wenzhou Prefecture during this period that official documents repeatedly criticized this, in view of the shortage of grain, as “a taste for luxury and excitement.”96 Despite such criticism, these social customs hung on tenaciously. However, the period from early June to late September is when temperatures are highest in Wenzhou Prefecture, like other parts of southeastern China. Dietary hygiene, given the high summer temperature, was a problem and contributed to the outbreak and spread of intestinal diseases. According to records from the Pingyang County Sanitation and Epidemic Prevention Station, dysentery occurs throughout the year, but 75 percent of cases happen between June and October and the peak comes in August (accounting for 22 percent of the total cases in the year).97 The rhythms of agricultural production, traditional festivals, and social customs had a deadly effect on the spread of cholera in Wenzhou Prefecture in 1962. The summer harvesting and planting began almost precisely when the

Mobile People, Mobile Disease

first cholera case occurred in Rui’an County, on July 4, and ended on August 3.98 During this, the busiest time of the year for agriculture, peasants committed to harvesting and then to planting the next rice crop within two weeks, which led to population concentration. This in turn aided the rapid spread of cholera, either by cholera patients or by convalescent carriers. This transmission process was quickly worsened by gatherings around the traditional festivals that followed the agricultural production season. For residents who had survived the famine, summer 1962 was more of an excuse than usual to enjoy these festivals. In one suburban commune of Wenzhou City, 127 of 138 production teams held a banquet to celebrate the bumper crop of grain for 1962.99 At these banquets, seafood in particular favored disease transmission. As the Pingyang County Cholera Epidemiology Investigation Team pointed out in 1963, local residents in coastal areas were partial to seafood, including fish, shrimp, and razor clams. The opening of the free fishing market meant that fishermen were coming and going from infected areas frequently. Seafood was therefore easily contaminated with cholera because seafood products (razor clams, for example) were often contaminated, as they were bred in river water.100 Meanwhile, many guests at the gatherings were either atypical cholera patients or convalescent carriers. These festivals and wedding ceremonies during this period soon became a major source of contagion. In Xianjiang Commune, Xianjiang District, in Rui’an County, a commune member got married on September 15, 1962. The family held a small wedding banquet and invited thirty guests to attend. The dishes served included razor clams, pork, and chicken. Within forty-eight hours of the banquet, guests became ill one by one until a total of twelve were affected. Investigations into the case found that the bride’s brother had been hospitalized with cholera on July 24 and had been discharged after treatment on August 30. He served as the chef preparing the banquet food.101 The spread of cholera was further worsened by the social customs of visiting relatives after illness. This led to a chain reaction of cholera transmission.102 In Xincheng District in Rui’an County, there were 180 households and 830 residents. Ge Changrong became the first cholera patient after he visited his father in Rui’an County Town. He ate contaminated food during the visit with his father at the county hospital. Ge Changrong’s uncle, who lived nearby, came to visit him, and shortly thereafter he became sick with cholera, too. In Rui’an and Pingyang Counties, contagion caused by visits to cholera patients became another important factor, one that accounted for around 11 percent of total cases.103 It was even worse when cholera patients died, as families usually chose an

73

china a nd the choler a pa ndemic

74

Table 2.1. Three peaks of cholera transmission in Zhejiang Province, 1962 Peak

Date

Occasion or festival

Highest number of cases

Length of peak (days)

Total cases

Major areas

1

July 22

Rice harvest

298

4

808

Rui’an County

2

August 17

Hungry Ghost Festival

330

11

2,582

Pingyang County

3

September 14

Mid-Autumn Festival

234

18

2,629

Pingyang County

Source: Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan, “Fuhuoluan de liuxingbingxue,” November 7, 1962, ZJA, Vol. J166-2-129.

auspicious day to bury their deceased. Corpses were kept in homes for six to seven days, and the gatherings for burial ceremonies brought people into contact with the sources of cholera present and spread the disease even further. 104 In Rui’an County, one Daoist monk held a ceremony following the death of a cholera patient, then returned home, developed cholera, and infected his family members, too. In Yongqiang District in Wenzhou City, a Daoist monk died after hosting a funeral ceremony for a cholera victim. His family held a funeral ceremony for him, inviting the villagers to have dinner. Of the total seventy banquet guests, fifteen of them soon had cholera.105 Social festivals and gatherings thus created cholera transmission chains that escalated into an epidemic. As if this were not enough, 1962 was doomed to be an extraordinary year, one in which the transmission effects of the festivals and gatherings were further worsened by the weather. While cholera was ravaging Wenzhou Prefecture, four typhoons hit the area.106 The first brought 150 millimeters of rain, while the third was the most serious storm the area had experienced in a century. Typhoons, storms, and heavy rain affected all the counties of coastal Wenzhou, while Pingyang and Rui’an suffered the most serious damage.107 These typhoons basically coincided with the rhythms of agricultural production and festivals between July and October. The first of the four typhoons hit around the time the rice harvest was to begin. The following three hit Wenzhou Prefecture one week ahead of each of three important rural festivals—the Hungry Ghost and Mid-Autumn Festivals, as well as the Double Ninth Festival, for seeking blessings for good fortune and for worshiping ancestors. The heavy rain from typhoons washed rubbish, debris, and raw sewage into rivers and waterways,

Mobile People, Mobile Disease

causing water pollution and increasing the spread of cholera, which was then worsened by the gatherings for the festivals. These two factors conspired to form a vicious cycle of transmission. The spread of cholera in Wenzhou Prefecture formed specific peaks following local traditional festivals. As the Health Division of the Rui’an County People’s Commission found, “the first peak [in Rui’an County] formed after villagers celebrated the harvest of the first rice crop. They held banquets to taste the new grain and lavishly ate food and drank wine. On July 21–23, the number of cholera patients reached 211 per day on average.” The second peak formed during the Hungry Ghost Festival, which brought 64 cases per day. The third peak formed around the Mid-Autumn Festival, when there were 25 cases per day. Correspondingly, the cholera in Wenzhou Prefecture formed three peaks in Zhejiang Province because the former accounted for 97 percent of the total number within the province (table 2.1).

CONCLUSION While cholera spread from the seat of Rui’an County to other counties and cities within Wenzhou Prefecture within less than a month, it also started spreading northward along the coastlines of Zhejiang Province toward the neighboring prefectures of Taizhou, Ningbo, Zhoushan, and Shaoxing. 108 By September 12, 1962, cholera had affected the coastal areas around the mouth of the Qiantang River, which is adjacent to the provincial capital, Hangzhou. 109 By early October, cholera had already reached the mouth of the Yangtze River in the north of Shanghai Municipality, before gradually stopping when the temperature dropped in October.110 By this point, the cholera pandemic had affected the whole of southeastern coastal China, with Wenzhou Prefecture being the most seriously stricken area (table 2.2) and Zhejiang the most seriously affected province. As Li Lanyan, director of the Zhejiang Provincial Health Department, admitted at the Provincial Health Cadre School meeting on December 25, 1962, “this year the number of cholera cases in our province was the highest in the nation.”111 As this chapter has shown, sociopolitical changes, human ecology, and social customs interacted and further affected disease transmission during the cholera pandemic in the summer of 1962. This process demonstrated the spectrum of population mobility modes, from the victory of the Communist revolution in 1949 to the Great Leap Forward and associated famine in 1958–1961. National

75

Table 2.2. Cholera on the southeast coast of China, 1961–1988

Counties affected

3,975

0

Cases

340

0

Deaths

25

0

Counties affected

11,578

0

Cases

716

0

Deaths

*

*

28

2,226

Cases

*

*

0

160

Deaths

3

284

10,747

0

Cases

0

7

606

0

Deaths

Wenzhou Prefecture, Zhejiang Province

35

2

8

Yangjiang County, Guangdong Province

Deaths

20

88

367

Zhejiang Province

Cases

772

429

*

12

Fujian Province

4,318

1

17

Guangdong Province

8,666 2

363

Year

1961

6

16

1961–1964 1962 4

*

12

17

1

*

351

66

27

2

17

190

3

726

420

1,391

62

1963

*

6,966

1

15

1964

416

12,033

*

2

218

3,818 26

*

*

*

0

0

0

11

274

3,706

2

26

1

*

788

404

0 2,549

0

613

*

31

0 3

0

2

20

0

0

0

11,034

36

*

0

*

20

*

358

1,111

1,618

*

*

*

31

*

4,340

54

31

*

2

85

*

77

324

79

*

2

4,066

6,920

3

37

1,222

26,536 30

129

2,802

33

1978 50

11

41

13,240

1979 2,546 17

124

Subtotal

1980 1,357

13,282

1965–1977

1981 4

*

1978–1988

1982 1983

*

0

*

3

*

3

*

309

0

*

0

1

341

1

0

24

0

0

145

0

3,357

*

0

*

*

*

26

*

*

0

31

*

43

3,234

*

0

21

*

2,674

11

*

1985 2,810

0

14

1984 1986

36

1,967

124

8

15,995

15

21

1

1,842

3

271

48

23,868

352

658

1987

53,675

1988 Subtotal

* Data unavailable.

Sources: Yangjiangshi difangzhi bianzhuan weiyuanhui, Yangjiang xianzhi, 938–39; Zhonggong Yangjiang xianwei Yu Xin shuji, “Liuxingbing diaocha baogao,” 1961, GYJA, Vol. X38.A12.1. 36; Guangdong difang shizhi bianzhuan weiyuanhui, Guangdong shengzhi: Weishengzhi, 169; Fujiansheng difangzhi bianzhuan weiyuanhui, Fujian shengzhi: Weishengzhi, 61; Wenzhoushi weishengzhi bianweihui, Wenzhoushi weishengzhi, 131–32; Zhejiangsheng weisheng fangyizhan, Zhejiangsheng yiqing ziliao huibian, 1950–1979, 46; Zhejiangsheng weisheng fangyizhan, Zhejiangsheng yiqing ziliao huibian, 1950–1979 (changdaobing fence).

Mobile People, Mobile Disease

industrialization and agricultural collectivization—two major aspects of socioeconomic development in the 1950s—had produced disorderly population movement during the Great Leap Forward and the famine. The reforms of 1961 targeted and controlled mobile populations, including refugees, internal migrants, and peasant workers. In the process, rural China became a less mobile and more closed society. Once mechanisms for institutionalized surveillance and control were consolidated, rural immobility was in place in China. However, there were some exceptions to these patterns in southeastern coastal China in the summer of 1962. In this specific geographic space, there was increased mobility as a result of the rising military tensions on the coastal front, the interprovincial flow of fishermen, and visits from overseas Chinese. Therefore, population mobility during this period presented the seemingly contradictory processes of making a sedentary society while coastal society became more mobile. However, the former was an institutionalized effort, while the latter comprised either urgent or temporary measures adopted within the framework of the former. As this chapter indicates, the government kept the movement of soldiers, fishermen, and overseas Chinese under tight control. In other words, a mobile society was secondary to a sedentary society because institutionalized control over population mobility was the predominant characteristic of restructured society during this period. Furthermore, these interactions between so-called “sedentary” and “mobile” populations intensified human ecological pressure on the land. At the same time, however, these changes had little effect on long-held social customs, and traditional festivals continued to be celebrated. These social customs and sociopolitical, geographic, demographic, and ecological factors converged to trigger the outbreak of a public health emergency. As subsequent chapters of this book will discuss, these factors not only contributed to the rise of an emergency disciplinary state but also brought about challenges to the public health emergency response—a large-scale but clandestine anticholera campaign.

77

PART II CONTAGION, SOCIAL DIVISIONS, AND BORDERS

3 SOCIAL DIVISIONS, EPIDEMIOLOGY, AND DISEASE DISTRIBUTION

W ENZHOU PREF EC T URE WAS NO S T R ANGER T O CHOL ER A. IN FAC T, I T WAS ONE OF the first areas in China to suffer from cholera during the first global cholera pandemic, in 1817.1 By the early twentieth century, there had been a further six major outbreaks of cholera in Wenzhou Prefecture.2 According to incomplete epidemiological data, between 1940 and 1947 Wenzhou Prefecture had five major outbreaks of cholera, which were attributed to chaotic population movements during the Anti-Japanese War and the Civil War. In these major outbreaks in the 1940s, cholera first broke out in Rui’an and Pingyang Counties and Wenzhou City and then spread northward to the coastal areas of Zhejiang Province while also moving south from Shanghai Municipality to Hangzhou City along highways and railways. Rui’an and Pingyang Counties and Wenzhou City were not only important entry points for these cholera epidemics in Zhejiang Province but also became the worst-affected areas in terms of incidence and mortality rates.3 The outbreak and transmission routes of cholera epidemics in Wenzhou Prefecture before 1949 show some similarities with those of the cholera pandemic in 1962. However, this outbreak emerged and spread within the specific context of the various sociopolitical restructuring initiatives that the Communist government began in the early 1950s and further strengthened beginning in 1961. These campaigns created a series of major social divisions, including the rise of rural/ 81

82

china a nd the choler a pa ndemic

urban divides, the blurring of gender roles, and divisions between soldiers and civilians, which significantly affected the new social epidemiological context and disease distribution during the cholera pandemic in the summer of 1962. This chapter examines how these social divisions significantly changed the social epidemiological context and the distribution of cholera. As this chapter indicates, the government’s investment patterns notably widened the gap in environmental sanitation and water management between rural and urban areas, which correspondingly resulted in the hierarchical shape of disease incidence rates. Enormous demands imposed on female laborers to support new agricultural production modes exposed women to cholera-infected water, which led to gender-equivalent cholera incidence rates for the first time. In the meantime, the stringent military medicine scheme shaped by sociopolitical changes since the 1950s and the stable provision of sufficient quantities of food for the army brought about the huge gap in incidence rates between soldiers and civilians.

SANITARY CIT Y, UNHYGIENIC COUN TRYSIDE For waterborne epidemic diseases like cholera, water is crucial in determining social epidemiological factors and distribution. As early as the mid-nineteenth century, correlations had already begun to emerge between social class, access to clean water, and transmission and distribution of epidemic diseases in Chinese treaty port cities. According to Kerrie MacPherson, the search for the cause and transmission paths of epidemic disease in Shanghai in the 1850s increasingly focused on the role of water, following campaigns of this sort in Europe. However, access to clean water varied greatly, and the vast majority of Chinese residents in treaty ports could not afford to pay for a private water supply.4 As Ruth Rogaski has argued in her study of the politics of water in Tianjin in the early twentieth century, “water that poured from pipes and faucets distinguished wealthier Chinese from their compatriots who received their water in buckets from Dark Drifters” (water carriers). Chinese elites who could afford foreign-style architecture and bathrooms further separated themselves from their “deficient” compatriots through strategies of weisheng (hygiene).5 Access to running water correlates directly with the incidence rates of infectious intestinal diseases, including cholera. The epidemiological report on cholera in Shanghai Municipality claimed in 1942 that “the quality of the city’s running water is excellent because the water company manages this strictly.” In contrast, there were still many shallow wells in the city. The open mouths of these wells were near areas where rubbish piled

Soci a l Divisions, Epidemiology, a nd Disease Distr ibution

up and bacteria bred. The majority of cholera patients drank well water before the outbreak of the disease.6 In major treaty port cities like Shanghai and Tianjin, the emergence and provision of running water had diversified access to drinking water among the different social classes by the second half of the nineteenth century. However, municipal water systems did not emerge in many Chinese cities until the late 1950s, at precisely the point when social restructuring programs produced the rural/urban divide as a result of the new residential system. Rural areas gained access to tap water much later than urban areas, and this delay affected the quality of drinking water, which in turn affected the hygiene differentials in each environment at this critical juncture in the epidemic’s progress. The management of drinking water shaped the social epidemiology and distribution of diseases, including the cholera pandemic in Wenzhou Prefecture in 1962. As analyzed in chapter 2, three major canals (Wenrui, Ruiping, and Ping’ao) cross Wenzhou City, the towns of Rui’an and Pingyang in those counties, and the countryside around them. Wenzhou City is small, with a surface area of just six square kilometers, and historically the land was a region of rivers and lakes. To the east and west, there were two canals outside the city to protect it. In the south, three water gates connected the city with Huichang Lake and controlled the volume of water in the river, channeling water into canals within the city, and those canals became the main source of water for drinking, cooking, and washing. The city was laid out in sections (fang) on a grid system that alternated streets and canals. These were connected by bridges and formed an integrated land-and-river transport network, in which boats were the main means of transport. The canals in the city had not changed much by the republican era: there were still a total of sixty-six, ranging between two and four meters in width. Because of this feature, local residents sometimes described the old city as the “Oriental Venice.”7 Wenzhou City residents relied mainly on canals and public wells for their water, although some relatively wealthy families constructed private wells in their own yards and collected water from them. By 1938, there were 814 wells in the city, 211 of which were public and 603 private.8 The wealthiest families favored mountain springwater from outside the city because it tasted better and was believed to be cleaner. For example, there was an old well in Jinshui Village, a western suburb of Wenzhou City, that was fed by a spring. Many villagers made a living by selling and delivering water from this well to city residents, and they would transport it there in the holds of boats, covered over by wooden planks.9

83

84

china a nd the choler a pa ndemic

Figure 3.1. Historic map of waterways in Wenzhou City, 1933. Personal collection of Huang Ruigeng.

An old villager, Lin Yongkui, recalled, “It was very difficult to tell the difference between river water and springwater. Sometimes lazy boatmen just collected water directly from the river [and passed it off as springwater].”10 Villagers in some rural areas, including certain suburban areas of Wenzhou City, had access to wells in the surrounding mountainous areas. However, there were not many wells on the alluvial coastal plains of Wenzhou Prefecture. The water from the few that did exist tasted slightly sour and was thus unpopular. Consequently, residents relied mainly on rivers or canals for their drinking water, as did rural villagers, who also used them to wash both agricultural equipment and commodes at the end of each day. By early the next morning, the dirt from these activities was believed to have settled, thus leaving the river water clean. Men got up early to fetch water from the river and store it in water jars, and then women came to the river to wash vegetables to prepare meals. Even water fetched the same morning was not considered to be ready for cooking, as it might contain mud, so villagers would purify it by putting white alum into the water jars. After

Soci a l Divisions, Epidemiology, a nd Disease Distr ibution

a few hours, the water would be considered safe to use. As Pingyang County produced large amounts of white alum, using this as a water-purifying technique was something every household could afford. Even today, villagers still believe that treating river water in this way purifies it. As local physician Gao Chunchai stated, “Water still flowed through the rivers at that time. Although it was dirty, it was different from today’s dirty water. At that time, there were not so many mobile people [to pollute the environment], nor were there any pesticides in use.” She further claimed, “The water was at its cleanest between the Dragon Boat Festival (Duanwu, around late May and early June) and October, when peasants planted water chestnuts in the river and nearby fields, which helped purify the water.”11 However, the water was not as clean and hygienic as Wenzhou City residents, villagers, and local physicians assumed. In Wenzhou City, the Wenzhou Maritime Customs Service reported in 1931, “The distribution of water by the city waterway system is plagued with problems. Boats can still travel up and down some rivers and canals, but others are foul-smelling ditches. Residents just dump rubbish into rivers at will, making them smell and turning the water black. . . . The provision of drinking water has declined rapidly.”12 In 1934, the government of Yongjia County (the former county town of which is now Wenzhou City) submitted a report to the Nationalist Zhejiang provincial government and requested assistance with comprehensive river cleaning: “The Yongjia waterways were cleaned every six to seven years during the Qing dynasty. Since the founding of the Republic of China, the river has only been cleaned once, and even this was insufficient. . . . Many years have passed since then and the situation has only worsened.”13 It seemed that there was no response after the report was filed. Drinking water under such circumstances was problematic. In 1938, the Yongjia Epidemic Disease Hospital in Wenzhou City checked the water in public wells, private wells, rivers, ponds, springs, and the municipal running water in 538 spots after the outbreak of cholera. The surveys found that only a quarter of the water sampled was suitable as drinking water. Although well water was supposed to be cleaner and more hygienic than river water, more than 65 percent of public and private wells had been contaminated by cholera. Only 43.1 percent of water from the 109 water boats surveyed was drinkable. This survey indicates that urban areas had no noticeable advantage over rural areas in terms of the cleanliness of their drinking water, which was an important vector for spreading cholera. The only major difference was that the Yongjia Epidemic Disease Hospital dispatched staff to treat drinking wells in urban areas during the cholera epidemic. This team also numbered all water boats and recorded information

85

Figure 3.2. A waterway in Wenzhou City, ca. 1902–1928. Personal collection of Huang Ruigeng.

Figure 3.3. South gate wharf, Wenzhou City, 1910. Personal collection of Huang Ruigeng.

Soci a l Divisions, Epidemiology, a nd Disease Distr ibution

on the volume of water they transported and where they sold it. At five o’clock every morning, water boats congregated outside the south gate wharf for their water to be treated, after which they were issued stamped metal certificates that would be updated every day.14 However, these emergency measures during the cholera outbreak in 1938 did not essentially change the sources of drinking water. By 1950, the Wenzhou City Health Bureau of the Communist government found that there were 2,191 public and private wells in the urban area. Well water was still the main source of drinking water for most city residents. According to the sample survey of 727 households in 1952, 80 percent relied on well water, although a few used river water and even rainwater. However, among those wells whose water was believed to be drinkable, there were actually many problems due to construction techniques. The wells were lined with brick but lacked either cement or lime as mortar or sealant, there were no ditches around their openings, and residents often placed chamber pots, urine buckets, and other waste near them. The open brickwork meant that polluted water seeped into the wells.15 For rural residents in Rui’an and Pingyang Counties, the sources of drinking water were basically the same as those of their ancestors. The Pingyang Sanitation and Epidemic Prevention Station gazetteer reported, “Because of poverty and backwardness, . . . residents mainly drink river and pond water, while people in mountainous and semimountainous areas use both brook and well water.”16 However, this water supply was also unreliable. For example, in Bishan Commune, Rui’an County, on the Feiyun River delta, there was a total population of 14,500 people. Around 80 percent got their drinking water from the river and ponds. At sunny times of the year, streams and ponds would dry up within a few days, so peasants would have to fetch water from areas five kilometers away. In the spring and rainy seasons, water in fields and ditches would flow into streams and ponds, contaminating them.17 However, access to water in urban and rural areas gradually started to change in the early 1950s. The change first occurred in Wenzhou City. In view of rampant diarrheal illness each summer, the city government began to clean and purify well water in 1952 to improve the quality of drinking water for residents. The government trained a total of 286 water purification workers.18 Meanwhile, industrial development, increased population, and waste silting meant that city waterways were becoming more and more polluted. The Wenzhou City Environmental Sanitation Department started converting rivers into sewers within the city during the Patriotic Health Campaign in 1952, in which workers filled in rivers and installed

87

88

china a nd the choler a pa ndemic

Figure 3.4. Construction of the sewer system in Wenzhou City, 1950s. Personal collection of Huang Ruigeng.

sewer lines alongside them.19 By 1957, 10.8 kilometers of sewer lines had already been laid by the city.20 In March 1958, in order to completely eradicate mosquito breeding places in the urban area, the Wenzhou City People’s Commission decided to convert an additional 15 polluted rivers into sewers and mobilized all work units to participate in filling in the riverbeds.21 By the end of 1958, the government had converted 21 rivers into sewers. In the meantime, the Wenzhou City government dredged many blocked rivers

Soci a l Divisions, Epidemiology, a nd Disease Distr ibution

and cleaned up polluted water, silt, and rubbish. In March 1958, the government set up river washing stations in order to sluice out dirt and keep waterways clean. It also relocated some urban factories that had been polluting waterways.22 Toilets were targeted as another important source of pollution: those that fell short of hygiene standards were basically filled in, and urine buckets were gradually prohibited. Stool cesspits were replaced with wooden buckets, which would be cleaned by the city’s sanitation staff. Stables for cattle were to be cleaned every three days and the floors of pigsties to be covered with concrete and the straw changed every week.23 River dredging, sewer construction, factory relocation, and toilet renovation not only improved the quality of river water within city areas but also improved the quality of residents’ drinking water by greatly reducing contamination. More significantly, the Wenzhou City government started providing running water to all residents after the Xishan Water Plant was constructed in 1957. This relieved water shortages among urban residents and even became a model for high-quality, low-cost water supply across Zhejiang Province.24 Local historian Zhou Baoluo recalled, “At that time, the piped water did not reach every household like today. There were a few standpipes on each road or lane. Water would be provided for only around ten hours a day, and residents had to pay the water plant for this.”25 But the provision of running water increased steadily, and by 1961 there were 61 water supply stations in Wenzhou City, providing water to 168,000 residents or 66.2 percent of the urban population. Compared with 1958, the volume of water used by people going about their daily lives increased by 26.7 percent.26 In 1961, the Wenzhou City Health Bureau pointed out that because the main source of drinking water for urban residents was now running water provided by the water plant, monitoring the quality of this supply was important. The bureau instructed that the plant should improve checks and repairs of water pipes and prevent water pollution.27 This increase in the availability of running water led to a significant drop in the use of well water, although some wells did remain. For example, in Wuma Commune in Wenzhou City, only 64 wells were used as a source of drinking water, which represented only 18 percent of the original 347 wells.28 Furthermore, the quality of well water was also controlled. The city’s health bureau stipulated that each hospital was required to send out personnel to purify all public wells on a regular basis.29 Despite improvements to drinking water and general sanitation standards in Wenzhou City, the situation in outlying areas did not change much in the 1950s. As local historian Zhou Baoluo recalled, “when running water was provided to

89

90

china a nd the choler a pa ndemic

urban residents in 1958, areas on the outskirts of the city were not yet established districts. Water, electricity, and road infrastructures were incomplete. Many residents still depended on well water and river water in these areas.”30 By August 1963, more than one hundred thousand people in three outer urban areas of Wenzhou City still drank river water.31 In rural parts of Wenzhou Prefecture, including the main grain production areas, Wenrui Plain and Ruiping Plain, the sources of drinking water did not change much either. A survey of Tangxia District in Rui’an County found that 56 percent of the population still drank river water in 1962 and usually did not purify it beforehand.32 Even worse, the start of the agricultural collectivization campaign in 1952 led to river water becoming even more polluted than before. To enhance agricultural productivity, both human and animal feces were promoted as major sources of fertilizer. For example, in Liming Commune in the Wenzhou suburban area, there were 1,985 households. On average, each household had 1.09 toilets, 0.5 pigsties, and 1.6 manure pits. In summer and autumn, these toilets, pigsties, and manure pits attracted a great many flies. In the rainy seasons, heavy rain would wash manure and feces into the rivers.33 The majority of these areas used boats dedicated to moving feces, which would be spread on fields as fertilizer. When the feces boats were overloaded, their cargo would spill into the river and then be further spread by traveling boats and junks.34 Furthermore, urban areas in Wenzhou City often transferred pollution to rural areas. The cleaning of polluted rivers in the city was usually combined with the work of collecting and delivering manure during the Patriotic Health Campaigns from 1952 onward. For instance, Wenzhou Prefecture launched the urgent Patriotic Health Movement in March 1960 to improve environmental hygiene in the city and to support agricultural production in suburban areas by cleaning rivers in urban areas and collecting silt from them for use as fertilizer.35 River silt was moved to rural areas on boats and junks, so the rivers connecting the city and suburban areas sometimes also became polluted when the silt spilled into the river. The changes in drinking water supply had significant impacts on cholera epidemiology in the summer of 1962. According to the water sample testing conducted by the Zhejiang Province Cholera Prevention and Treatment Technical Supervision Central Station (table 3.1), only seven out of forty-five water samples (15.55 percent) in urban areas of Wenzhou City tested positive for cholera. In contrast, in two suburban districts, 42.8 percent of water samples tested positive. There were significant differences in the incidence of cholera in urban versus suburban areas: Wenzhou City’s rate was 1.37 per thousand, while that of the

Soci a l Divisions, Epidemiology, a nd Disease Distr ibution

91

Table 3.1. Test results of water samples and cholera incidence in suburban and urban areas of Wenzhou City, 1962 Percentage of positive water samples (%)

Cholera incidence (‰)

7

15.55

1.37

44

23

52.27

11.93

30

10

33.33

4.03

20

0

0.0

0.868

42.8

5.6

Number of Number of samples positive water samples taken

Areas

Districts

Urban

City

45

Yongqiang Wutian

Suburban

Sanxi

Average

Source: Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan, “Zhejiangsheng 1962nian fuhuoluan liuxing qijian xijunxue gongzuo gaikuang,” November 1962, ZJA, Vol. J166-2-129.

three suburban districts was 5.6 per thousand on average. Among the latter, both Yongqiang and Wutian are areas of plains with waterways. But Yongqiang was the principal destination for the silts collected during the Patriotic Health Campaigns in Wenzhou City in the early 1960s and thus showed the highest incidence (11.93 per thousand). As a semimountainous area, Sanxi had the lowest figure (0.868 per thousand). The incidence in Wutian was near the average. Cholera epidemiology in the broad rural area outside of Wenzhou City, including Rui’an and Pingyang Counties, also exhibited specific characteristics. Like other counties across China, each of these was made up of county towns and rural areas. Ironically, county towns did not enjoy many advantages in terms of drinking water quality. In Rui’an County Town, there was a canal called the Hao River that was connected to the river flowing through the town. This canal was not only a defensive feature but was also used to carry water in and out of the city for residential use and agricultural irrigation. Most residents used this river water as drinking water but also washed clothes, commodes, and vegetables in it, which seriously polluted the water. The poor management of a sewage and garbage dump further polluted this river water. In the early 1950s, the Sanitation and Epidemic Prevention Station had cleaned the town streets by collecting garbage from each household and dumping it in rural areas. However, when responsibility for street cleaning was handed over to the town hygiene management office in 1958, no one was assigned to continue this effort, so pig manure and garbage once again piled up in the town and were then flushed into the river after heavy rains, contaminating water sources.36

92

china a nd the choler a pa ndemic

In contrast to Wenzhou City, wells had not been common in Rui’an County Town. In 1952, the county town started improving water quality by digging new wells, renovating old wells, and purifying the water with chlorinated lime. From 1958 on, the government disinfected water storage jars (which were usually made of pottery) every other day.37 All the same, there were only around thirty wells by the time cholera broke out in the summer of 1962. The pollution of well water was not as serious as that of river water because residents could not wash clothes and chamber pots in wells nor did manure boats ply their surface. However, wells could still be contaminated, and they played a secondary role in disease transmission, particularly infectious intestinal diseases.38 Moreover, just before the outbreak of cholera in 1962, Rui’an County Town hospital officials stated that “the masses were eagerly requesting a solution to the problem of drinking water in the town. They suggested adopting the ‘people-run, government-subsidized’ approach to setting up a simplified running water system, including digging public wells in order to improve the quality of drinking water and reduce the spread of infectious intestinal diseases.”39 Given these circumstances, river water was a notable source of contagion when the cholera pandemic first reached Rui’an County Town in the summer of 1962. As described earlier, the first cholera patient in Rui’an County was sixtythree-year-old Chen Azhu, an ordinary resident living on a lane not far from the river. Although there was no epidemiological evidence to confirm that Chen Azhu’s cholera was caused by this water, the river played an important role in the spread of cholera. Of the 334 cases in Rui’an County Town in 1962, a total of 303 (90.7 percent) were among residents who lived along the river.40 Well water was another major transmission vector. For example, on July 27–28, three residents came down with cholera after drinking water from a well in a narrow lane behind the County People’s Hospital, near the cholera ward. This well had been contaminated by sewage from the hospital after heavy rain.41 The water and sanitary conditions in Pingyang County Town were very similar to those of Rui’an County Town, particularly as each was crossed by a major canal. However, the use of the river as the main source of drinking water correlated with cholera incidence rates in 1962. For example, in Lingxi District in Pingyang County, 48.2 percent of residents drank river water and the cholera incidence rate was 4.2 per thousand. In Yishan District in Pingyang County, 90.4 percent of the population drank river water and the incidence of cholera reached 9.95 per thousand.42 The comparison of cholera incidence rates between rural and urban areas

Soci a l Divisions, Epidemiology, a nd Disease Distr ibution Table 3.2. Comparison of cholera incidence rates between towns and rural districts along major canals in Wenzhou Prefecture, 1962 County/city

Town/rural district

Incidence rate (‰)

Urban area

1.37 Suburban area

Wenzhou City

Wutian

4.03

Yongqiang

11.93

Average

7.98

County town

8.82 Rural districts

Rui’an County

Tangxia

6.1

Xincheng

9.1

Xianjiang

13.0

Average

9.4

County town

9.91 Rural districts

Pingyang County

Wanquan

9.79

Aojiang

9.83

Yishan

9.95

Qianku

7.24

Average

9.2

Sources: Rui’anxian renwei weishengke, “Fuhuoluan liuxing qingkuang yu fangzhi gongzuo de zongjie baogao,” 1962, RAA, Vol. 142-7-2; Pingyangxian fuhuoluan liuxingbingxue diaochazu, “Pingyangxian fuhuoluan liuxing yinsu de fenxi,” October 1962, ZJA, Vol. J166-2-162.

along the major canals of Wenzhou City and Rui’an and Pingyang Counties further indicates a rural/urban divide in the correlation between cholera and water supply and sanitation. As table 3.2 shows, there is a clear hierarchical structure to incidence rates, which were lowest in Wenzhou City (1.37 per thousand), higher in the Wenzhou City suburban area (7.98 per thousand), and highest of all in the two counties (9.3 per thousand). Incidence rates in the Rui’an and Pingyang County towns were 8.82 and 9.91 per thousand, respectively, putting them on a par with rural areas due to the absence of running water and poor sanitary environments.

93

94

china a nd the choler a pa ndemic

The hierarchical shape of cholera incidence reveals the impact of resource distribution on the social epidemiology of cholera. For its emergency measures in response to the epidemic, Wenzhou Prefecture instructed each county to improve the quality of drinking water for local residents. For example, Yongqiang District, located in the suburban area of Wenzhou City, assigned staff to dam the river temporarily using rice barrels and agricultural boats, after which they used chlorinated lime to purify the water before providing it to local people. The brigade dispatched cadres and militia to manage the water supply.43 In view of the importance of drinking water, the Wenzhou Prefecture government launched a well-digging campaign after the 1962 cholera pandemic. According to a report from the Wenzhou Prefectural Health Work Meeting in December 1963, these new wells solved the water problem for around six hundred thousand people in the prefecture, around one-sixth of the total population. However, the problem was that local residents did not often use the majority of those newly constructed wells. They fetched water from these wells only in summer and autumn, when the river was low or when water from the fields flowed into the river and dirtied it. However, when the river waters were high again and were looking clean by late autumn, the river was a more convenient source of water, and it tasted much better than well water.44 All in all, the new wells were of no real significance; they were simply a form of compliance with instructions from higher up the chain of command.45 In view of this situation, Wenzhou Prefecture authorities stated that more than half the total population needed to switch from river water. Construction of new drinking water plants began in a few major towns in 1964.46 Following this, Rui’an County proposed setting up a small drinking water plant in the county town between 1963 and 1967 to provide water for fifty thousand residents. In rural areas, sand-filtered wells and underground wells were to be promoted to provide water for rural commune members.47 However, this plan was little more than a blueprint because the actual work was not easy. By 1964, there was still no running water in the county seat in Rui’an, where 63 and 17 percent of residents drank river water and well water, respectively. In the other main cholera-affected districts, river water was still the main source of drinking water. Pingyang County also suffered the same problem, and running water was not available there until August 1974.48 According to You Rongkai, a physician and medical historian at Wenzhou Central Hospital Medical Group, running water did not become widely available at the township level until the 1980s and didn’t reach rural areas until the 1990s.49 Up until this period, the distribution of intestinal

Soci a l Divisions, Epidemiology, a nd Disease Distr ibution

diseases, including cholera, continued to follow the same hierarchical pattern as cholera distribution in 1962, with clear differences across the rural/urban divide. The timing gap in access to running water also demonstrates the impact of this rural/urban duality on disease incidence in changing sociopolitical contexts through resource distribution.

GENDERED DIVISION OF L ABOR, WOMEN, AND RATES OF CON TAGIOUS DISEASES The social restructuring that began in the 1950s produced not only a rural/urban divide but also radically changed gender relations. Accordingly, the gender profile of the 1962 cholera pandemic’s epidemiology changed as well. Like other areas in Zhejiang Province and the Yangtze Delta, women rarely participated in agricultural production in rice paddy fields in the Rui’an and Pingyang Plain areas, according to local historian Zhou Baoluo.50 As local villager Ye Degui from Wanquan District in Pingyang County told the cadres of the Wenzhou Prefecture Party Committee who came to investigate the serious famine over the two years prior to 1961, “before ‘liberation,’ women mainly made grass mats at home. . . . They prepared meals and delivered meals to those working in the field. During the busiest times of the agricultural year, there were five meals a day to make and take, which left them with no time to participate in agricultural production itself.”51 Within this traditional division of labor between men and women, women’s chances of coming into contact with infected soil and water were much lower than men’s, while women’s vulnerability and diseases were associated with their main social duty—sexual reproduction—as Angela Leung has shown.52 The typical example of this gender difference in disease distribution is schistosomiasis, which ravaged twelve provinces in southern China for more than forty years before the founding of the People’s Republic of China in 1949. The incidence of the disease was particularly high in the areas along the Yangtze River. According to parasitological expert Chen Chaochang’s research on a thousand schistosomiasis cases in Zhejiang Province, 95 percent of patients were peasants and 80 percent of them were male.53 In an article entitled “A Survey of Schistosomiasis in Our Country,” published in the China Medical Journal in 1942, two parasitologists wrote, In the Chinese countryside, men are usually in charge of agricultural production and laboring in the field. Women are responsible for housework. Women are

95

96

china a nd the choler a pa ndemic

prevented from exposing their bodies and skins by old feudal ethical codes. They therefore have much less chance of contracting infections than men. This is why there are more male patients than female patients. All the same, this does not mean that women did not have any chance of catching infections or illnesses. Some aspects of housework, such as washing rice, vegetables, and clothes, had to be done in rivers. . . . In contrast, in some areas of our country, such as Anhui, Fujian, Guangdong, and Guangxi Provinces, women participated in agricultural production on par with men and therefore were equally likely to contract schistosomiasis. The incidence rates were the same.54

This gender difference in infection rates was also applicable to waterborne infectious diseases like cholera. As mentioned earlier, cholera affected Wenzhou City in the summer of 1938. As table 3.3 indicates, from July 5 to August 18 of that year, the First Epidemic Prevention Hospital in Wenzhou City treated a total of 1,273 male patients and 656 female patients, accounting for 66 percent and 34 percent, respectively, of the total number of cases. Among younger adults in their twenties and thirties, who formed the majority of adult laborers, there were 585 male and 265 female patients, accounting for 69 percent and 31 percent of the total cases within those age groups.55 However, as part of the Communist emphasis on women’s liberation, women began to take part in agricultural production on a large scale in the early 1950s.56 This was to have consequences for women’s vulnerability and exposure to cholera in 1962. In Wenzhou Prefecture, around 25,200 women took part in rice seedling planting in 1954. Within two years, this figure had increased nearly fourfold, to 93,257.57 Women’s participation in agricultural production was further facilitated by the huge demand for labor that came with increased industrial production and agricultural collectivization. After the mid-1950s, industrial projects and the Great Leap Forward led to shortages of male agricultural laborers, as men were being actively organized to participate in irrigation work, construction projects, industrial projects, and the great steel-making campaign. Wenzhou Prefecture launched five major hydraulic and electricity station projects in 1959; more than a million laborers were involved.58 With so many men working at these construction sites, women laborers were the only remaining option for agricultural production. Within this new gendered division of labor, the impact of the new cropping system and planting techniques brought by the agricultural collectivization was more significant for women, as they labored more intensively in the rice paddy

Soci a l Divisions, Epidemiology, a nd Disease Distr ibution

97

Table 3.3. Comparison of gender distribution of cholera cases in Wenzhou Prefecture, 1938 and 1962

Yongjia County (Wenzhou City), 1938 Age Number of cholera cases groups Men Women Total No. % No. % 0–9 240 146 60.8 94 39.2 10–19 223 135 60.5 88 39.5 20–29 486 336 69.1 150 30.9 30–39 364 249 68.4 115 31.6 40–49 272 177 65.1 95 34.9 50–59 183 116 63.4 67 36.6 60–69 144 104 72.2 40 27.8 70–79 17 9 52.9 8 47.1 80–89 1 1 100 0 0 Total

1,929

1,273 66.0 656

34.0

Total

Rui’an County, 1962 Number of cholera cases Men Women

550 541 585 571 309 342 252 80 21

No. 334 313 291 285 184 196 146 37 12

% 60.7 57.9 49.7 49.9 59.5 57.3 57.9 46.3 57.1

No. 216 228 294 286 125 146 106 43 9

% 39.2 42.1 50.3 50.1 40.5 42.7 42.1 53.7 42.9

3,251

1,798

55.3

1,453

44.7

Sources: Disan zhanqu Wenzhou jingbei silingbu, “Zhushedui gongzuo baogao,” 1938, WZA, Vol. 204-1-17; Rui’anxian renwei weishengke, “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao,” August 20, 1962, RAA, Vol. 142-7-2.

fields in the summer months. Before 1956, Wenzhou Prefecture, like other parts of the Yangtze delta area, either grew a single rice crop per year or alternated a rice crop in summer/fall with a rapeseed or wheat crop in winter. After 1956, the government started promoting the double rice cropping (or continuous cropping) technique: two rice crops in summer and autumn and one rapeseed or wheat crop in the winter. Using this cropping system, peasants had to harvest the first rice crop and plant the second within the two weeks between the “great heat” (dashu) and the beginning of autumn (liqiu), a time of year that was also known as the “double quickness” (i.e., quick harvesting and quick planting).59 Linked to the new cropping cycle, the amount of arable land doubled compared to the previous year. Another immediate and significant change, as Philip C. C. Huang has noted, was that the intense new cropping system created immense pressure on laborers between the first and second rice crops and between the second rice crop and the winter crop.60 In particular, the new cropping system resulted in tension between the demand for laborers and the time needed to

98

china a nd the choler a pa ndemic

Figure 3.5. Planting rice seedlings. People's Pictorial, no. 9 (1963).

harvest and plant rice crops. The older, single cropping method required the work of two adult male laborers per mu, while continuous rice cropping required nearly twice as many. Meanwhile, in 1959 Wenzhou Prefecture launched campaigns for early and dense planting of rice seedlings, as well as innovative techniques for transplanting the seedlings in order to produce more grain. In particular, the density of rice plants per unit of area planted rose quickly.61 As women had rarely participated in rice planting and harvesting before, Wenzhou Prefecture called on women across the area to learn from the “Seven Celestial Princesses” (qixiannü)—a campaign based on an ideal model of women who planted rice seedlings in neighboring Huangyan County. On March 15, 1961, Wenzhou Prefecture convened a meeting and selected model rice planters to participate in contests. Each county dispatched representatives to attend the meeting and exchange experiences. Every county later launched a campaign to promote rice-planting techniques among women, inspired by the Seven Celestial Princesses. These model teams were given names such as the Ten-Flower Team (shizhihua) in Pingyang and the Thirteen Sisters Team (shisanmei) in suburban

Soci a l Divisions, Epidemiology, a nd Disease Distr ibution

Figure 3.6. Women planting rice seedlings in rice paddies. People's Pictorial, no. 9 (1965).

Wenzhou City.62 A report by the Wenzhou Prefectural Party Committee Work Team claimed in 1961, “After agricultural collectivization, particularly over the past two years, a large number of women have started participating in production in the paddy fields, harvesting rice, planting seedlings, and weeding fields.”63 Government policies gave attention to women’s health following this shift.64 However, for women who were working in the paddy fields for the first time, it was often a miserable experience.65 Their situation was worsened by local government’s demand for even more labor. For example, in suburban areas of Wenzhou City, local communes required women to fulfill “ten responsibilities” during the busy summer months. These included being responsible for reaping rice, threshing it, plucking and planting seedlings, drying grain in the sun, and so on. Some communes required women to participate on a par with male laborers:

99

100

china a nd the choler a pa ndemic

“going out and coming back together, eating in the fields, and sleeping in the fields.” In some areas, little care was shown for the women workers’ physical well-being. Women in Tang’er Commune participated in the rice harvest during heavy rain, but when they later asked to return home and change their clothes, the production brigade cadres refused. Some communes coerced women during the Great Leap Forward by threatening to reduce their food rations if they did not take part in agricultural work.66 Soon, amenorrhea, prolapsed uterus, and leukorrhea became more prevalent among rural women.67 Model female commune members first fell victim to these women’s diseases. In Xianju County, the model Seven Women Generals all experienced amenorrhea. In Pingyang County, the leader of the Ten-Flower Team could not participate in agricultural production because of illness. The situation soon worsened. For example, in Chengquan Commune in Pingyang County, 23.7 percent of 4,975 adult women laborers had officially reported having one of these female illnesses by August 1960.68 However, the actual figures were probably higher, as women were often reluctant to report such private matters unless their situation was very serious. This was not unique to Wenzhou Prefecture. According to the obstetrics department at No. 2 Medical College in Shanghai Municipality, women laborers accounted for 70 percent of total laborers in its suburban areas. Most prolapsed uterus patients were laborers between the ages of twenty and fifty, who accounted for more than 80 percent of the laborers in suburban Shanghai.69 The prevalence of women’s diseases was largely caused by the intensity of their physical labor during the Great Leap Forward, which was further worsened by hunger during the subsequent famine. As mentioned in chapter 2, Wenzhou Prefecture had not fully recovered from the famine when cholera hit in the summer of 1962. Women’s health was thus still generally fragile when cholera hit Wenzhou, and this greatly increased their vulnerability to disease. As the local historian Zhou Baoluo explained, “relatively speaking, women’s physiques are weaker. At that time, many people suffered serious malnutrition and hunger. This lowered resistance to disease.”70 The formal, widespread roll-out of the new agricultural production mode in 1961 increased women’s burdens. A work point–based payment scheme further facilitated adult women’s participation in agricultural work, particularly during the “quick harvesting and quick planting” period each summer. A local villager, Lin Tongfa, recalled, “Male commune members worked for more than 300 days a year, every day except very rainy and cold days. But during busy agricultural

Soci a l Divisions, Epidemiology, a nd Disease Distr ibution Table 3.4. Gender distribution of cholera cases in Zhejiang Province, 1962 Prefecture

Total cases

Wenzhou

10,106

Ningbo Zhoushan

Male

Female

Number

%

Number

%

5,450

53.93

4,546

46.07

314

155

49.36

159

50.64

196

116

59.18

80

40.82

Taizhou

156

84

53.85

72

46.25

Total

10,872

5,805

53.39

4,967

46.61

Source: Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan, “Fuhuoluan de liuxingbingxue,” November 7, 1962, ZJA, Vol. J166-2-129.

times, women also took part, leaving their children at home alone and closing the doors. . . . The highest work points total that male commune members received was 10.5, while women received only 8 points. However, women did not perform any worse than men at planting seedlings and harvesting rice.”71 This payment scheme effectively forced women to work in the fields and greatly increased their exposure to cholera. As former People’s Commune Party secretary He Nangao put it, “women leaving the family space, going out into society and increasing their contact with [wider] social groups all led to being infected [with cholera].”72 For women, agricultural production during the summer directly exposed them to cholera. A villager named Han Yonggang recalled, “In villages, we drank the water wherever we were laboring. We did not have kettles. In some busy production seasons, we had to work very hard for long hours, so we needed to drink a lot.”73 As highlighted in chapter 2, when cholera first broke out in Rui’an County in early July 1962, peasants had to harvest and then plant the next rice crop within two weeks. The excrement of cholera patients, mildly affected patients, and healthy carriers contaminated the water in the cholera-affected areas. The blurring of traditional gender roles in agricultural work made both male and female adult laborers equally likely to contract waterborne infectious diseases. As table 3.3 indicates, of the 3,251 cholera patients in Rui’an County in 1962, 55.3 percent were men and 44.7 percent women. This ratio basically corresponded to the proportion of men and women in the county’s population as a whole that year (53.4 percent to 46.6 percent, respectively).74 The distribution of cholera in Zhejiang Province in 1962 follows a similar pattern (table 3.4). More significantly, among those aged twenty to thirty-nine, the age group that was the main source of adult agricultural laborers, the gender distribution of cholera

101

102

china a nd the choler a pa ndemic

was almost even in Rui’an County in the summer of 1962. This ratio greatly contrasted with the epidemic of 1938, when women did not take part in agricultural work and accounted for only 30 percent of the total number of patients in the same age groups. This finding illustrates the impact of social restructuring on the gender division of labor and its interactions with the social epidemiology of diseases. Over the first decade of the People’s Republic of China, women had come to participate in the same forms of labor as men. Because more exhausting work was being demanded of them and because they were more undernourished, they were vulnerable to whatever diseases might come their way. They began to suffer commensurate rates of cholera, as well as higher rates of female-specific disease, than they had suffered in the past.

S TRONG SOLDIERS, WEAK CIVILIANS, AND MEDICAL CARE While women, who had previously been less vulnerable to cholera, now had equal chances of catching it, the reverse was true of soldiers, who had once been more susceptible to the disease but now were less likely to become infected. As chapter 2 has pointed out, Wenzhou Prefecture was not only a cholera-affected area but also the coastal front in the Preparation for War effort against Chiang Kai-shek’s Reclaim the Mainland campaign. The health of the PLA soldiers stationed in cholera-infected areas on the coastal front became a particular concern for central and local governments during the cholera pandemic in 1962 and afterward. The government committed to guaranteeing soldiers’ health and nutrition by strengthening a series of military medical schemes that it had initiated since 1949. The focus on “strong soldiers” led not only to extremely low incidences of cholera in the PLA compared with the Nationalist army before 1949 and among civilians in the early 1960s; it was also another reflection of the impact of social restructuring on the Chinese military system and its relationship with civilians since the 1950s. The emphasis on “strong soldiers” was a major sociopolitical issue in theory and in practice for both the Nationalist and Communist governments. As early as the 1930s, the Nationalist government intended to establish a modern conscription system based on household registration in order to enlist qualified soldiers. However, by the outbreak of the Anti-Japanese War in 1937, the government had neither established a modern household registration system nor completed a nationwide census of adult males. The Nationalist government therefore started conscripting soldiers directly through a quota scheme, whereby each locale had

Soci a l Divisions, Epidemiology, a nd Disease Distr ibution

to provide a certain number of soldiers. Because of political inefficiency, poor compensation packages for soldiers’ families, and negative attitudes toward the military, this conscription scheme met with strong resistance. Rich families paid a bribe to evade conscription or hired someone to take a family member’s place, while local governments arrested, kidnapped, or sold adult males in order to meet their quotas. During this process, there was no medical examination scheme for new soldiers. The hardships of army life and chronic mismanagement meant that death and desertion became commonplace. In fact, only around 25 to 56 percent of new conscripts actually reached their destinations during the Anti-Japanese War.75 Nutrition was another serious problem for the Nationalist army. In an article entitled “Raising the Army First, Nutrition First,” published in 1944, the editor pointed out, “Nation-building depends on army-building, army-building depends on soldier-building, and soldier-building rests on nutrition. . . . Everyone [soldiers] was yellow-faced and emaciated, fragile and lethargic. They saddened our hearts. This was because the national physique was weak and new soldiers’ nutrition was poor. They did not have enough to eat, and they were physically weak. How could we ask them to be strong, keep up their morale, and become better fighters?”76 According to the account of a survivor of the battle against the Japanese invasion of Wenzhou in 1941 and 1942, “The Nationalist Army’s No. 33 Division in the Wenzhou area was not on an equal footing with Japanese soldiers at all. Chinese soldiers were covered in skin ulcers and were skinny and fragile. Every day, we only ate two meals of bad rice and salty preserved cabbages without any oil. Many soldiers were even too weak to hold guns on the battlefield.”77 Likewise, epidemic prevention, health care, and general hygiene were extremely poor in the army, and neither officers nor soldiers had much understanding of these issues.78 These factors resulted in the outbreak of epidemic diseases such as cholera and reduced the army’s fighting capacity.79 After 1949, the Communist military medicine scheme marked a sharp contrast to that of its predecessor. In 1950, PLA soldiers had suffered seriously from schistosomiasis in the suburban areas of Shanghai when they carried out amphibious landing exercises in infected river water in preparation for the war against Taiwan.80 This incident was one of the reasons why the Communists aborted the military campaign in question. From then on, the Communist government was particularly concerned about the health of PLA soldiers and created a set of military medical schemes based on its prerevolution practices. Indeed, many major post-1949 medical and health campaigns were first launched in the

103

104

china a nd the choler a pa ndemic

army and then promoted among civilians nationwide, including the nationwide campaigns against schistosomiasis and malaria.81 At the institutional level, measures to protect soldiers’ health began with a medical examination during conscription. After receiving orders regarding the number of soldiers needed to enlist, each county government called for all eligible young people to register with township governments according to their household registration information and then organized medical examinations for candidates. For example, the PLA planned to enlist a total of 1,365 soldiers from Pingyang County in 1958. After receiving this order, Pingyang County organized 56 medical staff to form three medical examination teams. Before the medical examinations started, these teams contacted rural cadres to get information on candidates’ health records. Medical teams went on home visits to find out more about the young men’s health statuses. They then held formal medical examinations and consulted with one another regarding illnesses that were hard to identify.82 By the early 1960s, this medical examination had become more formalized and included three stages: the preliminary medical exam, a formal exam by local medical staff, and a medical review by PLA officers.83 Through this coordinated action by the rural administrative and medical systems, the PLA ensured that it recruited the strongest young men it could. This selection process meant that PLA soldiers had some of the strongest physical conditions of all Chinese nationals, which provided strong immunity against cholera in 1962. This physical strength stood in sharp contrast to the situation among civilians, who were still recovering from the Great Famine when cholera ravaged southeastern coastal China in the summer of 1962. This divide between strong soldiers and weak civilians further increased due to the PLA’s food and nutrition scheme after 1949. In particular, levying contributions of grain and other staples from each locale became a key aspect of “supporting the front” (zhiqian) in the Preparation for War activity that started in the late 1950s, when the Second Taiwan Strait Crisis broke out. According to instructions from the central government, local governments were to prepare and stockpile supplies during peacetime in order to supply local armies during wartime.84 As described in chapter 2, the PLA moved into the coastal counties of Wenzhou Prefecture from the north on a large scale in late June. On July 10, PLA troops stationed in each county submitted their monthly request for food to the Prefectural Committee to Support the Front. After the prefecture approved the provisioning plan, the committee’s provision station started supplying the PLA.85 The designated staple and supplementary food allowances were calculated

Soci a l Divisions, Epidemiology, a nd Disease Distr ibution

as a percentage of grain supplies. The target grain supply for the army stationed in Pingyang County was at 578,000 jin (500 grams) in August. The amount of yellow beans was equal to 7 percent of total grain; vegetable oil, salt, and pork was equal to 3.3 percent; while vinegar and sauces represented 6.7 percent. In addition, the supplies also included fresh eggs, concentrated milk, milk formula, and red sugar, which were provided to officers and wounded soldiers.86 As the provision of supplies to the army was a key part of “supporting the front,” the Wenzhou prefectural committee instructed local governments to do their best to meet the army’s demands and guarantee food hygiene standards. It was particularly important for aquatic products, oil, Chinese cabbage, pork, and eggs to be uncontaminated to prevent food poisoning; rotten or spoiled food was not allowed to be supplied to the army. According to instructions, each storage unit had to regularly provide new supplies, discard any that were no longer in a safe state, and strive to prevent supplies from rotting.87 The provision of food to troops stationed in the coastal areas of Wenzhou Prefecture in the summer of 1962 contrasted dramatically with the diet and hygiene of local civilians. Local residents in coastal areas typically ate foods that were easily contaminated by cholera, such as fish, shrimp, and razor clams, and hygiene problems meant that other foods, such as meat, melons, fruit, and leftovers were cross-contaminated. According to three major hospitals in Wenzhou in 1962, dietary etiology accounted for around 57 percent of the total cholera patients, while the remaining 43 percent of cases were caused by water and other factors.88 Supplying food and other strategic materials for the Preparation for War campaign was a heavy burden for local residents, all of whom were still recovering from the famine and struggling with the cholera pandemic. In June 1962, the Preparation for War work reached its peak with the arrival of a large number of PLA soldiers in Wenzhou Prefecture. The prefecture was instructed to supply the troops with grain and supplies that accounted for 15 percent of all stored grain and 35 percent of other supplies for urban and rural residents in the whole prefecture. This consumed all the grain allocated to rural and urban residents. Grain storage in Wenzhou Prefecture in 1962 dropped to its lowest level on record since 1949.89 The extremely limited availability of food made local residents more vulnerable to cholera than were the PLA soldiers, whose food and nutrition were strictly guaranteed. The availability of medical facilities and care for the army further widened the gap between PLA soldiers and civilians. Veterans Zhang Wenzhong and He Nangao served in Fujian and Jiangsu Provinces before the Cultural Revolution.

105

106

china a nd the choler a pa ndemic

Both of them recalled that a very complete medical system was already in place in the PLA by the early 1960s. Usually there were one to two health workers for each company (lian), one health clinic for each battalion (ying), and one health brigade for one regiment (tuan). At the division level (shi) and above, there was a comprehensive hospital that had a complete set of medical equipment, supplies, and staff. The veteran He Nangao recalled, “All the people in the army were young men. They had few illnesses. At that time, there were many malaria [cases], stomach ailments, flu, and bone fractures among soldiers. Medical treatments were free and medical facilities were better in army hospitals. Army doctors had graduated from formal medical universities, and all illnesses could be treated in a timely manner. It was really different from the situation for locals. Hospitals at the county level and below were very poorly equipped. Furthermore, peasants did not have the money to seek treatment, and they suffered from shortages of medicine and doctors.”90 The army was also particularly vigilant against infectious diseases among soldiers in peacetime. He Nangao continued: “In the early 1960s, the state was very watchful of infectious disease. When I was a soldier from 1962 to 1965, I remember that whenever there was a sign of infectious disease, the army would organize all soldiers to undertake epidemic prevention measures. We began big clean-ups and health checks. Everyone would be given a mask to cover his mouth. Cookhouse soldiers would test and purify water sources. Patients would be sent to the hospital and be isolated. I had dysentery at that time and stayed in the hospital for a week.”91 This vigilance was further enhanced when major infectious diseases broke out. The PLA soldiers moved to the southeast coast on a large scale in June 1962. In view of the fact that cholera had been spreading in Guangdong Province since February 1962, the Ministry of Health and the General Logistics Department of the PLA issued a joint circular on June 23, 1962, on strengthening hygiene and epidemic prevention in the war zone. The circular ordered them to strengthen coordination between each locale and the PLA, work together to improve hygiene and epidemic prevention in the war zones, and protect the safety of both soldiers and civilians. Each war zone was to strengthen its hygiene and epidemic prevention agencies, assign more staff and equipment, and train epidemic prevention staff to improve their political and professional proficiency. In order to prevent major infectious diseases, the circular also instructed that those in the coastal areas of Guangdong, Fujian, and Zhejiang—that is, the areas within 150 kilometers of the sea—should conduct general cholera inoculation work. Following these instructions, PLA soldiers were duly inoculated.92

Soci a l Divisions, Epidemiology, a nd Disease Distr ibution

Figure 3.7. Drawings depicting epidemic prevention work by the People's Liberation Army. Nanjing Military Region Logistics Department Epidemic Prevention Brigade, 1980.

After the outbreak of cholera in July 1962, the PLA further implemented and enhanced their vigilance against the disease. Sun Fuzhi was a PLA military officer who arrived in Wenzhou in June 1949 and stayed on at the PLA Wenzhou Military Region’s health division. In 1970, he was appointed deputy director of the Wenzhou prefectural bureau and worked there until his retirement in the 1990s. He effectively witnessed the unfolding of medicine, health, and disease in Wenzhou Prefecture after 1949. Sun recalled that “PLA Contingent No. 27 was stationed in Wenzhou Prefecture as part of the Preparation for War in June 1962. Together with a contingent that was already stationed in Wenzhou, there were more than fifty thousand soldiers in the prefecture by summer 1962. In view of the rampant cholera in the Wenzhou area, we made two strict regulations. First, soldiers were forbidden from coming into contact with cold water. Even the water for brushing their teeth in the morning needed to be boiled. Second, at night, water should be boiled and put aside for use the next day.”93 Meanwhile, the PLA also tried to prevent cholera transmission from civilians

107

108

china a nd the choler a pa ndemic

to the army via newly conscripted soldiers. The PLA instructed that “no military conscriptions in 1963 should be conducted in any residential committee, factories, government agencies, schools, and rural areas affected by cholera in 1962.” This regulation affected conscription work. As the Wenzhou Prefectural Committee pointed out in a report, “the rampant transmission of cholera caused the difficulties in meeting the military conscription targets. Of the sixty-five residential committees surveyed, fifty-five had been affected by cholera. According to this principle, no soldiers would be conscripted from a large number of production brigades, villages, and residential committees in Pingyang County, Wenzhou City, and Rui’an County.” In view of this situation, Wenzhou Prefecture instructed that Pingyang and Rui’an Counties should try their best to conscript new soldiers from uninfected areas while conducting additional medical examinations. Meanwhile, the prefecture increased its conscription quota in mountainous areas that had been less affected by the disease.94 Because of the strict hygiene policies described above, cholera incidence rates were extremely low among the troops on the coastal front in Wenzhou Prefecture. According to Sun Fuzhi, “There were two cholera cases among cookhouse soldiers. Both of them contracted cholera when they left the military camp to purchase vegetables from the local market. Cookhouse soldiers had more opportunities to leave their camps and come into contact with water and other sources of infection.”95 The Pingyang Sanitation and Epidemic Prevention Station records indicate that there were five cholera cases among PLA soldiers during the 1962 cholera pandemic: “The PLA moved southward and entered the Wenzhou area as part of the Preparation for War in June. One army field hospital from Jiangsu Province marched through Zhejiang Province to reach Pingyang County, with the hospital finally stationed in Rui’an County. It was a long and exhausting march. Within nine hours of their arrival in Rui’an, one of the staff members had succumbed to cholera. On the third day, a hospital care worker also became ill.” The report attributed the cases of illness to “exhaustion and fatigue after the long march and the different habits of new areas.”96 Regardless of the two cases described by Sun Fuzhi or the five cases recorded in the Pingyang County Sanitation and Epidemic Prevention Station documents, there is no doubt that cholera incidence rates among PLA soldiers during the 1962 pandemic were extremely low, particularly in view of the fact that there were fifty thousand soldiers in coastal areas, which implies incidence rates of between 0.04 and 0.1 per thousand. This figure contrasted sharply with incidence rates among civilians in the same areas. The cholera incidence rate along major canals

Soci a l Divisions, Epidemiology, a nd Disease Distr ibution

in coastal areas of Wenzhou City and Rui’an and Pingyang Counties was higher than 9.2 per thousand, with peaks of 15.63 per thousand in Shuiting Commune, Pingyang County. The PLA’s incidence rate was even lower than that of civilians in mountainous areas (where the rate was 0.38 per thousand).97 In this sense, the PLA camps became a sort of haven against cholera in Wenzhou Prefecture, the most seriously stricken area in coastal China during the pandemic in the summer of 1962.

CONCLUSION The cholera pandemic in 1962 demonstrated three distinctive features of social epidemiology and disease distribution: a hierarchical structure between urban and rural areas, blurring boundaries between males’ and females’ rates of disease, and a dramatic imbalance between soldiers and civilians. The changes made by the new national government after 1949 to reorganize the population, limit its mobility, and harness its labor were strengthened in 1961–1962. As this chapter shows, the rise of the divided rural/urban residential system from the 1950s onward notably widened the gap in sanitation and drinking water provision between rural and urban areas. Greater resources were given to urban areas. The renovation of waterways, purification of well water, and provision of running water greatly improved the quality of drinking water for urban residents. In contrast, the outer urban and vast rural areas in each of the counties considered here did not see corresponding improvements, even in county towns. Indeed, water quality in these rural areas actually worsened due to water pollution following the Patriotic Hygiene Campaign and the agricultural collectivization campaigns in the 1950s. Cholera incidence rates were therefore structured hierarchically: incidence was lowest in urban areas, followed by suburban areas, and was highest in rural areas. This correlation between cholera incidence and drinking water and sanitary environment due to uneven resource distribution between rural and urban areas continued throughout Mao’s period of leadership. Meanwhile, as part of the political discourse of women’s liberation, huge demands were placed on female laborers to support new agricultural production methods during collectivization. This made women more vulnerable than before to waterborne infectious diseases such as cholera and ultimately made them as equally likely to contract cholera as men. This marks a significant change in the gender structure of the social epidemiology of infectious diseases in Chinese history. The vulnerability of women in this cholera pandemic further complicated

109

110

china a nd the choler a pa ndemic

the image of women in China after 1949; they were portrayed as having been liberated by political movements, saved by midwifery services and other reproduction-related reforms, and mobilized to participate in socialist construction as they, in Mao’s famous phrase, “held up half the sky.” The changing face of the military and its relationship with civilian populations resulted in a huge gap in incidence rates between soldiers and civilians in Wenzhou Prefecture, despite its being both a cholera-affected area and a coastal front. The stringent medical examination scheme, the supply of sufficient quantities of food, a complete medical care scheme, and strict preventive health measures all strengthened soldiers’ health. These sociopolitical changes were all brought about by national social restructuring initiatives, including the establishment of the household registration system and the coordination between the PLA and local governments. However, civilians, particularly rural residents, suffered disadvantages in terms of resource distribution compared with both troops and urban residents. To some extent, the extremely low cholera incidence among the PLA troops was due to the sacrifices made by China’s peasants. In all, the radical changes in social epidemiology and distribution in terms of rural/urban, male/female, and military/civilian confirm that epidemics and pandemics are not merely biological events; they are also intertwined with social and political changes. As the next chapter will investigate, the response to a public health emergency within this sociopolitical context contributed to the rise of an emergency disciplinary state.

4 QUARANTINE AND ISOLATION The Rise of Multiple Borders

IN THE SPRING OF 1946, YONGJIA COUNTY SUFFERED PLAGUE AND CHOLERA OUTBREAKS as a result of chaotic large-scale population movements following the end of the Anti-Japanese War the previous year. In Yongjia County Town, now Wenzhou City, there were around thirteen hundred cholera patients, while plague spread throughout the year. In view of the seriousness of the situation, the Nationalist provincial government declared Yongjia County to be an infected area on April 9, 1946.1 The Southeast Plague Prevention Center of the Ministry of Health arrived and set up a quarantine station and isolation hospital to accommodate patients.2 During the plague outbreak, a man from Jinshui Village who ran a grocery store in the county town was infected with the plague and isolated in the infectious disease hospital. However, one night he escaped quarantine and sneaked back to his village. He was soon arrested by the village head. To prevent the further spread of plague, he and his family were detained on a large boat that was anchored in the middle of the river that flowed through the village. Every day the village asked a person to row over to deliver water and food to them. Three members of the family died of the plague, including the grocer himself, and the other four survived. Following “liberation” in 1949, there were “struggle meetings” against class enemies, and at one of them the surviving sons of the grocer accused the village head of persecuting their family and causing these 111

112

china a nd the choler a pa ndemic

deaths. After being severely criticized, the Nationalist village head was sentenced to death by the local government for serving as “an agent of the reactionary Nationalist government in suppressing the poor masses.”3 The quarantine restrictions imposed on this grocer were typical of disease control measures in China’s past. In her path-breaking research on the history of leprosy in China, Angela Leung has identified several ways that lepers were expelled and isolated in imperial China. One was to drive them onto boats, provide them with a little rice, wood, and other daily necessities, and then push them out onto rivers or into the sea, where they often perished. By the early twentieth century, Nationalist government activists were promoting the strict isolation of patients, which was believed to be the most effective way of preventing the spread of leprosy. However, the Nationalist government lacked the necessary resources to implement and maintain such coercive isolation measures, so it abandoned this approach and resorted to cooperating with Western missionaries to jointly run leprosy houses.4 The Yongjia grocer incident of 1946 reveals the combination of traditional and modern ways of dealing with disease. After the failure of modern hospital isolation, a seemingly traditional method was used (putting the plague patient and family members onto a boat), but they were provided with food and water every day rather than being left to die as a means of avoiding further contagion. Meanwhile, the local administration, in the form of the village head, played a key role in the quarantine process. However, the operation itself was obviously far from efficient because the plague patient was able to escape isolation. After 1949, historical continuities and the contemporary influence of Soviet models shaped the implementation of quarantine and isolation for eradicating and preventing infectious diseases. The new strategies were carried out in the context of the gradual formation of the Communist government administrative system. In the early 1950s, these methods were applied to combat plague in northern China with small-scale assistance from the Soviet Union.5 When cholera first broke out in Yangjiang County, Guangdong Province, in June 1961, the central government mobilized medical resources and personnel across the country to impose a cordon sanitaire around the affected areas in order to prevent further spread. These interventionist response schemes in northern China and Guangdong established a general framework for the control of cholera in the Wenzhou area in 1962, which allowed the governments to further institutionalize and implement containment measures that centered on quarantine and isolation. Meanwhile, the restructuring of the People’s Commune system and

Qua r a ntine a nd Isolation

the strengthening of the mass militia scheme were being undertaken as key elements of social restructuring. It was significant that quarantine and isolation procedures were intended to create borders to contain the cholera outbreak while the social restructuring process was simultaneously creating administrative and militia-related borders. These two concurrent processes of border creation interacted to shape both population mobility and the spread of disease, which in turn affected social restructuring. However, at about the time when quarantine and isolation were being adopted and implemented in modern China, it was being suggested elsewhere that quarantine be abandoned as an excessively interventionist method in terms of both technical and efficiency aspects.6 After the cholera pandemic began in 1961, the World Health Organization (WHO) pointed out that quarantine and isolation practices had proved to be ineffective in containing the disease because the percentages of asymptomatic infection and mild cases were extremely high.7 WHO also noted that countries usually took excessive and repressive approaches, though these efforts had been only partially successful in the past.8 In this sense, while the large-scale implementation of quarantine and isolation pursued by the Chinese government was aimed at containing population mobility during the cholera pandemic, these methods functionalized the social control targeting either mobile or dangerous groups. This chapter investigates the rise of multiple borders (natural, administrative, militia, and quarantine) and their significance in the reciprocal interaction between interventionist prevention measures and social restructuring during the pandemic in 1962–1965. It argues that the interventionist scheme to control the pandemic not only harnessed opportunities provided by the broader social restructuring initiatives but also directly contributed to these efforts and significantly facilitated the rise of the emergency disciplinary state.

INVISIBLE BORDERS, FROM THE NATURAL TO THE ADMINIS TRATIVE As in other agricultural societies, the conceptions of borders for villagers in traditional, rural, clan-based Chinese society were relatively vague. Life centered on the home village, and visible borders usually consisted of any important geographical features, like rivers and mountains.9 The scope of mobility for villagers was confined to neighborhoods, villages, or neighboring areas because of production modes, economic conditions, and transport-related and geographical constraints.10 Wenzhou, in the southeastern corner of Zhejiang Province, was

113

114

china a nd the choler a pa ndemic

no exception to this pattern. As described in chapter 2, the Wenzhou area is surrounded by mountains to the north, west, and south, while the sea forms its eastern boundary. The whole area is further fragmented by various rivers and other mountains; indeed, it is the most mountainous prefecture in Zhejiang. The divisions formed by these geographical features were a major influence on how villagers conceptualized borders. These visible borders functioned as barriers to population movement, which was further exacerbated by poor transport conditions. In the early 1950s, cadres from Taishun and Wencheng Counties, in the mountainous southwest of Wenzhou, would spend seven to eight days reaching Wenzhou City when they had to attend meetings there.11 However, with the establishment of the rural administrative system, the initiation of the agricultural collectivization campaign in the early 1950s, and the promotion of the People’s Commune system, administrative borders for villages in the Wenzhou area were gradually established, as they were in other parts of China. With the rise of immobile society prior to the outbreak of cholera, compositional homogeneity, political surveillance, and economic egalitarianism contributed to the rise of invisible borders based on the administrative system. The household registration system divided the whole population into rural and urban households that were basically affiliated with production brigades and work units, respectively. Within each organization and unit, membership was highly homogenous and not open to outsiders, which created an invisible border that greatly limited mobility. As the veteran He Nangao put it, “at that time, there was actually no population mobility. No one went outside their area as migrant workers do today. Almost all marriages occurred within the same areas. The few mobile individuals included peddlers, blacksmiths, road construction workers, factory purchasing agents, government officials who went to other parts of the country to do surveys, those seeking medical treatment, and soldiers on leave.”12 Meanwhile, political surveillance also contributed to the rise of invisible borders, with the letter of introduction (jieshaoxin) scheme used to justify a trip’s purpose. According to He Nangao, rural commune members going on a long journey to visit relatives and friends needed to request that their production brigade issue and sign a travel permission letter. Commune members then had to take this letter to the commune, which would add comments on the document indicating that they “support the production brigade’s decision” or “this fact is verified.” This letter had to be shown at lodgings and at public security checks at bus stations, in hotels, and on ferries. As for government staff, He Nangao, who later become a public security bureau officer after he left the army, noted, “At that

Qua r a ntine a nd Isolation

time, there were no identification cards, just work permits. You had to produce letters of introduction for work duties and accommodation.”13 The inconvenience of obtaining letters of introduction reduced population movement, but the economic egalitarianism of the commune system also facilitated the formation of invisible borders. The People’s Commune and its work point scheme, which was pegged to the labor, age, and sex of commune members, had already confined the majority of the Chinese population to rural areas, making commune members’ survival impossible if they left their own production brigades.14 Moreover, after the implementation of the unified purchase and sale of grain in 1953, the government started issuing grain and oil coupons to strengthen planned management and control the volume of grain and oil sales.15 This grain and oil coupon scheme was closely tied to the rural/urban household registration system: only residents in urban households affiliated with work units and residential committees received grain coupons, while those from rural areas were basically excluded from these entitlements. If commune members went to the city and other areas, they had to purchase grain coupons if they wished to purchase foods like noodles and steamed buns. Coupons were very costly, roughly equivalent to the income from two to three days’ work for peasants in the Wenzhou area in the 1960s. These economic conditions resulted in villagers using as few coupons as possible, which therefore constrained their mobility.16 As the crucial component of the salary and welfare package in work units and residential committees, the grain scheme was based on per-capita rations for urban household residents. Each adult was provided with a ration of thirty jin of grain per month. Author Miu Tianshun recalled, “Even when parents visited their children, it was all right for them to stay for a few days. They didn’t need to pay money, but they had to give their children their grain coupons because their children’s families only had limited grain coupons. It was all right to have a meal or two at the homes of relatives or friends, who would reluctantly accept you. However, if you were not considerate, did not understand the situation they were in, and continued to accept meals at their homes, they would ask you to leave.”17 Furthermore, anyone who had to travel outside the county or province needed to exchange their local coupons for national or provincial grain coupons. Therefore, this scheme also constrained the mobility of urban residents. The grain and oil coupons effectively created invisible borders that prevented the outflow of villagers from rural areas, the influx of villagers into urban areas, and the movement of urban residents. This border was maintained and balanced by high levels of economic egalitarianism resulting from per-capita

115

116

china a nd the choler a pa ndemic

welfare packages in urban work units and residential committees and the work point scheme in People’s Communes in rural areas. In sum, invisible borders based on population homogeneity, political surveillance, and economic egalitarianism strengthened administrative borders and created institutional advantages for the implementation of large-scale quarantine during the cholera outbreak in summer 1962.

DRAWING BORDERS, QUARANTINE PARTITION, AND ENCIRCLEMEN T A week after the first cholera case was confirmed in Rui’an County in July 1962, Zhejiang Province’s health department issued its first circular on cholera quarantine. The circular mainly focused attention on preventing the spread of cholera from Wenzhou to outside areas and protecting the safety of two major cities in Zhejiang Province (Hangzhou and Jinhua) and Shanghai Municipality, in view of the significance of their geographic locations (map 4.1).18 As the capital of Zhejiang Province, Hangzhou City is a major railway hub, one that is crossed by the Zhe–Gan line (Zhejiang Province–Hu’nan Province) and the Hu–Hang line (Shanghai Municipality–Hangzhou City). Another line connects Hangzhou with Ningbo, an important commercial and military port where the PLA’s East China Sea fleet is stationed. Another major railway station in Zhejiang Province is Jinhua County Station, which is on the Zhe–Gan line. North of Zhejiang lies Shanghai, one of China’s major metropolitan areas. In the early 1960s, the railway was the fastest and most commonly used form of long-distance transport, one that could spread cholera quickly. To prevent cholera from spreading across the country, it was crucial to keep it from spreading to the cities of Hangzhou, Jinhua, and Shanghai. The provincial government divided Zhejiang into three zones and assigned different control and prevention duties. It classified cholera-affected areas, including Rui’an County, Pingyang County, and Wenzhou City, as Zone 1. Within this zone, local governments were required to firmly contain the spread of cholera and then eradicate it. The areas outside Wenzhou that were not affected were classified as Zone 2. It included all other counties in Wenzhou Prefecture, all counties in Zhoushan Prefecture, and the coastal areas of Taizhou and Ningbo Prefectures, as well as the major cities within Zhejiang Province, such as Hangzhou, Ningbo, and Jinhua. These areas were required to implement quarantine for people from Zone 1, as well as passengers from Guangdong, fishermen, and returned overseas Chinese. Any passengers going to Zone 1 would need to produce

Qua r a ntine a nd Isolation

Map 7. Quarantine stations and area classifications in Zhejiang Province, 1962–1964

valid inoculation certificates when purchasing bus and train tickets. All other areas in Zhejiang Province were classified as Zone 3.19 In this way, the Zhejiang provincial government partitioned the whole province into a series of concentric circles that centered on the cholera-affected Wenzhou area. Within these geographical zones, the provincial government set up major observation stations in Quxian, Jinhua, Hangzhou, and Jiaxing, all located along the railway line that connected Zhejiang Province to Hunan Province and the line connecting Shanghai to Hangzhou, which also connected to the national north-south rail arteries.20 In September, the government established temporary transport observation stations along the line from Hangzhou to Ningbo City.21 In this way, observation stations formed a quarantine belt along these three railway lines passing through the northwest, north, and northeast of Zhejiang Province. A series of high mountains between Wenzhou and this quarantine belt formed a geographical barrier. Two kinds of barriers, one human (the railway observation stations) and one natural (the mountains) thus helped contain cholera within the Wenzhou area. In addition, because cholera mainly spread via fishermen, the

117

118

china a nd the choler a pa ndemic

Zhejiang provincial government set up temporary joint quarantine stations in three major archipelagos in the three coastal prefectures of Wenzhou, Taizhou, and Ningbo.22 The quarantine stations on these islands formed a quarantine belt in the East China Sea. In combination with the railway and geographical belts on land, they formed the first quarantine ring around Wenzhou. Within this quarantine ring, the provincial government formed a second ring of quarantine control mechanisms along the major highways and maritime routes that connected Wenzhou to other areas of the province. In the west, the government implemented quarantine in Jinyun Station on the Jinhua–Wenzhou highway line that connected Wenzhou with the central portion of Zhejiang Province. In the north, quarantine checks were established at Linhai and Ningbo Stations on the highway connecting Wenzhou and the coastal areas of Zhejiang.23 In the south, Pingyang and Taishun Counties in Zhejiang Province and Fuding County in Fujian Province set up a joint quarantine station at Fenshuiguan Gate in 1963. Wenzhou Prefecture set up extra transport quarantine stations to form a third quarantine ring, in locations which were the first stops en route to neighboring prefectures and provinces in three directions, including on the Qing River in the northeast, Feiyun River in the southwest, and the Meiao Quarantine Station in the west.24 Through these three quarantine rings, the government aimed to blockade the three locations that were most seriously affected by cholera: Rui’an County, Pingyang County, and Wenzhou City. Within these three quarantine rings, the county and city governments further divided quarantine zones from the county level down to that of districts and communes, on the basis of the existing administrative structure.25 For example, Wenzhou City had set up four quarantine stations, eighteen quarantine teams, and twenty-nine quarantine points by September 11, 1962.26 Within county and city quarantine circles, each commune and district was responsible for setting up quarantine stations on important highways and in towns. The infected and neighboring areas were further classified into blockaded areas, semiblockaded areas, and control areas. Blockaded areas included cholera-affected natural villages in rural areas, residential areas in urban towns, or areas containing several natural villages. Natural and geographical features like rivers and roads were classified as major demarcations. Semiblockaded areas were those within a five-kilometer radius of blockaded areas, while control areas were outside blockaded and semiblockaded areas.27 In this way, quarantining partitions and encirclement involved a process of

Qua r a ntine a nd Isolation

redrawing and reclassifying borders based on existing administrative borders. There was some overlapping with administrative borders, while traditional natural and geographical demarcations also played roles. During this process, geographic, administrative, and quarantine borders emerged and interacted to form multiple boundaries, with administrative borders still playing the dominant role, because quarantine and isolation were implemented on the basis of administrative units.

INTERWEAVING ADMINIS TRATIVE, MILITIA, AND QUARAN TINE BORDERS While the quarantine network was established by redrawing and reclassifying the administrative network, this coincided with the intensification of the mass militia scheme that had been promoted since the summer of 1962 as part of the Preparation for War campaign. Since 1949, creating militias had been touted as a national priority for building social stability and economic prosperity. In 1952, the government started implementing a general militia scheme.28 In August 1958, the party’s Central Committee issued “Resolution on Militia Work” and “Everyone a Soldier” (quanmin jiebing), which coincided with the launching of the Great Leap Forward and the attendant establishment of People’s Communes. Every male and female citizen between sixteen and fifty years of age, except for landlords, rich peasants, antirevolutionaries, bad elements, and rightists, were enrolled in militia organizations. The structure of this mass militia was bound up with the administrative system as noted below: the shi (division) was based on the county, the tuan (regiment) was based on the commune, the ying (battalion) was based on production brigades, and the lian (company) was based on production teams, under which pai (platoons) and ban (squads) were set up. In Wenzhou Prefecture, militia members made up 32 percent of the total population by March 1959. At the start of the 1960s, the worsening of relations with the Soviet Union and United States further facilitated the development of militia organizations. In March 1962, each county in Wenzhou Prefecture set up people’s armed forces committees and strengthened militia leadership, following instructions from the provincial military war preparation office. The government reorganized the militia throughout the prefecture and arranged them into different teams in coastal areas and fishing areas. In the meantime, each of the twenty-three key communes in Wenzhou City, as well as Pingyang, Rui’an, Yongjia, and Yueqing Counties, set up smaller militia companies, which could be put into service in the event of war.29

119

120

china a nd the choler a pa ndemic

Militias were a tool of the party’s “dictatorship of the proletariat.” As the Communist Party proclaimed, the purpose of the militia was to fight against enemies inside and outside the country and to protect the people’s interests. According to this directive, the militia should support the army’s battles and provide support for the front during wartime, as well as support the army and public security forces in launching the fight against class enemies in peacetime.30 They were therefore charged with patrolling, surveillance, and suppression.31 The militia also constituted a new process of border partitioning. Enemies were believed to be hiding in the border areas of each county, including mountainous areas and along riverbanks, in transport and economic centers, and among fishermen and boat people. These were classified as priority areas for militia work. The district and commune militia committees in these key areas further subdivided and designated zones and set up militia watch posts to target any suspicious movements of people, even hunters, persons burning charcoal, wood cutters, herbal medicine collectors, forest rangers, and cattle herders. Surveillance teams were taught how to follow and report on enemies and send out communications signals.32 Networks of militia organizations thus kept the whole of society under close surveillance through the partition of administrative regions, and they served as a vehicle through which the party penetrated every corner of the society. During the Preparation for War period in the summer of 1962, the organization of this mass militia further reduced the mobility of the masses through the various surveillance posts and patrols, and this in turn created normalized “borders” for ordinary people. In other words, it was militiamen and women who were enforcing internal borders. Therefore, the political and military missions and the significance of the militia were greatly enhanced and could be readily mobilized in other emergencies. Right after the outbreak of cholera, the administrative, militia, and quarantine borders were quickly interlinked through collaboration and division of labor as authorities implemented the quarantine process. Each city and county government was instructed to establish epidemic prevention headquarters under the leadership of the county’s party committee secretaries and the county governors. The headquarters were usually composed of various departments, including those responsible for transport, railways, health, commerce, grain, civil affairs, public security, and people’s armed forces. Each department was tasked with different coordination duties involving quarantine in their own sectors. For example, departments of transport and railways were in charge of selling tickets, checking tickets, and overseeing quarantine on buses and boats. Health

Qua r a ntine a nd Isolation

departments coordinated patient quarantine, isolation, treatment, disinfection, and preventive inoculation. This organizational structure was designed to supervise and coordinate quarantine.33 In terms of actual quarantine practices, regardless of whether we are speaking of major quarantine stations located on provincial and prefectural borders, medium-size quarantine stations, or village isolation points, administrative and medical staff and militia members were the backbone of quarantine crews. Administrative staff were in charge of operations and coordination, medical personnel were responsible for technical observation and medical treatment, and the role of militia men and women was to block off areas and maintain security and order. This was particularly noticeable in the large number of village isolation points, where a village cadre, a health-care worker or commune clinic doctor, and a member of the militia were on duty. Quarantine stations thus interwove geographical, administrative, and militia borders and became articulation points along these multiple borders for local societies experiencing the cholera outbreak.

HOSPITAL LOCATIONS, PATIEN T DIS TRIBU TION, AND T WO FORMS OF ISOL ATION While quarantine partition and encirclement practices created multiple borders and networks that aimed to prevent the rapid spread of cholera, a simultaneous and equally crucial step was to set up hospitals following the principle of immediate isolation of patients in the local area, which was believed to have some advantages. For example, isolation at home was convenient for patients’ families, and patients could receive treatment upon the arrival of medical staff. Isolation could also help the treatment process by enabling doctors to visit patients at any time and immediately know how they were faring. Strict isolation was further believed to benefit epidemic prevention, as it cut off contact with the outside world. In sum, isolation was believed to reduce the death toll, the number of medical staff required for managing patients, and disease transmission because of centralized management and disinfection of contaminated sewage.34 For all these reasons, the Zhejiang Provincial Prevention and Treatment Team set up isolation hospitals and isolation points based on the commune as an organizational unit in the cholera-affected areas of Wenzhou Prefecture. For example, in Rui’an County this entailed the establishment of twenty isolation hospitals and thirty-one isolation points of different sizes, all staffed by more than seven hundred medical personnel.35

121

122

china a nd the choler a pa ndemic

These isolation hospitals and points were arranged differently at different administrative levels. At the county level, some existing county people’s hospitals were designated as isolation hospitals, among them Rui’an County People’s Hospital, Pingyang County People’s Hospital, and the Wenzhou City Infectious Diseases Hospital. Below the county level, because the poor facilities at district and commune clinics could not accommodate cholera patients, deserted temples, school classrooms, theaters, and clinics were selected as locations for isolation hospitals. As clinic doctor Wei Shanhai from Xianjiang Commune, Xianjiang District, Rui’an County, recalled, “At the beginning, cholera patients were sent to the commune clinic. The building was not big, and there were not many staff. Later there were too many patients. With no other options available, we set up an isolation point at Yangkeng Temple, which happened to be located on a small hill. Before liberation, there had been a few monks living there. It was easy to isolate patients. The commune dispatched two members of the militia to guard the door, and we treated patients. The conditions were extremely poor. Patients just lay on tables.”36 While doctors treated cholera patients at isolation hospitals and isolation points, they also provided saline solution drips to patients at home. Even today the doctors I interviewed still had very vivid memories of these experiences. As Dr. Ye Yuguang of Dongtou Hospital on the island in Wenzhou City recounted, “patients vomited and had diarrhea everywhere. Their excrement looked like dirty rice water, which we had to walk over and even kneel down in it to administer intravenous injections of saline solution.”37 Wang Jingfu, who was the doctor at the Li’ao Township Health Clinic in Rui’an County, recalled how wary doctors had to be of contracting the disease themselves: “Doctors provided saline solution drips to patients at home. On one night, we started providing saline solution drips and worked until the noon of the second day. When we treated patients at their homes, we did not eat their food. Some doctors were so hungry that they became exhausted. They collapsed when they returned home. It was really exhausting. We didn’t even dare to drink boiled water at patients’ homes.”38 County hospitals, isolation hospitals below the county level, and patient homes were the three major locations of cholera treatment during the pandemic. Although basic yet effective medical therapies like saline solution drips were applied at these different locations, patient distribution was quite uneven in county seats and rural areas. As mentioned above, the basic principle of cholera prevention was the immediate isolation of patients locally, because long-distance movement would further spread infection. Although county hospitals had advantages

Qua r a ntine a nd Isolation

in terms of medical facilities and proficiency, transferring even serious cholera patients was not recommended by county health bureaus and epidemic prevention stations. The township doctor Wang Jingfu recalled, “We encountered a few serious cases. It was really hard for us to handle them, so we called the county for assistance. But they asked us not to send patients to the county hospital because patients would have diarrhea on the road and contaminate it.”39 This principle of isolation on the spot obviously influenced the distribution of patients in rural and urban areas, together with the selection of locations for isolation hospitals. At the same time, the economic burdens resulting from treatment at isolation hospitals and centers also impacted patient distribution. Right after the outbreak of cholera in the region, each county made regulations for charging cholera patients. Medical units would collect fees for medicine if patients could afford these. Under no circumstances could treatment be delayed just because a patient could not afford the fees.40 Nevertheless, treatment rates were differentiated according to medical unit features. Treatment stations set up by public medical units charged standard-rate fees, while collective medical units followed a separate and higher rate: 50 cents for standard saline solution injections and 20 cents for each additional 500 cubic centimeters, when large quantities were required. The price was equivalent to around one to two days’ wages for peasants. 41 These rates were applied to isolation hospitals, centers, and home treatments. By early September, the government had shifted its stance on fees and ordered that treatment for cholera patients should be provided for free. Compared with homes, isolation hospitals and centers were at a disadvantage. First, treatment of cholera patients at isolation hospitals and centers required the transfer of the patient and involved the participation of family members. However, when the cholera was spreading in the Wenzhou area, it happened to be the busiest agricultural harvesting and planting season (July and early August). Any interruptions to or interference in agricultural production would incur huge economic losses. Second, cholera patients had to resolve their own ration issues. 42 As discussed above, acquiring extra ration coupons implied a heavy economic burden for peasants, which discouraged them from becoming indebted by borrowing coupons. This financial obstacle, along with fear of contagion at isolation hospitals, meant that many cholera patients preferred treatment at their own homes. Isolation on the spot, economic issues, and fear of contagion meant that the distribution of patients for treatment at different locations resulted in specific features according to the type of treatment site. According to the clinic analysis report prepared by the Zhejiang Provincial Cholera Prevention Technical

123

china a nd the choler a pa ndemic

124

Table 4.1. Geographic distribution of cholera cases at three major hospitals in Wenzhou Prefecture, 1962 Wenzhou City Infectious Disease Hospital, 1962

Rui’an County People’s Hospital

Pingyang County People’s Hospital

Areas

Cases

%

Cases

%

Cases

%

Urban area (county town)

197

85.6

143

47.8

197

51.7

Suburban area

19

8.4

87

29.1

0

0

Rural area

14

6.0

69

23.1

184

48.3

Total

230

100

299

100

381

100

Sources: Wenzhoushi chuanranbing yiyuan, “230li fuhuoluan linchuang fenxi,” October 1962, ZJA, Vol. J166-2-162; Rui’anxian renmin yiyuan, “Fuhuoluan 300li linchuang fenxi,” September 1962, ZJA, Vol. J166-2-162; Pingyangxian renmin yiyuan, “Fuhuoluan 381li linchuang fenxi,” October 22, 1962, ZJA, Vol. J166-2-162.

Supervision Central Station, the numbers of patients at Rui’an County People’s Hospital, Pingyang County People’s Hospital, and the Wenzhou City Infectious Diseases Hospital were 549, 381, and 230, which accounted for only 16 percent, 9 percent, and 13 percent of total cholera patients in each locale, respectively, in 1962.43 In other words, although they were equipped with the best medical facilities and personnel, these county and city hospitals did not treat the majority of cholera patients. Furthermore, the cholera patients at these hospitals were mainly from urban areas and county towns, according to the hospitals’ own reports (see table 4.1). In Wenzhou City, 85.6 percent of the cholera patients treated at the hospital were from urban areas, while those from suburban and rural areas accounted for 8.4 percent and 6.0 percent, respectively. At the Rui’an and Pingyang County People’s Hospitals, around 50 percent of the cholera patients were urban. The ratio of rural to urban cholera patients at these hospitals did not correspond to the general demographic ratio, in which urban populations represented only 10 percent, as discussed in chapter 2. Rural cholera patients were largely excluded from these hospitals. Moreover, although the government promoted treatment at isolation hospitals and centers, in-home care still played an indispensable role in isolation and treatment and even outperformed isolation hospitals and centers in terms of patient numbers. According to statistical data from Pingyang County in 1962, 1,923 cases (44 percent) were treated under isolation conditions at a medical facility, while 2,443 were treated at home (56 percent).44 The commune doctors

Qua r a ntine a nd Isolation

I interviewed confirmed this figure. In Pingyang County, Li Chengqin, a doctor from Shitang Commune who was involved in epidemic prevention work, recalled that most patients were treated at home.45 The distribution of patients therefore presented a pyramid-shaped structure in which the number of patients treated at county people’s hospitals accounted for the minority of the patient total, while those at isolation hospitals and centers below the county level and homes in rural areas accounted for the vast majority. This patient distribution structure corresponded to the rural/urban divide, which the isolation measures helped strengthen. Because of compulsory quarantine and isolation, patient households and isolation hospitals/centers confined patients and their families to households, villages, and communities. While governments imposed compulsory isolation on cholera patients, healthy villagers imposed self-segregation on themselves. As commune doctor Wei Shanhai of Xianjiang Commune in Xianjiang District, Rui’an County, recalled, “In the 1960s it was relatively simple to implement quarantine for cholera patients. At that time, we just drew lime circles around cholera patient households and asked them not to come out. The people were quite honest and obedient. In the meantime, other villagers imposed self-segregation [ziwo geli]. They were scared of cholera and afraid of catching it. They wouldn’t visit cholera patient households. This self-segregation was very significant.”46 In this way, the compulsory quarantining of cholera patients and self-segregation by healthy villagers formed a two-part isolation process during the pandemic and was another factor in reducing population movement. However, isolation was not an entirely straightforward way of containing the spread of cholera at the outset of the outbreak or during the entire hospitalization, treatment, and discharge process. The Cholera Epidemiologic Investigation Team of Pingyang County admitted in its analysis report that “none of the isolated cholera patients were actually able to meet the requirements for timely isolation” (in other words, they were too slow to comply with isolation procedures).47 As table 4.2 indicates, the timely admission of cholera patients into isolation hospitals and centers was no easy task. Although 71.3 percent of cholera patients in Rui’an and Pingyang Counties were admitted to hospitals within twenty-four hours, some 28.6 percent of patients were only admitted one or more days after symptoms developed. The percentage admitted after two or more days was 14.4 percent. These late-admission cholera patients became potential sources of cholera contagion. In the meantime, early discharge was another source of contagion. As

125

china a nd the choler a pa ndemic

126

Table 4.2. Time between patients contracting cholera and being admitted to hospital in Rui’an and Pingyang Counties, 1962 Days elapsed before patient was admitted to hospital (number of cases)

Hospitals 1 day

2 days

3 days

4 days

5 days

6–10 days

11 days or more

Total

Rui’an County County People’s Hospital

1,095

163

82

43

27

31

14

1,455

%

75.2

11.2

5.7

3

1.9

2.1

1.0

100

Pingyang County County People’s Hospital

271

50

20

16

9

9

1

376

Chengguan Hospital

48

49

3

9

2

4

0

115

Aojiang Isolation Hospital

139

61

22

10

1

9

0

242

Yishan Isolation Hospital

128

13

20

4

6

0

0

171

Subtotal

586

173

65

39

18

22

1

904

%

64.8

19.1

7.2

4.3

2.0

2.4

0.1

100

Grand total

1,681

336

147

82

45

53

15

2,359

%

71.3

14.2

6.2

3.5

1.9

2.2

0.6

100

Sources: Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan, “Zhejiangsheng 1962nian fuhuoluan 1982li linchuang fenxi,” November 1962, ZJA, Vol. J166-2129; Pingyangxian fuhuoluan liuxingbingxue diaochazu, “Pingyangxian fuhuoluan liuxing yinsu de fenxi,” October 1962, ZJA, Vol. J166-2-162.

mentioned in chapter 2, cholera broke out and spread in the Wenzhou area in late July and early August, the “double quickness” time of harvesting and planting. This prompted some patients to leave isolation hospitals very quickly in order to participate in agricultural production, so they did not remain for further observation. The Rui’an County People’s Commission Health Division pointed out in its report that “although some production teams still paid patients work points and grain during the isolation period, they were worried that no one would take care of their household plots, as well as the old and young members of their families. They thus took themselves out of the hospital, causing cholera to spread widely and swiftly.”48 The length of isolation was also affected by hospital facilities, as small hospitals often had to deal with many cholera cases. In Rui’an County, patients would stay at hospitals for three to six days on average. 49 This period, as the Cholera

Qua r a ntine a nd Isolation

Epidemiological Investigation Team of Pingyang County admitted, was much less than recommended: “The length of isolation of cholera patients did not meet requirements (fifteen days after the onset of illness). These patients were still potential sources of contagion.”50 More significantly, the differences in length of isolation between rural and urban patients were sharp. The statistical data on patients in selected isolation hospitals and centers in Pingyang County indicate that 92.27 percent of rural cholera patients in Qianku District were isolated and hospitalized for only a week. In contrast, 83.73 percent of urban patients stayed in the hospital for two to three weeks, while only 16.27 percent were isolated for a week. Between patient admission and discharge, the isolation process itself was a potential source of contagion at the isolation hospitals because of disinfection issues. There were instructions that outlined schemes for the disinfection of patients, relatives, and staff. For example, the Puxi Commune temporary isolation hospital in Rui’an County was divided into two sections—contaminated and clean sections. According to the instructions, the hospital should stress the nursing of cholera patients and the management of relatives who visited patients. All contaminated clothing, quilts, utensils, and sewage from patients and relatives were supposed to be carefully disinfected.51 However, actual practices differed greatly from these guidelines, as the Rui’an County People’s Commission Health Division admitted in an internal report, “because of the conditions in the rural areas, where housing is crowded and rundown and isolation hospitals have poor facilities.” Contaminated sections could not be separated from clean ones, while disinfection work could not be conducted effectively. Because of poor management, family members and relatives who visited hospitals therefore potentially spread cholera to healthy populations.52 In this sense, although isolation restrained population mobility and strengthened the rural/urban dichotomy through different isolation locations, isolation practices still allowed cholera to spread.

THE PROBLEMS OF QUARAN TINE BORDERS The difficulties of implementing isolation practices to control patients were also seen in quarantine practices targeting mobile populations, be they patients, suspected sufferers, or healthy individuals. As noted earlier, the quarantine process redrew borders and established a tight surveillance network, while quarantine stations were assigned the duty of checking cholera patients and suspected

127

128

china a nd the choler a pa ndemic

cholera sufferers mainly through medical observation and cholera inoculation certificates. While medical observation of mobile populations with noticeable symptoms was the easiest way to identify cholera patients, checking inoculation certificates became the most convenient and secure way to identify suspected cholera sufferers and potential carriers of the disease. This was because it was believed that healthy populations would have immunity against cholera for six days after inoculation. In view of this belief, the Zhejiang provincial government issued detailed regulations on inoculation on August 2, 1962, at the height of the cholera pandemic. According to the new rules, any passenger from an affected area or who passed through or entered one or more such areas should hold a valid inoculation certificate.53 Those without certificates would receive inoculation and be issued certificates afterward and would not be allowed to leave until the inoculation become effective.54 Compared with checking cholera inoculation certificates, detaining cholera patients and suspected sufferers at quarantine stations was more complicated. According to regulations, each major quarantine station designated by the provincial government was to set up a detention check-up center and prepare quarantine beds in accordance with the volume of the mobile population and the number of passengers. The detainment center’s task was to admit suspected sufferers, conduct first aid and treatment, and observe passengers with contraindications, those without certificates, and those whose inoculations had not been effective, while isolating individuals who had had close contact with cholera patients. In terms of costs, while the medical treatment and accommodation fees incurred during the observation period were to be covered by health departments, patients, suspected carriers, and those who had contact with patients had to pay for their own food and provide ration coupons.55 Passengers who had not received preventive inoculation or whose inoculations were not yet effective were to pay the costs incurred while they were under observation at quarantine stations.56 Quarantine measures and the potential out-of-pocket costs that would be incurred during detention therefore created formidable barriers to movement, particularly for rural people, who had already been severely limited by the rise of invisible borders. Nevertheless, population mobility still existed during the pandemic. Therefore, the quarantine scheme targeted most mobile populations via transport vehicles, emphasizing control of “three gates”: where tickets were sold, where people entered stations, and where people boarded buses and boats. Purchasing tickets with certificates was adopted as the most important step in

Qua r a ntine a nd Isolation

this process. Quarantine staff assisted ticket officers in checking inoculation certificates. The quarantine process extended further into the transport system. For example, in order to prevent potential contagion through transport vectors, Wenzhou City provided training on quarantine procedures for boat captains and asked them to assist in checking the preventive inoculation certificates of those traveling on the transport boats. They provided basic knowledge on hygiene and other medical issues to captains and sailors, who then took part in epidemiological reporting, disinfection, and assisting in checking passenger certificates. Vehicle quarantine checks also entailed close cooperation with drivers. The work summary of transport quarantine stated, “When passengers without valid certificates tried to get around the system by boarding buses en route rather than at bus stations, the driver would drive the bus back to the quarantine station.”57 Compared with the quarantine schemes for ordinary mobile populations, the one for fishermen faced challenges arising from particular geographic conditions. For example, Dongtou District in Wenzhou City is made up of more than ten islands that in the early 1960s were home to 7 People’s Communes, 57 production brigades, 457 production teams, and a total population of 49,011. This included 7,581 people working on 561 fishing boats. Wenzhou City set up the Dongtou Fishing Port Temporary Joint Quarantine Station at Dongtou Wharf. However, because there were many islands in Dongtou, fishermen could anchor their boats anywhere, thus hampering the quarantine process.58 In view of this situation, the Zhejiang provincial government ordered that any fishermen working in the province’s fishing grounds would be required to produce valid preventive inoculation certificates when they purchased grain, wood, or water and sold fish. Those without certificates who were from areas that had not been affected by cholera would be issued certificates after they had been inoculated. Those without certificates who came from infected areas would receive supplementary inoculation and be kept under observation for six days. They would not be issued certificates enabling them to sell their catch until after their inoculations became effective.59 The government’s control over the basic necessities of this highly mobile economic group was relatively effective when implementing quarantine because noncompliance would have a serious effect on fishermen’s incomes. The quarantine scheme further constrained the mobility of an already very sedentary population. It regulated the movements of mobile populations and monitored the activities of epidemiologically and even politically dangerous groups of people. Quarantine extended into every corner and created a huge

129

china and the choler a pa ndemic

130 9000 8000 7000

Passengers

6000 5000 Passengers

4000 3000 2000 1000 0 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969

Figure 4.1. Numbers of passengers traveling by sea from Rui'an County, 1955–1969. Rui'anshi jiaotongju, Rui'anshi jiaotongzhi, 42.

and tight surveillance network. An immediate and noticeable result of the quarantine procedures was a further decline in population mobility. For example, the number of passengers who took sea voyages in coastal areas of Rui’an County in 1962 and 1963 were six hundred and five hundred, respectively, which were the lowest figures over the period from 1955 to 1987. The 1962 figure was less than half that of 1961 and much lower than in 1955, when passenger sea routes were opened (fig. 4.1). Like other aspects of public intervention in the cholera pandemic, the implementation of quarantine procedures was not perfect, particularly at major quarantine stations on prefectural and provincial borders, such as Meiao, on the way from Wenzhou to central Zhejiang, and Fenshuiguan Gate, on the road between Zhejiang and Fujian Provinces. Slightly more people passing through such stations traveled on foot than by vehicle: for example, during the five months of “quarantine work” at the Fenshuiguan Gate Joint Quarantine Station from June 1 to November 5, 53,967 people passed through by vehicle and 64,562 were on foot. The work summary described the difficulties those in charge of the station encountered: “We initially had no experience on how to handle quarantine checks of passengers traveling on foot. Many passengers traveled between Fuding County in Fujian Province and Pingyang County in Zhejiang Province. There were around 1,000 passengers per day, and there were always some passengers who made trouble and escaped the quarantine checks.” To address this

Qua r a ntine a nd Isolation

problem, the quarantine station printed and filled in the “Daily Statistical Report on Inoculation Certificate Checks and Supplementary Inoculation” to obtain accurate figures on the number of passengers traveling on foot. The work summary goes on to describe how “in order to prevent passengers from evading checks, we adopted the ‘ladder-shaped’ approach to checks. When passengers traveling on foot arrived in a group, quarantine staff arranged themselves across the road to monitor the passengers. The quarantine officers in the front row conducted the checks, while those at the back kept an eye on passengers. In this way, we prevented from escaping those passengers who did not understand preventive inoculations.”60 Another problematic aspect of quarantine procedures was that it was difficult to identify suspected cholera patients. As mentioned above, cholera was mainly spread via patients at different stages, by carriers, and by contaminated materials. Patients with serious or obvious cholera symptoms were either isolated on the spot or at the nearest hospitals or isolation centers. It was relatively easy to do this, as these patients were usually in such a bad state that they were unable to travel long distances. In contrast, patients with mild cases of cholera and suspected carriers who had not yet come down with the disease did not show very noticeable symptoms, making it harder for quarantine staff to identify and detain them.61 However, the Rui’an County Sanitation and Epidemic Prevention Station pointed out in its epidemiological survey report in October 1962 that “mild, atypical cholera cases and cholera carriers were the main sources of long-distance transmission and infection.” Among the 798 surveyed cases included in the report, 536 (70.55 percent) did not have an obvious history of contact with cholera patients. The report admitted that it was very hard to find any obvious contact history.62 This feature was also seen in quarantine work in the Wenzhou area, particularly for those quarantine stations located at key transport crossings. For example, the Zhejiang/Fujian Province Fenshuiguan Gate Joint Sanitation Supervision Station admitted in its work summary for a five-month quarantine period in 1963 that these measures to prevent the spread of cholera were not always effective: “During the quarantine period, we found few suspected cholera patients. So far we have been unable to establish a set of useful practices to identify mild and atypical cholera patients.” The figures supported this point: this quarantine station conducted checks on 118,523 persons from June 1 to November 5 but identified only 5 suspected cholera cases.63 Similarly, the Wenzhou City Meiao Quarantine Station that was established on August 23, 1962, conducted

131

china a nd the choler a pa ndemic

132

Table 4.3. Quarantine statistical data for Fenshuiguan Gate Joint Quarantine Station for Zhejiang and Fujian Provinces, 1963 Month June

Vehicles Total

Passengers

Buses Trucks 331

By bus or truck

On foot

Suspected cases identified

9,715

9,984

0

586

255

July

819

244

575

9,505

7,037

0

August

1,004

261

743

10,822

16,208

5

September

792

275

517

10,112

16,770

0

October

1,045

292

753

12,180

13,884

0

November 1–5

120

42

78

1,620

719

0

Total

4,366

1,369

2,997

53,954

64,602

5

Source: Zhemin fenshuiguan lianhe jiaotong weisheng jianduzhan, “Jiaotong jianyi gongzuo zongjie,” November 10, 1963, ZJA, Vol. J166-2-194.

quarantine checks on 18,179 persons between then and October 15 but identified only 5 suspected cases.64 Even if quarantine stations were able to identify typical and atypical cholera patients and suspected sufferers, they could not detain and keep them under observation due to the poor facilities. Meiao Quarantine Station was an important facility outside the cholera-affected area of Wenzhou Prefecture. However, as the station reported in a work summary in 1963, “many passengers were detained and observed [here]. However, the station did not have a clinic to detain and observe people, and it was hard to solve the accommodation and food issues for anyone we detained. We do not have designated staff to manage them, so these people were sent home or just sent back to their original departure point. Obviously, this went against the official top-down quarantine instructions.”65 Similarly, the Fenshuiguan Gate Joint Quarantine Station was operated by three counties in two provinces: Pingyang and Taishun Counties in Zhejiang Province and Fuding County in Fujian Province. For this important station, Dr. Chen Chengye, who had been the director of Pingyang County Sanitation and Epidemic Prevention Station since 1958, recalled in his personal memoir that this area was desolate and uninhabited when cholera was ravaging the southeastern coastal area.66 Because of these conditions and insufficient equipment, Fenshuiguan Gate Joint Quarantine Station admitted in 1963 that “it had not yet detained and observed suspected cholera sufferers.”67 This problem of the implementation of quarantine continued throughout the course of the cholera outbreak from 1962 to 1965.

Qua r a ntine a nd Isolation

PRIVILEGED CL ASSES, CROSSING BORDERS, AND QUARANTINE E VASION Regardless of their efficacy in preventing the spread of cholera, the isolation and quarantine schemes greatly reinforced the highly immobile nature of Chinese society at the time. However, as chapter 2 indicates, there was still some degree of long-distance mobility, which was usually associated with specific social groups, such as party and government cadres, PLA personnel, and returned overseas Chinese. Interestingly, means of transport became important indicators of people’s sociopolitical status and the hierarchy of different social classes. Private cars and military vehicles were more associated with the social classes who enjoyed political and social privileges in Mao’s China, including cadres, army personnel, and overseas Chinese. Buses, trucks, and foot travel were the forms of transport used by the masses. Among different social groups, local government cadres had more chances to travel than others did in this sedentary society. These cadres, particularly senior government and party officials, had the political power and status to either decline quarantine requests or not to cooperate with the work of quarantine staff when they passed through quarantine stations. As the Fenshuiguan Gate Joint Quarantine Station of Zhejiang and Fujian Provinces pointed out in its work summary in 1963, “every time vehicles passed, we waved a red flag to stop them and the majority of drivers followed our instructions. However, some cars, military vehicles, and trucks did not agree to take part in quarantine checks. Some cars did not even stop at the quarantine stations, which produced very negative impacts on the masses” (in other words, it damaged cadres’ reputations among the masses).68 Under certain circumstances, disputes broke out between cadres and quarantine staff. Meiao Quarantine Station in Wenzhou City pointed out the problem directly in its work report, while first admitting its own difficulties: “Although we tried to persuade people to comply, the results were still not ideal. Particularly when the station got very busy, it was easy [for staff] to get emotional and forget to keep calm. When they encountered someone who was reluctant to undergo quarantine examinations, there would be a clash. Disputes broke out, and this damaged their relationship with the masses.” The report then specified that “over the past two months, the majority of these disputes were caused by local cadres.” The summary requested support for their efforts from local governments: “We quarantine staff are working hard to reform ourselves. In the meantime, we suggest local government should strengthen education for cadres, enhancing

133

134

china a nd the choler a pa ndemic

their understanding of transport quarantine to make sure that there will be no disputes.”69 Compared with cadres’ evasions of quarantine examinations, the clashes between the army and quarantine staff were more serious and intense. In Mao’s China, the PLA enjoyed particular political and social privileges that isolated them from the local political system. These became more marked during the time that Wenzhou Prefecture was engaged in the Preparation for War campaign. There were no specific regulations through which to implement quarantine among army personnel; so as long as soldiers claimed they were fulfilling their military duty, it was a great challenge for civilian quarantine station staff to conduct quarantine examinations. For example, when cholera was sweeping southeastern coastal Zhejiang in August 1962, one military car carrying eight PLA officers left a military air base in Taizhou Prefecture and headed toward the provincial capital city. From there, the officers indicated, they would leave for a meeting in Beijing. At Linhai Quarantine Station, the nearest station to Taizhou Prefecture, they refused to submit to any quarantine examinations and drove off, and quarantine staff did not dare to react.70 In some circumstances, however, the attempted evasion of the quarantine borders caused quarrels between quarantine staff and PLA soldiers, and some arguments escalated into physical fights. Because of the geographic locations of troop bases, these quarrels and clashes usually occurred in quarantine stations along Zhejiang Province’s seacoast and around the capital city of Zhejiang Province, where the Zhejiang Military Region headquarters was located. As mentioned earlier, Wenzhou City’s Meiao Quarantine Station and the Fenshuiguan Gate Joint Quarantine Station were the most important of these stations, and their work summaries reveal how these conflicts unfolded and were resolved. The Meiao Quarantine Station was established on August 23, 1962. A total of twenty staff were to carry out health checks, observation, isolation, and inoculation activities. Among them, the staff of the military enlistment bureau and the public security bureaus, as local government representatives, were responsible for resolving issues with the PLA.71 At ten o’clock in the morning on October 7, a PLA military jeep left Qingtian County and drove toward Wenzhou City via Meiao Quarantine Station. Five people, including Captain Cao Shanzheng and the driver, refused to undertake quarantine examination and two people did not have certificates, so the quarantine staff attempted to detain them. As the director of Meiao Quarantine Station reported, the five army men were irritated by quarantine staff requests during this process, and the staff were angered by

Qua r a ntine a nd Isolation

the soldiers’ responses. The two sides started pushing each other, which then escalated into fierce physical fighting. One of the soldiers broke the sternum of a quarantine staff member, who was subsequently admitted to the hospital. However, the local government could do nothing to detain and punish these five soldiers.72 In his work report, the aggrieved director complained that the quarantine work was really not an easy task, and he cautiously expressed his anger, proposing that the provincial government impose disciplinary sanctions: “We have been educating our comrades to improve themselves. Meanwhile, we also suggested that the local governments and military strengthen education programs and further enhance people’s understanding of the significance of the transport quarantine work.”73 Similar clashes took place between soldiers and the staff at quarantine stations in each locale. More significantly, the reporting procedure and methods, the rhetoric of reports, and the process by which such matters were officially handled reflected the sensitiveness of quarantine matters involving the army. According to regulations, the evasion of quarantine examinations, including both noncooperation and refusal, was a very serious issue, one that should be reported to the Zhejiang Provincial Epidemic Prevention Headquarters Office in a written report. The latter then compiled these reports, rewrote them, and submitted them to the Zhejiang Provincial Health Department, which in turn submitted them to Zhejiang’s provincial government. On October 24, 1962, the Zhejiang Provincial Epidemic Prevention Headquarters compiled six quarantine reports involving quarantine violations by military personnel, including a report by the Meiao Quarantine Station for October 7. These reports were forwarded to the secretary-general of Zhejiang’s provincial government. However, the report from the Zhejiang Provincial Epidemic Prevention Headquarters on the military vehicle incident at Meiao Quarantine Station was very restrained. The report did not mention physical fighting or the injury of quarantine staff, though it did include the station director’s report, which did mention these things, for reference. At the end of the formal report, the Provincial Epidemic Prevention Headquarters politely pointed out, “The abovementioned things made a very negative impression on the local masses and created difficulties for us as we went about our quarantine work.” The headquarters further requested that the secretary-general of the Zhejiang provincial government notify the Zhejiang Provincial Military Region to ensure that the following steps were taken: “1. Strengthen the education of the personnel concerned and follow the transport quarantine orders issued by the Zhejiang Provincial

135

136

china a nd the choler a pa ndemic

People’s Committee. 2. When soldiers go out for duty, affiliated military units should provide them with individual and collective quarantine certificates.” The secretary-general of the Zhejiang provincial government read these reports two weeks later, on November 7, and commented in the leader comments column, “This report has been ignored for a long time. Store it temporarily over there [zancun].”74 This meant that processing the complaint would be postponed indefinitely, the reason for which was straightforward. While Preparation for War was the predominant sociopolitical theme on southeastern coastal front in the early 1960s, repercussions for the PLA’s refusal to implement quarantine would perhaps jeopardize the political careers of high-ranking provincial officials. Compared with the Meiao Quarantine Station incident, which occurred on October 7, 1962, the handling of a clash between PLA soldiers and quarantine staff in Sanmen County in the north of Wenzhou Prefecture ref lected even more cautiousness on the part of local government. On November 14, PLA Squad 6406, including a lieutenant colonel, boarded a bus in Wenling County and headed toward Ningbo City. When the vehicle reached the bus station in Gaojian, quarantine staff boarded it to check passenger inoculation certificates. Officials from the bus station and the local quarantine station described the ensuing events in a report: Quarantine staff comrade Zhu Meiting found that the inoculation certificates carried by two comrades in this squad of PLA soldiers were not congruent with their own information. (One was a blank certificate and one was borrowed, as the person presenting the certificate was around twenty years old, while the person named on the certificate was thirty-one years old.) Our quarantine staff member asked, “Comrade, how old are you?” The soldier ignored the question and refused to respond. At this time, a deputy squad leader approached, saying, “Fuck you! Who do you think you are! How dare you check our certificates. Get out of here!” When our quarantine staff member tried patiently to persuade them to comply, the deputy squad leader continued to shout and curse at him. Finally, our quarantine staff member responded by saying, “Fuck you! You’re a PLA soldier. You should not be swearing at me!” (The quarantine staff has since made a self-criticism for this comment.) After this, another quarantine staff member got on the bus and tried to persuade them. But they continued to ignore our requests. At this moment, the quarantine station director got on the bus: “This is an order of the Provincial Party Committee.” They didn’t listen to him and instead just swore at him, calling him “You fucking director!”75

Qua r a ntine a nd Isolation

The incident soon escalated. A few soldiers grabbed quarantine staff member Zhu Meiting, beat him up, and refused to let him off the bus. Angered by this incident, the Gaojian station staff wrote a full report to the county’s culture and health bureau the following day. In the report, the staff of the bus station and quarantine station angrily complained, “Why were the squad of PLA soldiers that boarded the bus so rude as to detain our staff by force? Why didn’t the lieutenant colonel intervene? What is the explanation for their behavior? We were only conducting quarantine work. Did we commit a crime?”76 To support their accusation, the Gaojian station staff invited local witnesses from different political and social backgrounds to write reports and provide evidence. These people included an armed police officer, a villager, a party secretary from the local commune, and a veteran. Each witness signed and put a red-inked thumbprint on the documents, and the descriptions they provided were basically in accordance with the station reports. But the most interesting aspect was the opinion expressed by the armed police officer, Hu Dezhong, who was a sergeant and squad leader from the Chinese People’s Armed Force stationed in Sanmen County. When the incident began, he was waiting for the bus, because he would soon be reporting for military duty. He happened to witness this clash and stepped in to stop it. In his testimony, he laid blame directly on the soldiers: “The PLA soldiers dragged and pushed the quarantine staff member into the bus and held him there for four to five minutes. It’s wrong!” But the armed police officer did not stop there. After praising the quarantine staff at the Gaojian station for strictly implementing higher-level instructions and directives, he also criticized them: “However, they [the staff] should have taken the organization of the army and the specific needs of those carrying out military duty into consideration. These soldiers were on duty and had departed together as a squad. More than ten of the soldiers had already been inoculated, and there should have been no exception for these two soldiers. But particularly in the current situation, all army actions affect the Preparation for War efforts. Would it have affected military action if two soldiers had been detained at the bus station?”77 In other words, the rather ambiguous statement from this prudent and clever armed police officer reveals that he fully understood the political and social meaning of the army. His criticism of both the PLA soldiers and the quarantine staff not only agreed with the quarantine staff statement but also took the interests and prestige of the army into consideration. In doing so, he not only maintained his own integrity but also avoided the political problems that would have followed if he had shown support only for the station staff. All these reports and testimonies were collected within

137

138

china a nd the choler a pa ndemic

four days and submitted to the Sanmen County Culture and Health Bureau right after the clash. Ironically, however, not until January 5, 1963—some fifty days later—did Zhejiang Provinces’ health department forward them to the general headquarters of the Zhejiang Military Region. In the column for leader comments on this report the following was written: “Leave this for the Division of Mass Work of the Political Department of the Provincial Military Region to handle.”78 No further information is available on whether anything eventually happened in response to this clash between the army and civilians. Although the army personnel and senior government officials evaded quarantine examinations and exercised their privileges in crossing borders, the government did not actually grant them such privileges, because any violation of quarantine regulations was supposed to result in serious punishment. In contrast, quarantine involving overseas Chinese visitor groups was more unusual. As discussed in chapter 1, returned Indonesian Chinese had dual national identities, being perceived both as a returning, patriotic diaspora and as suspected disease carriers. The former made them objects of the United Front Work Department of the Communist Party, which also targeted returned overseas Chinese from other places, Hong Kong and Macau residents, and Chinese merchant seamen on foreign ocean liners. Meanwhile, the foreign currency brought by these overseas visitors was an important factor, so their mobility was not restrained but was instead guaranteed and facilitated. For example, the Zhejiang provincial government had regulations mandating that if overseas Chinese and Hong Kong and Macau residents paid for transport (taxi, buses, and chartered buses) and accommodation in foreign currency, they would pay only 80 percent of the standard prices provided they showed a letter of proof issued by the overseas Chinese travel agency in each locale. Likewise, they were given priority access to tickets, grain, nonstaple foodstuffs, and everyday commodities.79 More important, local governments made specific quarantine regulations for returned overseas Chinese visitors, Hong Kong and Macau residents, and foreign guests and visitors, extending quarantine waiver privileges and other special treatment.80 For example, the Foreign Affairs Office of Hangzhou City submitted a report to the provincial health department in October 1963. The report pointed out that there were many foreign guests visiting Xin’anjiang Hydraulic Station, Shaoxing, and other areas of the province and that quarantine checks were imposed on passengers and vehicles on major roads and highways. Quarantine staff had requested that foreign visitors stop for these checks, but the report proposed that such procedures should be done away with: “In order

Qua r a ntine a nd Isolation

to avoid such occurrences in future, it is proposed that, if foreign guests and overseas Chinese vehicles pass the quarantine station, staff should not require them to undertake examinations. Vehicles should make the following signals: during the daytime, parking lights should be switched on and the drivers should wave a newspaper. At night, vehicles should flash their headlights three times.”81 After the arrival of overseas Chinese visitors, the Zhejiang provincial government stipulated that “Overseas Chinese Affairs Departments, police substations, and travel agencies were to register and report the arrivals to local health departments, which in turn informed each relevant medical and health-care unit. After receiving this notice, each unit would quickly dispatch staff to do surveys and conduct three consecutive stool examinations and five days of medical observations. Anything suspicious would be reported to the health bureau.”82 In the stool examinations, “if any cholera patients or suspected carriers were identified, they would be persuaded to accept isolation at hospitals in order to prevent the transmission of infection.”83 In particular, for those with social, political, and economic influence, the Zhejiang Province’s health department stipulated that “medical staff may conduct brief feces examinations in toilets and persuade these people to leave stool samples for further thorough examination following the standard approach. During this process, the medical staff should be patient and persuasive.”84 The privileges of quarantine waiver and special treatment with regard to examinations for symptoms offered to overseas Chinese visitors during the 1961–1965 cholera pandemic contrasted with the treatment of their ancestors who had migrated overseas, including to Southeast Asia, in the nineteenth and early twentieth centuries. At that time, Chinese migrants were usually targeted as suspected disease vectors and suffered social and racial prejudice in quarantine.85 The historical memories and personal experiences of these returned overseas Chinese in the quarantine were usually highlighted and compared with their experience in China. And the Communist Party intended to demonstrate fraternity and benevolence to overseas Chinese and further justify its ruling legitimacy over their motherland.

CONCLUSION Multiple borders—including natural, administrative, quarantine, and militia borders—emerged during the cholera pandemic in 1962–1965. Cholera quarantine stations were interwoven with these multiple borders and created a tight

139

140

china a nd the choler a pa ndemic

surveillance network. However, there were problems around quarantine and isolation practices. As this chapter has shown, the locations at which isolation was implemented (hospitals, isolation centers, and homes) shaped patient distribution, which not only indicated the rural/urban dichotomy that was emerging at this time but also strengthened this divide. The isolation process itself became a potential source of contagion, while the quarantine scheme further restrained the mobility of sedentary populations, regulated the movements of mobile populations, and monitored the activities of “dangerous” populations. However, quarantine could not identify atypical patients and suspected carriers as effectively as the scheme had anticipated. In fact, Chinese cholera epidemiological experts noticed this problem during the pandemic. In December 1963, the deputy health minister of the People’s Republic of China, Xu Yunbei, convened and chaired a symposium of cholera epidemiological experts to examine the key practices of anticholera campaigns over the previous two years. Su Delong, professor of epidemiology at Shanghai Medical University, argued that “a survey in cholera-affected areas found that blockades of affected areas and isolation practices did not produce a noticeable difference in terms of statistical data. The survey could not verify that these measures had any real effects.” In his opinion, so-called “strict isolation” was merely nominal: cholera had already infected populations around the areas before isolation and disinfection practices were implemented. However, Du Kangping, who was deputy director of Shanghai Municipality Sanitation and Epidemic Prevention Station, disagreed with Su’s argument and pointed out, “This does not indicate that isolation was useless. The problems were due to poor management.”86 Notwithstanding these opinions, isolation and quarantine practices were adopted as basic measures for preventing the spread of cholera between 1962 and 1965 and even into the 1970s and early 1980s. In 2001, the Pingyang County Sanitation and Epidemic Prevention Station Gazetteer briefly mentioned the effect of quarantine in response to the 1978 cholera outbreak: “After cholera broke out in neighboring Fuding County in Fujian Province, the county government set up a quarantine station in a few locations, such as Fenshuiguan Gate Station, and imposed quarantine examinations on passing vehicles and passengers. However, the retrospective summary indicates that these quarantine procedures did not have the desired effect.”87 In this sense, as a traditional intervention-centered prevention scheme, the practice of quarantine and isolation was more significant as a social and political exercise that contributed to the social restructuring process than as an effective disease control mechanism.

Qua r a ntine a nd Isolation

As this chapter has argued, however, the newly formed social structure created new social hierarchies in which specific social groups, including the PLA, government cadres, overseas Chinese, and foreign visitors, enjoyed some privileges over the rest of the population. These privileges were justified in different ways: PLA personnel claimed that they were on military duty and were playing a key part in defending the coastal front areas. Cadres, particularly senior government and party cadres, were confident that they could ignore quarantine and isolation regulations based on their own administrative power and political status. The privileges enjoyed by overseas Chinese and foreign guests came from above, as they were made exempt from quarantine examinations and were offered special treatment. It should be noted that by the time of the outbreak of anti-Communist violence in Indonesia on September 30, 1965, large numbers of Indonesian Chinese had returned to mainland China. More detailed quarantine policies were issued to implement quarantine against these returned members of the diaspora in 1965. Although government officials, military personnel, overseas Chinese, and foreign visitors were able to evade border controls and quarantine examinations, they remained a very small minority. For most people, quarantine and isolation were urgent and coercive measures during these transitional years. These disciplinary practices not only restricted population mobility but also rationalized and strengthened the unfair distribution of medical and welfare resources, the implementation of various social control schemes, and the deprivation of some fundamental rights and freedoms within rural/urban divisions. These interventionist prevention measures therefore contributed to the broader social restructuring being undertaken in China at this time and affected the rise of the emergency disciplinary state in the long term. Quarantine and isolation thus demonstrated multifaceted and complicated scenarios of the dynamics between disease and social restructuring.

141

PART III PANDEMIC EMERGENCY, DATA, AND SOCIAL STRUCTURE

5 COMPREHENSIVE INOCULATION, RURAL RHY THMS, AND COMPILING REGISTERS

THE USE OF COMPREHENSIVE INOCULATION AS AN ANTICHOLERA APPROACH IN WENZHOU dates back to at least the 1930s. In the summer of 1938, cholera broke out on the southeast coast of Zhejiang Province around Wenzhou and Taizhou. In response, the Epidemic Prevention Center of the Wentai Defense Command under the Wenzhou Garrison Headquarters of the Third War Zone established an epidemic disease hospital and organized mass inoculation in Yongjia County and the adjacent rural areas. The army-led Epidemic Prevention Center’s plans for the inoculation roll-out included door-to-door inoculation of all residents, compulsory inoculation at key roadblocks, and eventually inoculation in each rural township. However, serious challenges were encountered at each stage of the implementation. In the first stage—door-to-door inoculation of all households—the inoculation team dispatched its members to contact the heads of nine townships in the region’s urban areas. Together they decided that the inoculation work should be organized around the bao (a grouping of one hundred households). The head of each bao, the baozhang, was inoculated in the bao office, after which the rest of the residents were to follow. However, some baozhang did not understand the significance of inoculation and were unable to communicate it to the people under their jurisdiction. This failure meant that many people often intentionally evaded inoculations. 145

146

china a nd the choler a pa ndemic

In view of this poor progress in inoculation of all households and the continued rampant spread of cholera, the inoculation team dispatched members to block key crossroads and conduct compulsory inoculation of everyone who passed. The Anti-Japanese Self-Guard Association (Kangri ziweihui) and the Youth Service League (Qingnian fuwutuan) agreed to assist the inoculation teams by undertaking propaganda and persuasion work around the different localities. Despite this, nobody from either of these two associations actually came to offer assistance. In addition, the staff at the Epidemic Disease Hospital were all from other parts of China, and their inability to understand the local dialect compounded the communication problem, since they were unable to persuade locals of the importance of receiving inoculations. When conflicts with local residents occurred, the local police were called in to assist and protect the medical teams. Meanwhile, the Epidemic Prevention Center also realized that even if there were a successful, comprehensive inoculation program in the urban areas of Yongjia County, the absence of simultaneous widespread inoculation initiatives in the countryside meant that there was still a risk that the disease would spread to urban areas. So the inoculation team recommenced their efforts and dispatched members to six rural districts starting on July 27. Again, the rural people did not understand the significance of preventive inoculation and often refused it altogether. Some villagers knelt down, pleading to have an inoculation waiver issued to them, while some township and bao heads even wrote notes to inoculation teams in the hope of gaining waivers for entire villages. The inoculation teams also faced direct abuse in some localities: a district clerk named Xu in No. 5 District assaulted a female team member, prompting the inoculation team to leave for the county town of Yongjia the next day. Ultimately, this army-led 1938 inoculation initiative was a failure because of the low rates of compliance among the targeted population. In its summary work report, the inoculation team claimed that they themselves were well organized, that both the team leader and members were highly proficient, and that materials like syringes and needles had been well disinfected. The report identified the problem as being the “people who assisted with inoculation [who] were not dedicated to this work.” These assistants were the local mediators assigned to the medical teams as they moved through the rural areas. In closing, the report even reminded readers that “even in Japanese-occupied areas, the enemy dispatched military police to conduct compulsory inoculation. Regardless of whether they are men or women, old or young, no one avoids being inoculated.”1

Compr ehensive Inoculation, Rur a l R hythms, & Compiling R egisters

The disappointment and concern felt by the cholera inoculation team in 1938 is palpable in their report and reveals the multiple challenges facing any government mobilizing grassroots inoculation programs during emergency situations in China. Twenty-five years later, in 1962, when cholera broke out again, the Communist government faced even more difficulties in implementing mass inoculation than its Nationalist predecessor had. In the early 1960s, medical experts believed that only when 80 percent of the total population had been inoculated could a community achieve adequate immunity against cholera. 2 Accordingly, on August 3, 1962, directives from Zhejiang Province’s party committee and the People’s Commission ordered that the entire population in each county of Wenzhou Prefecture had to be inoculated against cholera before August 15. The only exceptions to this order were children under three, adults over sixty, and those with allergic reactions to the inoculation.3 In the cholera-infected Rui’an County, Pingyang County, and Wenzhou City, the emergency inoculation initiative meant a comprehensive inoculation campaign in which local governments had to inoculate a total of 2.94 million people within twelve days.4 This emergency posed a serious challenge for local governments in view of the very limited time frame, the extent of their duties, and a serious shortage of medical personnel. Under these constraints, the officials responsible for the medical and administrative aspects of implementing the inoculation campaign had to coordinate it in an extremely efficient manner. However, international medical communities in the 1960s and 1970s questioned the effectiveness of cholera vaccine and did not recommend its use. In China, despite use of the cholera vaccine being very controversial during the pandemic, mass inoculation campaigns were used until their unsatisfactory effectiveness was confirmed in the early 1980s. This chapter examines the dynamics between the mass inoculation campaigns and restructured rural social systems during the cholera pandemic in 1962–1965, with a focus on the role of local agents and population data during the integration of the medical and administrative systems. It argues that inoculation campaigns not only harnessed local agents and household and accounting information provided by the broader social restructuring initiatives but also contributed to these initiatives by resulting in the compilation of inoculation registers and certificates. Inoculation campaigns with unsatisfactory effectiveness in fact functioned as population control and social surveillance and significantly strengthened the emergency disciplinary state.

147

148

china a nd the choler a pa ndemic

LOCAL AGEN T S, HOUSEHOLD INFORMATION, AND INOCUL ATION IN VILL AGES Inoculations were not a complete novelty for villagers in the Wenzhou region in the 1960s because smallpox variolation had been used for about a century. In the mid-nineteenth century, smallpox variolation was first applied via contact with a smallpox scab, which was ground into a powder and puffed into children’s noses.5 In 1874, this procedure advanced to the use of a human vaccine in which smallpox lymph from an infected child (doujiang) would be scratched into the arms of healthy children in order to cause a mild but protective infection and thus avoid the broader outbreak of smallpox over the whole body. Smallpox variolation gradually began to operate through a set of social relationships: the recipient children’s parents would invite the smallpox-infected children’s parents to have dinner, giving sweets as gifts to the children, and ultimately paying a fee to the inoculators after the first rice crop was harvested.6 With the introduction of the smallpox vaccine (niudou) in the Republic of China, the vaccination process gradually evolved into a medical and social event dominated by local medical practitioners known for their familiarity with local communities and their access to smallpox vaccines. Wang Jingfu, the doctor in Li’ao Township of Rui’an County, studied Western medicine under his mentor in 1947. As he recounted, “before Liberation [i.e., 1949], I went with my mentor to count the number of children in each village and then purchase smallpox vaccine from pharmacies with the families’ money. Right before the vaccination, villages would invite troupes to perform musical dramas [guci] to publicize the smallpox vaccination. We also collected money from the children’s families.” As Dr. Wang said, it was the rural medical practitioner’s personal actions that drove the initiative. There were a total of twenty villages in his township, and he followed his mentor as they moved around to vaccinate children in each village in turn.7 The main shortcoming of this smallpox vaccination scheme was that it depended on families buying the vaccines, and some could not afford it.8 Meanwhile, inoculation programs gradually became state public health initiatives in terms of how they operated and in the choice of vaccine types. However, these changes did not affect rural communities too much. In the late 1940s, smallpox and cholera were the only diseases targeted by the inoculations taking place in most counties in Zhejiang Province. Due to low vaccine production, few people were actually inoculated, and these were all residents of county towns.9 In July 1946, there was a cholera outbreak in a few counties under Wenzhou’s jurisdiction, so the local government sent an urgent telegraph to the Nationalist

Compr ehensive Inoculation, Rur a l R hythms, & Compiling R egisters

provincial government and requested both preventive vaccine and treatment medicines. On July 16, the provincial government mailed a hundred bottles of cholera vaccine to Wenzhou, although only eighty-six bottles arrived intact. These remaining vaccines were distributed only to hospitals in urban areas.10 After 1949, the process of community vaccination was no longer a medical-social event dominated by local medical practitioners. Instead, it came completely under the control of the state public health initiative—a system that quickly incorporated rural doctors. In the early 1950s, delivering mass smallpox vaccination was the first and immediate public health target for the Communist government. In Zhejiang, for example, the provincial health department usually calculated the number of potential smallpox vaccination subjects in each county according to the required immunity rates, assigned vaccination tasks, and then distributed vaccines, alcohol, needles, and vaccination registers to each county. Similarly, at the next level down, the county government arranged for vaccination work to be implemented using the district as the target unit. Subsidies were provided to medical practitioners by geographical area; the highest rate was for those sent to work in difficult mountainous terrain and the lowest to medical teams operating in the more easily accessible plains.11 Doctors signed contracts to carry out work in each area. Throughout the 1950s, community-based medical practitioners were gradually incorporated into the rural medical system after the Patriotic Health Campaign of 1952.12 At the same time, the government made great progress in the large-scale production of vaccines. From the early 1950s on, basic vaccines were available in sufficient supply for all inoculation efforts, such as for smallpox in 1950 and cholera in 1952, and the types of available vaccines increased gradually thereafter.13 By the time the cholera pandemic reached Guangdong in 1961, the public in various parts of China had been inoculated with vaccines against eleven diseases, including typhoid fever, bubonic plague, tuberculosis (BCG type vaccine), and diphtheria.14 That means inoculation had been a part of life for villagers for a while.15 The transformation of rural inoculation programs from family-managed behaviors mediated by local medical practitioners into state-led initiatives at the national level presented a preliminary framework for a modern inoculation program in rural Chinese society. During this process, existing local medical practitioners played important and transitional roles in facilitating the entry of modern inoculation programs into villages by functioning as local agents who were familiar with the residents of rural communities. However, some local

149

150

china a nd the choler a pa ndemic

medical practitioners failed to comply with all aspects of the new work style, such as the requirement to submit work reports and statistical data on their activities.16 Meanwhile, as the Pingyang County Sanitation and Epidemic Prevention Station reported, “some local medical practitioners fabricated inoculation figures and produced fake data to secure subsidies from the government.”17 During the 1950s, these nonprofessional behaviors of local practitioners were gradually contained and disciplined with the development of the state rural medical system and its corresponding medical institutionalization. However, the expansion of the inoculation program produced more daunting challenges. Different vaccines targeting different age groups entailed different dosages and varying contraindications. For example, dosages for the plague vaccine were divided into five age groups: children age two through six, seven through eleven, and twelve to sixteen, adults age seventeen to fifty-nine, and those over sixty. The inoculation technique used in this case was scarification, in which the skin was scratched in a specific pattern. For those age two to seven, one scratch was to be made; for those eight to fifteen, two scratches were made; and for those sixteen years and above, three scratches were made. The plague vaccine would be dripped into each of the breaks in the skin produced by these scratches. The combination of different dosages and scratch numbers therefore added an extra layer of complexity.18 For the program to be effective, it was crucial for it to have access to detailed, accurate biostatistical data on prospective inoculation subjects (i.e., population information). These data would be used to compile inoculation registers at the beginning of the process and verify inoculation records at the end. Even when demographic information was available, the practice of inoculation registration was not fully implemented. In its circular on preventive inoculation work arrangements in 1961, the Health Division of the Yongjia County People’s Commission pointed out that some communes did not have preventive inoculation registration schemes. Because of this, inoculation times were not recorded clearly, which meant that inoculation staff may not have known who had not been vaccinated. So preventive vaccination was ineffective. The circular further instructed, “Each commune clinic should set up preventive inoculation card schemes in order to avoid repeated and missing vaccinations and to expand inoculation coverage and ensure that all prospective subjects (children) are inoculated.”19 Another important challenge was how to implement inoculation programs in villages when the transport and communication conditions were still poor and underdeveloped. This involved a series of seemingly trivial but crucial steps,

Compr ehensive Inoculation, Rur a l R hythms, & Compiling R egisters

such as announcing upcoming inoculation programs and disseminating circulars, giving vaccinators directions on how to reach the households of prospective subjects, and recognizing and confirming the inoculation subjects. During this process, the cooperation of rural cadres, as state agents, was supposed to play a crucial part in the rural inoculation programs. However, some rural cadres were reluctant to cooperate. For example, the Rui’an County report of 1961 pointed out that some rural cadres still did not fully understand that inoculation was very important work. For example, when medical staff asked for assistance from commune and brigade cadres to distribute preventive medicine, some claimed they were making trouble and refused to help.20 To some extent, this was because cadres had an interest in maintaining agricultural production and building their local economy, and inoculation work would detract from this. However, incidents of noncooperation by rural cadres in inoculation and other public health programs should not be overemphasized. In general, the practice of implementing a modern inoculation program in rural China from the early 1950s on was a process of gradual coordination between the professional medical system and the local administrative system. This relatively short history of inoculation in villages meant that improved public health communication and cadres’ personalities both played important roles in the successful introduction of inoculation into villages. Under such circumstances, the disease emergency that prompted a campaign to vaccinate a total of 2.94 million people against cholera took only twelve days in Rui’an and Pingyang Counties and Wenzhou City in the summer of 1962. This emergency posed unprecedented challenges. At the heart of the problem lay the requirement to secure accurate population information and coordinate the professional medical system and the local administrative system. Reliable population information was crucial for both the preparation of inoculation registers and the compilation of inoculation statistics. These data would be used not only for providing cholera vaccines for the immediate inoculation campaign but also for manufacturing vaccines for the current year and planning vaccine production for subsequent years. An even more sophisticated level of data was required to identify villagers with contraindications and those in fragile health, who would not be inoculated and would instead be issued an immediate waiver. The fastest way to secure this information was to rely on local cadres, whose coordination and support would be crucial to achieving inoculation goals. As we will see below, local governments were tasked with addressing the problem of the inoculation emergency when their communities were undergoing significant social restructuring.

151

152

china a nd the choler a pa ndemic

These changes were reshaping the roles of rural cadres, the rhythms of agricultural production, and the quality of information available about villagers.

RURAL CADRES, HOUSEHOLD AND ACCOUN TING REGIS TERS, AND RURAL RHY THMS Between the Communist victory in 1949 and the early 1960s, China’s rural sociopolitical structure underwent major transformations. By the mid-1950s, county governments were responsible for a set of districts, townships, and administrative villages (also called advanced agricultural cooperatives). With the initiation of the People’s Commune campaign after September 1958, all districts were renamed People’s Communes, townships became production brigades, and advanced agricultural cooperatives became production teams. 21 In Wenzhou Prefecture, the first People’s Commune was formed on September 9, 1958, in Rui’an County. In fewer than 20 days, more than 90 percent of households had joined People’s Communes, and Wenzhou Prefecture basically implemented rural communization. On average, each commune had between 9,000 and 10,945 households.22 The largest commune comprised 24,777 households.23 As the party committee of Wenzhou City admitted in 1961, “this People’s Commune system was too large to be a useful basic accounting unit for efficient management.”24 As a result, official efforts to reduce the size of accounting units and “downsize” People’s Communes became a major theme in the sociopolitical restructuring process, even though its implementation was plagued with setbacks. By February 1962, the People’s Commune system of “triple-ownerships (communes, production brigades, and production teams) based on production teams” had been finalized and would last until the end of the Mao period. Meanwhile, the People’s Communes were decreased in size.25 This meant that the sizes of People’s Communes in Wenzhou Prefecture had plummeted to 1,518 households per People’s Commune, 126 per production brigade, and 16 per production team, respectively, by November 1961.26 The changes in Zhejiang Province were similar, with 1,913, 133, and 18 households per commune, brigade, and production team, respectively.27 After restructuring, each production team was responsible for organizing production as basic accounting units of three-tier ownership (commune, production brigade, and production team) of the People’s Commune system.28 The production team cadres included team directors, accountants, grain keepers, cashiers, and work point recorders. All these roles were part-time positions, meaning these people were supposed to participate in agricultural production

Compr ehensive Inoculation, Rur a l R hythms, & Compiling R egisters

as well as administrative work. Under this system, the capacity and abilities of production team cadres were crucial to the welfare of all the team members because grain and cash distribution at the end of each year depended entirely on the precise and appropriate management of agricultural production and the division of labor throughout the year. Accordingly, in spring 1962, the Zhejiang provincial party committee required each locale to train key cadres at the commune, production brigade, and production team levels, which the district and commune party committees did at night.29 The introduction of new payment schemes to reward individual peasants was another crucial factor in the restructured People’s Commune system, as they directly determined the productivity of commune members. Following the principles of “distribution based on contribution” and “more work, more income,” People’s Communes implemented a new payment scheme called “fixed work points, flexible recording” (sifen huoji), which used fixed labor points as a standard and recorded work points for commune members according to the actual quantity and quality of their work.30 Accountancy therefore became a core aspect of production team leaders’ work, one that was very detailed and complicated. Production teams’ accounting books contained work point registers and commune member booklets. In the work point registers, the work points earned by each commune member for participation in agricultural production were itemized. Commune member booklets were comprehensive documents on each commune member. They contained assessments of individuals’ work quality, their work points, their sales of pig or cow manure, financial investments, and receipt of advanced payment or materials. The production team’s accountant recorded the details in the booklet and gave it an official stamp.31 For these two dossiers, household registration information was crucial, as it would provide information about the available labor within each household. For this, Wenzhou Prefecture required cadres at each level to have basic information about each production brigade and to establish complete household archiving systems.32 The accounting taking place therefore contained detailed and accurate information about the agricultural production and incomes of each commune member and their entire household. In this sense, when the cholera pandemic affected China in the summer of 1962, production teams were the cellular level of the sociopolitical structure, the most basic grassroots social units. The new accounting registers micromanaged people’s lives, and rural cadres’ capacities and accurate demographic information were the most crucial factors in this micromanagement.

153

154

china a nd the choler a pa ndemic

This new power given to rural cadres and the implementation of new accounting systems led to new rhythms in agricultural production among rural people. As mentioned in chapter 3, Wenzhou Prefecture introduced a new threecrop system—a preliminary rice crop, a second rice crop, and then a third crop of either wheat or flowering edible rapeseed after 1956.33 With these new production rhythms, new sociopolitical structures shaped the daily lives of peasants and new social interactions centered specifically in the village space emerged. Usually each production team had its own storehouse that not only served as a headquarters but also could be used for things like storing grain or serving as a venue for team leader and commune member meetings. The building also housed the desks for those who recorded the work points for each commune member. Late each afternoon, commune members returned to the storehouse to report to the team leaders, while work point recorders noted their work points for the day’s efforts in their registers. At the same time, team leaders assigned the next day’s work to commune members so that they would know where to go and what to do the following morning. Each day, commune members would rise and go directly to their allocated fields. Production team leaders thus kept a close watch on each member’s allocated task and location. Production team storehouses also served as sites for social and leisure functions for local communities: people congregated there to chat after a day’s work, children played games on the playground, and county cinema teams organized film screenings there. Everyone congregated in the same space for all activities, amplifying the social, economic, and political importance of villages. There were only a few exceptions, when people had to work outside the confines of village space, but even these exceptions were usually arranged by production teams. In terms of a villager’s daily life, peasants would still follow the traditional agricultural patterns—rising at dawn and resting at sunset.34 In contrast to the lives of their ancestors, the lives of villagers in the 1950s were highly routinized, especially since the introduction of new communication technologies. Starting in 1956, a rural broadcasting system was gradually rolled out in each county of Wenzhou Prefecture. Speakers were installed inside rural households and became a key component of the propaganda system led by the county party committee’s propaganda department. Each production brigade also installed in each village a minimum of one loudspeaker, which was connected to the county broadcasting station system.35 This network broadcast three sessions a day to disseminate national and local political news and play music and entertainment programs. Particular songs

Figure 5.1. “More work, more income,“ 1961. ZNDZ, July 28, 1961.

156

china a nd the choler a pa ndemic

Figure 5.2. Sketch of “new villagers“ (e.g., party secretary, peasant-technician, warehouse keeper, female accountant, cowhand), 1961. ZNDZ, September 13, 1961.

preceded each session: “The Red East” for the morning session, “The Song of Motherland” for the noon one, and “Socialism Is Good” in the evening. Within these three sessions, there was a fixed timetable of programming, including a few key news programs.36 The prelude music, the timing of particular news programs, and the end of the broadcasting sessions produced regular routines among villagers. As Zheng Jinzhu, a former party secretary from one production brigade, explained, “Life when we were part of production teams was very simple and rhythmic.”37 The village loudspeaker also ensured that local news announcements, including calls to commune meetings, advertisements for upcoming movies, and even people asking for help looking for missing cows and so on, quickly reached every corner of villages. This broadcasting system thus greatly enhanced the sense of social routine for villagers and bound their activities together with the natural rhythms of sunrise and sunset. All in all, these new systems of organizing the rural population and their agricultural activities led to the emergence of a new administrative structure. This facilitated cholera inoculation and control measures, reshaping village life and reducing mobility. The government was better able to control everyday life, while anticholera measures added to the new boundaries erected around rural lives.

THE CHALLENGES OF EN TRY AND COORDINATION IN EMERGENCY INOCUL ATION When the cholera pandemic reached China in the summer of 1962, rural Wenzhou was in the process of adapting to the new sociopolitical structure and the specific rhythms of the new forms of agricultural production. When cholera began to spread, the government reacted promptly in terms of the organization,

Compr ehensive Inoculation, Rur a l R hythms, & Compiling R egisters

mobilization, and maneuvering of medical personnel and materials. Within two days of the confirmation of the first cholera patient in Rui’an County, the deputy director of the health department in Zhejiang Province had led 24 experts and epidemic prevention cadres to Wenzhou Prefecture and started directing the cholera prevention and treatment work. On July 28, Zhejiang Province and Wenzhou Prefecture deployed more than 400 medical staff to three affected areas—Rui’an and Pingyang Counties and Wenzhou City. Those who actually arrived (318 in total) came from medical units in Jiangsu Province, as well as Hangzhou, Jiaxing, Huzhou, and Jinhua Prefectures in Zhejiang Province, and from Wenzhou Prefecture itself. On July 30, the provincial government assigned 700 additional school of health graduates to cholera-affected counties in Wenzhou Prefecture.38 These students therefore accounted for the majority of medical forces deployed to combat cholera during the summer of 1962.39 As almost all these medical staff were nonlocals, providing them with accommodation and food was important for the inoculation emergency. Right after dispatching medical teams, Zhejiang Province’s health and finance departments made a very detailed subsidy scheme for epidemic prevention staff and instructed the Wenzhou prefectural government to implement it.40 Despite these efforts, the number of medical workers was far lower than the total needed for epidemic prevention work, particularly for the speedy, simultaneous inoculation of people in both infected and uninfected areas, in view of the huge number of inoculation subjects. In Rui’an and Pingyang Counties, a total of 240 medical staff from the provincial and prefectural cholera prevention and treatment teams participated in the mitigation effort, in addition to medical staff at county hospitals and sanitation and epidemic prevention stations, district health clinics, and township union clinics, as well as various independent medical practitioners.41 Therefore, the urban medical system was grafted onto the rural medical system, thus forming a pyramid-shaped whole in which epidemiological experts analyzed cholera strains, urban medical doctors treated cholera patients, and school of health students worked as assistants, while rural medical practitioners mainly performed inoculation work and tended to cholera patients. Within this system, each medical practitioner and staff group was designated to specialize in one particular area of technical work, according to their proficiency levels. The reshuffling of the medical system resulting from this emergency inoculation program meant that coordination between the medical and administrative schemes was crucial for its success. For this, each county and city party

157

158

china a nd the choler a pa ndemic

committee organized epidemic prevention and a treatment headquarters, setting up a specific office to process daily work. The party committee and the governments at each level set up core leadership organizations, which were headed by the party secretary and coordinated the division of labor. For instance, each of the five major cholera-affected districts in Rui’an County transferred one-third of its cadres to assist with epidemic prevention and treatment work.42 Based on the district as a unit, district health clinics organized inoculation teams. For example, in Xianjiang District, the district health clinic organized the inoculation team, which comprised forty-two staff, the majority of whom were students at the Wenzhou School of Health. The team was further divided into two groups, each of which was led by a supervisor. Each group was then divided into four large teams and eight small teams, each of which was made up of two to three people operating in independent work units. Once these administrative and medical arrangements had been made, the party committees convened meetings to designate production brigade directors and accountants to assist with guiding the teams around the areas where they were to carry out their work, publicizing the programs and registering their population.43 Preparation for emergency inoculation in rural areas entailed an intense, efficient division of labor between the urban and rural medical systems, as well as coordination of the medical and administrative systems. A key problem was that the emergency inoculation started amid the busiest agricultural production season, the time known in the region as dashu (the “great heat,” or July 23), when peasants harvested the first rice crop while also aiming to plow the fields and plant the seedlings for the next rice crop before liqiu (the beginning of autumn, or August 8). As indicated in the previous chapters, the timing of this agricultural production work usually determined the whole community’s grain output for the year. That year, 1962, was also very significant for Wenzhou Prefecture because the region was still recovering from the effects of the previous years’ famine.44 To add to this pressure, local cadres were not only busy harvesting the first rice crop, they were also fully occupied with intense preparation for a war predicted to be on the horizon. Even local cadres with the best of intentions could not commit entirely to inoculation work, and the problem of noncooperative cadres dragging their heels also remained. Rui’an County’s health bureau criticized some district and commune cadres, particularly those of production brigades, for their failure to fully understand the importance of containing the epidemic’s spread. The criticism pointed out that when no one took charge of the work, even the best measures could not be implemented.45

Compr ehensive Inoculation, Rur a l R hythms, & Compiling R egisters

The lack of close cooperation between production brigade and production team cadres caused a number of fundamental problems. The failure to prepare rosters of the names of people to be inoculated became a source of particular contention. In areas where cholera broke out very early, many cadres did not prepare these rosters, partly because they did not have time to do so. As mentioned earlier, a large number of medical staff came from other areas, the majority of which were urban, and so they did not personally know the villagers they were inoculating.46 They simply inoculated whomever they were able to and remained unaware of the progress being made across the village population as a whole. As the inoculation program expanded, teams did not know which villagers had yet to be inoculated, so some people missed out and others received repeat doses.47 The Wenzhou School of Health team working in Taoshan District in Rui’an County was emblematic of these problems. In the beginning, the medical team inoculated whichever villagers they could access, and they had no way of knowing the overall status of the entire target population. After the first round of inoculation, the teams returned for a second round, but in the absence of proper records, some villagers who had not actually been inoculated claimed that they had been and refused to cooperate. The medical staff were unable to verify these villagers’ claims. They gradually realized that if they were going to be able to inoculate the entire village population, they had to have complete demographic data for each commune, production brigade, household, and household member. They then started surveying the population in earnest and making formal inoculation registers. These registers provided information on the number of villagers who either required preventive inoculation or were exempt because of contraindications. Based on this information, medical teams were then able to determine the number of medical personnel required and to arrange a rational work schedule. Based on these registers, medical teams moved from household to household and provided inoculated villagers with certificates, which improved processes and made inoculation work more convenient and effective.48 Inoculation teams also encountered problems in fitting their work around agricultural production and the rhythms of village life. Some inoculation teams from urban areas did not understand the intensity of the “quick harvesting and quick planting” season. In Fenghe Commune in Rui’an County, the inoculation team copied the list of commune members from the accounting books. On the morning of August 4, 1962, they started their inoculation work in the Zhengzai brigade by visiting households per the information provided in the household registers. The plan was to vaccinate those people who worked in the fields and to

159

160

china a nd the choler a pa ndemic

do so when they returned home at noon or night. By nine o’clock that night, however, the total number of people inoculated had reached only 475. The medical team soon discovered that trying to vaccinate at night was inefficient because the lack of light made the task difficult. Moreover, during this busy agricultural season, laborers were exhausted at the end of the day, making it easy for them to hide from inoculation staff. If a medical team member knocked on one door, other nearby households would close their doors to avoid being disturbed. Sometimes when staff entered a household, its residents were already fast asleep. Problems of this sort meant that many young adults, the core of the agricultural labor force, missed out on the inoculation.49 Unsurprisingly, student team members from the school of health did not really have any experience of rural life and work. The work summary admitted quite frankly that they were naïve in the way they planned their work, expecting they would be able to finish it in just over a day. Once they started, however, they found they could not locate even formal laborers, let alone women and children.50 Inoculation programs in mountainous areas introduced them to conditions that were beyond anything these urbanites could have imagined; peasants in these parts usually labored on the mountains throughout the day, so medical teams found villages empty of people during the day. Even children living in mountain regions would be out with the cattle in daylight hours. Intensive inoculation at night seemed to be the only option. However, the distances between each of the rural households were significant and the mountain roads rugged. The majority of the school of health students had been born and grown up in urban areas and had never climbed mountains, let alone walked winding, rugged mountain roads at night.51 The emergency inoculation initiative in the summer of 1962 revealed serious deficiencies in coordination between the medical and administrative systems. These problems included the absence of active coordination and participation of rural cadres, the absence of inoculation registers, and failure to accommodate inoculation programs with agricultural production schedules and diverse rural life rhythms. In other words, although the broader social restructuring of communes and lower-level social units that had occurred between 1961 and 1962 had solved the key issues of identifying local agents and providing basic population information, executing the inoculation program was often problematic because this information was not fully optimized. This resulted in slow, uneven inoculation progress in 1962. For instance, although cholera broke out on July 11, 1962, in Pingyang County, only about 51 percent of the total population had

48,671

75,738

625,339

32,480

68,237

38,654

Xianjiang

Mayu

Taoshan

Pingyangkeng

Huling

Gaoyou

39,241

70,371

34,957

66,532

81,066

52,216

123,296

64,723

81,761

55,536

123,679

87,532

50,760

1964

77.4

56.4

52.4

82.9

69.3

92.2

81.6

94.9

82.1

1962

64.2

51.2

67.7

83.0

85.4

83.0

80.9

81.4

83.1

1963

81.1

83.6

84

82

78

76

1964

Apr. 1–15

Mar. 1–15

Jul.–Sep.

Mar. 1–15

Jul.–Sep.

Mar. 1–15

Mar. 1–15

Mar. 1–15

Mar. 1–15

Mar. 1–15

Mar. 1–15

1963

Jul.–Sep.

Jul.–Sep.

Jul.–Sep.

Jul.–Sep.

Jul.–Sep.

Jul.–Sep.

Jun.–Sep

1962

Dates

90 90 90

Mar. 10–20 Mar. 17–24 Mar. 17–27

90

90

90

90

90

100

1962

15

15

15

15

15

15

15

15

15

1963

10

7

10

4

10

7

1964

Number of days

Mar. 15–18

Mar. 4–14

Mar. 15–21

1964

Inoculation dates

1962

27+35

25+32

25+37

30+41

27+143

19+42

99+60

25+75

45+52

1963

50+90

35+170

42+95

60+122

55+45

51+68

1964

Number of medical staff (medical professionals + health-care workers)

Sources: Rui’anxian fangyi zhihuibu, “Rui’anxian yijiuliusannian fuhuoluan fangzhi gongzuo jishu zhuanye zongjie,” October 10, 1963, RAA, Vol. 142-8-4; Rui’anxian renwei weishengke, “Rui’anxian pingyuan diqu 63nian tong 64nian yufang zhushe (diyici) qingkuang,” August 1964, RAA, Vol. 142-9-2.

124,787

Tangxia

88,118

53,020

51,978

85,734

Chengqu

1963

Vaccinated

1962

Xincheng

District

Percentage of total population (%)

Population

Table 5.1. Progress on cholera inoculation in Rui’an County, 1962–1964

162

china a nd the choler a pa ndemic

been inoculated by August 23. In areas like Fanshan District, the inoculation rate reached only 10 percent in rural areas and around 30 percent in towns.52 It took medical teams took more than three months, from late July to early October, to finish inoculation work in Wenzhou Prefecture. This patchy result in the region that was the epicenter of the cholera epidemic in both Zhejiang and China, despite receiving huge medical resources and assistance from the central government, reveals the extent of the challenges China faced. For other areas that were not seriously affected by cholera, inoculation made even slower progress. In Zhejiang Province as a whole, only 42.28 percent of the total population had been inoculated by October 4, 1962.53

THE CONCERTED MASS INOCUL ATION CAMPAIGNS The emergency inoculation program of 1962 obviously did not meet its original targets. By mid-October, the cholera pandemic had receded with the drop in temperatures as winter approached, and only sporadic cases were reported. Following instructions issued by the Zhejiang provincial party committee, local governments in Wenzhou Prefecture started to review the program’s success and prepare for the following year. The Rui’an government pointed out that “a major problem lay in the coordination between the epidemic prevention workers and rural administrative systems. Preventive inoculation work depended entirely on the coordination of a wide variety of actors in the government and medical systems. In order to achieve their goals, health-care workers depended on commune cadres to publicize the program and coordinate villages so that they could inoculate villagers systematically.”54 The report prepared by the Yongjia County Sanitation and Epidemic Prevention Station further highlighted the division of labor between epidemic prevention and administrative systems in the inoculation programs. In view of this problem, county sanitation and epidemic prevention stations and district and commune health-care stations (i.e., union clinics) were asked to reorganize their inoculation teams in 1963. Each team would be composed of three to five members, including a brigade cadre, an accountant, a medical worker, and a rural health-care worker.55 Within this structure, each person was designated a specific task. The accountant collaborated with health-care stations to compile inoculation registers, cadres took the inoculation teams to each locality, medical doctors performed the actual inoculations, and health-care workers assisted the medical staff.56 The work report summaries from Zhejiang Province’s health department

Compr ehensive Inoculation, Rur a l R hythms, & Compiling R egisters

also pointed out that the emergency inoculation effort of 1962 suffered because epidemic prevention work was not appropriately integrated with the agricultural production calendar. The department’s report pointed out, “Sanitation and epidemic prevention work should be understood as being a priority aspect of the agricultural production cycle, as good health will ultimately enhance agricultural production. Inoculation teams should pay particular attention to the agricultural work timetables that set the rhythms of life in rural areas and ensure that in subsequent years inoculation programs are rolled out during the quiet seasons before the peak summer cholera season.” In view of the fact that the immunity provided by the cholera vaccine in the 1960s lasted for only four months, the reports advised that inoculation should be conducted twice in order to assure sufficient levels of immunity. The first total cholera inoculation campaign was to target all eligible subjects and take place before spring plowing (in March and April). The second campaign was to be conducted between the spring harvest and the summer harvest and planting work (in June) but target only vulnerable population groups, such as fishermen, cleaners, kitchen staff, and people living along transport lines. This was known as “reinforcement inoculation.” The report claimed that this schedule would not affect agricultural production but would instead benefit commune members because they could develop immunity against cholera before the time of year when they went to work intensively in the rice paddies.57 The report further stipulated that inoculation programs should adopt a rapid campaign format that entailed teams spending only two to four days in each locality. Three to five days after the inoculation campaign, a round of supplementary injections should be arranged for those who had missed inoculation.58 Meanwhile, the issue of having steady supplies of cholera vaccines was addressed at the national level. In view of the insufficient vaccine supplies that delayed the roll-out of the emergency inoculation in some areas in the summer of 1962, the Ministry of Health ordered that timely production of cholera vaccines must be guaranteed into the future and that their quality must be improved. The ministry placed the budget for epidemic prevention in a special category at the national, provincial, and prefectual levels according to the principles of “specific budget, specific allocation, and specific usage.”59 Accordingly, nationwide cholera vaccine production in 1963 was twenty-seven times higher than in 1961.60 More significantly, as a result of medical teams’ experiences regarding the impact of vaccine quality on different population cohorts, dosages for different age groups were further refined. The criteria for various contraindications were

163

164

china a nd the choler a pa ndemic

also refined and expanded to include acute infectious diseases and other febrile illnesses, tuberculosis, acute hepatitis, hepatic cirrhosis, heart disease, and high blood pressure. In addition, people with allergies, women pregnant less than eight months, women with a history of miscarriage, and those breastfeeding babies under one year old were all included in the exempt category.61 Addressing the new, more specific dosages and noneligible groups required extremely delicate and efficient coordination between medical professionals and grassroots communities. Consequently, the role of rural cadres and the accuracy of registers during this new round of inoculation in 1963 would be even more significant than before. As local agents and keepers of information, rural cadres were effectively village gatekeepers, while village accountants maintained basic demographic data. In 1963, not only were they instructed to host inoculation teams and guide medical staff around their localities, they also had to help compile inoculation registers based on brigade household registers and team accounting books. Together these processes now directly determined the reliability and accuracy of the inoculation program. Learning from the problems caused by disorganized and missing household data during the emergency inoculation in the summer of 1962, local governments in Wenzhou Prefecture called for household inoculation registers to be compiled. As early as December 1962, each county had already started preparing to print household registration books for the 1963 inoculation cycle. Zhejiang Province’s health department required that these new inoculation registers not copy the household registers used by some production brigades because the latter were derived from production team data, which were organized by labor rather than by household and thus were not suitable for inoculation work. Instead, health departments were instructed to compile inoculation registers by identifying household population, visiting each household to check the data, and cross-checking these registers against grain distribution books, and only once these steps had been completed should they finalize inoculation targets in each area.62 Production brigade inoculation registers would then be arranged systematically and used to break down the population of the entire commune for inoculation work. This method avoided the inconvenience of constantly “turning the pages of whole registration books to find [all the members of] one household.” This approach sped up inoculation considerably.63 Meanwhile, local health-care workers were mobilized through an incentive payment scheme from 1963 onward. Health-care workers, who had been trained on a large scale during the Great Leap Forward, were supposed to have been

Compr ehensive Inoculation, Rur a l R hythms, & Compiling R egisters

readily available for assisting with the inoculation program of 1962. As special local agents, their familiarity with the villages was supposed to facilitate the entry of inoculation teams and help verify inoculation registers. However, the post–Great Leap economic readjustment policies had a negative impact on health-care workers because it devalued their roles. In January 1961, the policy of taking “agriculture as the foundation of the economy and industry as the leading sector” was formally adopted.64 This move caused many production brigades to ban medical and health-care work. Local cadres suggested that it would be better if health-care workers instead devoted themselves to agricultural tasks.65 This resulted in significant reductions in their numbers. By the time the cholera pandemic had reached China, only a nominal form of health-care organization existed in some areas.66 Health-care workers were therefore not mobilized on a large scale during the 1962 cholera inoculation campaign, even though the delivery of vaccinations depended entirely on medical personnel.67 In view of this lesson, the health-care worker scheme was soon resumed in Wenzhou Prefecture and other areas in Zhejiang Province. For example, Rui’an County started providing health-care workers with partial subsidies drawn from the epidemic prevention budget following three main inoculation strategies. First, county health bureau and inoculation teams distributed a 2.6-cent subsidy per injection to the worker performing the injections. Second, health-care workers who were not able to administer injections were to help doctors distribute inoculation certificates, and the subsidies would be split between the two (70 percent to the doctor and 30 percent to the health-care worker). Third, some production brigades provided extra work points for health-care workers.68 In Wenzhou Prefecture in 1963, annual per capita income was 100 yuan or less in 98 percent of the production teams, so most rural laborers’ daily income was around 27 cents, equivalent to the fee for giving ten cholera inoculations.69 Consequently, the new payment system was very attractive: as the summary documents for inoculation work pointed out, “because of the implementation of a proper payment system, the majority of health-care workers were very enthusiastic.”70 In the inoculation campaigns of the subsequent years, local health-care workers accounted for the majority of inoculation team personnel. For example, Yueqing County mobilized 603 medical staff to do inoculation work on March 1–20, 1963. Of these personnel, 6.14 percent were from state-owned departments, 37.48 percent from collective medical units, and 10.78 percent from individual medical practitioners, while health-care workers from rural areas accounted for the remaining 45.6 percent.71 This feature was especially evident in other areas

165

166

china a nd the choler a pa ndemic

of Zhejiang Province, where the incidence of cholera was not serious. In these areas, there were relatively few urban medical teams to support the inoculation program, which was basically conducted by health-care workers, who made up the majority of those involved, along with local public and private medical staff from county hospitals, district/commune health care stations (i.e., union clinics), and independent medical practitioners.72 From 1963 onward, total inoculation campaigns were therefore quickly coordinated by joint work on the part of the medical and administrative systems through the division of labor among local cadres, accountants, medical staff, and health-care workers. These campaigns were organized around the rhythms of the agricultural calendar. For example, Rui’an County divided cholera inoculation work into three stages in 1963. In the first stage, from mid-February to March 1, the work mainly aimed to survey the general situation and prepare for inoculation. With the district as a unit, the county sanitation and epidemic prevention station trained health-care workers. Each district and commune compiled inoculation registers and obtained demographic information. After readying personnel and materials, each district selected one to two pilot communes where inoculation workers could gain experience. During the second stage, after March 1, the work focused on fully mobilizing medical forces and initiating the inoculation campaign. Following official instructions, local cadres were in charge of mobilization and organization, while health professionals were responsible for the inoculation itself. During the third stage, inoculation teams conducted sample surveys to guarantee efficacy and inoculate any people who had been left out.73 Within the overall inoculation campaign, inoculation work in villages fit into the rhythms of agricultural production and rural lives. As Zheng Jinzhu, a former party secretary from one production brigade, explained, “in those days, it was very clear where commune members were, such as planting seeds in the field or collecting tea in the mountains. We made announcements through the village loudspeakers so everyone knew about the inoculation campaign. We just led doctors to the fields to carry out their work.”74 Meanwhile, the mobilization of local health-care workers increased the number of inoculation personnel, and they also acted as local agents to strengthen the verification of inoculation registers. They therefore extended medical and administrative assistance to inoculation teams and brigade cadres, respectively. Ample supplies of cholera vaccine also helped guarantee that large-scale inoculation campaigns in coastal areas ran smoothly.

Compr ehensive Inoculation, Rur a l R hythms, & Compiling R egisters

These improvements greatly increased the speed of inoculation campaigns in 1963 and beyond. As mentioned earlier, from 1963 on, inoculation work was conducted twice each year, with the first round aiming at mass inoculation and the second one targeting specific areas and population groups. In Rui’an County, where cholera first broke out in 1962, the inoculation rates for 1962 and the first round of inoculations in 1963 were 79.67 percent and 76.78 percent, respectively. In other words, slightly fewer people were inoculated in 1963 than in 1962. However, as table 5.1 shows, the 1963 program was much faster, taking only 15 days (the first round) and 10 days (the second) in contrast to 90 days in 1962.75 The 1963 figures for Pingyang County were similar, with inoculation rates reaching 83.3 percent of the population in just 15 days.76 Inoculation campaigns had become even more efficient by 1964, when the first round of inoculation in cholera-affected districts in Rui’an County reached between 76 percent and 83 percent of the population in 10 days. Tangxia District was particularly fast: 123,679 people were vaccinated in just four days. The mass inoculation campaigns in 1963 and subsequent years thus effectively coordinated the administrative and medical systems and met the emergency inoculation targets of the cholera pandemic. As the following discussion will show, inoculation information became a crucial nexus between the efforts of the two systems, in which local agents played indispensable roles.

INOCUL ATION REGIS TERS, CERTIFICATES, AND SOCIOPOLITICAL UNIT S The key issues that had hampered the inoculation programs of 1962 were resolved by reducing the size of production teams, which were basic social and accounting units; by changing the tasks assigned to rural agents; and by compiling reliable inoculation registers. Importantly, the inoculation campaign of 1963 and subsequent campaigns had direct impacts on the two basic sociopolitical units—rural production teams and urban work units—in that different types of data contributed to further strengthening of the ongoing social restructuring prompted by the failure of the large communes and of the Great Leap Forward. In this process, the three different registers being used in rural areas—that is, the household, accounting, and inoculation registers—became intertwined. As mentioned above, inoculation registers were not compiled by copying production brigade household registers directly. Instead, they were the reedited household registers based on household, location, and labor. Their accuracy was verified against production team accounting registers, including work point registers

167

168

china a nd the choler a pa ndemic

and commune member booklets. In this sense, the compilation of inoculation registers served to improve household registers and strengthen their capacity for describing demographic data. Meanwhile, the inoculation process also generated a new social record— inoculation certificates, which contained the names and ages of inoculated subjects, vaccine dosages, contraindications, health status, and so on. One certificate was to be issued for each subject. To prevent people from borrowing, purchasing, or selling inoculation certificates and to facilitate the checking of those certificates, Zhejiang Province printed a set of identical certificates that varied only by series number. This established a regulated, uniform document for medical workers to fill in and stamp with their officially allocated seals.77 Both inoculation registers and certificates contributed to the creation of a new set of archival records for whole populations—epidemiological data, which were later used during the cholera pandemic and outbreaks of other infectious diseases. Following inoculation, the county sanitation and epidemic prevention staff organized supplementary inoculation teams that comprised local administrative leaders, medical staff, and the masses. Production brigades were designated as basic units for checking and verifying data. Wang Jingfu, the doctor (discussed earlier) who followed his mentor to conduct smallpox inoculations before 1949, recalled, “In cholera-infected areas, the inoculation rate had to reach 95 percent. If people did not show up for inoculation, we went to their home when they were sleeping. They were afraid of this because the higher-ups would come and investigate. We did not dare to make inoculation figures up because leaders would do a survey in a given village and check five to ten households in order to establish a sample of inoculation rates.”78 According to official instructions, the inoculation verification process was to consist of “four checks”: a check of the inoculation register against household and accounting registers, a check of inoculation certificates to ensure that the correct number of people had been inoculated, a check of the vaccine dosage for each relevant age, and a check of the number of inoculation waivers with reference to the number of total inoculated subjects. These checks were recorded on forms that were submitted to the commune, which would collate them and prepare two copies, one for the county and one for the district. As long as they met the required standards, each commune would be issued a “certificate of quality.”79 This follow-up process therefore verified and cross-checked population information in household and accounting registers with the compilations of inoculation registers/certificates. This process was very significant for the concurrent restructuring of the People’s Commune system as

Compr ehensive Inoculation, Rur a l R hythms, & Compiling R egisters

social, production, and epidemiological data became more accurate and reliable through repeated verification. Compared with the delicate dynamics of inoculation in rural areas, inoculation campaigns in urban areas were more straightforward. The comparative ease of delivery was due partly to the nature of the basic urban social units and partly to the relatively complete household information available and the corresponding social monitoring schemes that had already been established by the time of the cholera outbreak. Urban residents belonged to either residential committees or collective work units, which managed resident information, population mobility, political surveillance, wages, and welfare packages strictly and efficiently. These factors contributed to the comparatively quick implementation of inoculation among urban residents during the cholera emergency. During the first mass inoculation campaign conducted in Wenzhou City in March 1963, local governments were so confident of their existing population registration systems that the compilation of inoculation registers started only three days before the campaign was to take place. Residential committees drew up inoculation registers based on the actual population that was resident at the time, including any people staying in the area who did not have local household registration data. The registers divided people into groups and assigned where they would be vaccinated, whether in classrooms, workshops, or administrative offices. One day before the vaccines were to be administered, each epidemic prevention subquarter of the city compiled a detailed inoculation program based on the principle of “collectives first and scattered populations second.” Each work unit was informed of its responsibilities and underwent mass inoculation in turn. The government stipulated that the payment of March salaries would be made only upon presentation of preventive inoculation certificates at all collective units, including government agencies, factories, shops, hospitals, and schools. Grain department officials were able to issue residents grain-purchasing certificates only after they had seen these same inoculation certificates stamped with an official seal. This coercive method was effective in promoting compliance with the inoculation campaign, and it could be applied to almost all urban residents. Similar methods could not be enforced in rural production brigades because of the way rural work was organized. The differences in rural and urban inoculation procedures also illustrate the significance of the organizational structure of basic social units for a successful response to an emergency inoculation. Regardless of these differences, the inoculation campaigns of 1963 and subsequent campaigns functioned as sociopolitical exercises for the two basic social

169

china a nd the choler a pa ndemic

170

units—production teams and work units—by integrating and verifying different types of data and implementing corresponding monitoring schemes. During this process, inoculation certificates played a specific role. The regulations of the time stipulated that people had to carry their inoculation certificates whenever they went outside their production brigades and work units. Inoculation certificates then quickly became like passports for daily life, such as in the quarantine examination discussed in chapter 4.80 The issuance of inoculation certificates and the official limitations on population movements to further restrict the mobility of production teams and work units, the creation of which had already reduced population mobility, contributed to the formation of a sedentary society.81 These reciprocal dynamics of inoculation certificates and social structure are reflected in the low absenteeism of villagers from their places of residence during the years when pandemics occurred. Long-term absentee villagers accounted for only 2.07 percent of the total population during the cholera inoculation campaign in selected rural areas, county towns, counties, and cities in Wenzhou Prefecture in 1963–1964. Peasants were also the least mobile of all workers. For example, in the rural and urban areas of Wenzhou City, a total of 1,458 residents were absent during the cholera inoculations in 1964. According to statistical data on occupational distributions, the highest number of absentees could be found among urban residents (492) and workers (169) but not among peasants. The number of absentee villagers was just 5.82 The number of absences was one factor in people not receiving inoculations. Other explanations included contraindications for vaccination in people with certain health conditions, refusals, and simply not showing up for inoculation. For example, in the first mass inoculation campaign in Tangxia District, Rui’an County, in 1964, 7.1 percent of the subjects targeted to receive inoculation did not receive a vaccine for one of these three reasons. In terms of distribution, it was contraindications, refusals, or absence that accounted for 51 percent, 28.8 percent, and 21.2 percent of the total number of subjects who missed inoculation, respectively.83 In this sense, the inoculation campaign and the population immobility caused by the compartmentalization of rural society, based as it was on production teams, strengthened each other during this period.

CONCLUSION During the cholera pandemic that affected southeastern coastal China from 1962 to 1965, there was a reciprocal dynamic between the mass inoculation

Compr ehensive Inoculation, Rur a l R hythms, & Compiling R egisters

campaigns and the restructuring of social systems. The newly undertaken social restructuring facilitated the entry of inoculation efforts into villages. Local agents, including rural cadres and health workers, took on the role of gatekeepers for inoculation campaigns and coordinated the operations of the medical and administrative systems. Household and accounting registers provided accurate demographic information for inoculation registers. Although the 1962 emergency inoculation encountered serious challenges, the subsequent campaigns of 1963 and beyond were rectified to ensure that their schedules better integrated with agricultural production and rural rhythms brought by social restructuring. In turn, these inoculation campaigns enhanced the party’s control over local agents, particularly those rural cadres who had recently been through an administrative restructuring process. The government was able to mobilize these cadres for epidemic inoculation work while also improving their administrative capacity as key local agents for the state. Inoculation registers and certificates created a new set of archival records for whole populations’ epidemiological data, while inoculation certificates also became key identity documents. This compilation process repeatedly verified social and production data, that is, household and accounting registers. These inoculation campaigns incorporated the medical and administrative systems while combining social, production, and epidemiological data to encompass the whole of society, in which local agents played crucial roles. The reinforced role of local agents and the availability of a comprehensive set of demographic data during the inoculation campaigns further functionalized population control, facilitated the formation and topdown imposition of a new, broad-reaching social structure, and contributed to the formation of a sedentary society. As compulsory measures, mass inoculation campaigns not only strengthened the disciplinary function of the party and government but also created a nascent but active surveillance tool during the pandemic. These campaigns therefore facilitated the rise of the emergency disciplinary state in the years of social restructuring. However, when the mass inoculation campaign against cholera was being implemented in Wenzhou and other areas of southeastern coastal China in 1962 and afterward, international medical communities were questioning the relative effectiveness of the cholera vaccine. These medical groups argued that there was no evidence to suggest that there was a significant difference in the fatality rates between the inoculated and the unvaccinated populations. Cholera inoculation could reduce morbidity but did not have much effect on mortality among those suffering severe clinical cholera.84 In 1966, the assistant director-general of the

171

172

china a nd the choler a pa ndemic

World Health Organization, P. M. Kaul, himself a cholera expert, even pointed out that one dose of ordinary cholera vaccine gave little or no protection. Moreover, as those vaccines with strong efficacy produced general or severe reactions in those being inoculated, even these vaccines could not be recommended for widespread application. Therefore, he concluded no fully effective specific preventive measures were currently available against cholera.85 By the early 1970s, the WHO had explicitly pointed out that inoculation was usually of no help for cholera control. Instead, it claimed that “cholera vaccines give health departments and inoculated subjects a false sense of security, which make them give up more effective measures. Inoculation takes up much of the personnel and resources that should be applied in those more worthwhile controlling efforts.”86 In an internal report that seemed to predict the WHO’s stance about cholera vaccination, Wenzhou City admitted in 1963 that although widespread cholera inoculation could enhance the immunity of the masses, it was not as effective as the smallpox vaccination. Epidemic reports from each locale indicated there were still many outbreaks of cholera after the inoculation program had been administered. This result meant that even with a comprehensive inoculation program, cholera outbreaks could not be prevented.87 In December 1963, the Ministry of Health convened a symposium in which cholera epidemiological experts examined key practices in the anticholera campaign over the previous two years. Su Delong, a professor of epidemiology at Shanghai Medical University, frankly identified the shortcomings of the “Preliminary Report on Epidemiological Efficacy Observations on the Cholera Vaccines,” a version of which was compiled by institutes of biological products across China. Su argued that “the data we collected on the ground provided no evidence that preventive inoculation was effective in preventing cholera.” In his opinion, the experimental control group in the report was not designed in advance and was therefore not comparable with the actual inoculation group. Middle-aged and older adults, who had a higher chance of getting infected, accounted for the majority of the control group. Even the cholera incidence rate of the experimental control group did not point to the conclusion that cholera vaccines were effective. Professor Su also pointed out that the report actually admitted in thirteen places that there was no noticeable difference between the inoculation group and the control group. Based on these materials, the argument that the cholera vaccine was effective was not persuasive. The author of the aforementioned report, Wei Xihua, deputy director of the Shanghai Institute of Biological Products, responded, “Our report truthfully reflected the results. The vaccine is generally effective. The cholera vaccine is

Compr ehensive Inoculation, Rur a l R hythms, & Compiling R egisters

definitively effective, but not strong.” There were supporters for both sides of the argument.88 Nevertheless, mass inoculation campaigns were still implemented during the next two decades according to the schedules and rhythms established in 1963. Although Chinese medical scientists had made efforts to invent new types of cholera vaccines, their results were unsatisfactory.89 As a result, preventive inoculations against cholera were phased out in China in the late 1970s. Starting in 1980, Zhejiang Province no longer assigned mass inoculation tasks to local governments.90 The inoculations that were implemented mainly targeted specific groups, including fishermen, kitchen staff, cleaners, and medical staff.91 Mass inoculation officially stopped in Pingyang County in 1981.92 In Zhoushan Prefecture in eastern coastal Zhejiang Province, the local health gazetteer openly admitted in 2002 that “inoculation has been applied as the major method for preventing cholera since 1962. Each year, the government has inoculated thousands of people. However, ultimately this proved not to be very effective. The program could not prevent the spread of cholera. After 1983, cholera inoculation work ceased.”93 The ineffectiveness of the cholera vaccine was confirmed in China by the early 1980s. However, the experience in the cholera inoculation campaigns of 1962–1965 improved and institutionalized the inoculation scheme for other diseases in the following decades. This practice thus contributed to public health more broadly in Mao’s China and thereafter. Functionalized as tactics to control and surveil the population, all these inoculation campaigns strengthened the emergency disciplinary state in the changing sociopolitical context. In this sense, the cholera inoculation campaigns in the early 1960s were a significant social and political exercise rather than merely an episode in the medical and public health history of China.

173

6 STOOL SAMPLES, ARCHIVING PATIENTS, AND STATISTICAL POLITICS

DIS E A S E S URV E IL L ANCE AND S TAT IS T IC S COMPIL E D DURING PANDE MIC S W E RE A thorny issue in the epidemic prevention system of twentieth-century China. According to physician Hong Tiansui, the dysfunction in epidemic reporting was due to poor coordination between the medical and administrative systems. Dr. Hong was a medical graduate of the Imperial University of Tokyo in Japan, the founding director of Rui’an County Hospital, the director of Pingyang County Hospital, and doctor-in-chief at Wenzhou Ouhai Hospital from 1937 to 1943, during the war. In 1945, he was promoted to the directorship of the Zhejiang Provincial Medical and Epidemic Prevention Brigade. Drawing on his epidemic prevention experience over many years, he described the situation in 1945 as bleak—the community-based system of law enforcement and control (baojia) was incomplete, and the medical system, which depended on health-care workers in rural areas and towns, was basically nonexistent. In Hong’s view, baojia heads’ low literacy skills and the many official duties they had to perform meant that they were unable to accurately identify the causes of death for local residents. Only when multiple patients died or were ill did the authorities start reporting outbreaks to the county government. When such epidemic information reached the county government, local hospitals did not have the medical personnel to respond promptly, so the county would report to 174

stool sa mples, archiving patients, a nd statistica l politics

the provincial government, which then dispatched epidemic prevention teams. Official documents were then circulated among the different departments. However, as Dr. Hong pointed out, “because the response had been delayed, epidemics could not be contained now. Under some circumstances, when the county government received epidemic reports and telegraphed the provincial authorities to dispatch medical staff to conduct prevention and treatment work, they didn’t hesitate to exaggerate the situation, sensationalizing it to obtain greater medical and pharmaceutical subsidies.”1 By spring 1949, it seemed that some of Dr. Hong’s criticisms of the epidemic surveillance scheme had been taken to heart by health authorities. The Nationalist Zhejiang provincial government designed a bottom-up epidemic reporting network: the preliminary epidemic reporting line (yiqing chubaoxian) included various clinics, hospitals, and practitioners. The reference epidemic reporting line (cankao yiqingxian) basically followed the administrative system, including police, baojia heads, and practitioners of Chinese medicine. Through this procedure, epidemic information from the preliminary line (the medical system) was reported to county/city hospitals and the Third Division of the Provincial Health Department, which was in charge of epidemic prevention and which would forward data on the epidemic to the central government. These reports followed a ten-day cycle. Information transfer from the reference line (the administrative system) stopped when it reached the provincial level, a process that took place once a month. In other words, this epidemic reporting scheme was more oriented to the medical system, and county hospitals and city health bureaus were supposed to play a crucial role in operating the whole scheme. Practitioners of Chinese medicine, who accounted for the majority of the available medical personnel in rural areas, were not included in the medical reporting system (i.e., the preliminary epidemic reporting line). Moreover, this design existed only on paper because the Communist army took control of Zhejiang in May 1949, before the reporting system was implemented. Nevertheless, it does provide a comparative perspective for understanding the new epidemic surveillance system that was to be developed during the Communist regime. The difficulties of epidemic reporting caused by the problems in coordination and in the capacity of the administrative and medical systems still haunted the new regime after 1949. Although the Communist government quickly established a complete administrative system right after its revolutionary victory, the medical system (which included the epidemic prevention scheme) did not emerge until the mid-1950s, just six to seven years before the outbreak of the

175

176

china a nd the choler a pa ndemic

global cholera pandemic in 1962. Even worse, the medical system was further fragmented due to the economic retrenchment in 1961. One of its severe impacts was the emergence of medical commercialism, in which independent medical practitioners in particular struck out on their own for profit, but at the risk of state censure.2 These not only posed great challenges for those responding to the pandemic but also provided a significant opportunity for improving the epidemic reporting scheme through the restructuring and integration of the medical and administrative systems in the sociopolitical contexts of the early 1960s. The establishment of the epidemic statistical data scheme during this process was significant for the concurrent social restructuring. Foucault explains the wide reach and significance of data collection within the medical system, arguing that the hospitals of the eighteenth century, in particular, were great laboratories for scriptuary and documentary methods. The keeping of registers, their specification, the modes of transcription from one to the other, their circulation during visits, their comparison during regular meetings of doctors and administrators, the transmission of their data to centralizing bodies (either at the hospital or at the central office of the poorhouses), the accountancy of diseases, cures, deaths, at the level of a hospital, a town and even of the nation as whole formed an integral part of the process by which hospitals were subjected to the disciplinary regime.3

As Benedict Anderson argues, the gathering of data reflected and contributed to the rise of the nation-state as a particular type of “imagined community.”4 To some extent, both Foucault’s and Anderson’s theses could be applied to an analysis of the significance of the epidemic statistical data scheme in Mao’s China. This chapter aims to examine the dynamics of disease surveillance, statistical politics, and social restructuring during the pandemic. It argues that these dynamics combined to accelerate the institutionalization of the medical system, the medicalization of the administrative system, and the epidemiological categorization of populations, which significantly contributed to the rise of the emergency disciplinary state.

OUTPATIEN T DEPARTMEN T S FOR IN TES TINAL DISEASES AND S TOOL SAMPLES As of July 30, 1962, the cholera outbreak was still confined to Wenzhou Prefecture in Zhejiang Province. In order to obtain information about the progress of the cholera epidemic that was both reliable and timely, the provincial health

stool sa mples, archiving patients, a nd statistica l politics

department instructed that Wenzhou City and Rui’an and Pingyang Counties should report to the health department by telephone every day and submit a written report every week. Likewise, the Wenzhou Prefecture Culture and Health Office was to report to the provincial health department every Wednesday and Saturday by telephone and submit written reports every ten days. The reports were to include the numbers of all confirmed cholera cases, the death toll, and the distributions of these two aspects in each district, commune, and township. Even the time of day the telephone calls were to be made was stipulated.5 County health bureaus played crucial intermediate roles in this reporting procedure, as they were simultaneously responsible for collecting epidemic information and supervising epidemic reporting below the county level. However, this was a daunting task. From the early 1950s on, the Communist government tried to extend epidemic reporting to the township level. As early as 1953, an experimental scheme was initiated in Hang County, where the provincial capital of Zhejiang was located. This scheme divided the area into three levels following the principle of “regionalized reporting” during epidemics: level A was the entire county, the B-level regions were centered on district clinics, and the C-level regions focused on township union clinics or work units with medical and health facilities. However, the actual disease-reporting work was quite inconsistent, and underreporting was commonplace. For example, in Sandun District of Hang County, which claimed to conduct reporting work very well, the underreporting rate reached 61.22 percent in 1957.6 Epidemic reporting work did not actually exist in many counties across the province in the mid-1950s. It was not until 1959 that Rui’an County established a two-level epidemic reporting system for the first time: county health clinics and district health clinics formed the upper tier (level A), while township health clinics were the lower tier (level B). Each unit and region designated staff to undertake reporting work and unified reporting times and schedules.7 However, this nascent reporting scheme faced serious challenges due to poor staffing and a lack of properly equipped medical units by the early 1960s. For example, symptoms of cholera and intestinal diseases in summer were hard to differentiate quickly and easily because of the low medical proficiency of some staff and the fact that almost all medical staff at the time had little clinical experience in treating cholera patients. In fact, as Deputy Health Minister Qian Xinzhong admitted at the cholera prevention and treatment work meeting attended by health officials from southeastern coastal provinces in December 1962, “the identification and reporting of cholera patients happened too late in 1962. In some areas, it was delayed for

177

178

china a nd the choler a pa ndemic

more than twenty days.”8 As mentioned in the introduction to this book, when the first cholera patient, Chen Azhu, was admitted to the Rui’an People’s Hospital on July 5, only a few elderly medical doctors had any experience in treating cholera patients before 1949. The majority of other young medical staff had never seen cholera patients. After the case was forwarded to the Wenzhou Prefectural Sanitation and Epidemic Prevention Station for further examination on July 6, epidemiological experts there could not confirm the diagnosis either. With the assistance of experts from the Provincial Sanitation and Epidemic Prevention Station who had been urgently summoned to Wenzhou, it was finally confirmed on July 16 that it was the El Tor strain of cholera.9 Such delays happened at the county hospital and the prefectural sanitation and epidemic prevention station, not to mention medical units below the county level. For example, in Xiwan Commune of Pingyang County, clinical doctors diagnosed cholera as acute gastroenteritis in the summer of 1962. Within five days, there were thirty-five cholera cases. The death toll reached eleven, and the fatality rate was high, at 26.6 percent.10 Either wrong diagnosis or delayed confirmation of cholera resulted in very passive epidemic prevention work. In Bishan Commune in Rui’an County, staff regarded the outbreak of an infectious intestinal disease as being an ordinary complaint and did not pay close attention to it. Soon, the disease spread into neighboring communes, at which point the county government urgently notified commune clinics that it was cholera and warned local medical staff to be vigilant. On receiving these instructions, doctors were shocked and soon started improving their reports to the commune’s party committee.11 The poor medical proficiency of the hospitals and clinics below the county level was exacerbated by local customs. Many people believed that having diarrhea in the summer was common and even good for one’s health. There was an old saying that “a thousand gold coins could not buy diarrhea in June [referring to summer]” because diarrhea was claimed to dispel “coldness” and “toxins.”12 Therefore, it was crucial for epidemic surveillance that medical staff understood how to identify cholera patients and how to distinguish cholera from other intestinal diseases. In fact, the occurrence of both intestinal disease and cholera basically followed the same curve from January to September in Rui’an County in 1963 (fig. 6.1). At that time, the most effective and realistic way was to conduct stool sample tests in hospitals and clinics, which required bolstering the services of hospitals and clinics, particularly those below the county level. Given these circumstances, in 1963 Zhejiang Province’s health department

stool sa mples, archiving patients, a nd statistica l politics

179

Monthly Incidence of Intestinal Diseases 4000

3597

3500 2735

3000 2500 1754

2000 1500

986 678

1000 500

75

47

65

Jan

Feb

Mar

124

0 Apr

May

June

July

Aug

Sep

Monthly Incidence of Cholera 23

25 20 15

12 8

10

6

6

4

5 0

2

1

0 Jan

Feb

Mar

Apr

May

June

July

Aug

Sep

Figure 6.1. Monthly incidence rates for intestinal diseases (top) and cholera (bott om) in Rui'an County, 1963. Rui'anxian weisheng fangyizhan, “1963nian fuhuoluan fangzhi gongzuo qingkuang de baogao,” 1963, RA A, Vol. 142-8-4.

began instructing hospitals and clinics at the county level and above to establish an outpatient department for intestinal diseases, and this outpatient service was to operate from April to October, the peak season for infectious intestinal diseases. The department’s scheme called for each hospital and clinic to have a deputy director, who was to be in charge of this new development. In the general outpatient department, a nurse was in charge of performing a preliminary intestinal disease check, which consisted of asking patients some brief but obligatory questions about their symptoms. On doing so, patients were given a bamboo registration stick. Those showing symptoms of diarrhea and vomiting would be referred to the outpatient department for intestinal diseases, where a stool sample would be tested. For serious cases, nurses would register patients, process the patients’ payment of their fees, and collect medications on their behalf. People who were suspected of having cholera were to be reported to the county’s sanitation and

180

china a nd the choler a pa ndemic

epidemic prevention station within an hour.13 By following these procedures, hospitals and clinics were expected to identify suspect cholera cases quickly and undertake further epidemiological examinations using stool samples. In the same way, each district and commune health-care clinic also created a specific table for categorizing intestinal diseases and designated a staff member to conduct stool tests following the procedure established by the relevant outpatient department for intestinal diseases. To avoid underreporting cases, clinics usually required doctors to carry three sample tubes in their medical kits (home visits were still a very popular form of medical attention in the early 1960s).14 If the doctors encountered any suspected intestinal disease patients, they could collect stool samples and submit these to clinics in a timely fashion.15 Although these procedures improved the efficiency of stool sample collection, most district and commune clinics in the early 1960s did not have the facilities or skilled staff needed to conduct stool tests. As a consequence, stool samples were to be submitted to county epidemic prevention stations.16 Li Chengqin, a doctor at the Wanquan District clinic in Pingyang County, recalled the stool sample routine as follows: “At the beginning of the day, we prepared small bottles and put some antiseptic solutions into each bottle. And then we used cotton-tipped sticks to collect stool samples and collected the bottles. The district clinic designated a specific staff member to collect samples from each commune clinic and forward them to the county sanitation and epidemic station.”17 To facilitate this process, Pingyang County’s health bureau coordinated with the county’s industry and transport bureau to collect stool samples. The health bureau provided two test boxes to hold bottles of patient stool samples for each district. Each commune collected patient stool samples and test forms and submitted them to district health clinic staff, who put them into test boxes and locked them before handing them over for transport on buses traveling between the district and the county town bus station. In the reverse direction, the Pingyang County Sanitation and Epidemic Prevention Station prepared empty test boxes and placed supplies of preservative liquid and the results of the last stool tests into boxes, which were then distributed from the Pingyang bus station to each locale. Every bus and boat transporting the materials had a designated person to undertake this duty.18 The frequency and ways of submitting stool samples varied slightly in different counties. In Rui’an County, the county town required that stool samples be collected twice a day. Taoshan District dispatched staff on bicycles to collect samples in its communes, and Tangxi District requested that a boat company deliver stool samples stored in designated containers.19

stool sa mples, archiving patients, a nd statistica l politics

The stool sample collection and testing scheme was further institutionalized in subsequent years. By the mid-1970s, Pingyang County gave instructions that “stool samples should be sent to destinations on time every day and should not stay at commune clinics overnight.” To achieve this, the county’s sanitation and epidemic prevention station arranged a specific car, designated collection points, and set up a detailed timetable for collecting stool samples across the county. The car departed from the county town at eight o’clock each morning, stopping to collect samples at commune clinics located on main roads or from designated collection points for clinics that were not along roads.20 The creation of outpatient departments for intestinal diseases and the establishment of mechanisms to collect and test stool samples were crucial steps for identifying cholera patients, and these measures effectively overcame the shortfalls in facilities and staff medical proficiency in commune clinics in the early 1960s and thereafter. This was significant for the institutionalization of epidemic prevention schemes against intestinal infectious diseases, including cholera.

DEFRAGMEN TING THE MEDICAL SYS TEM Despite the major new institutional designs for outpatient departments handling intestinal diseases and stool sample schemes, the actual work of identifying cholera suffered setbacks due to the fragmentation of the rural medical system in 1961 and beyond. As a part of its economic retrenchment and social restructuring efforts of the early 1960s, the Communist government transitioned state-funded district and commune clinics to union clinics, which were collective medical units responsible for their own profits and losses. Medical staff were encouraged to work as “full-time independent medical practitioners who complement socialist health work.”21 In the meantime, the state retreated from medicine and health in rural areas in terms of investment and subsidies. Under the new system, union clinics in rural Wenzhou and other counties in Zhejiang Province functioned as doctor collectives and implemented a payment scheme of basic salaries plus bonuses.22 This new payment scheme prompted medical practitioners in rural union clinics to become more active, as their performance directly affected their salaries and thus their family’s living standards. However, compared with basic salaries plus bonuses at union clinics, it was more attractive for many medical practitioners to resign from the clinic and return home to practice medicine independently, as a way of increasing their income without having to share it

181

182

china a nd the choler a pa ndemic

with colleagues and clinics.23 As a result, the number of independent medical practitioners increased steadily. By promoting economic incentives, this reform had a significant impact on medicine and health care in rural areas, one that was largely focused on medical commercialism. As a report from Gaolou District in Rui’an County pointed out, “the economic viewpoint is widespread. The trend toward financial incentives, basic salaries plus incentives (bonuses) . . . and the mind-set of ‘treat more to earn more’ are becoming increasingly evident.”24 This pursuit of profit by medical practitioners resulted in a fragmented medical system, which caused further problems for epidemic prevention work. Many medical staff and practitioners were reported to be unwilling to undertake epidemic prevention work, arguing that this was not their duty and that it just created extra work for them.25 This medical commercialism affected cholera prevention and treatment in 1962. As the deputy party chief of the Wenzhou Prefectural Committee, Li Wenhui, pointed out during a telephone conference in September 1962, when cholera was ravaging the prefecture, “local medical professionals were not willing to collaborate with those from other areas. Some were arrogant. Aojiang Clinic in Pingyang County even rejected the medical professionals dispatched by the central government. Although there are many medical staff, they did not cooperate well, and this caused significant reductions in work.”26 At the national meeting for cholera prevention in November 1962, Li Lanyan, director of the Zhejiang Provincial Health Department, admitted that “there was a serious conflict between epidemic prevention and the medical staff of these collective medical entities.”27 Compared with the government-controlled medical system, independent medical practitioners were viewed by the authorities as performing much worse during the pandemic. For example, in October 1962 the Rui’an County Epidemic Prevention Headquarters criticized “some ignorant and incompetent charlatans (including some independent medical practitioners),” arguing that they “did not assist the government with its epidemic prevention work. Instead, they tried to make profits by cheating the masses during the cholera pandemic. They cheated them and even caused the death of cholera patients.” Furthermore, these scattered and independent medical practitioners could not report cholera cases promptly, as they were not affiliated with government-controlled union clinics. In view of this situation, the Rui’an County Epidemic Prevention Headquarters instructed that “strict management and training of these illegal medical and pharmaceutical practitioners should be implemented, and legal punishments

stool sa mples, archiving patients, a nd statistica l politics

imposed if necessary. Supporting this phenomenon implies cruelty for other people. We should adopt effective measures immediately and stop similar things from happening.”28 The government initially controlled independent medical practitioners via registration, restrictions on mobility, and reductions in their numbers. In July 1962, the Rui’an County government instructed that Chinese and Western medical practitioners, itinerant doctors, dentists, and pharmaceutical peddlers should register with local health clinics, which would investigate their applications and examine their medical proficiency before forwarding applications to the county health bureau for approval. Medical licenses were then issued to practitioners, and they were assigned specific geographical areas in which they could offer their medical services. It was also ordered that itinerant medical practitioners who left their own counties should register with the county health department in their destination county and obtain approval before practicing medicine.29 These measures meant that the professional space for independent medical practitioners in Chinese society gradually became limited, and the secure option for them was to join collective medical units at the district and commune levels.30 With the initiation of the Socialist Education Campaign in 1963, in view of rampant medical commercialism and the impact it was having on cholera prevention, Zhejiang Province’s health department decided to coordinate with relevant departments to crack down on “speculative and profiteering behaviors among medical and pharmaceutical staff,” stop the outflow of independent medical and pharmaceutical practitioners from union clinics, and fully review fee rates for union clinics and independent medical practitioners.31 This medical commercialism was further infused with political meaning. As the Party Leadership Group at the Ministry of Health pointed out, “Medical commercialism was a reflection of reactionary conceptions, bourgeois individualism, and pure professionalism in medical and health work. It was a reflection of serious, critical class struggle in the medical and health system.”32 Medical practitioners with “negative” political backgrounds were the immediate targets. As a key step in the party leadership strategy, a party committee branch was established in some union clinics. Each district party committee started assigning a party secretary to district hospitals and allocating cadres to commune clinics while dismissing directors deemed incapable and irresponsible.33 These political measures tightened the government’s firm control over medical practitioners within the medical system. Meanwhile, district and commune union clinics gradually started to adopt the basic format of separating medical

183

184

china a nd the choler a pa ndemic

expertise from bureaucratic management while clinics implemented regulations for daily duties, financial work, training, and staff development. In particular, some union clinics began implementing a twenty-four-hour outpatient system. This process contributed to the work of the outpatient department for intestinal diseases, facilitated the collection of stool samples from suspected cholera patients, and kept both confirmed and suspected cholera patients under close surveillance.34 The cholera pandemic also had significant effects on perceptions of Chinese medicine and its role in society in a way that accelerated the process of medical institutionalization. In the nineteenth century, Western and Chinese medicine used similar remedies to cure acute infectious diseases, including cholera and plague.35 This phenomenon changed with the advent of saline solution and antibiotics to treat cholera after the 1940s.36 These new treatments put Chinese medicine at a disadvantage during the pandemic. The treatment for El Tor cholera patients was essentially the same as for traditional cholera; it depended mainly on replenishing body fluids and electrolytes and supplementing these efforts with antibiotics.37 There were three main types of cholera patients. The first were moderately and severely dehydrated patients, who were usually given intravenous injections of between two thousand and three thousand milliliters of saline solution.38 The second type of patients received antibiotics because El Tor cholera vibrio was very sensitive to tetracycline, chloromycetin, kanamycin, and neomycin, which could shorten the treatment course but did not replace rehydration.39 A third treatment method was oral hydration with glucose-containing electrolytes; mildly dehydrated patients received this solution from the late 1960s onward. Severely dehydrated patients were usually switched to this method from intravenous treatment when their blood pressure had returned to a normal level and they had stopped vomiting. Of these methods, rehydration and the restoration of the electrolyte balance were the most widely applied therapies in the treatment of cholera during the pandemic in the early 1960s. In the Wenzhou area, the favored treatment method was to supplement patients’ fluids using saline, 5 percent glucose, and natrium lacticum solution. The dosage and hydration speed were determined according to doctors’ instructions.40 Even today, all the doctors I interviewed who had taken part in cholera prevention and treatment work vividly recalled how they provided large amounts of saline solution to patients via IV drips in both arms and both legs. Clinic doctor Wei Shanhai of Xianjiang Commune in Rui’an County recounted how “at that time, we mainly used saline solution drips. A drip in just

stool sa mples, archiving patients, a nd statistica l politics

one arm was not enough for acute patients because they dehydrated too quickly. We had to give them saline solution through both arms and even both legs until they stopped vomiting and having diarrhea. For the most serious cholera patient, I used thirty-eight bottles of saline, which seems incredible today.”41 The pandemic response of Chinese medicine practitioners was totally different. After the outbreak of cholera in 1962, Rui’an County called on the medical community to strengthen cooperation between Chinese and Western medicine, conduct medical and pharmaceutical research, and encourage followers of the different schools, theories, and understandings of Chinese and Western medicine to freely explore various ways to steadily improve the proficiency of medical and pharmaceutical staff.42 Following this directive, Chinese medicine practitioners proposed prescriptions following the treatment principles of “pattern differentiation and treatment determination” (bianzheng lunzhi). These included qiangxin huiyang fa (method for strengthening the heart and restoring yang) for cholera patients suffering from four cold limbs and weak pulses, qingre lishi jieshu fa (method for lowering fevers, expelling dampness, and resolving summer heat) for patients with nonstop diarrhea and high fevers, and tiaoli piwei xiaodaofa (method for digesting and expelling by attuning and regulating the stomach and spleen) for patients with abdominal swelling. Chinese medicine practitioners also proposed using acupunctural points to counteract vomiting, diarrhea, irritation, and insanity; reduce fevers and headaches; enhance appetites; improve breathing and urination; and prevent heart attacks and shock. In practice, however, it was very hard to apply these methods. There were three main difficulties: medicines were difficult to swallow, some patients vomited after taking decoctions, and some patients refused to take medicine. Administering acupuncture to acute cholera patients was no easy task either.43 As a consequence, Chinese medicine was rarely used with urgent cholera patients. Instead, practitioners only turned to it when patients’ symptoms had subsided or vomiting had stopped. Prescriptions included magnolia berry (wuweizi), charred fructus crataegi (jiaoshanzha), largehead atractylodes rhizome (baizhu), radix paeoniae alba (baishao), and licorice (gancao).44 The role of Chinese medicine during the cholera pandemic significantly impacted the fates of practitioners of Chinese medicine, who still constituted much of the available medical personnel in rural China during the early 1960s.45 With regard to traditional medical practitioners in cholera pandemics, Sheldon Watts has argued that after the identification of cholera vibrio and the confirmation of the vital importance of water in cholera transmission, control of cholera was

185

186

china a nd the choler a pa ndemic

simplified to isolate affected patients and every bit of the fecal matter, vomit, urine, or sweat they expelled. He argued that illiterate, locally born health practitioners undertook this easy task under the general supervision of competent medical authorities.46 To some extent, his argument could also be applied to literate practitioners of Chinese medicine during the cholera pandemic. As chapter 5 has suggested, a pyramid-shaped system was formed when the urban medical system was grafted onto the rural medical system in response to the cholera pandemic. Within this temporary system, these rural medical practitioners, who mainly performed inoculations and nursed cholera patients, formed the lowest level of the pyramid, with school of health students working as assistants and making up the middle levels, while the epidemiological experts who analyzed virus strains and the urban medical doctors who treated cholera patients were at the top. Despite the Chinese medicine practitioners’ position at the bottom of the pyramid, for many of them cholera epidemic prevention became a major opportunity for studying Western medical technologies, such as injections, drips, and other treatment techniques, in partnership with other health-care workers. Nevertheless, Chinese medicine practitioners, particularly those from older generations, increasingly faced challenges to their authority in local medical communities. To some extent, these challenges facilitated their ability to join hospitals and clinics within the state medical system, where they could further improve their medical proficiency and thus guarantee their livelihood. The impact of medical technologies thus significantly increased the institutionalization of the medical system, as did the regulation of medical practice and political indoctrination and control, the latter of which targeted medical commercialism during the Socialist Education Campaign. The immediate result of this process was that the pool of intestinal disease patients quickly expanded at the hospitals and clinics where most patients sought treatment. For instance, the number of intestinal disease patients at hospitals and clinics reached 2,411 in Wenzhou City’s Wuma Commune following the establishment of outpatient departments for intestinal diseases in 1963, which represents a 40.3 percent increase compared with the same period in 1962.47 At the same time, stool samples could be submitted to the county’s sanitation and epidemic prevention station more promptly. Thanks to outpatient departments for intestinal diseases and stool sample examination, medical staff could identify suspected cholera cases and confirm the diagnosis more quickly. This was particularly significant for identifying the first cholera case in a given area (that is, the index case), as it

stool sa mples, archiving patients, a nd statistica l politics

alerted the government to take immediate action. In Wenzhou City, the first cholera case was identified by the outpatient department for intestinal diseases of a clinic on April 13, 1963.48

THE COMPARTMEN TALIZATION OF THE EPIDEMIC SURVEILL ANCE NE T WORK As discussed above, the establishment of outpatient departments for intestinal diseases, the submission of stool samples for tests, and greater control over medical practitioners formed three integral steps in medical institutionalization in 1963 and thereafter. These measures significantly changed the commercially driven and fragmented medical system through institutionalization, changes to technology and personnel, and administrative procedures by extending the epidemic reporting network to the commune level (township). However, this scheme did not reach the bottom level—villages (production brigades)—because of the limited medical personnel and medical facilities available. This meant that the target reporting times for confirmed and suspected cholera cases (twelve hours in urban areas and by the second day in rural areas) could not be achieved by following the official cholera reporting procedures.49 In view of the deficiencies that official reports found in the 1962 anticholera campaign, it was imperative for the government to extend the epidemic reporting scheme from communes to villages (production brigades) while bifurcating and strengthening the reporting line using both medical professional and voluntary “mass” ways in order to keep all villagers under close surveillance. In 1964, Zhejiang Province’s health department designated Rui’an County as the experimental site for the new epidemic reporting network and gave instructions to “strengthen and adjust professional epidemic reporting organizations, while promoting the voluntary ‘mass’ reporting network.”50 Following these instructions, the Rui’an County government implemented a three-tier epidemic reporting scheme (through health-care workers in production brigades, production teams, and “courtyards,” which in Rui’an County meant a group of a few households). This system was established in more than two hundred production brigades across the county. At the first level, brigade health-care workers were responsible for epidemic reporting and other auxiliary work, such as assisting patient families, family visits, and disinfection. This level was the downward extension of the professional reporting network in production brigades. At the second and third levels, the reporting network was made up of production team health-care workers and courtyard health-care workers,

187

188

china a nd the choler a pa ndemic

who were in charge of epidemic reporting for their own production teams and courtyards. These lower two levels made up the voluntary reporting network in villages. Health-care workers at these two levels mainly focused on identifying infectious diseases in summer and winter, mastering reporting methods for acute infectious diseases, and understanding the symptoms of common infectious diseases and prevention methods.51 Brigade health-care staff were part-time workers paid by production brigades. As young commune members, they had some degree of literacy, a basic understanding of health science, and some preliminary work experience. Production team health-care workers were usually women cadres, while courtyard health-care workers tended to be older women who commanded great respect, were authority figures among “the masses,” and were usually found “reading and chanting Buddhist scriptures in their homes.” As the Rui’an County Health Division further explained, “health-care workers are divided into those with relatively high proficiency and older women and female cadres with mediocre health knowledge.” In terms of the reporting schedule, courtyard health-care workers identified patients on the spot and then reported them to the production team and brigade health-care workers, who in turn identified whether they were suffering from an infectious disease or were suspect cases, before reporting findings to doctors at the commune level.52 In this way, the professional epidemic reporting scheme and the mass voluntary reporting network were extended and integrated into villages. In addition to this vertical extension of the epidemic reporting system, a horizontal regionalization scheme was also created. In this design, each commune was divided into five or six regions, depending on their individual situations. Each region had to set up epidemic disease reporting points and was to train one or two politically reliable reporters. Trainees, who were usually selected from among health-care workers, brigade accountants, and primary school teachers, attended courses on the prevention of various epidemic diseases. To obtain the latest data on epidemic diseases and contain their spread, reporters were instructed to submit reports to union clinics on both a regular and occasional basis.53 In this reporting scheme, production brigade accountants became the second-most common reporters after health-care workers. To a great extent, this was because they were most familiar with the statistical data on their villages. Other reporters included women cadres.54 Regardless of the vertical extension or horizontal regionalization of the system, the epidemic reporting system penetrated into every corner of villages.

stool sa mples, archiving patients, a nd statistica l politics

Meanwhile, the restructuring of the People’s Commune system served to facilitate the development of the epidemic reporting scheme. As indicated earlier, the size of the individual People’s Communes was reduced greatly, while the numbers of People’s Communes, production brigades, and production teams increased correspondingly after 1961. Therefore, the number of epidemic reporters also increased in the new scheme. For instance, there were 3,413 health-care workers in Rui’an County in 1963, but by 1965 that number had increased to 4,421.55 Because of the increased number of epidemic disease reporters, villagers were under closer surveillance from the local government. The epidemic reporting scheme in more urban towns was established based on residential communities, sections, and courtyards.56 As a report from Wenzhou City’s epidemic prevention headquarters pointed out, “This scheme had three advantages to it: it meant that convening a meeting was convenient, reporting epidemic disease was quick, and doing sectional contract work [diduan baogan] was easy.”57 The compartmentalized epidemic reporting scheme based on administrative systems was very significant for the entire epidemic prevention system. The aims of the new scheme were to speed up reporting and limit underreporting of disease cases by keeping residents under much closer medical surveillance. The immediate result of this new network was that infectious disease suspects were identified and reported on more quickly than before. More significantly, compartmentalized epidemic reporting implied a degree of medicalization of the administrative system within the sociopolitical restructuring that was taking place at the time. The vertical downward extension of the epidemic reporting scheme allowed the hierarchical administrative system to further penetrate into households by imposing medical and health authorization in different ways, such as preventive inoculation, water purification, and raising awareness about hygiene. The horizontal regionalization entailed a further medical regionalization of grassroots administrative systems, including People’s Communes in rural areas and residential committees in urban areas and towns. These vertical and horizontal processes were intertwined with the professional reporting network and voluntary reporting network at the grassroots level of the administrative system. Close surveillance schemes based on both the administrative and medical surveillance network mobilized and incorporated all potential agents, including young commune members, women cadres, brigade accountants, primary school teachers, and even elderly women. Under these circumstances, all residents were thus kept under the close surveillance of local medical and administrative

189

190

china a nd the choler a pa ndemic

authorities. The political ethos of surveillance that permeated the administrative system meshed well with the requirements of medical surveillance in a cholera epidemic.

S TOOL TES T S, PATIENT ARCHIVING, AND EPIDEMIOLOGICAL CATEGORIZATION The aim of the institutionalization of the medical system and the medicalization of the administrative system was to identify and confirm cholera patients and do so promptly during the pandemic. Meanwhile, it was also crucial to establish a complete set of statistical data on cholera patients and potential patients. This information not only summarized epidemic records and allowed administrators to keep patients under constant surveillance, it also predicted epidemiological trends and then enabled administrators to take preventive measures. With the end of the cholera pandemic in November 1962, Wenzhou Prefecture initiated its “search for cholera bacterial sources” (yiyuan jiansuo) by conducting stool tests in cholera-affected areas. Under this scheme, county sanitation and epidemic teams organized stool examinations for all recovered cholera patients. Copies of each patient’s results were saved by the commune, district, and county. Stool examinations were then extended to those who had been in closest contact with recent cholera patients and to key occupational groups who were more susceptible to cholera, such as catering staff, chefs, medical staff and cleaners, transport staff, cadres, boatmen, and fishermen.58 In this way, local epidemic prevention authorities had started creating sets of statistical data on these three major groups by early 1963. This statistical archiving work was extended to the outpatient departments for intestinal diseases after the scheme was initiated in May 1963. Zhejiang temporary provincial regulations dictated that the outpatient department for intestinal diseases at each hospital and clinic should use single-page case files for patients to record their residential addresses, symptoms, epidemiological history, and inoculation history. Meanwhile, the department set up specific registration logs to record all visiting patients in the department. Departments saved these two sets of records for the purpose of analyzing statistical data while submitting another two copies to the county sanitation and epidemic prevention station and district clinic on Tuesdays and Fridays.59 By the end of 1963, local epidemic prevention departments had established a preliminary patient archive system that maintained data on recovered cholera patients, those who had had close contact with cholera patients, key vulnerable

stool sa mples, archiving patients, a nd statistica l politics

groups, and new cholera patients. This nascent scheme was very important for disease prevention work over the years that followed. Because cholera incidence in Wenzhou Prefecture plummeted from 10,717 cases in 1962 to 286 cases in 1963 and 3 cases in 1964, patient archiving work, or the classification and filing of information about patients based on stool tests, became the main focus of epidemic prevention.60 As the Rui’an County People’s Commission warned, “The existence of a source of infection could cause the outbreak and spread of infectious diseases at any time. The ultimate aim of disease eradication is to contain the spread of sources of infection. Some people think that the absence of clinical cholera patient reports means that infectious disease has already been eradicated. However, they are unaware that cholera vibrio being incubated in healthy populations is a dangerous factor and the main challenge facing current epidemic prevention work.”61 Under these circumstances, local epidemic prevention departments classified surveillance subjects based on stool sample tests in 1964. By 1965, as a crucial part of “searching for sources of infection,” the patient archive was further institutionalized by the categorizing of the individuals included in it and the recording of the timing and frequency of stool tests. Zhejiang Province’s health department ordered each locale to examine repeatedly those who had had cholera over the past two years, as well as all suspect patients, carriers of the cholera vibrio, and those who had come into close contact with cholera patients between January and April (that is, before the season when cholera usually occurs). In particular, general examinations were conducted among people who lived near infection areas, key vulnerable groups, and people who had visited cholera-infected areas in 1964 and their family members. According to the instructions, three stool tests should be carried out for these people.62 The county sanitation and epidemic prevention station worked with district and commune health-care stations to conduct a general examination to investigate prospective subjects, compile test registers, and assign numbers to each subject. Medical staff used these registers to collect stool samples and test them.63 Based on this information, staff made patient register books and mapped patient distribution based on production brigades as units.64 In this way, patient archives were integrated with household registers, just as inoculation registers were, as described in chapter 5. Patient archive work based on stool tests was significant not only for anticholera campaigns but also for the general epidemic prevention system during the same period. As a report from the Rui’an County Sanitation and Epidemic Prevention Station pointed out in late 1963, “accurate and complete epidemic

191

192

china a nd the choler a pa ndemic

disease data should be accumulated gradually year by year. However, just gathering epidemic disease data is not enough: instead, we should correct and manage this and try to make the data more accurate.” The report continued, “For this purpose, each epidemic prevention department should carefully collect and sort epidemic data, prepare a set of epidemic reporting cards, investigation forms for epidemic diseases, a specific medical record for infectious diseases, and individual registration books. We would be able to conduct comprehensive scientific analysis based on these original materials.”65 Following these recommendations, commune health-care stations or union clinics recorded data on infectious diseases they had previously categorized, made monthly disease distribution maps, and submitted epidemic reporting cards. Above them, the district health clinics supervised the registration of epidemic diseases by the commune health-care stations, and they ensured that the information was reported on time. In turn, county sanitation stations were in charge of compiling and processing epidemic information across the county. They did this by collecting epidemic information reporting cards and infectious disease registrations by categories of diseases and patients and including these cards in the county infectious disease archives.66 Creating a patient archive based on stool tests during the cholera pandemic was a process of epidemiological categorization of an entire population, which had been undergoing sociopolitical classification through different campaigns and schemes, such as class, family, and household status, since the early 1950s. With the perfection of the disease reporting scheme, the statistical data on infectious diseases based on complete household registration information became more accurate than before. Significantly, these epidemic statistical data schemes further verified, corrected, and strengthened traditional sociopolitical categorization schemes.67 The government therefore set up a completely new statistical protocol during the social restructuring between the Great Famine and the Cultural Revolution, which came to function as an alternative social control scheme.

BUREAUCRACY, RESOURCE DIS TRIBU TION, AND S TATIS TICAL POLITICS The epidemic statistics scheme based on the institutionalization of the medical system and the medicalization of the administrative system was part of a wider statistical system that gradually arose in 1950s China. As Arunabh Ghosh points out, extensiveness (guangfanhua), completeness (zhengtihua), and objectivity (keguanhua) became three features of standardized socialist statistical work.68 In rural areas, the statistical network linking production teams to the commune

stool sa mples, archiving patients, a nd statistica l politics

was gradually established from the mid-1950s on, after the beginning of the Agricultural Collectivization Campaign and the Great Leap Forward. However, the reliability (i.e., objectiveness) of statistical data was fraught with serious, controversial problems, such as false reports and the forgery of figures at different levels. Underpinning the creation of new statistical knowledge was its link to the politics of the time. Having solid statistics helped to show political loyalty, and such data could be used to assess political performance. By 1957, per the instructions of the party and government leaders seeking to verify the correctness of the Great Leap Forward, the principle that would be guiding statistical work might have been summarized as follows: “Whatever statistical data the party and government leaders require, we will provide it; wherever political campaigns and production campaigns go, we will follow.”69 This principle directed politically motivated local cadres to draw up statistics that proved their performance and loyalty. As the General Office of the Wenzhou Prefectural Committee declared in 1959, commune secretaries never actually issued forms reporting on agricultural production to production brigades. Instead, “the clerk staff just guessed the figures or let comrades who worked in production brigades make oral reports. The correlation of political performance assessments and statistical work resulted in a specific problem. They underreported the state’s needs and requirements and overreported progress on agricultural production. They reported excessively high figures for their achievements and excessively low ones for the problems they were facing, if they reported them at all. The situation was particularly extreme in reports on achievements and progress.”70 As each commune was assessed on the basis of its agricultural production, this became a core aspect of political rivalry between communes. For example, three communes sharing one telephone line in Xincheng District in Rui’an County eavesdropped on phone calls to find out about the other communes’ reports so as to then report higher figures for their own communes at the height of the Great Leap Forward campaign.71 Meanwhile, assigning large quantities of paperwork was another important way to show political enthusiasm and commitment. For example, Zhejiang Province’s agriculture, education/culture, and health departments issued a total of 70 types of statistical forms, which involved a total of 1,780 items relating to rural areas during the Great Leap Forward.72 Some figures were hard to obtain. For instance, in January 1958, Wenzhou City launched its first Seven Pest Eradication Campaign, which was designed to wipe out fleas, cockroaches, and other insects. In reports on the progress of this sanitation campaign, the numbers of these eradicated pests were required to be brought down to single digits.73

193

194

china a nd the choler a pa ndemic

Although the Agricultural Collectivization Campaign and the Great Leap Forward ended with the outbreak of cholera in summer 1962, the impact of this kind of statistical bureaucracy lingered because of the close relationship between the assessment of political performance and statistical work. In August 1963, the Wenzhou City Health Bureau criticized a few hospitals for “reporting cholera cases too generously,” which would mean that the local government appeared not to have been effective at cholera prevention and treatment. In some counties of Wenzhou Prefecture, epidemic information could be reported only after the county party commission had approved it. In view of this situation, Li Lanyan, the director of Zhejiang Province’s health department, complained, “Leaders in some areas were afraid of being labeled infectious disease-affected areas. They hid epidemic information because they were afraid that local goods would not be able to move out of the area to be sold [which would affect the local economy and then further impact the assessment of their political performance]. Therefore they were unwilling to report infectious diseases and did not implement the principle of ‘baobing congkuan, chabing yaoyan’ [broadly reporting and seriously examining].”74 Meanwhile, the extension of the epidemic reporting scheme and patient data archiving initiated during the cholera pandemic in 1963 also unexpectedly brought about some bureaucratic changes within health administration departments. In 1965, Zhejiang Province’s health department criticized some grassroots health units for issuing flawed statistical forms to rural communes and urban residential committees: “Over the past few years, because our health administration authorities have become seriously bureaucratic, they have lost control over the issuing of statistical forms. They have issued some forms that are completely divorced from reality, some of which are completely nonsensical. These not only caused hard work but also had very negative political impacts.” In view of this, the department warned that all grassroots health organizations should refrain from issuing such statistical request forms following the instructions from the Ministry of Health in its “Circular on Resolutely Forbidding the Over-Issuing of Statistical Forms.” These instructions required that local health administration department issue only new forms that had been approved, such as the statistical annual health forms in 1964 and the regular statistical health forms in 1965.75 The distribution of medical resources along the urban/rural divide also had a significant impact on statistical work relating to cholera and other epidemic diseases. As mentioned earlier, district and commune health-care stations or union clinics were basically collective medical entities that were responsible

stool sa mples, archiving patients, a nd statistica l politics

for their own profits and losses. Although they were newly institutionalized through medical regulation and political discipline during the cholera pandemic, the government did not provide them with funding, which state-owned medical units did receive from the government. This funding structure affected the entire epidemic prevention system at the county level and below, further impairing epidemic surveillance and statistics to some extent. For example, the Rui’an County Health Bureau pointed out in December 1964 that the bureau had made great efforts to improve grassroots health organizations over the past two years. However, a few serious problems with medical doctor collectives persisted in terms of epidemic prevention work. Worse still, there were only two staff members for the management of grassroots health organizations at the county health bureau, including a member of the Communist Party who was in charge of pharmaceuticals. Because of an insufficient number of medical officials, the department intended to recruit one more staffer from collective medical units to assist the county health department in strengthening the management of district and commune union clinics. The cost of this was to be covered by local union clinics. The health bureau would charge 0.05 percent of gross business revenue from each medical unit as a management fee. It was estimated that this fee would raise approximately 300 yuan per month.76 This resource distribution structure also affected medical staff and their proficiency. Because there were insufficient staff in outpatient departments for intestinal diseases, stool sample testing frequency was not improved at district and township union clinics. For example, the Rui’an County Sanitation and Epidemic Prevention Station admitted in the report it submitted to Zhejiang Province’s health department in 1964 that “epidemic prevention staff and equipment could not keep up with the demands of the actual work. Only 30 percent of health-care stations [i.e., union clinics] had full-time epidemic prevention staff in charge of collecting and recording epidemic information, categorizing infectious diseases, and analyzing the regional distributions of infectious diseases by month. In the majority of health-care stations, there was no full-time staff for this work, not to mention any who could analyze epidemic information.” Medical proficiency was another serious problem. The Rui’an County Sanitation and Epidemic Prevention Station report continued, stating, “The majority of the medical staff were rural practitioners of Chinese medicine who were born and grew up in villages. Their medical proficiency was very poor, although the medical institutionalization process allowed them to join medical collectives and improve their proficiency. Some had no understanding of basic standards for diagnosis.”77

195

196

china a nd the choler a pa ndemic

Under these circumstances, outpatient departments for intestinal diseases at hospitals and clinics suffered from institutional dysfunction due to constraints on medical personnel and their proficiency levels. One might naturally expect criticism of the proficiency of rural medical practitioners coming from above. But there was also a willingness to be critical of the performance of the outpatient departments for intestinal diseases that had been set up by the administration. In March 1964, Zhejiang Province’s health department acknowledged that outpatient departments for intestinal diseases played an important role in identifying the origins of cholera, promoting preventive measures, and controlling the spread of the disease since their establishment in 1963. Nevertheless, the report then pointed out that “some hospitals were careless regarding the work of their outpatient departments for intestinal diseases.”78 The Rui’an County Sanitation and Epidemic Prevention Station also admitted in late 1964 that “we assumed that as long as they could manage the outpatient department for intestinal diseases well, they would be able to control the vast majority of acute intestinal diseases. However, that was not the case.”79 In some hospitals and clinics, the report complained, patients with obvious symptoms were typically registered and stool samples were taken from them, while patients with mild diarrhea were not registered and no stool samples were taken. Likewise, local patients were subject to this procedure, but those from other areas coming to visit relatives and friends were not. Some clinics registered patient names but didn’t completely fill in registration forms for them.80 For example, a retrospective survey found that only 25 percent of the intestinal disease patients in Tangxia District in Rui’an County had been registered in 1963, when the outpatient department for intestinal diseases was first established.81 As is indicated by table 6.1, the underregistration rate in 1964 in outpatient departments for intestinal diseases of hospitals and clinics located in Rui’an County town was still above 47 percent. When the funding scheme for local collective medical units adversely affected epidemic surveillance in local clinics, the refusal or avoidance of medical treatment by rural populations also went beyond the control of the professional and voluntary reporting networks in villages.82 Many Chinese villagers were unwilling to disclose the illnesses of their family members to outsiders because of social customs and medical beliefs. Furthermore, as mentioned earlier, many people believed that it was very common and even good to have diarrhea in the summer, when intestinal diseases were rampant. This unwillingness to cooperate was defined as “resistance due to old customs” in the official documents.83 However, the fees charged for stool tests and medical consultations were even

stool sa mples, archiving patients, a nd statistica l politics

197

Table 6.1. Underregistration rate of patients at the outpatient departments for intestinal diseases, Rui’an County, 1964

Dates

Number of prescriptions examined

Number of cases diagnosed with intestinal diseases (total)

Number of missing registrations

∙ Nanmen

Aug. 25–31

430

28

17

61.0

∙ Laogong

Aug. 25–31

689

15

7

47.0

Clinics

Underregistration rate (%)

County town clinic

∙ Dajia ∙ Lianhe Xianjiang District clinic

Aug. 25–31

682

74

41

55.0

Aug. 20–Sep. 4

383

22

20

91.0

Aug. 25–31

747

22

31.0

Xincheng District ∙ Tingtian clinic

Aug 23–Sep. 1

17

6

35.4

∙ Central clinic

Aug 23–Sep. 1

760

32

10

33.3

July 1–15

1129

221

0

0.0

26

5

19.2

Tangxia District ∙ Changqiao clinic Mayu District ∙ Caocun clinic

Jun. 26–Jul. 6

Source: Rui’anxian renwei weishengke, “Fangyi jiancha qingkuang,” 1964, RAA, Vol. 142-9-4.

more important than traditional beliefs. As early as 1952, the State Council began granting free medical services to civil servants at each government level, as well as to party and association members and disabled veterans of the revolution.84 In the same year, labor insurance medical services were granted to workers in state-owned enterprises.85 However, the peasants who made up the majority of the Chinese population had no public medical care, except for inoculation against infectious disease, endemic disease treatment, and sporadic free clinical services. In contrast, the expenditures for the free medical services enjoyed by civil servants in Zhejiang Province accounted for 40 percent of the total expenditures of health departments by 1962. Zhejiang Province’s health and finance department observed that “this situation has already seriously affected health budgets and the development of medicine and health care.”86 These schemes for medical resource distributions continued until the establishment of outpatient departments for intestinal diseases in 1963 and afterward. According to regulations on cholera epidemic prevention costs issued jointly by the Zhejiang Province’s finance department and its health department in 1964,

china a nd the choler a pa ndemic

198

if patients with infectious intestinal diseases and diarrhea were admitted to outpatient departments for intestinal diseases and wished to have stool tests, they needed to pay the hospital twenty cents. As stated earlier in this chapter, in some district medical units and collective union clinics, there were no medical facilities for conducting stool examinations and stool samples had to be submitted to a county sanitation and epidemic prevention station. Under these circumstances, medical units would charge a fee of ten cents for submitting a stool sample.87 The total fee of thirty cents for one stool examination was a high price for commune members, who earned less than thirty cents per day on average in the Wenzhou area in the early 1960s.88 For all these reasons, commune members who sought treatment for intestinal diseases at hospitals accounted for only a portion of patients. Many members neither sought treatment nor purchased medicine at all if they had diarrhea, and other patients with diarrhea and/or vomiting continued laboring in the fields. For example, according to a survey of the Linao Production Brigade in Pandai Commune, Rui’an County, in 1964, there were ninety-three intestinal disease patients. However, only thirty-one patients visited doctors and the number of patients who did not seek treatment reached sixty-two, accounting for 66.7 percent of patients with such symptoms.89 The epidemic statistics that outpatient departments for intestinal diseases collected were still incomplete because they only had access to information on patients who had consulted local clinics or doctors.

CONCLUSION The rise of epidemic statistical politics was very significant within the social restructuring process that took place during the pandemic of 1962–1965. As this chapter explores, this process effectively integrated and restrengthened both medical and administrative systems. The measures taken involved medical institutions, technologies, practitioners, epidemic reporting schedules, patient archives, and epidemic data analysis, and they endowed the administrative system with surveillance power through structural compartmentalization. This process functioned as a new sociopolitical control and disciplinary scheme for the government. It was very significant that this nascent epidemic statistical scheme in principle brought about a comprehensive categorization of the entire population according to epidemiological definitions, such as former cholera patients,

stool sa mples, archiving patients, a nd statistica l politics

those who came into close contact with cholera patients, key vulnerable groups, healthy populations, and so on. During this process, the government attempted to control cholera by controlling population data. By recording the number of cholera cases, the government not only acquired knowledge about cholera itself, its progress, and its speed across the country, it also acquired knowledge on population numbers, right down to the village level. Population numbers were now clearly recorded at the level of individuals and households, which functioned as sites of knowledge for both medical attempts to control cholera and the government’s attempts to control mobility and productivity in rural villages. The surveillance of medical agencies and of a central government was affected by a totality of populations and individuals. These two processes reinforced one another. The significant factor here is that this process entails a convergence between different sets of population data both during the cholera pandemic and after, which included baseline household registration records, preventive inoculation registers, epidemic patient archives, categorized epidemic population records, and the population numbers that were expected to be affected by epidemic diseases, especially in rural areas. These statistical politics were much easier to implement in an urban society, which was organized into work units, because of more complete and reliable population data and effective control schemes. For example, in 1963, the Wenzhou Prefectural Epidemic Prevention Headquarters issued instructions that all employees of prefectural departments and enterprises, as well as school students, should have three stool tests conducted at two-day intervals before departing for Hangzhou City and other provinces for work or study or to attend meetings. When checking in at hotels, they should take the stool test results issued by epidemic prevention departments with them. They would be denied accommodation if they did not have documented test results. Staff traveling for work were to carry letters of introduction issued by their own work units and have their stool tests undertaken at designated hospitals, which were responsible for conducting tests for them. Unlike rural populations, the examination fee (thirty cents) would be covered by the government via its free medical services and labor medical insurance schemes.90 However, as this chapter argues, the epidemic statistics scheme suffered from institutional dysfunction due to excessive bureaucracy and weak resource distribution. These problems were difficult to remedy within the broader social restructuring taking place because many of those responsible were motivated by the political implications of performance assessment schemes and also because

199

200

china a nd the choler a pa ndemic

the rural/urban divide in health care remained extreme. Nonetheless, the epidemic statistical politics based on the surveillance of epidemic information was very significant for social restructuring in the early 1960s. In all, as the new and integral biopolitical control tool, the epidemic statistical scheme quickly developed as a crucial part of an emergency disciplinary state, which was further strengthened by the control of epidemic information, as the final numbered chapter will discuss.

7 “NO. 2 DISEASE” A National Secret

WENZHOU PREFECTURE IN ZHE JIANG PROVINCE WAS THE MOS T SERIOUSLY S TRICKEN area in the first global pandemic that affected Communist China after 1949. In view of the increasingly devastating spread of cholera, the deputy ministers of the Ministry of Health, Qian Xinzhong and Xu Yunbei, spent July and August 1962 in Wenzhou, where they supervised and coordinated the epidemic prevention work, managing medical professionals, materials, and technologies.1 Although they obtained strong support from the central government, the national-level emergency response in Wenzhou Prefecture was small in scale compared to work by local governments in southeastern coastal China, including both cholera-affected and unaffected areas, or relative to major municipalities nationwide. By the start of the Cultural Revolution in 1966, the pandemic had produced a total of 29,613 cases and resulted in 2,306 deaths across Guangdong, Zhejiang, and Fujian Provinces in southeastern coastal China. According to the admittedly incomplete statistical data of the time, the epidemic was contained by this point, and there were only a few sporadic cases of cholera reported subsequently in Mao’s China. However, the Chinese government’s large-scale anticholera campaign was effectively a clandestine operation, as there was no coverage of it in central or local media. In the official history of medicine, health, and disease in post-1949 China, this pandemic has been downplayed, described in simple terms such as 201

202

china a nd the choler a pa ndemic

“in the early stages of this global cholera pandemic, it spread to Yangjiang and Yangcun Counties in the west coast of Guangdong Province and to the Hong Kong and Macau areas in July and August 1961.”2 Some local gazetteers published in the 1980s and 1990s in cholera-affected areas make brief mention of this pandemic but avoid statistical detail. This local outbreak of a global cholera pandemic disappeared within classified internal government documents because the pandemic information control program in 1961–1965 was a coordinated political response. This chapter examines why the government was concerned with epidemic information and how it committed to controlling it in the specific domestic and international sociopolitical contexts of the time. It also shows how information control contributed to the concurrent social restructuring. It argues that, due to religious, social, and political concerns, the pandemic was ruled a “national secret” and cholera was referred to simply as the “No. 2 disease.” All information on the pandemic was strictly controlled and used for political discipline, indoctrination, and ideologizing.

RELIGIOUS PRACTICES, SOCIAL ORDER, AND POLITICAL LEGITIMACY IN PANDEMICS After 1949, the Communist government was vigilant in guarding against acute infectious diseases like cholera. As early as spring 1950, the Ministry of Health of the Central People’s Government and the Ministry of Health of the People’s Revolution Military Committee had issued a joint circular stating, “According to earlier statistical records, cholera has been ravaging almost all of China, with major outbreaks every three to five years. . . . The summer will soon be upon us. . . . In each area of south China, each government should take immediate action.”3 The new regime’s vigilance against epidemics and pandemics was not only due to high incidence rates and the deaths they caused. It was also motivated by challenges to the social order and the political legitimacy brought into question by diseases due to their impact on major religious, social, and political events. Rampant epidemics and pandemics brought extreme suffering to generation after generation in Chinese history, some leaving indelible marks on popular memory. Accounts of these acute diseases were usually dominated by terrifying tales of suffering. In a local description of the cholera pandemic in Zhejiang Province in the early 1900s, “cholera was called ‘huyi’ (tiger epidemic). People who had carried the corpses of cholera patients to be buried a few days earlier would be carried to their own graves by other people a few days later.”4

“no. 2 disease”

The frequent occurrence of epidemics and pandemics throughout history further led people to develop supernatural interpretations of the etiologies of these diseases, with many seeing pandemics as divine retribution for immoral behaviors, including sexual promiscuity and gluttony.5 These supernatural interpretations naturally increased the popularity of religious practices during pandemics, either as collective efforts or as individual household actions to drive away the ghosts and demons of epidemics.6 According to Paul Katz, the expulsion of plague demons in the history of Zhejiang Province focused on the cult of a deity named Marshal Wen (Wen yuanshuai), who was in charge of preventing the outbreak of epidemics or expelling pestilent forces. The cult of Marshal Wen originated in Pingyang County as early as the Song dynasty and then spread to Wenzhou, Hangzhou, and other parts of Zhejiang Province and China, a pattern of spread that generally followed the geographical distribution of epidemics and pandemics.7 Plague-expulsion festivals were often a community response to epidemics and pandemics, with residents taking whatever preventive measures they thought were efficacious. For example, residents in Wenzhou paraded statues of Marshal Wen around their neighborhoods to expel plague.8 Religious practices also permeated daily life in Wenzhou before 1949. A Wenzhou native, Han Yonggang, recalled the ideologies, organization, and popularity of these: “In 1946, small lanes crossed all over Wenzhou City. People believed in superstition back then but not in bacterial transmission. Each lane had its own Buddha, each different from the others. A few lanes shared a larger Buddha, whose position was equivalent to the director of the urban residential committee. Each locale held a big ceremony on a specific day of the year, when tens of thousands of people would participate in welcoming this Buddha, whose status was like that of the local mayor rather than the national leader, who was the equivalent of the Shakyamuni Buddha [the founder of Buddhism].”9 These supernatural interpretations of disease etiologies contradicted Communist political ideologies based on atheism. Collective efforts to drive epidemic ghosts and demons away through popular religious rituals and ceremonies like the cult of Marshal Wen were believed to be a threat to the social order because of their great appeal to local residents. Religious practices also challenged the political legitimacy of the Communist Party because they established a parallel structure of authority that undermined the officially preferred hierarchical chain of social organization based on neighborhood committees. In response to this threat, the party’s medical and health campaigns from the early 1950s on were closely intertwined with campaigns against religious

203

204

china a nd the choler a pa ndemic

practices. As the word campaign suggests, the language of epidemic prevention contained militaristic metaphors for health care and epidemic prevention, like “fight,” “eradication,” “targeting,” and “annihilation.” These terminologies originated from the experience of war and shaped not only the ways in which infectious diseases were understood but also the methods for preventing epidemics in peacetime.10 Diseases were also portrayed as enemies in these campaigns, representing potential challenges to social order and the political legitimacy of the Communist Party. While it actively engaged in different prevention and treatment schemes and campaigns, control over epidemic information also became important political work designed to reduce the social and political impacts of epidemics. By the time the cholera pandemic reached China in 1962, the government had already suffered serious social and political crises after the catastrophic Great Leap Forward and Great Famine. Left fragile and sensitive, the Chinese government now faced more serious challenges. Collective reactions during the pandemic, such as panic and flight, also included large-scale religious healing practices, which posed immediate danger to the social order and promoted cholera transmission. For example, Wuliang Temple in the Shenxian Mountains of Cihu Commune in Wenzhou City hosted hundreds of pilgrims in July and August 1962. These pilgrims came from Rui’an and Pingyang Counties in the south and Wenzhou City and Yongjia County in the north. The pilgrims all traveled long distances, attracted hawkers, and without adequate public facilities would urinate freely in areas around the temple. On August 17 a monk at the temple died of cholera, followed by another five days later. Around two weeks after this, one pilgrim had cholera, and another two monks were identified as cholera carriers. As these monks never left the temple, it was assumed that cholera had been spread by pilgrims. A fifty-eight-year-old villager then prayed at the temple and was infected with cholera after eating contaminated shrimp and prawns. Heavy rainfall then washed contaminated water into the rivers at the bottom of the mountain. Within fourteen days of the first monk coming down with cholera, a total of twenty-three other cases emerged in eight neighboring villages.11 In the government’s view, the cholera pandemic also impaired political legitimacy and China’s national image. As Deputy Health Minister Qian Xinzhong pointed out in December 1962, “Our nation is a socialist country. An outbreak of cholera is incompatible with the image of health and culture in the nation. It is highly politically impactful. Since Liberation, there has been no cholera, which has improved our international reputation. . . . The occurrence of acute infectious

“no. 2 disease”

intestinal diseases like cholera is an indicator of low levels of health work and people’s living conditions.”12 Under such circumstances, control over information about the cholera pandemic was believed not only to prevent social panic and reduce the spread of superstition but also to maintain political legitimacy and the national image. Pandemic information control was therefore highly politicized: implementing a top-down pandemic information control scheme was important political work that mirrored and corresponded to the bottom-up information collection scheme. Pandemic information control was a new facet of the anticholera campaign, in contrast to more traditional measures such as quarantine, isolation, and inoculation that have been discussed in previous chapters.

HIERARCHICAL INFORMATION, DISEASE ENCODING, AND POLITICAL DISCIPLINE Any information control scheme entails the classification of information, issuing procedures, access rights, and continuous monitoring. As early as the Yan’an era (1936–1947), the Communist Party had basically established principles regarding the hierarchical classification of and access to information. In his book on the Yan’an Rectification Movement, Chinese historian Gao Hua analyzed the logic of hierarchical information structuring by the Communist Party: While the masses are classified as left, middle, and right, party members can be classified as left, middle, and right, too. Since human beings are classified, the right to access information [zhi] is against egalitarianism. The political consciousness and theoretical proficiency of middle- and low-level party members could not resist the attack of the “poison” spread by domestic and international newspapers and magazines. Only a few senior party officials who went through tough tests are qualified enough to be allowed to access certain important information. The more senior officials were, the fewer the limits that would be imposed. There was no need for the ordinary masses to obtain information beyond that contained in party newspapers in order to maintain their political and thought purity. Nevertheless, ordinary party members could access more information than ordinary masses by reading party materials and listening to reports and instructions at party meetings, which were a privilege that only party members had in terms of information. However, compared with senior party cadres, ordinary party members’ rights were meaningless.13

By the early 1960s, the information control scheme had been finalized with the implementation of the “Regulations on Protecting National Secrets Issued by

205

206

china a nd the choler a pa ndemic

the Commission for the Protection of National Secrets of the Central Committee of the Communist Party of China.” According to these regulations, national secrets generally refer to “all matters that the party and the state have not decided on yet, or have decided on but not publicized, or that are not allowed to be publicized.” National secrets not only included all national defense and military plans, development strategies, and national defense projects but also national economic plans, budgets, financial matters, material resources, and price fluctuations. National secrets also broadly covered cutting-edge scientific research, public security, industry projects, transportation, locations of key mining resources, and so on. In particular, the scope of national secrets extended to “overseas Chinese affairs, culture and education, and health and pharmaceuticals.”14 The regulations also set out detailed instructions on protecting secrecy. All secret documents, materials, and drawings were to be classified as top secret, confidential, or secret. Different secrecy protection measures would be adopted for each level. According to these regulations, “Each recipient work unit should designate politically reliable clerical staff to open and register documents. If documents indicate that chiefs of work units should receive them in person, the documents should be handed over to either chiefs of staff or those designated by chiefs to open them.” Upon receiving top-secret and confidential documents from higher up the chain of command, “Each work unit should strictly follow instructions if higher-up units have specified the scope of dissemination. Recipient work units should not expand this.”15 Work units usually organized chiefs of staff and key staff and cadres designated by chiefs to read and study such information. Nonparty cadres were prohibited from reading confidential party documents. If necessary, the party committee chief could approve and designate a specific section for them to read or disseminate to them orally. In terms of communication, the regulations instructed that “all matters involving national secrets should not be communicated via unencoded telegraph messages [mingma dianbao] or radiotelephones. . . . Each unit should refuse to answer any queries about important secrets and requests to obtain confidential statistical figures sent by radiotelephone and unencoded telegraphs and should further report to the secrecy protection commission.” Regarding management, “all top-secret, confidential, and secret documents should be sorted every six months at the city level and each quarter at grassroots units. All discarded documents should be destroyed under the close surveillance of two staff designated by the chief.” Meanwhile, the party and the government constantly required “each locale to enhance revolutionary vigilance to prevent spies and any other

“no. 2 disease”

antirevolutionary elements from stealing political, national defense-related, scientific, or technological secrets.”16 He Nangao, after he returned from military service in 1965, became a commune clerk in charge of receiving and storing official documents. He was promoted to the position of commune party secretary in the late 1970s. In his experience, the issuing of documents followed the procedure of “first inside the party and then outside the party”: It was routine for Central Committee and central government documents to be distributed at the county level. These documents were classified into top secret, confidential, and secret, which were indicated on the top right corner. Following the orders contained in Central Committee documents, the county prepared and issued instructional documents to grassroots units for implementation. A lot of documents were publicized only to party committee secretaries and directors at township or People’s Commune levels. Party committees then informed all party members within their townships and communes about them, before the party branches of production brigades convened mass meetings to announce these instructions. All county documents that were distributed to the township or commune levels were then registered, classified, and saved according to secrecy level. By the end of each year, all documents had to be submitted to the county archives for storage.17

The epidemic information control scheme was developed and strengthened within this framework from the early 1950s onward, including the definitions of secrecy level, issuing procedures, and access rights. Furthermore, as a specific way of protecting secrets, the government assigned a code to each reportable infectious disease. This control scheme was already in place by the time of the Great Famine. In November 1960, Zhejiang Province’s party committee office instructed each locale to classify all information on hunger, diseases, and famine refugees as secret documents in view of the devastating effects of the Great Famine. It ordered that all statistics should be reported from the bottom up, while all epidemic information that had been disseminated to units at lower levels should be recalled.18 In order to strengthen secrecy protection, the provincial party committee instructed that infectious diseases should not be reported using unencoded telegraph messages, which were believed to leak information to enemies. Instead, it designed a set of codes for major infectious diseases. For example,

207

208

china a nd the choler a pa ndemic

0001 diphtheria 0002 scarlet fever 0003 meningitis 0004 measles 0005 pertussis 0006 anterior poliomyelitis 0007 influenza 0008 bacillary dysentery 0009 amoebic dysentery 0010 typhoid fever The reporting format included the disease code, incidence, and mortality. For example, 0012 was the code for infectious hepatitis, so if there were ten cases of infectious hepatitis and one death, the report should use the following formal code: (0012) 10 (1).19 The government imposed sanctions on violations of this reporting procedure. For example, on November 17, 1960, Wenling County, under the jurisdiction of Wenzhou Prefecture, used an unencoded telegraph message sent to the Zhejiang provincial government to report hunger, disease, and people fleeing famine. The provincial party committee ordered the Wenzhou prefectural committee to criticize Wenling County’s party committee, which was required to engage in self-criticism.20 Right after cholera broke out in Guangdong Province in 1961, the epidemic information control scheme was enhanced and cholera information was quickly elevated to “national secret” level. The party and government system were kept informed of the cholera pandemic in a strictly controlled fashion. In July 1961, the Ministry of Health continually sent internal warning circulars to each province in southeastern coastal China. Zhejiang Province’s health department released an urgent circular concerning the prevention and treatment of infectious diseases during the summer following a cable from the Ministry of Health. Without specifically indicating Guangdong Province, the circular warned that cholera had broken out in a few counties and communes in the neighboring province in coastal areas and had not yet been contained. The circular added that “though there was one province between our province and the infected province, there are many coastal counties and cities, islands, and railway networks and contact is frequent. Each locale must be vigilant and take immediate urgent measures.”21 After the reemergence of cholera in eastern Guangdong Province in February 1962, the central government repeatedly sent out similar warnings.22 As a crucial

“no. 2 disease”

step in preparing for the outbreak of cholera, the Ministry of Health distributed Compiled Data on Cholera Prevention and Treatment, a publication prepared by the Guangdong Provincial Epidemic Prevention Bureau, to the southeastern coastal provinces on March 5, 1962. Each copy of the book was given a reference number: Zhejiang Province’s health department received three copies, numbered 64, 65, and 66. In distributing these materials, the Ministry of Health pointed out in a circular that “cholera epidemic information is a national secret. Each unit should protect information strictly when using it and should not lose it. These volumes should be stored as secret materials and should not be lost. Each unit may organize relevant staff to study the information collectively. With the approval of work unit chiefs, senior and middle-level epidemic prevention and medical staff can borrow these materials, but they should not take them outside work units.” The circular also stipulated that “each locale should not use and cite statistical data on the cholera epidemic or the names of cholera-affected areas. The technical content of epidemiological or clinical studies, tests, or preventive measures in this book should not be copied and published.” The director of Zhejiang Province’s health department signed the receipt slip and submitted it to the Ministry of Health as evidence of receiving these three volumes.23 After the cholera pandemic spread northward through the southeastern coastal areas in July 1962, the Ministry of Health collected cholera pandemic information nationwide through a bottom-up epidemic reporting scheme, as discussed in chapter 6. Meanwhile, the ministry regularly edited and updated Compiled Data of Cholera Prevention and Treatment, based on the experience of each province. Each edition of these materials had a predetermined number of copies, and a code was assigned for each recipient. On December 29, 1962, the Ministry of Health distributed 655 paperback and 30 hardcover copies to 16 provinces and municipalities, including Guangdong, Fujian, Zhejiang, Shanghai, and Jiangsu. Zhejiang Province received 46 volumes of materials (numbers 145–90) and two hardback copies (numbers 71 and 72), after which Zhejiang Province’s health department prepared a registration form for issuing them. Each recipient person was assigned a number and unit according to their political rank in the party and government system. In the circular accompanying the materials sent to the Wenzhou Prefectural Sanitation and Epidemic Prevention Station, Zhejiang Province’s health department stipulated, “Compiled Data of Cholera Prevention and Treatment issued by the Ministry of Health is top-secret material. We are distributing it to Comrade Lin Yuncheng of your unit for use and storage. After use, he should submit the

209

210

china a nd the choler a pa ndemic

material to the unit, which should store the book as secret material. If this comrade is transferred to another job, he should return the material to the unit.”24 Each locale compiled reference materials on cholera that were then distributed to districts, commune cadres, and clinic directors. They would copy some content according to local publicity needs, to be used in oral announcements to the masses.25 Through this top-down scheme, the government controlled and filtered pandemic information based on political hierarchies. In order to avoid the leak of cholera pandemic information, the government designated code “02” for cholera in the reporting system to replace the earlier system of numbers. In a circular dated July 30, 1962, Zhejiang Province’s health department instructed that “all documents and materials involving epidemic information relating to this disease [cholera] should be processed as top-secret documents. The code ‘No. 2’ should be used as the unified code in telephone and telegraphic reporting in order to prevent official secrets from being leaked.”26 This encoding originated from the infectious disease management regulations issued by the Ministry of Health in May 1955, which divided infectious diseases into two categories: Type A plague (No. 1), cholera (No. 2), and smallpox (No. 3), while Type B included fifteen other kinds of infectious diseases.27 In order to intensify secrecy protection around cholera, the government continuously monitored data flows and the information dissemination processes. The Zhejiang Provincial Epidemic Prevention Headquarters ordered that all prefectural, city, and county epidemic prevention headquarters and quarantine stations should not use their own official seals to submit reports and issue documents but should instead do so only in the name of the health bureau.28 Each government agency was to send a copy to higher-up levels and to the party committee at the same levels when issuing circulars and instructions concerning the cholera pandemic to lower levels. The Zhejiang provincial government therefore kept the circulation and dissemination of official files concerning the cholera pandemic under close surveillance and quickly identified problems that arose during this process. For example, the Wenzhou Prefectural Epidemic Prevention Headquarters compiled its Bulletin of Epidemic Prevention Work, which focused on cholera pandemic information, and it distributed copies of each issue to different administrative and medical units as “internal materials” in July 1963. After receiving copies of these bulletins, the Zhejiang Provincial Epidemic Prevention Headquarters notified the Wenzhou Prefecture Epidemic Prevention Headquarters

“no. 2 disease”

that pandemic information should be processed as “top secret” and should be reported only to higher-up levels. The instructions required the Wenzhou Prefecture to correct each issue of these bulletins that had been wrongly labeled “internal materials,” something that could have caused the leaking of pandemic information. The instructions drew particular attention to the fact that the headquarters should not mention accurate statistical figures on the pandemic in documents distributed to lower levels.29 Similarly, in Zhenhai County in neighboring Ningbo Prefecture, the county health bureau issued a circular on the epidemic prevention plan on June 22, 1964. Following secrecy protection regulations, this circular was supposed to be a top-secret document because it mentioned information on cholera-affected areas in 1962 and thus was not to be circulated to grassroots units. The Zhejiang Provincial Sanitation and Epidemic Prevention Station soon identified this problem in the file forwarded by the Zhenhai County Health Bureau and issued a warning circular to Zhenhai County, criticizing it for not processing the file appropriately for a top-secret document and for disseminating it to grassroots units. The circular warned that this file could easily leak secret information on cholera and lead to serious problems. It further ordered the Zhenhai bureau to change the secrecy level of the document and prevent a similar incident from occurring again in the future.30 Facing serious criticism from the provincial government, the Zhenhai County Epidemic Prevention Headquarters carried out an immediate investigation. In the response document, the Zhenhai bureau admitted that its current situation was due to the careless issuing of documents: although the bureau had indicated it was a top-secret document in the draft, it classified the final document as ordinary. Zhenhai County admitted that this was a serious fault and that it had not really educated the relevant staff. The county had already notified the grassroots units that received the documents that they had to be secured.31 Mirroring this top-down control, there was bottom-up monitoring within the hierarchical administrative system. On September 5, 1962, Zhejiang Province’s health department reported to the Ministry of Health that the Commodities Bureau of the Ministry of Chemical Industry had sent unencoded telegrams to inquire about the use of medicine for cholera patients. In response, the ministry reported and criticized the Ministry of Chemical Industry.32 The government also regularly destroyed materials containing cholera pandemic information. With the approval of the Secrets Protection Commission of Zhejiang Province’s party committee in January 1963, the province’s health

211

212

china a nd the choler a pa ndemic

department instructed each relevant department to conduct a comprehensive check of all materials containing cholera pandemic information and gather these items together, while destroying important documents following regulations regarding the destruction of archival documents. Specifically, individuals were instructed not to retain materials concerning the cholera pandemic.33 These monitoring schemes continued until the very end of the cholera pandemic. By January 1966, cholera had been basically contained and members of Zhejiang Province’s disease prevention and treatment team returned to their original work units. According to instructions from Zhejiang Province, “Each person should be educated on how to keep information secret before their departure. No one should take away documents concerning this cholera pandemic. All materials and notebooks should be submitted to local health bureaus for storage.”34

SILEN T MEDIA AND THE INDOCTRINATED MASSES During the 1961–1965 cholera pandemic, the government also kept strict control over media reports concerning the outbreak. This was relatively easy to implement because, as James Townsend and Brantly Womack argue, “the public communications network in China is almost exclusively an official (state or party) operation, subject in its content and management to the control of central political authorities.” In their opinion, “Virtually all information disseminated through the network is that which central leadership or subordinates acting on their perceptions of central intent have approved for public release. The public is told what the leadership wants it to know.”35 The secrecy protection regulation further filtered the information released via the media: “News and broadcasting units (including the editorial departments of blackboards and of wall newspapers) should conduct secrecy investigations before publication and broadcasting. If significant issues that could not be cleared and resolved are encountered, documents should be submitted to the authority in charge of investigations.”36 The media coverage of the cholera pandemic in 1961–1965 unfolded under this system in which the central government was in full control of the dissemination of reports, including their timing, content, and format. The People’s Daily, which was the mouthpiece of the Central Committee of the Communist Party of China, was the most authoritative newspaper in the hierarchical propaganda system. The first report on the cholera pandemic appeared on August 30, 1961. The report admitted that El Tor cholera had spread in Yangjiang, Yangchun, and Dianbai Counties of Guangdong Province.

“no. 2 disease”

The report highlighted the government’s efforts to contain the spread of the disease: Our government departments have taken effective measures to contain the spread of the epidemic. Patient tests have confirmed that the disease that has broken out in these areas is paracholera [i.e., El Tor cholera]. . . . After the outbreak of cholera in the areas mentioned above, the Ministry of Health of the central government immediately dispatched a batch of medical experts, including Guangdong medical and health staff, who went to these areas to conduct treatment and prevention work. They inoculated residents and fully controlled the spread of the epidemic. So far, there have been 284 confirmed cases of paracholera patients in Yangjiang, Yangchun, and Dianbai Counties, 28 of whom have died. Major cities and ports in Guangdong have already conducted preventive measures. There were no cholera patients in Guangzhou and Zhanjiang.37

This was not just the first but also the only media report concerning the cholera pandemic that spread in mainland China from 1961 to 1965. The remaining cholera-related reports covered the pandemic in neighboring areas, including Hong Kong, Taiwan, and other Asian countries, and had three types of content. The first covered the outbreak of cholera in Hong Kong on August 28, 1961, before the official recognition of cholera in mainland China on August 30. This report assured people that Guangdong Province’s health department had already taken urgent measures and strengthened transport quarantine.38 The second was a report on medical humanitarian relief that described how the Chinese Red Cross Society had donated cholera vaccine to the Philippines Red Cross Society, while the People’s Daily expressed its concern about the spread of cholera in the Philippines.39 The third type of report was about the spread of the cholera pandemic in Taiwan in July and August 1962 under the Nationalist regime. The report described how, “according to Taiwan newspapers, because of the careless attitude of the Chiang Kai-shek bandits toward cholera prevention and treatment in Taiwan, cholera has spread quickly and the number of cases has risen.”40 These reports served to enhance the national image of the Communist government and demonstrate its legitimacy. Four out of a total of six reports were published in 1961, when cholera was epidemic only in western Guangdong Province. However, after cholera spread northward into southeastern coastal China in June 1962, there were only two reports on cholera, but they were only about the disease in Taiwan, under the Nationalist government.

213

214

china a nd the choler a pa ndemic

Local newspapers followed the central government’s media regulations strictly. As indicated in chapter 2, the Masses of Southern Zhejiang was the official newspaper of Wenzhou Prefecture’s party committee. When the cholera pandemic affected Wenzhou Prefecture from late July to mid-August 1962, the only report concerning the cholera pandemic was a full-text reprint of the People’s Daily report regarding the supposed negligence of the Nationalist government over cholera prevention work.41 The report was circulated in both central and local newspapers on the same day—August 14. Even though there were four reports in local newspapers concerning health and medicine when cholera was ravaging Wenzhou Prefecture in July and August 1962, they still did not mention the outbreak or spread of the epidemic in Wenzhou. Instead, these reports described how committed local governments were to protecting the health of commune members during the planting and harvesting of summer crops. The two reports in The Masses on July 27, 1962, were the most representative. The first report went as follows: “All medical staff in Sanxi Commune, Wenzhou City, headed to the first front line of agricultural production and launched disease and heat prevention work, which were warmly welcomed by the masses.”42 On the same page there was an article entitled “On Preventive Inoculation” in the column “Common Knowledge of Hygiene.” The article pointed out that “during a person’s entire life, they might encounter the risk of viruses or bacteria at any time. If an inoculation vaccine was administered before the outbreak of an infectious disease to protect against it, it would be the most effective method for preventing this.” The article then listed the issues that should be paid attention to during the inoculation process.43 Although the article appeared during the comprehensive inoculation campaign in summer 1962, it did not mention the word cholera at all. Local media followed the line of central media, with the government constantly monitoring the situation and regularly issuing warning circulars concerning coverage of the cholera pandemic. On September 1, 1962, the East China Bureau of the Communist Party of China Central Committee and the Leading Party Group of the Ministry of Health convened an urgent meeting on health work in eastern China area and Guangdong Province. The instructions given at that meeting were as follows: “Each locale should not disclose any epidemic information to unauthorized persons and should definitely not publicize texts or make reports openly known.”44 Following these instructions, Zhejiang Province ordered that “all newspapers, blackboards, and broadcasting systems shall not publicize cholera information, print the information, or distribute written materials.”45

“no. 2 disease”

In this way, the report concerning paracholera (i.e., El Tor cholera) in Yangjiang County, Guangdong Province, on August 30, 1961, became the only source of information about this global pandemic that had reached five provinces and municipalities in southeastern coastal China in 1961–1965, including Guangdong, Zhejiang, Fujian, Shanghai, and Jiangsu. This report also became a source for academic research published in medical journals during the pandemic. In 1964, an article in Anhui Medical Journal entitled “Some Issues Concerning the Spread of Cholera over the Past Few Years” was one of only a few articles published in 1961–1965 on the spread of cholera in Asia. With regard to cholera in Guangdong Province, it said, “Foreign documents pointed out that cholera spread in Guangdong Province in June–July 1961, which was basically the same as what had been reported by the People’s Daily. In Yangjiang, Yangchun, and Dianbai Counties of coastal Guangdong Province, there were a total of 284 cases and 28 deaths.”46 However, as chapter 1 pointed out, there were actually 2,226 cases in Yangjiang County alone from June 22 to August 20, 1961, according to local archival records. Strict control over coverage of the cholera pandemic in national and local media kept the people across the country ignorant of this pandemic, particularly those in noncholera-affected areas. However, compared with the controlled flow of cholera pandemic circulars within the government system and the control of newspapers reports, the most challenging tasks concerned how to disseminate and publicize cholera information among the masses affected by the pandemic while retaining appropriate levels of secrecy. In the July 22, 1962, report on the urgent need to prevent or treat cholera, Wenzhou City’s party committee instructed each local government to teach the masses about how critical it was to prevent cholera and to treat patients who contracted it: “All collective units, residential committees, and production teams should hold joint meetings, talks, and symposiums, and make use of tools such as blackboards and broadcasting to raise awareness [about cholera prevention] among the masses. The approach to this should be unified and stress positive education rather than fearmongering, it should not use wireless broadcasting, and should not give out detailed epidemic information but should instead give the masses a general understanding of the situation in order to prevent enemy sabotage.”47 Following this directive, publicity campaigns about cholera followed the principle of “five mentions and five nonmentions” (wujiang wubujiang). The “five mentions” were “publicizing high incidence rates and mortality rates in Taiwan; publicizing high fatality rates in Southeast Asian countries, such as India, Indonesia, and Hong Kong; publicizing the fact that the old Chinese government did

215

216

china a nd the choler a pa ndemic

not care about the people’s health before Liberation; publicizing the advantages of preventive inoculation; and only publicizing information on infectious intestinal diseases in China while not mentioning cholera.” The “five nonmentions” referred to actively not mentioning the epidemic situations in the country as a whole; in any province, county, or community; or in texts, posters, and other printed materials.48 In short, the approach to publicity and education in cholera-affected areas avoided statistical data on the pandemic while focusing on epidemic prevention knowledge and political education. In terms of preventive knowledge, awareness-raising campaigns and education activities focused on three aspects: introducing the origins and development of cholera and forms of transmission; clarifying the relationship between epidemic prevention and treatment and agricultural production; and using photographs and microscope images to improve the masses’ knowledge of hygiene and understanding of the forms of transmission of cholera and simple methods of prevention.49 While education about hygiene and prevention provided residents with some basic knowledge, the party and the government used political education to further justify the Communists’ political legitimacy among the masses. The Rui’an County Sanitation and Epidemic Prevention Station pointed out in 1962 that any publicity should pay particular attention to the social panic caused by the cholera pandemic, as it was believed that this potential social disorder was intertwined with the current political situation.50 The station warned that “modern revisionism and reactionary parties were organizing an ‘anti-China chorus’ and attempting to isolate us politically and economically. . . . It was highly possible that they would use this germ warfare to launch a cruel persecution of our people.”51 This accusation echoed the Chinese government’s call to condemn the “U.S. imperialists’ war crime” of germ warfare in the Korean War, which led to the initiation of the Patriotic Health Campaign in China in 1952.52 Meanwhile, the local government gathered information in order to compare the handling of epidemics, medicine, and doctors before and after 1949, following the principle of praising the new Communist society and criticizing the old Nationalist society. Under this dichotomic discourse, epidemics and pandemics in the old society were described as miserable and devastating. In Xincheng District in Rui’an County, the district’s party committee convened a meeting in September 1962 that was attended by different classes. The focus of the meeting was political education in order to solve some specific problems relating to cholera prevention. An 84-year-old man named Lin Gensheng described how

“no. 2 disease”

he witnessed a large number of deaths during the cholera pandemic 20 years previously: “In Tingtian village, 223 adults died of cholera within one month. Daoists and monks are busy, the sound of crying and wailing is everywhere, there are no places to put coffins, and no one walks around at night.”53 In such stereotypical narratives, medicine for preventing and treating cholera was described as unaffordable for poor people in the old society. It was reported that a brigade party secretary in Rui’an County recounted at a meeting that “before the Liberation, one bottle of saline water to treat cholera cost one thousand jin [500 grams] of grain. Numerous poor people died because they could not afford treatment. Nowadays, the party and the government have dispatched doctors to take care of us. The previous government just let us die, while the new one is saving our lives. The Communist Party is the great savior of the poor masses.”54 Doctors in the old society were portrayed as being similarly merciless. In Xianjiang District, Rui’an County, an old villager invited to speak at the end of the political education meeting on cholera prevention described how, before the Liberation, Western medicine doctors who were invited to treat cholera patients would insist on arriving and leaving by boat. Patient families had to hire someone else to row boats and pay a fee of around 100 jin of grain. The medical fees these doctors charged were similarly high. Doctors would refuse to let patients’ families pick them up themselves because they thought these family members would spread cholera to their families.55 Instead, the people’s doctors under the leadership of the party and the Communist government were portrayed as “treating patients like dear relatives. They conducted preventive inoculation in villages and would patiently persuade villagers if they did not want to accept. They even forgot to eat or sleep they were so busy rescuing patients.” These guided narratives finally aimed to show that “the reactionary Nationalist government only knew how to exploit and suppress the masses and never cared about the people. Under the leadership of the Communist Party, the government takes the people’s interests into consideration and is making great efforts to improve people’s health, such as by strengthening their physical condition, eradicating disease, increasing the population.”56 The strict control of cholera pandemic information therefore served to advance political indoctrination.

AN ISOL ATED NATION, A GLOBALIZED HEALTH COMMUNIT Y In 1961–1965, the cholera-affected areas of southeastern coastal China were experiencing the global pandemic that first broke out in Makassar, Indonesia,

217

218

china a nd the choler a pa ndemic

in 1961. The Chinese government therefore faced another serious problem, this time regarding how to control pandemic information internationally. When cholera broke out in Southeast Asia and China in 1961, the global epidemic reporting network had already been operating in northeastern and Southeast Asia for nearly four decades. As early as 1925, the Eastern Bureau of the League of Nations Health Section was established in Singapore to collect and disseminate epidemiological information in the East or the Far East, which referred to “any country of the Pacific and Indian Ocean rims.”57 After World War II, the bureau was renamed the Epidemiological Intelligence Station of the World Health Organization (WHO).58 According to the WHO program, “Each state recognizes the right of the Organization to communicate directly with the health administration of its territory or territories. Any notification or information sent by the Organization to the health administration shall be considered as having been sent to the state, while any notification or information sent by the health administration to the Organization shall be considered as having been sent by the state.”59 However, the WHO is an intergovernmental organization with no supragovernmental authority. It cannot execute policies that override the will of its members’ governments.60 From 1948 to 1972, the People’s Republic of China was not a member country of WHO and remained isolated from the international epidemic reporting network. This specific relationship between the international organization and a nonmember country shaped the features of the politics of information control around the cholera pandemic when China defined the outbreak as being a national secret. During this pandemic, the Chinese government did not share epidemic information with the international community at the government level. WHO could not obtain direct information on the outbreak of the cholera pandemic in Guangdong Province in June–July 1961. The refugees fleeing Guangdong Province to Hong Kong became the only source of available information for the Hong Kong media and government and thus for the international community as well, including WHO. In response to the Hong Kong media reports and queries about cholera in Guangdong on August 18, 1961, the Guangdong government accused “agents of an American bacteriological warfare bureau for launching a cholera epidemic in southeastern Guangdong Province.”61 By August 24, the Hong Kong-based South China Morning Post was reporting that “it has now been definitely established that cholera has broken out in Chungshan [Zhongshan] County in Guangdong, adjoining Macau. Confirmation came last night from two sources[:] a girl who

“no. 2 disease”

has recently arrived in Hong Kong from Shekki [Shiqi], the capital of Chungshan . . . and from reports received by Macau residents from relatives in Chungshan.” This report did not give a precise number of cholera cases, but it estimated that more than fifteen thousand people had died recently in the cholera-affected counties in Guangdong Province.62 In the follow-up coverage, the South China Morning Post continued, “Though the cholera epidemic has been raging for some time on the Chinese mainland, local officials of Guangdong Province still insist that there was not a single case of cholera registered there, while claiming that regular precautions are being taken to guard against summer diseases, including cholera and smallpox. The Provincial Foreign Affairs Bureau further criticized [that] there were rumors abroad.”63 Meanwhile, WHO confirmed reports on the cholera pandemic in mainland China.64 Responding to its queries, the Chinese government, as mentioned above, announced via the China News Agency that “284 paracholera cases have been confirmed in Yangjiang, Yangchun, and Dianbai counties (in Guangdong Province) and there have been 28 deaths to date.” However, the report downplayed the situation and pointed out that the number of cases was steadily dropping. The report further insisted that it was paracholera rather than a classic cholera epidemic, as reported by WHO.65 Although it admitted to the presence of cholera within its borders, the Chinese government kept strict control over such information. The Zhejiang provincial government required each coastal county to conduct three consecutive stool tests and five days of medical observations for Chinese crews of foreign ocean liners, returned overseas Chinese, and those resident in Hong Kong and Macau in September 1964. The instructions stated, “Cholera information [is] a national secret, which should not be disclosed to any unauthorized persons. Any document involving cholera should be labeled ‘top secret.’“66 Medical staff were also instructed to pay particular attention to protecting secrecy when conducting stool tests and medical observations. If the subjects in question asked about the reasons for stool tests, the answer was to be as follows: “In recent years, epidemic diseases have been ravaging Southeast Asian countries. In order to strengthen prevention measures and act responsibly, stool tests are necessary.”67 The government was also absent from the increasingly strengthened cooperation of the international epidemic surveillance network. In view of the serious pandemic situation in Asia, WHO’s Western Pacific Regional Office convened an interregional meeting on cholera control in Manila in 1962. The meeting aimed to exchange information on the epidemiology, prevention, and control

219

220

china a nd the choler a pa ndemic

of cholera in the area. A follow-up meeting was also held there in 1964, with delegates from all over the world.68 However, the Chinese government did not attend these global health community meetings, an absence that affected cholera prevention. As Dr. Marcolino Gomes Candau, then WHO’s second director-general, claimed in 1962, WHO faced difficulties in combating disease in Asia due to lack of firsthand knowledge of the health situation in mainland China.69 By the late 1960s, the adoption of the cordon sanitaire and the requirement of inoculation certificates at frontiers was no longer encouraged, as they did not significantly prevent the spread of cholera.70 Instead, close cooperation and exchange of epidemiological information between infected countries and noninfected neighboring countries came to play crucial roles in preventing the global spread of cholera.71 China’s participation in the global disease surveillance network became increasingly important. Not until the Ministry of Health of China officially recognized the International Health Convention in June 1979 did the Chinese government officially start reporting cholera information to WHO.72 Although absent from the international community, the Chinese government kept up with the global pandemic surveillance network. As early as 1956, the Shanghai Hygiene and Quarantine Institute under the Ministry of Health had been in charge of collecting and compiling epidemic disease information in foreign countries. The sources of epidemic information included the relevant instructions and circulars from the Ministry of Health of each government, the weekly epidemic information from Geneva relayed by the Singapore station, and printed weekly epidemic information issued by WHO headquarters in Geneva, as well as the relevant information in the newspapers, books, and journals of international societies.73 And the Department of Sanitation and Epidemic Prevention of the Ministry of Health of China regularly translated and compiled information on cholera prevention and treatment therapies and methods published in international medical journals and distributed it to provincial departments for reference.74 At the same time, the Chinese government strictly controlled information forwarded by WHO. In May 1965, the Haikou Hygiene and Quarantine Institute of Guangdong Province received a weekly WHO bulletin, Epidemic Information Weekly no. 9. The government reported that these materials “contained reactionary pamphlets that attacked, slandered, and smeared the Central Committee of the Communist Party of China and Chairman Mao.” In the circular sent out to each provincial health department, the Ministry of Health warned, “This incident shows that class enemies are not willing to accept their failures. They

“no. 2 disease”

try to sabotage us everywhere at all times. We have to be very vigilant.” In order to strengthen management of the epidemic information, the Ministry of Health instructed that all medical and pharmaceutical units of each province and municipal and autonomous regions that received the Epidemic Information Weekly and other epidemic information and health materials mailed from foreign countries should submit them to province, municipality, and autonomous region health departments and bureaus for further examination. Medical science research and educational units and medical and health units affiliated with the Ministry of Health were to designate politically reliable party members to open and inspect these materials.75 In this way, the Chinese government created information asymmetries on cholera between itself and the globalized health community in the specific geopolitics of the Cold War. The Chinese government imposed quarantine on passengers entering China and required them to show cholera inoculation certificates, depending on the epidemic information of the countries where passengers came from.76 For instance, the Ministry of Health informed each provincial health department by telegraph on August 12, 1965, that “cholera is now ravaging Southeast Asian countries and has become endemic in Hong Kong and Macau. In order to effectively prevent cholera from spreading into our country, it has been decided that all visitors entering the country from Hong Kong and Macau should produce effective preventive cholera inoculation certificates on August 5 and afterward.”77 This requirement soon began to f luctuate depending on the diplomatic and ideological relationships between China and foreign countries during the Cultural Revolution, in which the politics of the cholera pandemic were blown up into political struggles between different camps. The Chinese government not only sought to instigate quarantine and demand inoculation certificates to demonstrate its sovereignty, it also adopted these measures as forms of political discipline against any governments that were politically and ideologically adversarial. In April 1968, the newly radicalized Ministry of Health criticized the old Ministry of Health, which Mao had already labeled the “City Lord Ministry of Health,” because it focused only on medical work and neglected political work. The report criticized quarantine staff at China’s customs agency for only checking the content and dates of cholera inoculation certificates but not paying serious attention to the political attitudes and identities of certificate holders. It criticized the fact that “‘imperialist and revisionist foreign agencies’ based in China issued preventive inoculation certificates to foreign diplomats

221

china a nd the choler a pa ndemic

222

and citizens from over 20 countries.” In particular, the report criticized a British consular/diplomatic office that stamped inoculation certificates for citizens from Britain, India, Kenya, Sri Lanka, Burma, Pakistan, Nepal, Afghanistan, Sweden, Finland, and Poland. The Soviet Union’s embassy in China, its consulates, and the clinic of the Czechoslovakian embassy were also accused of signing preventive inoculation certificates for citizens of the Soviet Union, Czechoslovakia, and Hungary. The report proclaimed that “these countries implemented the right to extraterritoriality within China and cheated our country’s quarantine agencies. This is a very serious issue in terms of both political relations and quarantine.”78 The report stipulated that from that point on, no preventive inoculation certificates signed and issued by foreign diplomatic agencies and their affiliated clinics based in China would be recognized by the Chinese government. Regarding preventive inoculation certificates issued by “Chiang Kai-shek’s bandit gang” in Taiwan, the report required that certificate holders sign statements to the effect that “Taiwan is an inseparable part of the noble territory of the People’s Republic of China and we do not recognize the Republic of China.”79 The politics of epidemics and pandemics further extended to countries within the socialist camp. When inspecting boats from so-called revisionist countries, such as the Soviet Union, Poland, Czechoslovakia, the Democratic Republic of Germany, and Hungary, the Chinese government instructed each locale to “treat them as those from capitalist countries in principle.” Meanwhile, quarantine staff should treat these “revisionist” countries differently from other capitalist countries and concentrate on organizing these countries to isolate and attack the Soviet Union.80 By this point, not just cholera pandemic information but all epidemic information and related quarantine and inoculation certificates in China became ideological documents rather than medical ones.

CONCLUSION Cholera pandemic information was highly politicized in the domestic and international political context of the early 1960s and contributed to the concurrent ground-level social restructuring process. Entrenched supernatural interpretations of etiologies, religious practices, and the social memory of prior cholera pandemics posed serious concerns for the Communist government in terms of maintaining social order and political legitimacy. Cholera functioned as a political metaphor, and effective control of it justified Communist rule. As part of the government’s response, cholera was defined as a national secret,

“no. 2 disease”

like other epidemic and pandemic information, and was coded as the “No. 2 disease.” Information on it was not only strictly controlled but also endowed with considerable political significance. Inside the government system, the topdown dissemination and surveillance of pandemic information became a way of politically disciplining cadres. The silencing of public media and the strict control of pandemic information released to the masses functioned as political indoctrination. In the international arena, the Chinese government created an information asymmetry between itself and the international health community and further endowed information about the cholera pandemic with a political function of advancing ideological work. Information control thus became a key feature of China’s emergency response schemes for epidemics and pandemics, in addition to traditional interventionist methods, like quarantine, isolation, and inoculation. This pattern has also extended to the government’s responses to major social events and natural disasters like earthquakes, even into the twentyfirst century.81 More significantly, the political discipline, indoctrination, and ideologizing imposed by the cholera pandemic information control scheme had a comprehensive impact on different administrative systems and social groups, such as the party and government system, the propaganda system, local cadres, medical professionals, and the ordinary masses. During this control process, criticism, self-criticism, punishment, control, and guided narratives were widely applied. As a coercive and disciplinary scheme, information control became an adjunct political event accompanying the cholera pandemic, one that significantly contributed to the concurrent social restructuring and, more broadly, to the rise of the emergency disciplinary state in Mao’s China and afterward.

223

CONCLUSION

I N H E R S T U D Y O F C H O L E R A I N E N G L A N D D U R I N G T H E N I N E T E E N T H C E N T U R Y, Margaret Pelling points out that this classic epidemic disease “attracted some of the kind of attention from historians that other diseases, excepting plague, have conspicuously lacked.” One of the reasons lies in cholera’s co-occurrence with disturbing social and political forces and its links to innovation in institutional and administrative structures.1 This dynamic relationship between disease and sociopolitical change became an increasingly obvious theme with the rise of modern bacteriology and the identification of Vibrio cholerae in the late nineteenth century. For example, Richard Evans argues that cholera in Hamburg in 1892 “provided a decisive impulse for change in constitutional and administrative reform.” He claims that “the cholera epidemic meant the great divide between the old Hamburg and the new.”2 Disease and politics remained linked as colonial medicine and modern public health programs appeared in different sociopolitical settings during the nineteenth and twentieth centuries. The spread and control of the cholera pandemic in southeastern coastal China in the early 1960s occurred in this broad historical context. As this book shows, this incident was inextricably intertwined with the ongoing social restructuring that took place during the significant transitional years between two major political events in Mao’s China: the Great Leap Forward and associated 225

226

china a nd the choler a pa ndemic

famine (1958–1961) and the Cultural Revolution (1966–1976). The response to the cholera pandemic sheds light on the formation of health and political governance schemes in relation to pandemics and the configuration of state medical and administrative systems in socialist China. It also reveals the operations of local and national political instruments in a context characterized by a divide between rural and urban areas and international isolation. This global cholera pandemic was not just a pathological, medical, or health-care-related incident in China; more importantly, it was also a significant social and political influence, one whose consequences reach into the twenty-first century. This study thus advances both empirical and theoretical knowledge concerning disease and social restructuring in China studies and the history of medicine. The social restructuring that began in the 1950s and was strengthened from 1961 onward shaped the mobility of populations and disease in the context of transnational and domestic politics in Southeast Asia and China, including decolonization, nation-building, national industrialization, and agricultural collectivization. In this process, the formation of a health emergency response scheme during the 1961–1965 cholera pandemic also shows the rise of the state (both the Communist Party and the government) through its commitment to medicine, health, and epidemic prevention. Public health had been a concern in China since the state-building process began in the early twentieth century. One of the concrete efforts was the establishment of the Central Epidemic Prevention Bureau in response to the plague in northern China in March 1919; that bureau maintained an epidemiological reporting service.3 While the work of the bureau was limited, to be sure, it had national ambitions and historical significance. As AnElissa Lucas and David Lampton have argued, public health blueprints and efforts in the 1920s and 1930s showed their continuities over the political rupture in China in 1949.4 However, efficient coordination between the central and local governments, as well as between the political and medical systems, has been a challenge in epidemic prevention. For instance, when the bubonic plague broke out in Shanxi Province in 1918, the central and provincial governments cooperated and acted quickly to eradicate it, establishing the perception that public health was a state issue. However, after the autumn of 1918, the central and Shanxi provincial governments showed decreasing concern about plague when it spread into areas under their jurisdiction. Epidemic prevention became an internal, county-level affair, perceived as a local public health issue. The rivers and mountain ridges that impeded the spread of the plague became the borders separating the central from the local.5

conclusion

The response to epidemics and pandemics after 1949 faced the same challenge and showed a different path. As this book indicates, Wenzhou was flanked by mountains to the north, west, and east, which prevented the spread of cholera, a waterborne disease. However, each locale’s epidemic prevention measures were closely coordinated and under the surveillance of various systems that were being restructured in 1961–1965. Using quarantine and isolation, the state coordinated and incorporated the administrative, militia, and medical systems. This strategy gave rise to new conceptions of borders, as well as practices to reinforce them, such that they eventually became an effective social control scheme and contributed to the Communist state’s wider social restructuring process. The inoculation program strengthened coordination between urban and rural medical systems and between the administrative and medical systems. By collecting epidemic information, the state strengthened the integration of medical and administrative systems through the institutionalization of the medical system, the compartmentalization of epidemic surveillance, and the epidemiological categorization of populations. Through its control scheme, the state gave pandemic information a political disciplining function, as well as the power to indoctrinate, and thereby comprehensively strengthened control of both the administrative and medical systems. The urgent epidemic response scheme stands as evidence of the concurrent rise of both health governance and political governance during the social restructuring process.6 The response to the cholera pandemic significantly affected people from all walks of life: local cadres, medical professionals, and the ordinary masses. Specifically, the cholera pandemic enhanced administrative capacity at the central and local levels by necessitating coordinated activities for epidemic prevention and careful management and allocation of medical professionals, health budgets, cholera vaccines, and treatment schemes. Local cadres’ duties were diversified, and their roles extended deeper into the community. This was particularly the case for commune and production brigade cadres during the social reconstruction process, because they were given political, economic, militia-related, and epidemic prevention duties and responsibilities as local agents of the state. Traditional medical practitioners, who had historically been dominant forces in responding to epidemics in local communities, were incorporated into the newly restructured medical system during the 1961–1965 cholera pandemic.7 Other medical professionals were also affected by the institutionalization of the medical system, whose members experienced continuous political discipline and indoctrination.

227

228

china a nd the choler a pa ndemic

For the ordinary masses, their identities as socialist citizens were gradually strengthened with the rise of administrative, political, and militia systems that were based on political surveillance and discipline. In the campaign against cholera, new control schemes were created through quarantine, isolation, inoculation, and epidemiological categorization, each of which contributed to state control. These control schemes were implemented and underpinned by health and disease statistics built on household registration status. This new use of data acted as a specific form of statistical politics under socialism and was incorporated into the social restructuring process. The state created a complete set of data on its citizens, and this process involved the introduction of political labels during the class struggle and other political campaigns, as well as the inclusion of family background data in household registration records, production activities in accounting registers, and health and disease information in inoculation records and epidemiological dossiers. The state further established a routine that politicized state penetration into people’s daily lives, as a result of which they became more accustomed to accepting this type of political influence and developed deeper understanding of the significance of the nation-state at a personal level. The response to this global cholera pandemic of 1961–1965 indeed created a new disciplinary scheme that integrated health governance and political governance and controlled the whole society in unprecedented ways. It thus contributed significantly to the rise of the emergency disciplinary state in Mao’s China. From the perspective of the history of medicine, the concept of an “emergency disciplinary state” presents a holistic understanding of public health care, epidemic prevention campaigns, and health emergency response schemes that were launched and continued throughout Mao’s China. I categorize these into ceremonial, regular, and emergency schemes, depending on the frequency of campaigns, the severity of the diseases, and how events unfolded. Ceremonial efforts included the various Patriotic Health Campaigns that were initiated during the Korean War in 1952 and targeted the “five pests” (flies, mosquitoes, mice and rats, lice, and bedbugs) and environmental hygiene. Each spring, local governments at every level would launch “Big Clean-Up” campaigns nationwide and mobilize people from all walks of life to participate.8 These periodic, regularly conducted campaigns were ordinary schemes for eradicating endemic parasitic and infectious diseases, such as smallpox, malaria, and schistosomiasis. These campaigns had their own periodic targets and work duty requirements and were supported by medical and public health systems and facilities. Emergency

conclusion

campaigns entailed an immediate response to outbreaks of epidemics and pandemics, including the epidemic prevention scheme that followed the major earthquake that struck Tangshan in 1976. Once the outbreak of an infectious disease was reported, personnel throughout the whole medical network could be immediately mobilized to combat the crisis.9 Ordinary citizens were “turned into an army of volunteer public health and sanitation workers.”10 The state sought to demonstrate its power and capacity in these interventionist programs. Of those programs, the health emergency scheme had the most radical and profound impact, as indicated in this book. Meanwhile, the rise of the emergency disciplinary state also occurred in a very specific geopolitical context, one in which a coastal front was being created in southeastern China in response to a potential military attack from the Nationalist government in Taiwan. In fact, the widespread militarization of society was a common theme for the two regimes on either side of the Taiwan Strait. Michael Szonyi has described how the militarization of Kinmen Island (Quemoy) under the Taiwan Nationalist government brought about the gradual formalization, systematization, and institutionalization of the militia and an intensive surveillance scheme based on the household registration system. The Communist and the Nationalist regimes demonstrated extraordinary similarities in their approaches. These included launching popular mobilization campaigns that combined material incentives with ideological exhortation, propaganda, and control over the flow of information, as well as the cult of patriotic martyrs and generals. Szonyi argues that these similarities were derived from the shared inheritance of Chinese political culture and Soviet-influenced Leninist parties. He has further pointed out that both sides participated in a process of “mirroring”: “They did not only imagine the enemy as the opposite of self but also engaged in the active fashioning of self in contrast to the enemy.” The two sides then used this difference to justify their own political legitimacy.11 One unique feature of the Communist regime’s response in mainland China was its policies on religious practice and women’s issues. Unlike the Nationalist regime in Taiwan, the mainland regime executed a severe crackdown on religious practices and certain social customs, including the complete prohibition of prostitution. Ironically, when women were the subjects of political liberation, their chances of falling victim to epidemics and pandemics rose as a response to other contingencies, such as famine and changes in work routines. It should be noted that the new sociopolitical structure was not the sole factor shaping the rise of the emergency disciplinary state during the cholera pandemic

229

230

china a nd the choler a pa ndemic

of the early 1960s; medical technology also played a major role. From the early 1950s onward, the Chinese government prioritized vaccine production, so for the first time there were sufficient vaccine doses for emergency inoculation work and a campaign against cholera during the pandemic. The use of saline solution to treat cholera was widely incorporated into public disease-control strategies. This technological progress further contributed to the sociopolitical restructuring process. The traditional medical therapies used before the 1950s were quickly discarded in favor of these new scientific treatments during the pandemic. Responses to cholera thus became a battlefield between traditional Chinese medicine and modern medicine, and thus the pandemic facilitated the marginalization of traditional medical practitioners and the institutionalization of the country’s medical systems. The impact of technologies was also reflected in telecommunications. By the time of the pandemic, telegraph, telephone, and broadcasting networks had already reached the People’s Commune and production brigade levels in rural areas. These systems played a crucial role in raising awareness about prevention and in disease-reporting schemes. Like medical technologies, telecommunication technologies also played a part in the social restructuring process in that timely epidemic reporting and maintaining the secrecy of pandemic information were two criteria in political performance assessments for local cadres during the pandemic. In all, the emergency disciplinary state was composed of the top-down leadership, the vertical bureaucratic system, and the horizontal grassroots social organizations (i.e., the People’s Commune system and work units based on the household registration system). Through the centralization of political power, the dominance of the administrative system, and the compartmentalization of local society, this regime was an integral and active governmental entity. The party and the central government maneuvered nationwide medical resources and personnel in response to the pandemic, medical and administrative systems jointly participated in epidemic prevention campaigns, and restructured rural and urban societies facilitated the implementation of traditional interventionist measures. It should be noted that though the party and the administrative system played the decisive roles, medical professionals, including those in the Ministry of Health, were very active during the pandemic.12 In general, this process depended on the availability of medical resources, the integration of the two systems, and the cooperation of local society. As this book indicates, it was not a straightforward process. However, once it was improved and standardized, the public health response scheme entrenched in

conclusion

the emergency disciplinary state demonstrated its capacity, efficiency, and assertiveness. The characteristics of the emergency disciplinary state were also reflected in other large-scale but clandestine campaigns in Mao’s era. To protect national sovereignty, the party carried out a massive campaign to industrialize China’s western region—the Third Front—in 1964–1980. Following this policy that promoted labor-intensive industry, the government mobilized the Railway Corps, rural militia, and regional railroad officers. Among them, rural militia accounted for more than 80 percent of total laborers.13 In the meantime, some practices of the Chinese government also echoed political features of the Cold War era, such as the definition and control of national secrets. For this, Kate Brown shows the public how nuclear weapon complexes—the Hanford site in Richland, Washington, in the United States, and Ozersk in the Soviet Union (i.e., plutonium cities)—were organized and controlled in secret.14 She also vividly recounts how the Soviet Union controlled the release of information in the wake of the Chernobyl nuclear disaster in 1986, which showed the type of motivation and operation that existed in the sociopolitical context of China.15 The rise of the emergency disciplinary state during the public health emergency response of 1961–1965 was of great significance in a broader historical context. Emergency responses to natural disasters, significant epidemics, political incidents, and social crises since late imperial China all involved a few crucial issues: how to address the relationship between empire and its bureaucratic system, how to operate a bureaucratic organization, and how to tackle the relationship among empire, local government, and society. However, emergency responses pursued the centralization of political power, strict control over the bureaucratic system, rapid transmission of information within bureaucratic organizations, and the precise definition of the government’s and society’s roles. Still, emergency actions always encountered challenges and difficulties in the changing sociopolitical contexts of the nineteenth and twentieth centuries.16 In this sense, public health emergency response protocols and the emergency disciplinary state were effectively integrated into Mao’s China during the cholera pandemic of 1961–1965. More significantly, this classical model combining health emergency protocols and state control demonstrated its far-reaching impact on responses to natural disasters, major epidemics, and public events in China in the decades following the pandemic. Examining disease and mobility, social restructuring, and the politics of technologies during the cholera pandemic in the 1960s therefore helps us to understand the basic logic underlying the response schemes for subsequent pandemics in Mao’s China and under subsequent leaders. The

231

232

china a nd the choler a pa ndemic

next major epidemic China faced was cerebrospinal meningitis, which spread throughout China when the already massive population movements got truly out of control at the peak of the “Great Link-Up” of the Red Guards during the early stages of the Cultural Revolution (an event also known as the “Great Networking Movement” [dachuanlian]). From autumn 1966 to spring 1967, the meningitis pandemic affected every major city and quickly spread to medium-sized and smaller cities and even remote and border areas. It affected most provinces in China and only started to decline in 1968, by which time there had been 3.04 million cases and 160,000 deaths, the highest mortality rate of all epidemic diseases in China after 1949.17 Although cerebrospinal meningitis broke out and spread across China during the most chaotic stage of the Cultural Revolution, the sociopolitical structure of the country was basically the same as it had been during the cholera pandemic. The health emergency scheme established during the cholera pandemic continued to operate during the cerebrospinal meningitis epidemic. This illustrates the significance of the integration of public health emergency response protocols and the emergency disciplinary state. Furthermore, the invention and application of meningitis vaccines after 1968 meant that mortality rates declined significantly. In other words, this meningitis epidemic fully demonstrated the correlations between the spread of disease, population mobility, sociopolitical control, and medical technology. However, the control of information during these pandemics means that it is still not clear exactly how the emergency response operated during the Cultural Revolution: there are insufficient data on disease distribution, incidence, and death tolls, the organization of medical professionals, and the invention of the meningitis vaccine. Cholera did not break out again in southeastern coastal China, except for sporadic cases in a few counties, between 1965 and 1977. For example, Wenzhou Prefecture in Zhejiang Province reported only two cases, one of which was fatal, during this period. However, with the gradual disintegration of the People’s Commune system and the beginning of China’s economic reforms in 1978, the population no longer remained sedentary. Cholera soon reemerged on the southeastern coast of China, reaching its peak in 1979–1980. The immobile nature of the population was first shaken up in Guangdong Province, where the Reform and Opening Up experiment began, and the total number of cases was very high compared with the numbers in Fujian and Zhejiang Provinces. Cholera outbreaks in the late 1970s further reveal the role of population mobility in the spread of epidemic diseases. More significantly, population

conclusion

movements show that the changing sociopolitical structure increasingly posed challenges to the classical health emergency response model. As China entered the new millennium, the shift from a sedentary society to an increasingly mobile one became an irreversible process. Millions of rural migrant workers were moving into urban areas. Transnational mobility also started to rise steadily as China began to integrate into the globalized world economy. Radical urbanization and globalization not only spread epidemic diseases more quickly but also facilitated the exchange of information and the spread of panic within society. In the meantime, urbanization and globalization brought about the unprecedented phenomenon of jobs becoming more and more temporary, as well as more mobile, which resulted in the fragmentation of the sociopolitical structure and further challenges to the classical health emergency model. Nevertheless, the fundamental structures and features of the emergency disciplinary state continued to exist and operate, including top-down leadership, the vertical bureaucratic system, and the horizontal grassroots social organizations (now termed administrative villages in rural areas and residents’ committees in urban areas). The response to the SARS pandemic in 2002–2003 underscored the dynamic relationship between disease and politics in the new era. The delayed response during the early stages of the outbreak disclosed the deficiency of public health and epidemic prevention efforts, which was a result of the commercialization of medical care in the 1980s and 1990s. However, the emergency disciplinary state demonstrated its resilience during the pandemic. The most criticized practice was the cover-up of SARS pandemic information in the early stage, which followed the official pattern of concealing the “No. 2 disease” outbreak in 1961–1965. However, once the traditional public health emergency response scheme was adopted to counter SARS, the government quickly mobilized the whole of society into a nationwide epidemic prevention campaign, particularly with respect to quarantine and isolation. The implementation of these traditional interventionist methods meant that the government abruptly reversed the rise of the mobile society and returned the populace to a more sedentary status. In other words, population mobility, epidemic prevention, and social structure were subsumed under disciplinary and coercive political forces. However, this emergency response scheme interrupted normal population movements that are inherent in any modern society. The abrupt reversal carried enormous social and economic costs, which is understandable when we consider how the comparatively free movement of labor has been a cornerstone of China’s rapid growth in recent decades.

233

234

china a nd the choler a pa ndemic

After the SARS pandemic, the Chinese government revamped its public health and disease control system. One of the significant steps it took was to establish the Infectious Disease and Public Health Emergency Online Reporting System, in 2004. This system erased the vertical, bottom-up reporting schedules. All grassroots medical and health units, including township and subdistrict clinics, could report notifiable infectious diseases and public health emergencies in the system, which could reach China’s Center for Disease Control instantly. However, as the key feature of the emergency disciplinary state, the centralization of political power and the dominance of the administrative system continued. In this online reporting system, information is monitored by the Center for Disease Control at different levels and then centrally. Nevertheless, the center is not authorized to respond to the outbreak of infectious diseases and public health emergencies. Addressing this lack of authority to respond, Katherine Mason points out in her analysis of public health changes after the SARS crisis that “the intense focus on transparency—along with accompanying suspicions about a Chinese propensity for nontransparency—encouraged a hypertransparency in Chinese biosecurity measures.” In her opinion, “hypertransparency” has two forms: “performative hypertransparency of dramatized disease fighting actions that played out in the media and in interactions with the public” and “technological hypertransparency of disease incidence data shared between levels of government.” However, Mason argues that these measures “largely failed—to stop local bureaucrats from exercising discretion in deciding what information to disclose, to whom and when.”18 Her arguments align with the governmental response to some epidemics, like the 2009 H1N1 pandemic.19 In recent years, China has been experiencing radical social restructuring and the strengthening of the emergency disciplinary state, which has significantly affected the outbreak, transmission, and control of epidemic diseases. When I was completing the manuscript for this book in the spring of 2020, the COVID-19 pandemic that first broke out in Wuhan City, China, was ravaging the world. As the Chinese government claimed on February 23, 2020, COVID-19 is “a major public health emergency that has spread the fastest, has the widest range of infections, and is the most difficult to prevent and control in China since the founding of New China.”20 This official statement fully discloses the challenges of undertaking a public health emergency response in a highly mobile and fragmented sociopolitical structure brought about by urbanization and globalization. However, in such a context the function and characteristics of the emergency disciplinary

conclusion

state are significantly strengthened, providing increased capacity for action and greater assertiveness of actions taken. In terms of epidemic surveillance, the index case of SARS was reported on November 16, 2002, and the SARS virus was not identified until April 16, 2003. Unlike SARS, the index case of COVID-19 was reported and identified within less than a month, from the first report of illness on December 8, 2019, to the novel coronavirus identification on January 7, 2020. However, the public health emergency response—the lockdown of Wuhan City—was not initiated until January 23. The role of centralized political power and the administrative system in the delayed response is worthy of discussion, and archival documents available at some point in the future will provide useful information for such a discussion. Nevertheless, once the government started responding to the pandemic, the classical public health emergency response scheme was readily adopted and strictly implemented on an unprecedented, nationwide scale. The successful implementation of traditional interventionist quarantine and isolation measures still depends on the vital structure and features of the emergency disciplinary state. It is very significant that the government abruptly reversed the shift to a mobile society and returned it to a more sedentary status while keeping the entire population under close surveillance by grassroots social organizations. In the meantime, a new disease control method, integrated with this old emergency response model, has been quickly developed and implemented during the COVID-19 pandemic. This new approach is the digitally assigned health code (jiankangma). In February 2020, the government of Hangzhou City, the capital city of Zhejiang Province, promoted the use of the health code for closely surveilling population movements during the pandemic. Each resident is required to apply for a health code on a smartphone via the Alipay app, which is a third-party mobile and online payment platform operated by Alibaba Group and used by 70 percent of the Chinese population in 2019. People simply fill in some basic information, including current residential address, current health status, whether or not they left the city in the past fourteen days, and whether or not they had contact with any confirmed or suspected COVID patients in the previous fourteen days. The essential information is processed following three principles, including space dimension (i.e., risk level of each subdistrict in urban areas or township in rural areas), temporal dimension (i.e., frequency and length of the person’s visit to infected areas), and social distancing dimension (i.e., the rate of contact with confirmed or suspected cases). Each resident is given either a green,

235

236

china a nd the choler a pa ndemic

yellow, or red health code. Holders of green codes can move in and out of the city freely. Yellow code holders must complete a seven-day collective isolation (with others at a designated facility) or isolation at home while updating the abovementioned information every day before they can receive a green code. For red code holders, they must isolate themselves for fourteen consecutive days if they want their codes to be changed to green. Residents must produce their health code when entering or leaving subdistricts and administrative villages, which are all under quarantine and isolation. Epidemic prevention departments monitor the movement of residents via smartphones and change each resident’s health code correspondingly. Like cholera inoculation certificates and the associated inoculation registers during the cholera pandemic of 1961–1965, digital health codes assumed the sociopolitical disciplinary and surveillance functions, which began when one applied for a health code. The health code scheme employs compulsory features by requiring each applicant to agree to surrender all the required personal information and mobile phone information to epidemic prevention departments, which are authorized by law to receive that information. The health code scheme operates in disciplinary terms by requiring each applicant to assure the authenticity and completeness of the information required and to take all legal responsibility for missing or incorrect information. During the pandemic, the government integrated a comprehensive set of demographic data covering physical movement, health status, financial situation, and biodata (such as fingerprint, face, and voice), and so on. The health code system thus becomes a mega online database. The health code is also a requirement for accessing businesses, shopping malls, subways, and other types of public transportation when quarantine and isolation are gradually lifted. Both cholera inoculation certificates and digital health codes allow the government to control population activities and facilitate the formation and top-down imposition of a new, broad-reaching social structure. The former contributed to the creation of a sedentary society, while the latter is congruent with a mobile society as it breaks through space and temporal constraints. In essence, the structure and features of the emergency disciplinary state played a crucial role in this process in Mao’s China and continue to do so today.

GLOSSARY

Baishao

白芍

Radix paeoniae alba; Chinese materia medica

Baizhu

白术

Largehead atractylodes rhizome; Chinese materia medica

Ban

班

Squad; a militia unit

Bao

保

A community-based administrative and social control unit before 1949; a grouping of one hundred households

Baobing congkuan, chabing yaoyan

报病从宽，查病要严

Broadly reporting and seriously examining

Baojia

保甲

A community-based administrative and social control system before 1949

Baozhang

保长

Head of each bao

Bianzheng lunzhi

辩证论治

Pattern differentiation and treatment determination

Cankao yiqingxian

参考疫情线

Reference epidemic reporting line

Changxin

尝新

Tasting new grain

Dachuanlian

大串联

Great Networking Movement, or Great Link-Up

Danmin

疍民

Boat people

Danwei

单位

Work unit

Dashu

大暑

Great heat; a traditional Chinese solar term

Diduan baogan

地段包干

Sectional contract

Doujiang

痘浆

Lymph from a smallpox-infected child

Duanwu

端午

Dragon Boat Festival

237

glossary

238 Fang

坊

Section

Fuhuoluan

副霍乱

Paracholera

Gancao

甘草

Licorice; Chinese materia medica

Gongliang

公粮

Public grain

Guangfanhua

广泛化

Extensiveness

Guanxi

关系

A network of mutually beneficial relationships

Guci

鼓词

Musical dramas in Wenzhou area

Guijie

鬼节

Hungry Ghost Festival

Huadong nanxia ganbu zongdui

华东南下干部纵队

East China Southbound Cadre Columns

Hukou

户口

Household registration

Huyi

虎疫

Tiger epidemic (i.e., cholera)

Jiankangma

健康码

Digitally assigned health code

Jiaoshanzha

焦山楂

Charred fructus crataegi; Chinese materia medica

Jieshaoxin

介绍信

Letter of introduction

Jin

斤

A Chinese unit of weight (= 500 grams)

Jingjian xiafang

精简下放

Streamlining and laying off

Kangri ziweihui

抗日自卫会

Anti-Japanese Self-Guard Association

Keguanhua

客观化

Objectivity

Kouliang

口粮

Grain rations

Lian

连

Company; a militia unit

Liang

两

A Chinese unit of weight (= 50 grams)

Liqiu

立秋

Beginning of autumn; a traditional Chinese solar term

Mingma dianbao

明码电报

Unencoded telegraph messages

Niudou

牛痘

Smallpox vaccine

Pai

排

Platoon; a militia unit

Pingyang

平阳县

A county in Wenzhou Prefecture

glossary

239

Qiangxin huiyang fa

强心回阳法

Method for strengthening the heart and restoring yang

Qiaogu

敲罟

“Beating” fishing boats; a fishing technique

Qing fengshou

庆丰收

Celebrating bumper crops

Qingnian fuwutuan

青年服务团

Youth Service League

Qingre lishi jieshu fa

清热利湿解暑法

Method for lowering fevers, expelling dampness, and resolving summer heat

Quanmin jiebing

全民皆兵

Everyone a Soldier

Rui’an

瑞安县

A county in Wenzhou Prefecture

Shi

师

Division; a militia unit

Shuangqiang

双抢

Quick harvesting and quick planting of rice crops

Sifen huozhi

死分活值

Fixed work points, flexible recording

Taishun

泰顺县

A county in Wenzhou Prefecture

Tanghe

塘河

Canal

Tiaoli piwei xiaodaofa

调理脾胃消导法

Method for digesting and expelling by attuning and regulating the stomach and spleen

Tuan

团

Regiment, a militia unit

Wangongjiu

完工酒

Celebrating the end of harvests

Wangye

王爷

Kingly Lord

Weisheng

卫生

Hygiene

Wen

瘟

Plague

Wencheng

文成县

A county in Wenzhou Prefecture

Wen yuanshuai

瘟元帅

Marshal Wen

Wenzhou

温州市、温州专区

A city and a prefecture in Zhejiang Province

Wujiang wubujiang

五讲五不讲

Five mentions and five nonmentions

glossary

240 Wuweizi

五味子

Magnolia berry; Chinese materia medica

Yi

疫

Epidemic disease

Ying

营

Battalion; a militia unit

Yiqing chubaoxian

疫情初报线

Preliminary epidemic reporting line

Yiyuan jiansuo

疫源检索

Search for cholera bacterial sources

Yongjia

永嘉县

A county in Wenzhou Prefecture

Yueqing

乐清县

A county in Wenzhou Prefecture

Zancun

暂存

Store it temporarily over there

Zhang

瘴

Epidemic disease

Zhengtihua

整体化

Completeness

Zhi

知

Information

Zhiqian

支前

Supporting the front

Ziwo geli

自我隔离

Self-segregation

NOTES

List of Abbreviations Archives CAA FYA GYJA HZA KQA NAA PYA RAA WPRO WZA YHA ZJA ZYJA

Chun’an County Archives, Qiandaohu Town, Zhejiang Province, China Fuyang District Archives, Hangzhou City, Zhejiang Province, China Yangjiang City Archives, Guangdong Province, China Hangzhou Prefectural Archives, Hangzhou City, Zhejiang Province, China Keqiao District Archives, Shaoxing City, Zhejiang Province, China National Archives of Australia, Canberra Pingyang County Archives, Kunyang Town, Zhejiang Province, China Rui’an City Archives, Zhejiang Province, China Archives of the WHO Western Pacific Regional Office, Manila, Philippines Wenzhou Prefectural Archives, Wenzhou City, Zhejiang Province, China Yuhang District Archives, Hangzhou City, Zhejiang Province, China Zhejiang Provincial Archives, Hangzhou City, Zhejiang Province, China Yongjia County Archives, Shangtang Town, Zhejiang Province, China

Newspapers QWB RMRB SCMP ST ZNDZ ZZRB

Qiaowubao [Overseas Chinese affairs newspaper] Renmin ribao [People’s daily] South China Morning Post Straits Times (Singapore) Zhenan dazhong [Masses of southern Zhejiang] Zhezhong ribao [Central Zhejiang newspaper]

Introduction 1. Snowden, Epidemics and Society, 266–68. 2. Walder, China under Mao, 180–81. 3. Wemheuer, Social History of Maoist China, 161–92; Townsend and Womack, Politics in China, 126; Zhonggong zhongyang dangshi yanjiushi, Zhongguo gongchandang lishi, 571–631. 4. Brown, City versus Countryside; Thaxton, Catastrophe and Contention; Wang, Organizing through Division and Exclusion. 5. Brazelton, Mass Vaccination; Barnes, Intimate Communities; Nakajima, Body, Society, and Nation; Bu, Public Health and the Modernization of China; Gross, Farewell to the God of Plague; Lynteris, Ethnographic Plague; Summers, Great Manchurian Plague; Rogaski, Hygienic Modernity. 6. As to the research concerning cholera in Europe and North America during the nineteenth century, see Pelling, Cholera, Fever and English Medicine; Delaporte, Disease and Civilization; Evans, Death in Hamburg; Snowden, Naples in the Time of Cholera; and Rosenberg, Cholera Years. For

241

242

notes to pages 8–17 studies of colonial medicine in Asia, see W. Anderson, Colonial Pathologies; and Arnold, Colonizing the Body. For representative works about cholera in Africa and South America since the 1970s, see Echenberg, Africa in the Time of Cholera; and Briggs, Stories in the Time of Cholera. 7. Peckham, Epidemics in Modern Asia, 142–92. 8. Cao, “Shuyi liuxing yu huabei shehui de bianqian”; Benedict, Bubonic Plague, 1, 37; Katz, Demon Hordes, 42. 9. Harrison, Contagion; Amrith, Migration and Diaspora, 5–7; Echenberg, Plague Ports. 10. Lee and Dodgson, “Globalization and Cholera,” 218–21. 11. Wu, “Zhongguo huoluan liuxing shilüe jiqi gudai liaofa gaikuang,” 22; MacPherson, “Cholera in China,” 506–9. 12. MacPherson, “Cholera in China,” 488, 492, 506, 512. 13. Lynteris, “Skilled Natives,” 305–14. 14. Dangdai zhongguo de weisheng shiye bianji weiyuanhui, Dangdai zhongguo de weisheng shiye, 267–68. 15. Bray, Social Space and Governance; Lü and Perry, Danwei. 16. Shapiro, Mao’s War against Nature; Lary, “‘Static’ Decades,” 29–31, 35–45. 17. Brazelton, Mass Vaccination, 153–55; Liu, China and the Shaping of Indonesia. 18. Thaxton, Catastrophe and Contention. 19. Cheng and Selden, “Origins and Social Consequences.” 20. Szonyi, Cold War Island, 79; Mozingo, Chinese Policy toward Indonesia. 21. Benedict, Bubonic Plague, 73–74. 22. Snowden, Naples in the Time of Cholera; Evans, Death in Hamburg, 403–69. 23. Echenberg, Plague Ports, xiii. 24. Evans, Death in Hamburg, 564. 25. Rosenberg, Cholera Years, 56. 26. Pelling, Cholera, Fever and English Medicine, 2. 27. Felsenfeld, “Review of Recent Trends.” 28. Fang, Barefoot Doctors, 30. 29. Rogaski, Hygienic Modernity; MacPherson, Wilderness of Marshes; Poon, “Cholera, Public Health”; Barnes, Intimate Communities. 30. Hershatter, Gender of Memory. 31. Peckham, Epidemics in Modern Asia, 142–44 (quote, 144). 32. Peckham, Epidemics in Modern Asia, 143. 33. Walder, “Organized Dependence,” 51–76. 34. Brazelton, Mass Vaccination, 133; Tomba, Government Next Door, 4, 7. 35. WPRO, “Paracholera El Tor,” 5–6. 36. Bashford, Imperial Hygiene, 123. 37. Bashford, Imperial Hygiene, 116, 120, 125 (quote). 38. Stern, Eugenic Nation, 24, 58–59 (quote). 39. Mooney, Intrusive Interventions. 40. Mason, Infectious Change, 70. 41. Xiao, Shengsichang. 42. Ku, “Anti-Malaria Policy,” 35. 43. W. Anderson, Colonial Pathologies, 180–206. 44. Mason, Infectious Change, 43, 46. 45. WPRO, “Paracholera El Tor,” 5–6.

notes to pages 18–30 46. Lam, Passion for Facts, 1–3 (quote, 1). 47. Ghosh, “Lies, Damned Lies,” 150–52; Ghosh, Making It Count. 48. Hanson, Speaking of Epidemics, 7; Rogaski, Hygienic Modernity, 57. 49. Kraus, “China in 2003,” 148. 50. Fewsmith, “China and the Politics of SARS,” 254. 51. He, “SARS and Freedom of Press,” 182. 52. Caballero-Anthony, “SARS in Asia,” 480–81. 53. Echenberg, Africa in the Time of Cholera, 3. 54. Echenberg, Africa in the Time of Cholera, 109–10. 55. Didelot et al., “Role of China,” 2–3, 14. 56. Wenzhoushi weishengzhi bianweihui, Wenzhoushi weishengzhi, 131. 57. Fang, “Global Cholera Pandemic.” 58. Diamant, “Why Archives?” 59. Schmalzer, Red Revolution, 18. Chapter 1. The Origins of the Epidemic 1. “Relie huanying cheng zuguo jieqiao lunchuan huiguo de huaqiao” [Warmly welcome returning overseas Chinese carried back by the ocean liners of the motherland], QWB, no. 3 (1960): 11–15. 2. Guangdong difang shizhi bianzhuan weiyuanhui, Guangdong shengzhi: Weishengzhi, 55; Fujiansheng difangzhi bianzhuan weiyuanhui, Fujian shengzhi: Haiguanzhi, 82. 3. Feith and Lev, “End of the Indonesian Rebellion,” 32–46; Felsenfeld, “Some Observations,” 290; Worth, “Current Cholera Pandemic,” 55. 4. Felsenfeld, “Some Observations,” 290. 5. Hu et al., “Origins of the Current Seventh Cholera Pandemic,” E7736. 6. Amrith, Migration and Diaspora, 65–66. 7. Long, “Quarantine Camp,” 1156. 8. Tagliacozzo, Longest Journey, 5; Amrith, Migration and Diaspora, 67–71. 9. Tagliacozzo, Longest Journey, 134–35. 10. Tagliacozzo, Longest Journey, 150. 11. Tagliacozzo, Longest Journey, 134–35. 12. Tagliacozzo, Longest Journey, 134, 150. 13. Amrith, Migration and Diaspora, 67–71. 14. Long, “Quarantine Camp,” 1156. 15. Peckham, Epidemics in Modern Asia, 50. 16. “Egypt: Pilgrimage to Mekka Declared Cholera-Infected,” 154. 17. The main difference between the hemolytic and nonhemolytic strains of Vibrio cholerae is the capacity to produce heat-labile soluble hemolysins, which are lipids and proteins that destroy the membrane of red blood cells and thereby cause lysis. See Barua, “Laboratory Diagnosis of Cholera,” 103. 18. Hu et al., “Origins of the Current Seventh Cholera Pandemic,” E7730–32. 19. Mosley, “Epidemiology of Cholera,” 23–24. 20. Yeoh, “Cholera,” 8. According to Echenberg, Vibrio cholerae El Tor was first identified by the English bacteriologist Armand Ruffer in the quarantine station port at Sinai on the Red Sea in 1897. See Echenberg, Africa in the Time of Cholera, 5. 21. Hu et al., “Origins of the Current Seventh Cholera Pandemic,” E7730–32. 22. Mosley, “Epidemiology of Cholera,” 23–24.

243

244

notes to pages 30–35 23. Kamal, “Seventh Pandemic of Cholera,” 1. 24. Weishengbu gongzuozu, “Jin 25nianlai shijie fuhuoluan de liuxing he fangzhi gaikuang (1937.9–1962.9),” November 1962, ZJA, Vol. J166-2-160. 25. Hu et al., “Origins of the Current Seventh Cholera Pandemic,” E7730. 26. McKeown, “Conceptualizing Chinese Diasporas,” 313–15. 27. Amrith, “Migration and Health,” 1569. 28. Australian Embassy in Jakarta, “The Chinese in Indonesia,” December 15, 1952, NAA, A1838/280, 3034/2/5/1. 29. Zhou, “Ambivalent Alliance,” 216. 30. Liu, China and the Shaping of Indonesia, 40; Purdey, Anti-Chinese Violence, 4. 31. Liu, China and the Shaping of Indonesia, 169. 32. Kuhn, Chinese among Others, 290. 33. Kuhn, Chinese among Others, 286–87. 34. Australian Embassy in Jakarta, “Chinese Ambassador to Indonesia,” August 1950, NAA, A1838, 406/9/2/12. 35. Horne, “Chinese Communists Representative Leave for Indonesia,” July 19, 1951, NAA, A1838, 406/9/2/12. 36. Lee, “Report to the Secretary, Department of External Affairs,” November 26, 1954, NAA, A11604, 407/1/1. 37. Purdey, Anti-Chinese Violence, 4–11. 38. Australian Embassy in Jakarta, “Indonesian-Chinese Dual Citizenship Agreement,” April 30, 1955, NAA, A11604, 407/1/1. 39. Loe, “Chinese in Indonesia,” January 23, 1956, NAA, A11604, 407/1/1. 40. Simpson, Economists with Guns. 41. Department of External Affairs, Canberra, Australia, “Report to the Secretary,” October 6, 1956, NAA, A11604, 407/1/1. 42. Zhou, “Ambivalent Alliance,” 225. 43. “Kuomintang Enterprises and Schools Placed under Government,” Times of Indonesia, October 10, 1958. 44. Wen, Erzhanhou dongnanya huaqiao huarenshi, 85–86. 45. Australian Embassy in Jakarta, “The Sino/Indonesian Dual Nationality Treaty,” 1957–1962, NAA, A1838/280, 3034/2/5/1 part 2. 46. Liang, Jinxiandai dongnanya, 394–95. 47. Ricklefs, History of Modern Indonesia, 324. 48. Mozingo, “New Development,” 3–4. 49. Mozingo, Chinese Policy toward Indonesia, 171–72. 50. “Huidao le wennuan de zuguo” [Returning to the warm motherland], QWB, no. 1 (1960). 51. Australian Embassy in Jakarta, “Sino/Indonesian Dual Nationality Treaty.” 52. Zhou, Migration in the Time of Revolution, 125–31. 53. “Guowuyuan guanyu jiedai he anzhi guiguo huaqiao de zhishi” [State Council’s directive on hosting and accommodating returning overseas Chinese], QWB, no. 2 (1960): 3. 54. Guang Xin, “Huangpugangbian de huanteng” [Jubilation in the Huangpu port], QWB, no. 2 (1960): 9. 55. “Relie huanying cheng zuguo jieqiao lunchuan huiguo de huaqiao,” 11. 56. Mozingo, Chinese Policy toward Indonesia, 175. 57. Dangdai zhongguo de Guangdong bianji weiyuanhui, Dangdai zhongguo de Guangdong, 235.

notes to pages 35–39 58. Mozingo, Chinese Policy toward Indonesia, 175. Lee Hui Ying is an Indonesian Chinese who left Indonesia and went to Taiwan in 1960. She recalled that the destination choice between Communist mainland China and Nationalist Taiwan involved both political and economic factors. She left Indonesia with about three thousand people on a Japanese ship and arrived in Taiwan. Passengers spent about 3,000 rupiahs per person during the journey. According to Lee, “Those who were less well-off went to the mainland on Chinese-funded ships.” Quoted in Randy Mulyanto, “Taiwan or Communism? The Chinese Who Fled Indonesia and Had to Choose,” This Week in Asia, November 16, 2019, https://www.scmp.com/week-asia/people/article/3037890/taiwan-or-communism-chinese-who-fled-indonesia-and-had-choose. For research on the diplomatic battle between the Communist mainland China and Nationalist Taiwan in Indonesia during the 1950s, see Zhou, Migration in the Time of Revolution, 72–96. 59. Von Kispal-van Deijk, “Ubiquitous but Elusive,” 81. 60. Zhongguo xinwenshe, Yindunixiya huaqiao he yindunixiya jiben qingkuang, 1. 61. Kamal, “Seventh Pandemic of Cholera,” 2–4. 62. Recent research indicates that there are four different hypotheses on the interepidemic persistence of V. cholerae over the past century, including animals as reservoirs, humans as reservoirs, continuous transmission in humans, and the environment as reservoir. See Islam et al., “Environmental Reservoirs of Vibrio Cholera,” 1–11. According to Kotar and Gessler, “Although it has been isolated from surface waters, no study has demonstrated water as a reservoir of toxic V. cholerae in the absence of a person with cholera using that water.” Environmental survival during interepidemic periods likely accounts for sudden multipoint outbreaks of cholera. Kotar and Gessler, Cholera, 287. As chapter 6 indicates, the anticholera campaign in China during the early 1960s mainly targeted the human reservoir. 63. Mosley, “Epidemiology of Cholera,” 26; Kaul, “Trends of Cholera,” 1010; MacPherson, “Cholera in China,” 516; Felsenfeld, “Review of Recent Trends,” 178; Felsenfeld, “Some Observations,” 291. 64. Mosley, “Epidemiology of Cholera,” 26; Kaul, “Trends of Cholera,” 1010. 65. Barua and Cvjetanovic, “Cholera during the Period 1961–1970,” 16. 66. Felsenfeld, “Review of Recent Trends,” 178; Felsenfeld, “Some Observations,” 291. 67. MacPherson, “Cholera in China,” 516. 68. Worth, “Current Cholera Pandemic,” 57. 69. Tagliacozzo, “Pilgrim Ships,” 48. 70. Kamal, “Seventh Pandemic of Cholera,” 3–4. In 1963, Ahmed Mohamed Kamal was professor emeritus of epidemiology and former director of the High Institute of Public Health, Alexandria, and former undersecretary of state at the Ministry of Health in Egypt. See Kamal, “Endemicity and Epidemicity of Cholera,” 277–87. 71. Felsenfeld, “Some Observations,” 290; “Deck Travel and the Risk of Cholera,” ST, August 1, 1961; “Cholera Outbreak,” ST, August 7, 1961. 72. Felsenfeld, “Some Observations,” 289–96. 73. Kamal, “Seventh Pandemic of Cholera,” 2; “Cholera Spreading: 3 Die,” ST, September 5, 1961. 74. Zhonghua renmin gongheguo Shanghai weisheng jianyisuo, “Shijie huoluan yiqing de zhangwo, fenxi yu yingyong,” October 1963, ZJA, Vol. J166-2-199. 75. Tagliacozzo, “Pilgrim Ships,” 48. 76. Kamal, “Seventh Pandemic of Cholera,” 2; “Cholera Spreading: 3 Die.” 77. Mozingo, Chinese Policy toward Indonesia, 175. 78. Godley, “Sojourners,” 335. 79. Yangjiangshi difangzhi bianzhuan weiyuanhui, Yangjiang xianzhi, 1129.

245

246

notes to pages 40–48 80. Yangjiangxian wenjiao weishengju, “Yangjiang xiaomie sihai zongjie,” August 7, 1958, GYJA, Vol. X38.A12.1.34. 81. Yangjiangxian wenjiao weishengju, “Yangjiang xiaomie sihai zongjie.” 82. Yangjiangxian fangyi zhihuibu, “Guanyu Yangjiang yiqing de zonghe baogao,” July 17, 1961, GYJA, Vol. X38.A12.1.36. 83. Zhonggong Yangjiang xianwei Yu Xin shuji, “Liuxingbing diaocha baogao,” 1961, GYJA, Vol. X38.A12.1.36. 84. Guangdongsheng fangyi zhihuibu Yangjiang gongzuozu, “Liuxingbing diaocha baogao,” August 24, 1961, GYJA, Vol. X38.A12.1.36. 85. Guangdongsheng fangyi zhihuibu Yangjiang gongzuozu, “Liuxingbing diaocha baogao.” 86. Qian, “Fuhuoluan fangzhi gongzuo de qingkuang ji jinhou renwu,” December 12, 1962, WZA, Vol. 38-14-7. 87. Qian, “Fuhuoluan fangzhi gongzuo huiyi zongjie,” December 1964, ZJA, Vol. J166-1-80. 88. Zhonggong Yangjiang xianwei fangyi zhihuibu, “Fangzhi fuhuoluanbing gongzuo zongjie,” October 23, 1961, GYJA, Vol. X38.A12.1.35. 89. Yangjiangshi difangzhi bianzhuan weiyuanhui, Yangjiang xianzhi, 938. 90. From 1961 to 2013, there were a total of 79,386 reported cholera cases in Guangdong Province, with 1,942 deaths. Li et al., “Distribution and Molecular Characteristics,” 70. 91. Madokoro, Elusive Refuge, 2–6. 92. Amrith, Migration and Diaspora, 122; Lary, “‘Static’ Decades,” 44–45. 93. Ku, “Immigration Policies,” 336. 94. Felsenfeld, “Some Observations,” 290. 95. Worth, “Current Cholera Pandemic,” 55. 96. Hong Kong Museum of Medical Sciences Society, Plague, SARS and the Story of Medicine in Hong Kong, 44. 97. WPRO, “Paracholera El Tor,” 3. 98. “Recent Cholera Outbreak: Government Report on Experience Gained,” SCMP, December 14, 1961. 99. Peckham, “Infective Economies,” 212–15. 100. WPRO, “Paracholera El Tor,” 2, 84. 101. Zhonghua renmin gongheguo Shanghai weisheng jianyisuo, “Shijie huoluan yiqing de zhangwo, fenxi yu yingyong.” 102. Wenzhoushi weishengju, “Guanyu xiaomie fuhuoluan de guihua (caoan),” November 1962, WZA, Vol. 38-14-7. 103. Weishengbu dangzu, “Zai yijiuliusannian weishengtingjuzhang huiyi shang de jianghua,” April 18, 1963, ZYJA, Vol. 1-9-63. 104. “Fear about Spread of Cholera,” ST, April 7, 1962. 105. “Cholera Takes Root in New Place,” ST, April 18, 1962. 106. Kotar and Gessler, Cholera, 276. 107. In China, El Tor cholera was called “paracholera” (fuhuoluan). In the rest of this book, I use the term “cholera” to refer to El Tor cholera, unless specifically indicated otherwise. 108. Bashford and Hobbins, “Rewriting Quarantine,” 399; Leung, Leprosy in China, 142; Mayne, “Guardians at the Gate,” 255–74. Chapter 2. Mobile People, Mobile Disease 1. Shelun [Editorial], “Xinnian xianci: Guzuganjin, tashi kugan, duoqu xinde shengli” [New Year

notes to pages 50–54 congratulatory message: Make utmost efforts, work hard, and win a grand new victory], ZNDZ, January 1, 1962. 2. Zhou Baoluo, interview by author, Wenzhou City, December 31, 2017. 3. Wenzhoushi liangshizhi bianzhuan weiyuanhui, Wenzhoushi liangshizhi, 58. 4. Wenzhoushi liangshizhi bianzhuan weiyuanhui, Wenzhoushi liangshizhi, 67–69. 5. Zhonggong Wenzhou shiwei dangshi yanjiushi, Zhongguo gongchandang Wenzhou lishi, 48. 6. The percentage of grain procured by the government accounted for 34.53, 37.62, 33.72, and 32.89 percent of total grain production in 1958–1961. See Wenzhoushi liangshizhi bianzhuan weiyuanhui, Wenzhoushi liangshizhi, 61–69. 7. Wenzhoushi liangshizhi bianzhuan weiyuanhui, Wenzhoushi liangshizhi, 61–69, 85. 8. Ye Yuguang, interview by author, Wenzhou City, December 28, 2016. 9. Zhejiangsheng renmin weiyuanhui minzu shiwuchu, “Guanyu Pingyangxian Fanshan, Mazhanqu shezu qunzhong chumai zinü de qingkuang baogao,” August 24, 1962, PYA, Vol. 10-14-11. 10. Fang, Barefoot Doctors, 68–70. 11. Rui’anxian renwei weishengke, “Guanyu chuanranbing fasheng qingkuang de baogao,” 1962, RAA, Vol. 142-7-5. 12. Zhonggong Wenzhou diwei gongzuozu, “Guanyu Pingyangxian Wanquan gongshe 1960nian huang, e, bing, si shijian de jiancha baogao,” April 7, 1961, WZA, Vol. 87-13-103. 13. Zhonggong Wenzhou shiwei dangshi yanjiushi, Zhongguo gongchandang Wenzhou lishi, 367. 14. Wang Changming, interview by author, Wenzhou City, December 31, 2017. 15. Pingyangxian renmin zhengfu, “Guanyu nongcun renkou wailiu qingkuang de diaocha baogao,” May 13, 1962, PYA, Vol. 10-14-10. 16. Zhonggong Wenzhou diwei shenghuo fuli weiyuanhui, “Guanyu nongcun renkou mangmu liuru Wenzhoushi qingkuang he chuli yijian de baogao,” September 29, WZA, Vol. 87-12-87. 17. Pingyangxian renmin weiyuanhui, “Guanyu zhizhi renkou ziyou liudong de gongzuo yijian,” January 7, 1962, PYA, Vol. 10-14-47. 18. Zhonggong Wenzhou shiwei, “Guanyu xunshu chuli gongkuang qiye shiye danwei zhaoshou de nongmin de zhishi,” April 22, 1959, WZA, Vol. 1-10-38. 19. Zhonggong Wenzhou shiwei dangshi yanjiushi, Zhongguo gongchandang Wenzhou lishi, 440–42. 20. Zhejiangsheng minzhengting, “Guanyu chuli wailiu lingdao xiaozu huiyi jiyao,” December 15, 1960, ZJA, Vol. J103-13-54. 21. Pingyangxian minzhengju, Pingyangxian minzhengzhi, 6. 22. Gonganbu, Neiwubu, “Guanyu jianjue zhizhi renkou ziyou liudong de baogao,” October 31, 1961, ZJA, Vol. J103-14-40. 23. Gonganbu, Neiwubu, “Guanyu jianjue zhizhi renkou ziyou liudong de baogao.” 24. Guowuyuan, “Guanyu anzhi ziyou liudong renkou de jixiang banfa,” February 14, 1962, ZJA, Vol. J101-13-57. 25. Zhejiangsheng minzhengting, “Guanyu Zhejiangsheng he Fujiansheng huxiang dongyuan qianfan ziyou liudong renkou de xieyishu,” February 7, 1962, ZJA, Vol. J103-13-54. 26. Pingyangxian minzhengju, Pingyangxian minzhengzhi, 7. 27. Zhonggong Wenzhou diwei, “Wenzhouqu yijiu liuernian jingjian zhigong yu yasuo chengzhen renkou gongzuo de zongjie (caoan),” February 2, 1963, WZA, Vol. 87-15-15. 28. Zhonggong Wenzhou diwei, “Wenzhouqu yijiu liuernian jingjian zhigong yu yasuo chengzhen renkou gongzuo de zongjie (caoan).” 29. Zhejiang shengwei zhengbian jingjian weiyuanhui, “Guanyu sannianlai jingjian gongzuo de baogao,” 587.

247

248

notes to pages 54–62 30. Cheng and Selden, “Origins and Social Consequences,” 644–45. 31. Benedict, Bubonic Plague, 81. 32. Dangdai zhongguo de minbing bianji weiyuanhui, Dangdai zhongguo de minbing, 178. 33. Zhonggong Pingyangxian nanji gongzuo weiweiyuan, “Guanyu zhanbei gongzuo qingkuang de jianbao,” June 18, 1962, PYA, Vol. 10-14-42. 34. Szonyi, Cold War Island, 66. 35. Lin and Zhao, “1962nian ‘Taihai weiji’ beijing tanyin,” 65–66. 36. Wenzhoushi junshizhi bianzhuan weiyuanhui, Wenzhoushi junshizhi, 29; Zhu, “Fangwen zhujun baogao,” June 15, PYA, Vol. 10-14-42. 37. MacFarquhar, Origins of the Cultural Revolution, 314. 38. Zhongguo renmin jiefangjun zongzhengzhibu, “Jinji dongyuan qilai, zuohao zhandou zhunbei, chedi fensui jiangfeibang de jinfan yinmou,” June 5, 1962, WZA, Vol. 87-14-89. 39. Weishengbu, jiefangjun zonghouqinbu weishengbu, “Guanyu jiaqiang zhanqu junmin weisheng fangyi gongzuo de lianhe tongzhi,” June 23, 1962, ZJA, Vol. J166-2-126. 40. Lin and Zhao, “1962nian ‘Taihai weiji’ beijing tanyin,” 70. 41. Robertson, “Refugees and Troop Moves,” 111–12. 42. Wenzhoushi junshizhi bianzhuan weiyuanhui, Wenzhoushi junshizhi, 29. 43. Zhonggong Pingyangxian nanji gongzuo weiyuanhui, “Guanyu zhanbei gongzuo qingkuang de jianbao,” June 18, 1962, PYA, Vol. 10-14-42. 44. Zhejiangsheng danganguan, Zhejiang ershi shiji tujian, 509. 45. Zhonggong Yongjia xianwei, “Guanyu gongan gongzuo zhanbei bushu de baogao,” June 25, 1962, ZYJA, Vol. 1-85-16. 46. Zhonggong Yongjia xianwei, “Zhanbei baogao dongyuan huiyishang jianghua cankao,” June 23, 1962, ZYJA, Vol. 1-8-65. 47. Xia Fuqin, “Jiji fazhan jinhai xiaoyuye shengchan” [Actively developing offshore fishing], ZNDZ, April 19, 1962. 48. Zheng Dalong, “Liushi gegongshe zuzhi sheyuan xiahai bu moyu” [Each commune of Liushi organized commune members to catch cuttlefish], ZNDZ, April 25, 1962. 49. Matsura, Wenzhou haishang jiaotongshi yanjiu, 180–200. 50. Chen Xuexing, “Woqu dongxun fengshou jiebao pinchuan” [Great news of very successful winter fishing in our prefecture keeps coming], ZNDZ, January 8, 1961. 51. Zhonggong Pingyang xianwei dangshi yanjiushi, Zhongguo gongchandang Pingyang lishi dashiji, 94. 52. Zhou Baoluo, interview by author, Wenzhou City, December 26, 2017. 53. Zhonggong Pingyang xianwei dangshi yanjiushi, Zhongguo gongchandang Pingyang lishi dashiji, 94. 54. Zhonggong Pingyang xianwei dangshi yanjiushi, Zhongguo gongchandang Pingyang lishi dashiji, 124. 55. Wenzhoushi shuichanju, “Guanyu Fujiansheng Fudingxian Qinyu gongshe Jianguo dadui zai dongtouyang jinxing qiaogu zuoye de konggao,” August 20, 1962, ZJA, Vol. J122-14-117. 56. Xia Fuqin, “Qingmingguo, muyulai” [Qingming festival has passed, cuttlefish are coming], ZNDZ, April 7, 1962. 57. Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan, “Fuhuoluan de liuxingbingxue,” November 7, 1962, ZJA, Vol. J166-2-129. 58. Thune, “Moving Stone,” 160–61. 59. Wang, Rui’an huaqiaozhi, 7–12.

notes to pages 62–69 60. Zhejiangsheng huaqiaozhi bianzhuan weiyuanhui, Zhejiangsheng huaqiaozhi, 73. 61. Zhejiangsheng huaqiaozhi bianzhuan weiyuanhui, Zhejiangsheng huaqiaozhi, 24–26. 62. Zhejiangsheng huaqiaozhi bianzhuan weiyuanhui, Zhejiangsheng huaqiaozhi, 249. 63. Zhejiangsheng renwei huaqiao shiwuchu, “Yijiuliuyinian qiaowu gongzuo zongjie,” February 28, 1962, ZYJA, Vol. 7-11-53. 64. Zhonggong Wenzhou diwei tongzhanbu, “Guanyu dangqian qiaohui qingkuang he huiyi yijian de baogao,” August 6, 1959, WZA, Vol. 87-11-59. See also Chan, Diaspora’s Homeland, 168. 65. Zhejiangsheng waishizhi bianzhuan weiyuanhui, Zhejiangsheng waishizhi, 284. 66. Zhejiangsheng huaqiaozhi bianzhuan weiyuanhui, Zhejiangsheng huaqiaozhi, 28. 67. Zhonggong Wenzhou shiwei, “Diaodong qiaojuan, guiqiao, huaqiao de jijixing,” August 11, 1959, WZA, Vol. 1-10-32. 68. Zhejiangsheng renwei huaqiao shiwuchu, “Yijiuliuyinian qiaowu gongzuo zongjie.” 69. Yongjiaxian qiaowuke, “1961niandu diyi jidu qiaowu gongzuo xiaojie,” May 2, 1961, ZYJA, Vol. 7-11-31. 70. Zhejiangsheng renwei huaqiao shiwuchu, “Yijiuliuyinian qiaowu gongzuo zongjie.” 71. “Wenzhou huaqiao lüexing fuwushe” [Wenzhou prefectural overseas Chinese traveling agent], ZNDZ, May 3, 1962. 72. Zhejiangsheng waishizhi bianzhuan weiyuanhui, Zhejiangsheng waishizhi, 284. 73. Rui’anxian renwei weishengke, “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao,” August 20, 1962, RAA, Vol. 142-7-2. 74. Rui’anxian renwei weishengke, “Fuhuoluan liuxing qingkuang yu fangzhi gongzuo de zongjie baogao,” 1962, RAA, Vol. 142-7-2. 75. Feiyunjiangzhi bianzhuan weiyuanhui, Feiyunjiangzhi, 52–53. 76. Wang Changming interview. 77. Chen, “Ruiping wanquan pingyuan yu tanghe shuixiang,” 48–52. 78. Lin, Wenzhou zuqun yu quyu wenhua yanjiu, 273. 79. Rui’anxian weisheng fangyizhan, “Youguan liuxingbingxue de ziran dili yinsu ji renkou zucheng qingkuang,” May 30, 1964, ZJA, Vol. J166-2-206. 80. Pingyang xianzhi bianweihui, Pingyang xianzhi, 131. 81. Zhou Baoluo interview, December 31, 2017. 82. Rui’anxian weisheng fangyizhan, “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao,” August 20, 1962, RAA, Vol. 142-7-2. 83. Pingyangxian renmin weiyuanhui, “Guanyu choudiao mingong canjia Tengjiao zhi Zhangji gonglu de tongzhi,” July 9, 1962, PYA, Vol. 10-14-41. 84. Wenzhoushi weisheng fangyizhan, “Wenzhou zhuanqu fuhuoluan liuxingbingxue diaocha baogao,” November 1963, ZJA, Vol. J166-2-198. 85. Hou and Gu, “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao,” August 1962, WZA, Vol. 118-11-64. 86. Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan, “Fuhuoluan de liuxingbingxue.” 87. Rui’anxian renmin yiyuan, “Fuhuoluan 300li linchuang fenxi,” September 1962, ZJA, Vol. J166-2-162. 88. Zhonggong Rui’an xianwei, “Guanyu fuhuoluan chuanranbing fangzhi qingkuang de baogao,” August 9, 1962, RAA, Vol. 1-14-28. 89. Zhejiangsheng fangyi zhihuibu, “Guanyu fuhuoluan fangzhi qingkuang he jinhou yijian de baogao,” September 26, 1962, CAA, Vol. 1-1-137.

249

250

notes to pages 69–83 90. Wenzhou zhuanqu fangyi zhihuibu, “Fangyi gongzuo jianbao,” August 10, 1962, WZA, Vol. 118-11-65. 91. Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan, “Fuhuoluan de liuxingbingxue.” 92. Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan, “Fuhuoluan de liuxingbingxue.” 93. Zhejiang minsu xuehui, Zhejiang fengsu jianzhi, 175. 94. Pingyang xianzhi bianweihui, Pingyang xianzhi, 787. 95. Pingyangxian liuxingbingxue diaochazu, “Pingyangxian fuhuoluan liuxingbingxue diaocha baogao,” October 1962, ZJA, Vol. J166-2-162. 96. Zhonggong Wenzhou shiwei, “Guanyu zuzhi sanji ganbu jiancha shengwei ‘dangnei tongxin’ guanche zhixing qingkuang de baogao,” February 5, 1963, WZA, Vol. 1-14-37. 97. Pingyang weisheng fangyizhanzhi bianzhuan weiyuanhui, Pingyang weisheng fangyizhanzhi, 23. 98. “Zongjie jingyan, zaijie zaili, zhengqu jinnian nongye shengchan quanmian fengshou” [Summarize experience, make persistent efforts, and try to achieve a very successful harvest this year], ZNDZ, August 3, 1962. 99. Wenzhoushi jinjiao yiyuan, “Jinjiao 1963nian 02hao bing de fangzhi gongzuo zongjie,” April 26, 1963, WZA, Vol. 38-15-12. 100. Yongjiaxian renmin weiyuanhui weishengke, “Yongjiaxian 1963nian fuhuoluan fangzhi gongzuo zhuanye chubu zongjie,” October 9, 1963, ZYJA, Vol. X-52-38. 101. Rui’anxian weisheng fangyizhan, “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao,” 1962, RAA, Vol. 142-7-2. 102. Rui’anxian weisheng fangyizhan, “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao.” 103. Rui’anxian Xinchengqu weishengsuo, “Miebing gongzuo huibao,” September 3, 1962, RAA, Vol. 1-14-179. 104. Yueqingxian Hongqiao renmin zhengfu, Hongqiao zhenzhi, 376. 105. Zhejiangsheng fangyi zhihuibu, “Guanyu fuhuoluan fangzhi qingkuang he jinhou yijian de baogao,” September 26, 1962, CAA, Vol. 1-1-137. 106. Zhejiangsheng danganguan, Zhejiangsheng ziran zaihai dashiji. 107. Rui’anxian weisheng fangyizhan, “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao.” 108. Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan, “Zhejiangsheng 1963nian fuhuoluan liuxingbingxue,” November 1963, ZJA, Vol. J166-2-198. 109. Zhejiangsheng fangyi zhihuibu, “Guanyu fuhuoluan fangzhi qingkuang he jinhou yijian de baogao,” September 12, 1962, PYA, Vol. 10-14-141. 110. Qian, “Fuhuoluan fangzhi gongzuo de qingkuang ji jinhou renwu,” December 12, 1962, WZA, Vol. 38-14-7. 111. Li, “Zai shengweisheng ganxiao huiyi shang de baogao,” December 25, 1962, ZJA, Vol. J165-12-98. Chapter 3. Social Divisions, Epidemiology, and Disease Distribution 1. Yang and Wang, “Haiguan yibao yu jindai Wenzhou de jibing,” 70. 2. Shen, Xunzhao Su Weilian, 175; Katz, Demon Hordes, 45. 3. Zhejiangsheng weishengting, “Jinnianlai de huoluan yiqing,” December 21, 1954, ZJA, Vol. J166-2-30. 4. MacPherson, Wilderness of Marshes, 40, 116–18. 5. Rogaski, Hygienic Modernity, 218–24. 6. Ba, “Shanghai huoluan liuxing zhi yanjiu,” 160. 7. Wenzhoushi wenrui tanghe baohu guanli weiyuanhui, Wenrui tanghe zhishi duben, 27.

notes to pages 83–90 8. Disan zhanqu Wenzhou jingbei silingbu, “Zhushedui gongzuo baogao,” 1938, WZA, Vol. 204-1-17. 9. Wang Changming, telephone interview by author, July 14, 2018. 10. Lin Yongkui, interview by author, Wenzhou City, April 29, 2017. 11. Gao Chunchai, interview by author, Wenzhou City, May 1, 2017. 12. Zhao, Jindai Wenzhou shehui jingji fazhan gaikuang, 316. 13. Yongjiaxian zhengfu, “Gaishan Yongjia chenghe jihua,” 6–15. 14. Disan zhanqu Wenzhou jingbei silingbu, “Zhushedui gongzuo baogao.” 15. Wenzhoushi renmin zhengfu weishengju, “Wenzhoushi yijiuwuyinian yinshui xiaodu gongzuo zongjie baogao,” 1952, WZA, Vol. 38-4-17. 16. Pingyang weisheng fangyizhanzhi bianzhuan weiyuanhui, Pingyang weisheng fangyizhanzhi, 54. 17. Rui’anxian renwei weishengke, “Yifeng yisu gaishan yinshui weisheng,” 1963, RAA, Vol. 142-8-4. 18. Wenzhoushi renmin zhengfu weishengju, “Wenzhoushi yijiuwuyinian yinshui xiaodu gongzuo zongjie baogao.” 19. Wenzhoushi danganguan, “Guanyu benshi chengshi jiben jianshe dangan qingkuang he jinhou yijian de baogao,” November 6, 1961, WZA, Vol. 51-12-13. 20. Zhonggong Wenzhou shiwei dangshi yanjiushi, Zhongguo gongchandang Wenzhou lishi, 308–10. 21. Wenzhoushi renmin weiyuanhui, “Guanyu zuzhi yiwu laodong duse hedao de tongzhi,” March 12, 1958, WZA, Vol. 51-9-24. 22. Wenzhoushi renmin weiyuanhui, “Guanyu chuli shiqu jiaoqu hedao wushui de jinji tongzhi,” February 11, 1958, WZA, Vol. 51-9-35. 23. Zhonggong Wenzhou shiwei, “Guanyu chuqihai jiangweisheng de baogao,” March 22, 1958, WZA, Vol. 1-9-51. 24. Zhonggong Wenzhou shiwei dangshi yanjiushi, Zhongguo gongchandang Wenzhou lishi, 308–10. 25. Zhou Baoluo, telephone interview by author, May 31, 2017. 26. Wenzhoushi jihua jingji weiyuanhui, Zhejiangsheng Wenzhoushi guomin jingji tongji ziliao huibian, 1–32. 27. Wenzhoushi weishengju, “Guanyu kaizhan yufang xiaji changdao chuanranbing gongzuo de baogao,” April 28, 1961, WZA, Vol. 118-11-64. 28. Wenzhoushi Wuma fangyi zhihui fenbu, “Guanyu 1–9 yuefen weisheng fangyi gongzuo de zongjie baogao,” November 30, 1963, WZA, Vol. 38-15-12. 29. Wenzhoushi weishengju, “Guanyu kaizhan yufang xiaji changdao chuanranbing gongzuo de baogao.” 30. Zhou Baoluo telephone interview, May 31, 2017. 31. Wenzhoushi fangyi zhihuibu, “Guanyu jinji jiaqiang fuhuoluan fangzhi gongzuo de tongzhi,” August 10, 1963, WZA, Vol. 118-12-31. 32. Rui’anxian Tangxiaqu weishengsuo, “63niandu weisheng gongzuo zongjie ji jinhou gongzuo yijian,” December 3, 1963, RAA, Vol. 142-8-18. 33. Wenzhoushi fangyi zhihuibu, “Liming gongzuozu fangzhi ’02’ gongzuo huibao,” October 1963, WZA, Vol. 38-15-12. 34. Rui’anxian renwei weishengke, “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao,” August 20, 1962, RAA, Vol. 142-7-2. 35. Zhonggong Wenzhou diwei, “Guanyu kaizhan yi jifei wei zhongxin de chunji aiguo weisheng tuji yundong de tongzhi,” March 9, 1960, WZA, Vol. 1-11-33.

251

252

notes to pages 91–99 36. Rui’anxian Chengguan yiyuan, “Guanyu chengzhen weisheng gongzuo qingkuang he jinhou yijian,” 1962, RAA, Vol. 142-7-12. 37. Rui’anshi difangzhi bianzhuan weiyuanhui, Rui’an shizhi, 175. 38. Hou and Gu, “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao,” August 1962, WZA, Vol. 118-11-64. 39. Rui’anxian Chengguan yiyuan, “Guanyu chengzhen weisheng gongzuo qingkuang he jinhou yijian.” 40. Rui’anxian weisheng fangyizhan, “Rui’anxian fuhuoluan liuxing bingxue diaocha baogao (chugao),” October 20, 1962, RAA, Vol. 142-7-2. 41. Hou and Gu, “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao.” 42. Pingyangxian liuxingbingxue diaochazu, “Pingyangxian fuhuoluan liuxingbingxue diaocha baogao,” October 1962, ZJA, Vol. J166-2-162. 43. Wenzhou zhuanqu fangyi zhihuibu, “Fangyi gongzuo jianbao,” October 4, 1962, WZA, Vol. 118-11-65. 44. Wenzhou zhuanqu weisheng huiyi mishuchu, “Yinshui weisheng,” December 30, 1963, WZA, Vol. 118-12-105. 45. Wenzhoushi fangyi zhihuibu, “Guanyu jishui weisheng gongzuo de tongbao,” March 22, 1963, WZA, Vol. 118-12-31. 46. Wenzhou zhuanqu weisheng huiyi mishuchu, “Yinshui weisheng.” 47. Rui’anxian renmin weiyuanhui weishengke, “1963–1972nian shinian guihua,” 1963, RAA, Vol. 142-8-11. 48. Pingyangxian weisheng fangyizhan, “Pingyangxian 1980–1984nian fuhuoluan ziliao zongjie,” 1984, PYA, Vol. 116-14-2. 49. You Rongkai, interview by author, Wenzhou City, April 27, 2017. 50. Fei, Jiangcun jingji, 151; Zhou Baoluo, telephone interview by author, April 30, 2019. 51. Wenzhou diwei gongzuozu, “Wanquan gongshe Baoyang shengchan dadui jingji diaocha ziliao,” June 15, 1961, PYA, Vol. 1-13-44. 52. Leung, “Weak Men and Barren Women,” 210. 53. Chen, “Zhejiangzhu xuexichongbing de fangzhi,” 13. 54. Wu and Xu, “Wuguo xuexichongbing zhi dagai,” 98. 55. Disan zhanqu Wenzhou jingbei silingbu, “Zhushedui gongzuo baogao.” 56. Hershatter, Gender of Memory. 57. Lin Jinxiu, “Wenqu funü gongzuo baxiang chengji” [Eight achievements of women's work in Wenzhou Prefecture], ZNDZ, March 8, 1957. 58. Wenzhou zhuanyuan gongshu, “Guanyu guoyou shuili dianli shigong shebei shiyong guanli de jixiang guiding,” November 12, 1959, WZA, Vol. 104-11-6. 59. Liu Huazhi and Liu Wanshui, “Shixing jihua yongniang, quanmian anpai shenghuo” [Plan for grain consumption and fully organizing lives], ZNDZ, January 6, 1961. 60. Huang, Peasant Family and Rural Development, 225. 61. Zhonggong Pingyang xianwei bangongshi, “Guanyu Wanquan diqu zhengzhi zuzhi jingji zhuangkuang de diaocha baogao,” April 25–July 12, 1961, PYA, Vol. 1-13-44. 62. Li, “Xuexianjin, zhuajianduan, xianqi qunzhongxing gaogongxiao yundong de gaochao,” April 5, 1959, WZA, Vol. 1-10-22. 63. Wenzhou diwei gongzuozu, “Wanquan gongshe Baoyang shengchan dadui jingji diaocha ziliao.” 64. Manning, “Marxist Maternalism.”

notes to pages 99–106 65. Fang, “Bamboo Steamers,” 420–43. 66. Wenzhoushi Sanxiqu fulian, “Sanxiqu sannianlai funü gongzuo zongjie baogao,” October 27, 1961, WZA, Vol. 85-11-18. 67. In the 1950s women’s participation in agricultural production caused them to fall victim to major parasitic diseases, which included filariasis and hookworm infection. However, the incidence of these diseases continued to drop in Wenzhou in the three decades that followed. And historically Wenzhou was not an area where schistosomiasis was prevalent. See Zhejiangsheng weisheng fangyizhan, Zhejiangsheng sichongbing ziliao huibian (1950–1987); and Zhejiangsheng weisheng fangyizhan, Zhejiangsheng yiqing ziliao huibian, 1950–1979. 68. Zhonggong Wenzhou diwei, “Guanyu zuohao funü laodong baohu gongzuo de tongzhi,” August 30, 1960, WZA, Vol. 87-12-6. 69. Guo, “Guanyu zigong tuochui de baogao,” 1962, PYA, Vol. 10-14-165. 70. Zhou Baoluo, interview by author, Wenzhou City, April 30, 2019. 71. Lin Tongfa, interview by author, Wenzhou City, May 1, 2017. 72. He Nangao, telephone interview by author, September 12, 2017. 73. Han Yonggang, interview by author, Wenzhou City, April 27, 2017. 74. Rui’anshi difangzhi bianzhuan weiyuanhui, Rui’an shizhi, 239. 75. Wang and Zhou, Wenzhou Lianhuaxin kangri zhanshi yanjiu, 192–93. 76. Bianzhe, “Yangbing diyi, yingyang diyi,” 20. 77. Veteran interviewed by Wang Changming and Zhou Baoluo, Wenzhou City, May 20, 2018. 78. Regarding the Nationalists’ efforts to improve health care among its soldiers, see Watt, Saving Lives in Wartime China; and Barnes, Intimate Communities. 79. Wang and Zhou, Wenzhou Lianhuaxin kangri zhanshi yanjiu, 218. 80. Gross, Farewell to the God of Plague, 15. 81. Liu, “Kongzhi he xiaomie nüeji de celüe he cuoshi,” December 1962, WZA, Vol. 118-11-59. 82. Pingyangxian bingyiju, “Guanyu 58niandu zhengbing tijian gongzuo zongjie pingbi cailiao,” October 27, 1959, PYA, Vol. 10-11-69. 83. Yongjiaxian renmin weiyuanhui weishengke, “Yijiuliusinian dongji zhengbing tijian gongzuo zongjie,” January 20, 1965, ZYJA, Vol. 7-21-26. 84. Wenzhou zhuanyuan gongshu, “Guanyu jinyibu jiaqiang zhanbei zhufu shipin jihua chubei tongzhi,” August 20, 1959, WZA, Vol. 104-11-11. 85. Pingyangxian renmin weiyuanhui, “Guanyu zuohao budui junxu gongying gongzuo de jidian zanxing guiding,” July 10, 1962, PYA, Vol. 10-14-41. 86. Wenzhou zhuanqu zhiqian weiyuanhui bangongshi, “Dui dangqian zhujun zhu fu shipin gongying jihua de shuoming,” August 8, 1962, PYA, Vol. 10-14-156. 87. Pingyangxian renmin weiyuanhui, “Guanyu zuohao budui junxu gongying gongzuo de jidian zanxing guiding.” 88. Wenzhoushi chuanranbing yiyuan, “230li fuhuoluan linchuang fenxi,” October 1962, ZJA, Vol. J166-2-162; Rui’anxian renmin yiyuan, “Fuhuoluan 300li linchuang fenxi,” September 1962, ZJA, Vol. J166-2-162; Pingyangxian renmin yiyuan, “Fuhuoluan 381li linchuang fenxi,” October 22, 1962, ZJA, Vol. J166-2-162. 89. Zhonggong Wenzhou diwei, “Guanyu renzhen anpai dangqian liangshi kucun de jinji baogao,” July 5, 1962, WZA, Vol. 87-14-40. 90. He Nangao, telephone interview by author, June 5, 2017; Zhang Wenzhong, interview by author, Wenzhou City, May 1, 2017. 91. He Nangao, telephone interview by author, June 17, 2017.

253

254

notes to pages 106–118 92. Weishengbu, jiefangjun zonghouqinbu weishengbu, “Guanyu jiaqiang zhanqu junmin weisheng fangyi gongzuo de lianhe tongzhi,” June 23, 1962, ZJA, Vol. J166-2-126. 93. Sun Fuzhi, interview by author, Wenzhou City, April 26, 2017. 94. Zhonggong Wenzhou diwei, “Guanyu yijiuliuernian zhengbing gongzuo de buchong zhishi,” February 18, 1963, WZA, Vol. 87-15-49. 95. Sun Fuzhi interview. 96. Rui’anxian renwei weishengke, “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao.” 97. Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan, “Fuhuoluan de liuxingbingxue,” November 7, 1962, ZJA, Vol. J166-2-129. Chapter 4. Quarantine and Isolation 1. Zhang, “Yongjia shuyi liuxing jianshi,” 37–55. 2. Yongjiaxian weishengju, Yongjiaxian weishengzhi, 9. 3. Huang Suixing, interview by author, Wenzhou City, April 16, 2017. 4. Leung, Leprosy in China, 90–92. 5. In general, the Soviet Union had significant influence on three aspects of medicine in Mao’s China: the design of China’s health administrative system, the organization of clinical care, and medical education. See Gao, “Foreign Models of Medicine,” 200; and Liu, Mafeng yisheng, 100–111. 6. MacPherson, Wilderness of Marshes, 49; Cvjetanovic, “Cholera as an International Health Problem,” 10. 7. Mosley, “Epidemiology of Cholera,” 26. 8. Raska, “Surveillance and Control of Cholera,” 115. 9. Huang, Longwan minsu, 106. 10. Wang, Dangdai zhongguo cunluo jiazu wenhua, 34. 11. Wenzhou zhuanshu, “Wenzhouqu dierge wunian jihua qijian jiaotong yunshu guihua,” February 6, 1958, WZA, Vol. 12-9-58. 12. He Nangao, telephone interview by author, June 17, 2017. His comments also emphasize the point that even the so-called “immobile society” wasn’t, in fact, as immobile as that expression makes it sound. 13. He Nangao, telephone interview by author, September 12, 2017. 14. Huang, Peasant Family and Rural Development, 182–85. 15. Wenzhoushi liangshizhi bianzhuan weiyuanhui, Wenzhoushi liangshizhi, 238–41. 16. Liu Buning, interview by author, Wenzhou City, May 1, 2017. 17. Miu, “Nanwang liangpiao,” 130–31. 18. Wenzhoushi weisheng fangyizhan, “Wenzhoushi jiaotong jianyi gongzuo zongjie,” October 25, 1962, WZA, Vol. 51-37-X. 19. Zhejiangsheng weishengting, “Guanyu fangzhi fuhuoluan fasheng he manyan de jinji zhishi,” July 27, 1962, PYA, Vol. 10-10-14. 20. Weishengbu, tiedaobu, “Weizai jingguang, jinghu tielu yanxian zhongdian chezhan huifu liuzhizhan de tongzhi,” July 30, 1962, ZJA, Vol. J166-2-134. 21. Zhejiangsheng renmin weiyuanhui, “Guanyu zai bensheng jingnei de zhegan, hangyong tielu shezhi linshi liuzhizhan de tongzhi,” September 17, 1962, ZJA, Vol. J166-2-134. 22. Zhejiangsheng renmin weiyuanhui, “Guanyu jiaqiang yumin yu yuqu fangyi gongzuo shishi banfa,” September 10, 1962, PYA, Vol. 10-14-141. 23. Zhejiangsheng renmin weiyuanhui, “Guanyu jiaqiang yumin yu yuqu fangyi gongzuo shishi banfa.”

notes to pages 118–127 24. Wenzhou zhuanqu fangyi zhihuibu, “Guanyu zhixing shengrenwei jiaotong jianyi de mingling de tongzhi,” September 29, 1962, WZA, Vol. 38-12-7. 25. The quarantine ring system discussed here is quite similar to the system used to eradicate smallpox in China in the late 1950s and the early 1960s. For a “ring vaccination” strategy against smallpox, see Brazelton, Mass Vaccination, 148. 26. Wenzhoushi weisheng fangyizhan, “Wenzhoushi jiaotong jianyi gongzuo zongjie.” 27. Zhejiangsheng weishengting, “Guanyu fangzhi fuhuoluan fasheng he manyan de jinji zhishi.” 28. Dangdai zhongguo de minbing bianji weiyuanhui, Dangdai zhongguo de minbing, 18. 29. Wenzhoushi junshizhi bianzhuan weiyuanhui, Wenzhoushi junshizhi, 243–45. 30. Zhejiangsheng renmin weiyuanhui, “Zhejiangsheng junqu guanyu banfa zhejiangsheng minbing zhanbei, zhiqing banfa zanxing guiding de tongzhi,” June 8, 1964, PYA, Vol. 10-16-13. 31. Perry, Patrolling the Revolution, 181–86. 32. Zhonggong Yongjia xianwei, “Guanyu yijiuliusiniandu minbing gongzuo renwu wenti de baogao,” April 20, 1964, ZYJA, Vol. 1-10-38. 33. Zhejiangsheng weishengting, “Guanyu jianyizhan, liuyansuo jigou shezhi, renyuan peibei ji jingfei kaizhi deng wenti de tongzhi,” April 30, 1963, RAA, Vol. 142-8-13. 34. Rui’anxian Xinchengqu weishengsuo, “Miebing gongzuo huibao,” September 3, 1962, RAA, Vol. 1-14-179. 35. Rui’anxian renwei weishengke, “Fuhuoluan liuxing qingkuang yu fangzhi gongzuo de zongjie baogao,” 1962, RAA, Vol. 142-7-2. 36. Wei Shanhai, interview by author, Rui’an City, December 28, 2017. 37. Ye Yuguang, interview by author, Wenzhou City, December 28, 2016. 38. Wang Jingfu, interview by author, Rui’an City, April 30, 2017. 39. Wang Jingfu interview. 40. Pingyangxian fangyi zhihuibu, “Guanyu fuhuoluan fangzhi gongzuo qingkuang he jinhou gongzuo yijian de baogao,” August 22, 1962, PYA, Vol. 10-14-28. 41. Pingyangxian renmin weiyuanhui weishengke, “Guanyu fangyi jingfei wenti de tongzhi,” August 21, 1962, PYA, Vol. 10-14-120. 42. Pingyangxian liangshiju, “Guanyu dangqian fangyi gongzuo zhong youguan liangshi wenti de lianhe tongzhi,” October 11, 1962, PYA, Vol. 10-14-119. 43. Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan, “Zhejiangsheng 1962nian fuhuoluan 1982li linchuang fenxi,” November 1962, ZJA, Vol. J166-2-129. 44. Pingyangxian fuhuoluan liuxingbingxue diaochazu, “Pingyangxian fuhuoluan liuxing yinsu de fenxi,” October 1962, ZJA, Vol. J166-2-162. 45. Li Chengqin, interview by author, Pingyang County, April 12, 2017. 46. Wei Shanhai interview. 47. Pingyangxian fuhuoluan liuxingbingxue diaochazu, “Pingyangxian fuhuoluan liuxing yinsu de fenxi.” 48. Rui’anxian renwei weishengke, “Fuhuoluan liuxing qingkuang yu fangzhi gongzuo de zongjie baogao,” 1962, RAA, Vol. 142-7-2. 49. Rui’anxian Xianjiangqu weishengsuo, “1962 niandu weisheng gongzuo zongjie,” December 30, 1962, RAA, Vol. 142-7-12. 50. Pingyangxian fuhuoluan liuxingbingxue diaochazu, “Pingyangxian fuhuoluan liuxing yinsu de fenxi.” 51. Wenzhou weisheng xuexiao, “Taoshanqu yiliaodui miebing gongzuo zongjie,” November 30, 1962, RAA, Vol. 142-7-11.

255

256

notes to pages 127–138 52. Rui’anxian renwei weishengke, “Fuhuoluan liuxing qingkuang yu fangzhi gongzuo de zongjie baogao.” 53. Pingyangxian renmin weiyuanhui, “Guanyu shishi jiaotong jianyi de jinji tonggao,” August 2, 1962, PYA, Vol. 10-14-28. 54. Zhejiangsheng renmin weiyuanhui, “Guanyu jiaqiang yumin yu yuqu fangyi gongzuo shishi banfa.” 55. Zhejiangsheng fangyi zhihuibu, “Zhejiangsheng jiaotong jianyi shixing xize,” September 17, 1962, PYA, Vol. 10-14-141. 56. Zhejiangsheng caizhengting, “Guanyu dangqian fangyi renwu youguan jingfei kaizhi wenti de buchong tongzhi,” August 29, 1962, PYA, Vol. 10-14-141. 57. Wenzhoushi weishengju, “Wenzhoushi jiaotong jianyi gongzuo zongjie,” October 25, 1962, WZA, Vol. 38-14-8. 58. Wenzhoushi Dongtou renmin yiyuan, “Dongtou yugang linshi lianhe jianyizhan,” December 25, 1963, ZJA, Vol. J166-2-194. 59. Zhejiangsheng fangyi zhihuibu, “Zhejiangsheng jiaotong jianyi shixing xize.” 60. Zhemin fenshuiguan lianhe jiaotong weisheng jianduzhan, “Jiaotong jianyi gongzuo,” November 10, 1963, ZJA, Vol. J166-2-194. 61. Zhejiangsheng weisheng fangyizhan, “Zhejiangsheng 1980nian fuhuoluan liuxing bingxue fenxi,” 19. 62. Rui’anxian weisheng fangyizhan, “Rui’anxian fuhuoluan liuxing bingxue diaocha baogao (chugao),” October 20, 1962, RAA, Vol. 142-7-2. 63. Zhemin fenshuiguan lianhe jiaotong weisheng jianduzhan, “Jiaotong jianyi gongzuo.” 64. Wenzhoushi Meiao jiaotong jianyizhan, “Gongzuo zongjie,” November 16, 1962, ZJA, Vol. J166-2-158. 65. Wenzhoushi Meiao jiaotong jianyizhan, “Gongzuo zongjie.” 66. Chen, Danche qi shenzhou, 2. 67. Zhemin fenshuiguan lianhe jiaotong weisheng jianduzhan, “Jiaotong jianyi gongzuo.” 68. Zhemin fenshuiguan lianhe jiaotong weisheng jianduzhan, “Jiaotong jianyi gongzuo.” 69. Wenzhoushi Meiao jiaotong jianyizhan, “Gongzuo zongjie.” 70. Zhejiangsheng fangyi zhihuibu bangongshi, “Junche bushou jianyi shili de huibao,” October 24, 1962, ZJA, Vol. J166-2-126. 71. Wenzhoushi Meiao jiaotong jianyizhan, “Gongzuo zongjie.” 72. Zhejiangsheng fangyi zhihuibu bangongshi, “Junche bushou jianyi shili de huibao.” 73. Wenzhoushi Meiao jiaotong jianyizhan, “Gongzuo zongjie.” 74. Zhejiangsheng fangyi zhihuibu bangongshi, “Junche bushou jianyi shili de huibao.” 75. Sanmenxian weishengju, “Guanyu 6406 budui mouban bu jieshou jiaotong jianyi wuli qunao yaoqiu diaocha chuli de baogao,” November 23, 1962, ZJA, Vol. J166-2-134. 76. Sanmenxian weishengju, “Guanyu 6406 budui mouban bu jieshou jiaotong jianyi wuli qunao yaoqiu diaocha chuli de baogao.” 77. Sanmenxian weishengju, “Guanyu 6406 budui mouban bu jieshou jiaotong jianyi wuli qunao yaoqiu diaocha chuli de baogao.” 78. Zhejiangsheng weishengting, “6406 budui bu jieshou jiaotong jianyi chuli qingkuang de fuhan,” January 5, 1963, ZJA, Vol. J166-2-134. 79. Zhejiangsheng renmin weiyuanhui bangongting, “Guanyu huaqiao he gangao tongbao yi waihui zhifu lüefei, qi jiaotong zhusu feiyong shixing bazhe youdai de tongzhi,” January 27, 1964, PYA, Vol. 10-16-40.

notes to pages 138–150 80. Regarding these privileges, see Chan, Diaspora’s Homeland, 160–62. 81. Hangzhoushi renmin weiyuanhui waishi bangongshi, “Dui waibin he huaqiao cheliang tongguo ke mianjian fangxin de yijian,” October 14, 1963, ZJA, Vol. J166-2-175. 82. Shaoxingxian weishengju, “Guanyu jiaqiang dui fuhuoluan fabing diqu de wailai ji waichu renkou de jianyi he guanli gongzuo de tongzhi,” April 7, 1965, KQA, Vol. 105-8-13. 83. Rui’anxian renmin weiyuanhui weishengke, “Guanyu xiaomie fuhuoluan de guihua,” 1963, RAA, Vol. 142-8-4. 84. Zhejiangsheng weishengting, “Guanyu dui huaji chuanyuan, guiguo huaqiao, gangao tongbao he shuqi fanxiao shisheng kaizhan yiyuan jiansuo de tongzhi,” July 24, 1964, ZJA, Vol. J166-2-206. 85. Huber, “Unification of the Globe,” 474. 86. Weishengbu, “Fuhuoluan xueshu wenti zhuanjia zuotanhui jiyao,” January 18, 1964, ZJA, Vol. J166-2-166. 87. Pingyang weisheng fangyizhanzhi bianzhuan weiyuanhui, Pingyang weisheng fangyizhanzhi, 21. Chapter 5. Comprehensive Inoculation, Rural Rhythms, and Compiling Registers 1. Disan zhanqu Wenzhou jingbei silingbu, “Wei pubian yufang zhushe gao gejie renshishu,” 1938, WZA, Vol. 204-1-17. 2. Felsenfeld, “Review of Recent Trends,” 180. 3. Zhejiangsheng weishengting, “Guanyu zengfa huoluan junmiao de tongzhi,” August 3, 1962, PYA, Vol. 10-10-14. 4. Wenzhou diqu geweihui shengchan zhihuizu, Wenzhou diqu guomin jingji tongji ziliao huibian, 1952–1970, 1–3. 5. Andrews, Making of Modern Chinese Medicine, 42. 6. Yueqingxian weishengju, Yueqingxian weishengzhi, 148. 7. Wang Jingfu, interview by author, Rui’an City, April 30, 2017. 8. Yueqingxian weishengju, Yueqingxian weishengzhi, 148. 9. Xu, Fuyangxian weishengzhi, 173. 10. “Huoluan yimiao dailai taishao, gongzuodui zaidian qingbo” [Too few cholera vaccines, inoculation team sent telegraph to ask for more vaccines], ZZRB, July 19, 1946. 11. Pingyangxian renmin zhengfu, “Guanyu buzhi yijiuwusinian chunji zhongdou gongzuo de tongzhi,” December 8, 1954, PYA, Vol. 10-6-132. For smallpox vaccination in Kunming City, Yunnan Province in the 1950s, see Brazelton, Mass Vaccination, 131–39. 12. Fang, Barefoot Doctors, 22–25. 13. Lin’anxian weishengzhi bianzhuan weiyuanhui, Lin’anxian weishengzhi, 254. 14. Huang and Lin, Dangdai zhongguo de weisheng shiye, 291–343. 15. Although some resisted at the beginning because of distrust and fear, villagers generally accepted inoculation as a way of epidemic prevention. See Fang, Barefoot Doctors, 27–28, 70–72; and Brazelton, Mass Vaccination, 123–31. 16. Pingyangxian Qiaodunqu weishengsuo, “Guanyu benqu qiuji zhongdou gongzuo zongjie baogao,” December 12, 1956, PYA, Vol. 10-9-273. 17. Pingyangxian weisheng fangyizhan, “Guanyu 1956nian weisheng fangyizhan gongzuo zongjie,” December 19, 1956, PYA, Vol. 10-8-225. 18. Wenzhoushi weishengju, “Guanyu kaizhan shuyi huojunmiao jiezhong gongzuo de tongzhi,” April 5, 1963, WZA, Vol. 118-12-30.

257

258

notes to pages 150–158 19. Yongjiaxian renmin weiyuanhui weishengke, “Buzhi yijiuliuyinian gexiang yufang jiezhong renwu de tongzhi,” January 16, 1961, WZA, Vol. 118-10-53. 20. Rui’anxian renwei weishengke, “Huling gongshe fangzhi jibing gongzuo jiancha qingkuang baogao,” March 6, 1961, RAA, Vol. 142-6-12. 21. Pingyangxian minzhengju, Pingyangxian minzhengzhi, 43. 22. Li Tiefeng, “Zhenan guanghui de shinian” [The glorious ten years of southern Zhejiang Province], ZNDZ, September 30, 1959. 23. Zhonggong Wenzhou shiwei dangshi yanjiushi, Zhongguo gongchandang Wenzhou lishi, 361. 24. Zhonggong Wenzhou shiwei, “Guanyu tiaozheng shijiao shedui guimo wenti de qingshi baogao,” May 27, 1961, WZA, Vol. 1-12-49. 25. Dangdai zhongguo de Zhejiang bianji weiyuanhui, Dangdai zhongguo de Zhejiang, 57, 64; Zweig, Agrarian Radicalism in China, 5. 26. Wenzhou zhuanshu bangongshi, Wenzhouqu guomin jingji tongji ziliao, 1949–1961, 7. 27. Zhejiangsheng nongyezhi bianzhuan weiyuanhui, Zhejiangsheng nongyezhi, 323. 28. Xue Suigui, “Chongfen fahui duiweihui de zuoyong” [Production brigade committee should fully play roles], ZNDZ, January 14, 1962. 29. Zhejiang shengwei, “Guanyu lunxun nongcun jiceng ganbu de zhishi,” 146–47. 30. Wen Guoshen, “Shengchandui shixing nayizhong jichou banfa hao” [Which type of payment scheme should production teams implement?], ZNDZ, June 13, 1962. 31. Zhejiangsheng nongyeting, Nongcun renmin gongshe shengchandui kuaiji jiaocai, 1–58, 75–76. 32. Zhonggong Wenzhou shiwei dangshi yanjiushi, Zhongguo gongchandang Wenzhou lishi, 426. 33. Liu Huazhi and Liu Wanshui, “Shixing jihua yongliang, quanmian anpai shenghuo” [Consume grain with plans, and comprehensively arrange lives], ZNDZ, January 6, 1961. 34. Qiu, Fenghuang cunzhi, 270. 35. Wenzhoushi jihua jingji weiyuanhui, “Zhejiangsheng wenzhoushi shehui zhuyi jianshe de weida chengjiu, 1957–1960,” 1961, WZA, Vol. 2-1-145. 36. “Wenzhou renmin guangbo diantai jintian bufen jiemu neirong” [Partial contents of Wenzhou People’s Broadcasting Station’s programs today], ZNDZ, October 13, 1960. 37. Zheng Jinzhu, interview by author, Chun’an County, April 8, 2011. 38. Zhejiangsheng weishengting, “Guanyu bensheng fuhuoluan liuxing qingkuang de huibao,” July 31, 1962, ZJA, Vol. J166-2-126. 39. Wenzhou weisheng xuexiao, “Fangyi gongzuo zongjie,” December 8, 1962, WZA, Vol. 38-14-10. 40. Zhejiangsheng caizhengting, “Guanyu dangqian fangyi renwu youguan jingfei kaizhi wenti de buchong tongzhi,” August 29, 1962, PYA, Vol. 10-14-141. 41. Rui’anxian weisheng fangyizhan, “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao,” 1962, RAA, Vol. 142-7-2; Pingyangxian weisheng fangyizhan, “Guanyu Pingyangxian fuhuoluan fangzhi gongzuo zongjie baogao,” November 30, 1962, PYA, Vol. 10-14-28. 42. Rui’anxian renwei weishengke, “Rui’anxian fuhuoluan fangzhi gongzuo ziliao huibian,” October 1962, RAA, Vol. 142-7-2. 43. Rui’anxian Xianjiangqu weishengsuo, “1962 niandu weisheng gongzuo zongjie,” December 30, 1962, RAA, Vol. 142-7-12. 44. Wenzhou diwei gongzuozu, “Wanquan gongshe Baoyang shengchan dadui jingji diaocha ziliao,” June 15, 1961, PYA, Vol. 1-13-44.

notes to pages 158–165 45. Rui’anxian renwei weishengke, “Fuhuoluan liuxing qingkuang yu fangzhi zongguo de zongjie baogao,” 1962, RAA, Vol. 142-7-2. 46. Rui’anxian renwei weishengke, “Rui’anxian fuhuoluan fangzhi gongzuo ziliao huibian.” 47. Zhejiangsheng weishengting, “Fuhuoluan Yufang jiezhong gongzuo zongjie,” May 14, 1963, ZJA, Vol. J166-2-140. 48. Wenzhou weisheng xuexiao, “Taoshanqu yiliaodui miebing gongzuo zongjie,” November 30, 1962, RAA, Vol. 142-7-11. 49. Rui’anxian Taoshanqu Fenghe gongshe baojianzhan, “Yufang liexing chuanranbing de zongjie,” November 20, 1962, RAA, Vol. 142-7-12. 50. Wenzhou weisheng xuexiao, “Fangyi gongzuo zongjie.” 51. Wenzhou weisheng xuexiao, “Taoshanqu yiliaodui miebing gongzuo zongjie.” 52. Pingyangxian fangyi zhihuibu, “Guanyu fuhuoluan fangzhi gongzuo qingkuang he jinhou gongzuo yijian de baogao,” August 22, 1962, PYA, Vol. 10-14-28. 53. Zhejiangsheng fangyi zhihuibu, “Guanyu fuhuoluan fangzhi qingkuang he jinhou yijian de baogao,” September 26, 1962, CAA, Vol. 1-1-137. 54. Rui’anxian Xianjiangqu weishengsuo, “1962 niandu weisheng gongzuo zongjie.” 55. Yongjiaxian weisheng fangyizhan, “Yongjiaxian 1963nian huoluan yufang zhushe gongzuo zongjie,” June 20, 1963, ZJA, Vol. J166-2-185. 56. Rui’anxian fangyi zhihuibu, “Xinchengqu weisheng dajun tupo yidian quanmian pukai,” March 6, 1963, WZA, Vol. 118-12-31. 57. Rui’anxian Xianjiangqu weishengsuo, “Guanyu xiaomie fuhuoluan de guihua,” December 28, 1962, RAA, Vol. 142-7-12. 58. Zhejiangsheng weishengting, “Fuhuoluan yufang jiezhong gongzuo zongjie.” 59. Weishengbu dangzu, “Guanyu yufang he xiaomie fuhuoluan de guihua,” December 1962, HZA, Vol. 1-28-6. 60. Wang Zhaoyuan, “Shengwu zhipin shengchan he yufang jiezhong gongzuo huiyi zongjie,” September 25, 1962, ZJA, Vol. J166-2-156. 61. Yunhexian aiguo weisheng yundong weiyuanhui, “Guanyu kaizhan fuhuoluan yufang zhushe youguan shixiang de tongzhi,” March 4, 1963, WZA, Vol. 118-12-30. 62. Yongjiaxian weisheng fangyizhan, “Yongjiaxian 1963nian huoluan yufang zhushe gongzuo zongjie.” 63. Rui’anxian Tangxiaqu weishengsuo, “63niandu weisheng gongzuo zongjie ji jinhou gongzuo yijian,” December 3, 1963, RAA, Vol. 142-8-18. 64. Zhonghua renmin gongheguo rishi bianweihui, Zhonghua renmin guoheguo rishi, 18. 65. Sidel and Sidel, Serve the People, 79. 66. Yuhangxian weishengju, “Guanyu sibing fangzhi gongzuo jixiang zhengce chuli wenti de diaocha baogao,” May 25, 1962, YHA, Vol. 87-3-74. 67. Fuyangxian weishengju, “Guanyu 1963nian fuhuoluan fangzhi gongzuo de zongjie,” 1963, FYA, Vol. 74-1-7. 68. Rui’anxian Xianjiangqu weishengsuo, “Guanyu xiaomie fuhuoluan de guihua.” 69. Wenzhou zhuanshu jihua jingji weiyuanhui, Wenzhouqu 1963nian guomin jingji tongji ziliao huibian, 23. 70. Rui’anxian Xinchengqu weishengyuan, “Lixue baojianzhan zenyang jiejue 64niandu nongcun baojianyuan baochou wenti de baogao,” March 1, 1964, RAA, Vol. 142-9-11. 71. Yueqingxian renmin weiyuanhui weishengke, “1963nian 02junmiao yufang zhushe gongzuo zongjie,” June 6, 1963, ZJA, Vol. J166-2-185.

259

260

notes to pages 166–175 72. Fang, “Global Cholera Pandemic,” 754–90. 73. Rui’anxian weisheng fangyizhan, “1963nian fuhuoluan fangzhi gongzuo qingkuang de baogao,” 1963, RAA, Vol. 142-8-4. 74. Zheng Jinzhu interview. 75. Rui’anxian weisheng fangyizhan, “1963nian fuhuoluan fangzhi gongzuo qingkuang de baogao.” 76. Pingyang weisheng fangyizhanzhi bianzhuan weiyuanhui, Pingyang weisheng fangyizhanzhi, 20. 77. Zhejiangsheng weishengting, “Fuhuoluan yufang jiezhong gongzuo zongjie.” 78. Wang Jingfu interview. 79. Pingyangxian fangyi zhihuibu, “Guanyu liji jinxing huoluan yufang zhushe jiancha gongzuo de tongzhi,” March 22, 1963, WZA, Vol. 118-12-30. 80. Zhoushanshi Putuoqu weishengzhi bianzhuan weiyuanhui, Putuo weishengzhi, 426. 81. It should be noted that inoculation certificates had been used in China before 1949. However, those certificates did not amount to any sort of sociopolitical control. For the certification of vaccination in the Chinese Civil War (1945–1949), see Brazelton, Mass Vaccination, 108–9. 82. Wenzhoushi weishengju, “Wenzhoushi yijiuliusinian huoluan junmiao yufang zhushe tongjibiao,” June 30, 1964, WZA, Vol. 38-16-5. Wenzhou City is the capital city of Wenzhou Prefecture. The population consists primarily of urban residents, while rural residents account for only a meager percentage. The numbers of absentees among urban residents and rural residents basically correspond to the area’s demographic character. 83. Rui’anxian Tangxiaqu weishengsuo, “Diyi jidu gongzuo zongjie yu jinhou gongzuo yijian,” April 25, 1964, RAA, Vol. 142-9-11. 84. WPRO, “Paracholera El Tor,” 10. 85. Kaul, “Trends of Cholera,” 1011. Although oral cholera vaccines have been tested since the early 1960s, they have never been widely adopted due to high costs, limited supply, and the requirement for two doses. By 2010, the WHO was still warning that oral cholera vaccines should only be used “as an additional public health tool” and should not replace sanitary measures. See Kotar and Gessler, Cholera, 287–88. 86. In 1973, the Twenty-Sixth World Health Assembly announced that it would revoke the clause in the International Health Regulations stating that international travelers should produce cholera inoculation certificates. Shijie weisheng zuzhi, Huoluan de kongzhi zhinan, 22. 87. Wenzhoushi Chengdong fangyi zhihui fenbu, “Guanyu 1963nian 2haobing fangzhi gongzuo de zongjie baogao,” October 19, 1963, WZA, Vol. 38-15-12. 88. Weishengbu, “Fuhuoluan xueshu wenti zhuanjia zuotanhui jiyao,” January 18, 1964, ZJA, Vol. J166-2-166. 89. Dangdai zhongguo de weisheng shiye bianji weiyuanhui, Dangdai zhongguo de weisheng shiye, 272–73. 90. Zhejiangsheng weisheng fangyizhan, “Zhejiangsheng 1980nian fuhuoluan liuxing bingxue fenxi,” 18. 91. Zhejiangsheng weisheng fangyizhan, “Yijiubalingnian fuhuoluan fangzhi gongzuo yaodian,” April 1, 1980, ZJA, Vol. J166-X-X. 92. Pingyang weisheng fangyizhanzhi bianzhuan weiyuanhui, Pingyang weisheng fangyizhanzhi, 41. 93. Zhoushanshi weishengzhi bianzhuan weiyuanhui, Zhoushanshi weishengzhi, 79. Chapter 6. Stool Samples, Archiving Patients, and Statistical Politics 1. Hong, “Wunianlai fangyi ganxiang,” 145–46.

notes to pages 176–183 2. Lampton, Politics of Medicine, 160. 3. Foucault, Discipline and Punish, 190. 4. B. Anderson, Imagined Communities, 166. 5. Zhejiangsheng weishengting, “Guanyu yange yiqing baogao de tongzhi,” July 30, 1962, PYA, Vol. 10-10-14. 6. Yuhangxian weishengju weishengzhi bianzhuanzu, Yuhangxian weishengzhi, 183–84. 7. Rui’anshi weishengzhi bianzhuan weiyuanhui, Rui’anshi weishengzhi, 130. 8. Qian, “Fuhuoluan fangzhi gongzuo de qingkuang ji jinhou renwu,” December 12, 1962, WZA, Vol. 38-14-7. 9. Zhejiangsheng weishengting, “Guanyu bensheng fuhuoluan liuxing qingkuang de huibao,” August 3, 1962, ZJA, Vol. J166-2-126. 10. Pingyangxian renwei weishengke, “Guanyu fuhuoluan fangzhi gongzuo zongjie baogao,” November 30, 1962, PYA, Vol. 10-14-28. 11. Rui’anxian Taoshanqu Fenghe gongshe baojianzhan, “Yufang liexing chuanranbing de zongjie,” November 20, 1962, RAA, Vol. 142-7-12. 12. Chun’anxian weisheng fangyizhan, “Guanyu fuhuoluan yisi bingren yidian chuli qingkuang huibao,” September 6, 1965, CAA, Vol. 37-11-7. 13. Zhejiangsheng weishengting, “Guanyu liji huifu changdao zhuanke menzhen de tongzhi,” March 26, 1964, ZJA, Vol. J166-2-206. 14. Fang, Barefoot Doctors, 125–27. 15. Rui’anxian Taoshan weishengsuo, “Fenghe gongshe shi zenyang kongzhi chuanranbing de,” February 20, 1964, RAA, Vol. 142-9-11. 16. Rui’anxian weisheng fangyizhan, “1963nian fuhuoluan fangzhi gongzuo qingkuang de baogao,” 1963, RAA, Vol. 142-8-4. 17. Li Chengqin, interview by author, Pingyang County, April 12, 2017. 18. Pingyangxian gongye jiaotongju, “Guanyu xunshu zhuansong huayanxiang de lianhe tongzhi,” June 7, 1963, WZA, Vol. 118-12-5. 19. Rui’anxian renwei weishengke, “Wu zhi liuyue changdao ji 02bing yiqu qingli tongjibiao,” July 1964, RAA, Vol. 142-9-2. 20. Pingyangxian weisheng fangyizhan, “Guanyu kaizhan yiyuan jiansuo he changdao menzhen gongzuo de tongzhi,” May 3, 1976, PYA, Vol. 116-3-2. 21. Jiankangbao shelun, “Fahui geti kaiyeyi de liliang,” 243–44. 22. Fang, Barefoot Doctors, 24. 23. Rui’anxian Xianjiangqu weishengsuo, “1962 niandu weisheng gongzuo zongjie,” December 30, 1962, RAA. Vol. 142-7-12. 24. Rui’anxian Gaolouqu weishengsuo, “Tizhi tiaozheng buchong fangan,” December 14, 1961, RAA, Vol. 142-6-13. 25. Rui’anxian Chengguan yiyuan, “Yiwu renyuan zhong de jieji douzheng yu liangtiao daolu douzheng de qingkuang,” November 9, 1963, RAA, Vol. 142-8-18. 26. Wenzhou zhuanqu fangyi zhihuibu, “Fangyi gongzuo jianbao,” September 6, 1962, WZA, Vol. 118-11-65. 27. Weishengbu, “Fuhuoluan fangzhi jingyan zongjie huiyi,” November 11, 1962, ZJA, Vol. J166-2-159. 28. Rui’anxian fangyi zhihuibu, “Guanyu jixu zuohao fangyi gongzuo xunshu pumie chuanranbing de baogao,” October 28, 1962, RAA, Vol. 142-7-10. 29. Rui’anxian renwei weishengke, “Guanyu jiaqiang yiyao weisheng renyuan guanli gongzuo jixiang guiding de tongzhi,” July 1962, RAA, Vol. 142-7-2.

261

262

notes to pages 183–189 30. Rui’anxian Tangxiaqu weishengsuo, “Weisheng jiancha zongjie baogao,” November 7, 1963, RAA, Vol. 142-8-18. 31. Zhejiangsheng weishengting, “Zhejiangsheng yijiuliuwunian weisheng gongzuo yaodian de tongzhi,” January 20, 1965, RAA, Vol. 142-10-12. 32. Weishengbu dangzu, “Zai yijiuliusannian weishengtingjuzhang huiyi shang de jianghua,” April 18, 1963, ZYJA, Vol. 1-9-63. 33. Wenzhoushi fangyi zhihuibu, “Guanyu zai yijiuliusinian jianjue xiaomie fuhuoluan de baogao,” February 25, 1965, WZA, Vol. 38-16-4. 34. Fang, “Global Cholera Pandemic,” 769–70. 35. Summers, “Congruence in Chinese and Western Medicine,” 30; Rogaski, Hygienic Modernity, 96, 100; Echenberg, Plague Ports, 17, 24, 40, 46. 36. Dangdai zhongguo de weisheng shiye bianji weiyuanhui, Dangdai zhongguo de weisheng shiye, 270. 37. MacPherson, “Cholera in China,” 490. 38. Fuyangxian fangyi zhihuibu, “Guanyu diyili fuhuoluan yisi bingli chuli ji jingguo qingkuang de baogao,” May 27, 1963, FYA, Vol. 74-1-7; Guangdongsheng weisheng fangyizhan xuanchuan ziliaoke, Fuhuoluan de liuxingbingxue, 2–3. 39. Fujiansheng difangzhi bianzhuan weiyuanhui, Fujian shengzhi: Weishengzhi, 62. 40. Wenzhou zhuanqu weisheng fangyizhan, “Chusihai, jiangweisheng, xiaomie jibing cankao ziliao,” October 1963, WZA, Vol. 118-12-26. 41. Wei Shanhai, interview by author, Rui’an City, December 28, 2017. 42. Xu, “Guanyu weisheng gongzuo de fayan,” 1962, RAA, Vol. 142-7-1. 43. Guangdongsheng fangyi zhihuibu, Shantou zhuanqu weisheng fangyizhan, “1962nian fuhuoluanbing linchuang zongjie,” October 31, 1962, ZJA, Vol. J166-2-160. 44. Pingyangxian Yishanqu weishengsuo, “Yishan geli yiyuan 02bing 174li linchuang fenxi,” October 8, 1962, ZJA, Vol. J166-2-162. 45. Fang, Barefoot Doctors, 42–66, 94–124. 46. Watts, Epidemics and History, 168. 47. Wenzhoushi Wuma fangyi zhihui fenbu, “Guanyu 1–9 yuefen weisheng fangyi gongzuo de zongjie baogao,” November 30, 1963, WZA, Vol. 38-15-12. 48. Zhonggong Wenzhou shiwei, “Guanyu liji kaizhan yi fangzhi fuhuoluan wei zhongxin de aiguo weisheng yundong de jinji baogao,” April 18, 1963, WZA, Vol. 1-14-42. 49. Zhonggong Zhejiangsheng weishengting dangzu, “Guanyu jiaqiang yufang huoluan shuru wosheng de jinji baogao,” June 1, 1962, HZA, Vol. 1-28-7. 50. Rui’anxian renwei weishengke, “Rui’anxian weisheng baojianyuan gongzuo qingkuang zongjie,” May 1965, ZJA, Vol. J166-1-86. 51. Rui’anxian renwei weishengke, “Rui’anxian weisheng baojianyuan gongzuo qingkuang zongjie.” 52. Rui’anxian weisheng fangyizhan, “1964nian Rui’anxian kaizhan yiqing yuce yubao gongzuo qingkuang,” December 1964, ZJA, Vol. J166-2-206. 53. Fuyangxian weishengju, “Qing zuohao huoluan yufang jiezhong gongzuo zongjie he jiaqiang yiqing baogao de tongzhi,” April 27, 1963, FYA, Vol. 74-2-12. 54. Fuyangxian weishengju, “Guanyu dangqian zhuyao jibing qingkuang he fangzhi gongzuo yijian de baogao,” August 29, 1963, FYA, Vol. 74-2-12. 55. Rui’anshi weishengzhi bianzhuan weiyuanhui, Rui’anshi weishengzhi, 105. 56. Wenzhoushi Wuma fangyi zhihui fenbu, “Guanyu 1–9 yuefen weisheng fangyi gongzuo de zongjie baogao.”

notes to pages 189–196 57. Wenzhoushi Chengdong fangyi zhihui fenbu, “Guanyu 1963nian 2haobing fangzhi gongzuo de zongjie baogao,” October 19, 1963, WZA, Vol. 38-15-12. 58. Wenzhou zhuanqu weisheng fangyizhan fangyi zhihuibu, “Guanyu jinyibu kaizhan yidian qingli gongzuo de yijian,” February 8, 1963, WZA, Vol. 118-12-7. 59. Zhejiangsheng weishengting, “Changdao chuanranbing zhuanke menzhen zanxing banfa,” September 19, 1963, RAA, Vol. 142-8-13. 60. Zhejiangsheng weisheng fangyizhan, Zhejiangsheng yiqing ziliao huibian, 1950–1979 (changdaobing fence), 4. 61. Rui’anxian renwei weishengke, “Yijiuliusannian shangbannian weisheng fangyi gongzuo qingkuang yu jinhou gongzuo yijian de baogao,” 1963, RAA, Vol. 142-8-5. 62. Zhejiangsheng weishengting, “Guanyu Zhejiangsheng 1965nian xiaomie fuhuoluan jihua youguan wenti de shuoming,” March 10, 1965, RAA, Vol. 142-10-12. 63. Rui’anxian renwei weishengke, “Guanyu yijiuliuwunian yiyuan jiansuo gongzuo yijian,” February 15, 1965, RAA, Vol. 142-10-3. 64. Rui’anxian renwei weishengke, “Guanyu chunji fangyi gongzuo qingkuang yu jinhou gongzuo yijian de baogao,” April 30, 1963, RAA, 142-8-10. 65. Rui’anxian weisheng fangyizhan, “Guanyu kaizhan yiqing yuce yubao gongzuo de jige wenti,” November 7, 1963, WZA, Vol. 118-12-5. 66. Rui’anxian weisheng fangyizhan, “1964nian Rui’anxian kaizhan yiqing yuce yubao gongzuo qingkuang.” 67. Xu, Fuyangxian weishengzhi, 171. 68. Ghosh, “Lies, Damned Lies,” 152–53; Ghosh, Making It Count. 69. Zhao, “Yuejinxing tongji tizhi de xingcheng he houguo”; Cai, “Between State and Peasant”; Merli, “Underreporting of Births.” 70. Zhonggong Wenzhou diwei bangongshi, “Guanyu dui Xincheng gongshe guanliqu yiji nongye tongji gongzuo de diaocha baogao,” September 18, 1959, WZA, Vol. 87-11-78. 71. Zhonggong Wenzhou diwei bangongshi, “Guanyu dui Xincheng gongshe guanliqu yiji nongye tongji gongzuo de diaocha baogao.” 72. Zhejiangsheng tongjiju, “Guanyu jingjian nongcun tongji baobiao de tongzhi,” May 25, 1960, PYA, Vol. 10-12-88. 73. Zhonggong Wenzhou shiwei, “Guanyu chuqihai jiang weisheng de baogao,” March 22, 1958, WZA, Vol. 1-9-51. 74. Zhejiangsheng fangyi zhihuibu, “Bayue qiri quansheng fangyi zhihui dianhua huiyi jiyao,” August 14, 1963, KQA, Vol. 105-6-21. 75. Zhejiangsheng weishengting, “Guanyu jianjue zhizhi lanfa weisheng tongji baobiao de tongbao,” January 21, 1965, RAA, Vol. 142-10-13. 76. Rui’anxian renmin weiyuanhui weishengke, “Guanyu shouqu yisheng jiti ban de yiliao jigou de guanlifei peibei ganbu, jiaqiang dui jiceng weisheng zuzhi guanli de qingshi baogao,” December 26, 1964, RAA, Vol. 142-9-1. 77. Rui’anxian renmin weiyuanhui weishengke, “Guanyu shouqu yisheng jiti ban de yiliao jigou de guanlifei peibei ganbu, jiaqiang dui jiceng weisheng zuzhi guanli de qingshi baogao.” 78. Zhejiangsheng weishengting, “Guanyu liji huifu changdao zhuanke menzhen de tongzhi.” 79. Rui’anxian weisheng fangyizhan, “1964nian Rui’anxian kaizhan yiqing yuce yubao gongzuo qingkuang.” 80. Yongjiaxian renmin weiyuanhui weishengke, “Guanyu zhuajin zuohao dangqian fuhuoluan yiyuan jiansuo deng gongzuo de yijian,” August 31, 1964, ZYJA, Vol. 7-21-26.

263

264

notes to pages 196–206 81. Rui’anxian Tangxiaqu weishengsuo, “Weisheng jiancha zongjie baogao.” 82. Yuhangxian weishengju, “Guanyu peizhi yiqing baogao shidian gongzuo jianbao,” May 5, 1964, ZJA, Vol. J166-2-206. 83. Chun’anxian weisheng fangyizhan, “Guanyu fuhuoluan yisi bingren yidian chuli qingkuang huibao.” 84. Zhonggong zhongyang wenxian yanjiushi, Jianguo yilai zhongyao wenxian xuanbian, 241–43. 85. Laodong renshibu laodong kexue yanjiusuo, Zhonghua renmin gongheguo laodong fagui xuanbian, 393. 86. Zhejiangsheng minzhengting, caizhengting, “Guanyu gongfei yiliao zhong cunzai de wenti he gaijin yijian de baogao,” September 4, 1963, WZA, Vol. 51-14-50. 87. Zhejiangsheng caizhengting, Zhejiangsheng weishengting, “Guanyu fuhuoluan fangzhi jingfei kaizhi fanwei, biaozhun ji youguan zhidu guiding de tongzhi,” June 7, 1964, KQA, Vol. 105-7-9. 88. Wenzhou zhuanshu jihua jingji weiyuanhui, Wenzhouqu 1963nian guomin jingji tongji ziliao huibian, 23. 89. Rui’anxian weisheng fangyizhan, “1964nian Rui’anxian kaizhan yiqing yuce yubao gongzuo qingkuang.” 90. Wenzhoushi fangyi zhihuibu, “Guanyu fu Hangzhoushi huo shengwai renyuan shixing dabian jianyan de jinji tongzhi,” December 12, 1963, WZA, Vol. 118-12-32. Chapter 7. “No. 2 Disease” 1. Fen, Wenzhou jishi, 169. 2. Dangdai zhongguo de weisheng shiye bianji weiyuanhui, Dangdai zhongguo de weisheng shiye, 267. 3. Zhongyang renmin zhengfu weishengbu, “Guanyu yanfang huoluan de lianhe zhishi,” 70–71. 4. Wu, “Ningbo jibing shihua pianduan,” 174–80. 5. Echenberg, Plague Ports, 24. 6. Benedict, Bubonic Plague, 100, 115. 7. Katz, Demon Hordes, 2–3. 8. L. Soothill, Passport to China, 104–5; W. Soothill, Mission in China, 266–68. These rituals were also performed in Yun’nan and Vietnam in the late nineteenth and twentieth centuries. See Hsu, Religion, Science and Human Crises, 62–63; and Vann, “Hanoi in the Time of Cholera,” 159. There was a similar plague deity called Kingly Lord (wangye) in Taiwan. According to Michael Szonyi, “To protect the village from disease, these temples held periodic rituals in which the gods were invited aboard a magnificent papier-mâché boat that was then floated off into the sea.” Szonyi, Cold War Island, 183. 9. Han Yonggang, interview by author, Wenzhou City, April 27, 2017. 10. Peckham, Epidemics in Modern Asia, 245; Arnold, Colonizing the Body, 168; Rogaski, Hygienic Modernity; Gross, Farewell to the God of Plague, 110. 11. Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan, “Fuhuoluan liuxingbingxue,” November 7, 1962, ZJA, Vol. J166-2-129. 12. Qian, “Fuhuoluan fangzhi gongzuo de qingkuang ji jinhou renwu,” December 12, 1962, WZA, Vol. 38–14–7. 13. Gao, Hongtaiyang, 374. 14. Wenzhoushi baomi weiyuanhui, “Wenzhoushi baomi gongzuo zanxing guiding (caogao),” May 23, 1963, WZA, Vol. 212–8-5. 15. Wenzhoushi baomi weiyuanhui, “Wenzhoushi baomi gongzuo zanxing guiding (caogao).”

notes to pages 207–213 16. Wenzhoushi baomi weiyuanhui, “Wenzhoushi baomi gongzuo zanxing guiding (caogao).” 17. He Nangao, telephone interview by author, September 12, 2017. 18. Zhonggong Wenzhou diwei, “Guanyu Wenling xianwei yong mingma dianbao paifa baogao xielou guojia jimi de tongbao,” November 21, 1960, WZA, Vol. 87-12-71. 19. Zhejiangsheng weishengting, “Guanyu jiaqiang chuanranbing tongji ji yiqing baogao de tongzhi,” December 21, 1960, KQA, Vol. 105-3-16. By 1962, different provinces were using different codes for diseases. For example, when cholera first broke out in Yangjiang County, Guangdong Province, in June 1961, the code for cholera was No. 102. See Zhonggong Yangjiang xianwei Yu Xin shuji, “Liuxingbing diaocha baogao,” 1961, GYJA, Vol. X38.A12.1. 36. 20. Zhonggong Wenzhou diwei, “Guanyu Wenling xianwei yong mingma dianbao paifa baogao xielou guojia jimi de tongbao.” 21. Pingyangxian renmin weiyuanhui weishengke, “Guanyu zhixing shengweishengting dangzu jiaqiang fangzhi xiaji chuanranbing de jinji tongzhi de tongzhi,” August 4, 1961, PYA, Vol. 10-13-50. 22. Weishengbu, “Guanyu Guangdongsheng fuhuoluan yiqing qingkuang de tongbao,” May 18, 1962, ZJA, Vol. J166-2-126. 23. Weishengbu, “Hanfa fuhuoluanbing ziliao huibian,” March 5, 1962, ZJA, Vol. J166-1-71. 24. Zhejiangsheng weishengting, “Fenfa fangzhi fuhuoluan ziliao youguan shixiang de tongzhi,” December 29, 1962, ZJA, Vol. J166-1-71. 25. Zhonggong zhongyang, guowuyuan, “Pizhuan huadongju weishengbu dangzu guanyu huadong diqu he Guangdongsheng weisheng gongzuo jinji huiyi qingkuang de baogao,” September 1, 1962, HZA, Vol. 1-28-6. 26. Zhejiangsheng weishengting, “Guanyu yange yiqing baogao de tongzhi,” July 30, 1962, RAA, Vol. 10-10-14. 27. Weishengbu, “Chuanranbing guanli banfa,” May 1, 1955, RAA, Vol. 142-8-13. 28. Zhejiangsheng fangyi zhihuibu, “Guanyu youguan yinzhang kezhi wenti de yijian,” July 30, 1963, RAA, Vol. 142-8-12. 29. Zhejiangsheng fangyi zhihuibu bangongshi, “Guanyu fuhuoluan yiqing yingzuo juemijian chuli de tongzhi,” July 8, 1973, ZJA, Vol. J166-2-165. 30. Zhejiangsheng fangyi zhihuibu bangongshi, “Qing zhuyi juemijian de baomi chuli,” July 18, 1964, ZJA, Vol. J166-2-79. 31. Zhenhaixian fangyi zhihuibu, “Qing zhuyi juemijian de baomi chuli,” July 22, 1964, ZJA, Vol. J166-2-79. 32. Weishengbu, “Youguan xielou yiqing de qingkuang,” September 28, 1962, ZJA, Vol. J166-2-126. 33. Zhejiangsheng weishengting, “Qing jiancha fuhuoluan fangzhi ziliao baomi he junzhong baocun qingkuang de tongzhi,” January 11, 1963, ZJA, Vol. J166-2-165. 34. Zhejiangsheng weishengting, “Guanyu diaohui canjia sheng fangbing zhibing gongzuodui ji jianyanyuan de tongzhi,” December 28, 1965, RAA, Vol. 142-10-12. 35. Townsend and Womack, Politics in China, 229–30. 36. Wenzhoushi baomi weiyuanhui, “Wenzhoushi baomi gongzuo zanxing guiding (caogao).” 37. Xinhuashe [Xinhua News Agency], “Guangdong Yangjiang dengxian fasheng fuhuoluan, jing caiqu youxiao cuoshi yiqing xunshu jianqing” [Cholera broke out in Yangjiang and other counties in Guangdong Province; the epidemic was quickly contained], RMRB, August 30, 1961. 38. Xinhuashe [Xinhua News Agency], “Xianggang fasheng huoluan, Guangdong jiaqiang rujing jiaotong jianyi gongzuo” [Cholera epidemic has broken out in Hong Kong; Guangdong Province has strengthened quarantine work], RMRB, August 28, 1961. 39. Xinhuashe [Xinhua News Agency], “Xiezhu feilüebin pumie fuhuoluan, wo hongshizihui

265

266

notes to pages 213–218 jueding zengsong yipi huoluan yimiao” [To assist the Philippines in eradicating cholera, our China Red Cross Society decided to donate a batch of cholera vaccines], RMRB, January 30, 1962; Xinhuashe [Xinhua News Agency], “Wo juanzeng de huoluan yimiao yundi feilüebin” [Cholera vaccines donated by our country have reached the Philippines], RMRB, February 16, 1962. 40. Xinhuashe [Xinhua News Agency], “Taiwan nanbu fasheng fuhuoluan” [Cholera broke out in southern Taiwan], RMRB, July 21, 1962; Xinhuashe [Xinhua News Agency], “Jiangfeibang mobuguanxin fangzhi gongzuo, Taiwan fuhuoluan yiqu xunshu kuoda” [Chiang Kai-shek bandit clique did not care about epidemic prevention and treatment work; cholera is spreading widely], RMRB, August 14, 1962. According to the statistical data in an internal volume edited by the Sanitation and Epidemic Prevention Department of the Ministry of Health of the People’s Republic of China in December 1962, the number of cholera cases was 347, and the death toll was 22 in Taiwan for that year. See Jiang, “Fuhuoluan de liuxingbingxue wenti,” 69. 41. Xinhuashe [Xinhua News Agency], “Jiangfeibang mobuguanxin fangyi gongzuo, Taiwan fuhuoluan yiqu xunshu kuoda” [Chiang Kai-shek bandit clique did not care about epidemic prevention and treatment work; cholera is spreading widely], ZNDZ, August 14, 1962. 42. He Yanlian, “Bangzhu shengchandui zuohao xialing weisheng” [Assist paroduction teams in conducting summer hygiene], ZNDZ, July 27, 1962. 43. Chen Zuohua, “Tantan da yufangzhen” [On preventive inoculation], ZNDZ, July 27, 1962. 44. Weishengbu, “Guanyu fuhuoluan yiqing xiemi de tongbao,” May 27, 1963, ZJA, Vol. J166-2-165. 45. Zhejiangsheng aiguo weisheng yundong weiyuanhui, “Yufang fuhuoluan zhishi koutou xuanchuan cankao,” September 21, 1962, ZJA, Vol. J166-27-60. 46. Wu, “Jinnianlai fuhuoluan liuxing de yixie wenti,” 175. 47. Zhonggong Wenzhou shiwei, “Guanyu jinji fangzhi fuhuoluan de baogao,” July 22, 1962, WZA, Vol. 1-13-12. 48. Rui’anxian Taoshanqu weishengsuo, “1963nian fuhuoluan fangzhi zhuanti jihua,” 1963, RAA, Vol. 142-8-18. 49. Rui’an xianwei renwei, “Xiaomie fuhuoluanbing de guihua,” January 4, 1963, RAA, Vol. 1-15-68. 50. Rui’anxian weisheng fangyizhan, “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao,” 1962, RAA, Vol. 142-7-2. 51. Rui’anxian weisheng fangyizhan, “Gei quanxian renmin de yifengxin,” January 3, 1963, RAA, Vol. 142-8-5. 52. Brazelton, Mass Vaccination, 129–31; Rogaski, Hygienic Modernity, 293–98. 53. Rui’anxian Xinchengqu weishengsuo, “Miebing gongzuo huibao,” September 3, 1962, RAA, Vol. 1-14-179. 54. Rui’anxian fangyi zhihuibu, “Guanyu fuhuoluan fangzhi baogao,” August 2, 1962, RAA, Vol. 142-7-2. 55. Rui’anxian Xianjiangqu weishengsuo, “1962 niandu weisheng gongzuo zongjie,” December 30, 1962, RAA, Vol. 142-7-12. 56. Rui’anxian Xinchengqu weishengsuo, “Miebing gongzuo huibao.” 57. Manderson, “Wireless Wars,” 117; Cvjetanovic, “Cholera as an International Health Problem,” 9. 58. World Health Organization, Guidelines for Cholera Control. 59. Briggs, Stories in the Time of Cholera, 256. 60. Lee, “WHO and the Developing World,” 25–28. 61. “Chinese Accuse US of Starting Cholera Epidemic,” SCMP, August 18, 1961.

notes to pages 219–230 62. “Current Cholera Scare Terrifies Population,” SCMP, August 24, 1961. 63. “No Cases of Cholera Registered in Canton,” SCMP, August 29, 1961. 64. “World Health Organization Report,” SCMP, August 23, 1961; “A Cholera Outbreak in China,” ST, August 24, 1961. 65. “Stop Press,” SCMP, August 30, 1961. 66. Zhejiangsheng weishengting, “Guanyu dui nike bayue qiri wei fangzhi di 288hao tongzhi de liangdian yijian,” September 11, 1964, ZJA, Vol. J166-2-206. 67. Shaoxingxian weishengju, “Guanyu jiaqiang dui fuhuoluan fabing diqu de wailai ji waichu renkou de jianyi he guanli gongzuo de tongzhi,” April 7, 1965, KQA, Vol. 105-8-13. 68. Ong, “Public Health and the Clash of Cultures,” 217. 69. “Piped Water for Communities: WHO Voices Concern over Dwindling Supply,” SCMP, September 26, 1962. 70. Cvjetanovic, “Cholera as an International Health Problem,” 10–12. 71. Raska, “Surveillance and Control of Cholera,” 116. 72. Dangdai zhongguo de weisheng shiye bianji weiyuanhui, Dangdai zhongguo de weisheng shiye, 268. 73. Zhonghua renmin gongheguo Shanghai weisheng jianyisuo, “Shijie huoluan yiqing de zhangwo, fenxi yu yingyong,” October 1963, ZJA, Vol. J166-2-199. 74. Weishengbu weisheng fangyisi, Guowai huolua fuhuoluan wenzhai. 75. Weishengbu, “Guanyu jiaqiang shijie weisheng zuzhi bianyin ‘yiqing zhoubao’ deng weisheng ziliao de guanli de tongzhi,” June 2, 1965, ZJA, Vol. J166-1-85. However, this archival folder does not contain these pamphlets. These “reactionary” pamphlets have likely been removed. 76. “Another Case of Cholera,” SCMP, August 31, 1962. 77. Zhejiangsheng weishengting, “Guanyu yaoqiu dui xianggang, aomen diqu rujing renyuan chushi youxiao huoluan yufang jiezhong zhengshu de jinji tongzhi,” August 12, 1965, RAA, Vol. 142-10-12. 78. Weishengbu, “Dui jianyi chazheng yudao de wenti chuli yijian,” April 10, 1968, WZA, Vol. 38-12-7. 79. Weishengbu, “Dui jianyi chazheng yudao de wenti chuli yijian.” 80. Jiaotongbu junguanhui, weishengbu, “Guanyu xiugai jiaqiang dui suxiu dengguo chuanbo jinchu gangkou jiancha wenti de tongzhi,” April 2, 1968, WZA, Vol. 38-12-7. 81. Fan, “‘Collective Monitoring,’“ 127–54. Conclusion 1. Pelling, Cholera, Fever and English Medicine, 6. 2. Evans, Death in Hamburg, 565. 3. Bu, Public Health and the Modernization of China, 116; Wu, Plague Fighter, 403–47. 4. Lucas, Chinese Medical Modernization; Lampton, Politics of Medicine. 5. Cao, “Guojia yu difang de gonggong weisheng.” 6. Greenhalgh and Winckler, Governing China’s Population. 7. Fang, Barefoot Doctors, 20–41. 8. Rogaski, Hygienic Modernity, 293–98. 9. Ding, “Yingdui SARS weiji de sanzhong tizhi.” 10. Rogaski, “Nature, Annihilation, and Modernity,” 389. 11. Szonyi, Cold War Island, 250–51. 12. Lampton, Politics of Medicine, 127–80.

267

268

notes to pages 231–234 13. Meyskens, “Third Front Railroads,” 238, 248–49; Meyskens, Mao’s Third Front. 14. K. Brown, Plutopia. 15. K. Brown, Manual for Survival. 16. Courtney, Nature of Disaster; Paltemaa, Managing Famine; Wemheuer, Famine Politics; Li, Fighting Famine; Will, Bureaucracy and Famine in Eighteenth-Century China; Kuhn, Soulstealers. 17. Epidemic cerebrospinal meningitis is “a bacterial form of meningitis, caused by the inflammation of the protective membranes covering the brain and the spinal cord. The bacterium spreads through contact with saliva from an infected, and possibly asymptomatic, person. Typically transmission occurs through coughing, sneezing, kissing or sharing drinking vessels, and the like.” Fan, “Epidemic Cerebrospinal Meningitis,” 198–99. See also MacFarquhar and Schoenhals, Mao’s Last Revolution, 113; and Deng, Zhongguo fangyishi, 620–24. 18. Mason, “Correct Secret,” 46. 19. Mason, “Correct Secret,” 45–58; Mason, Infectious Change, 143–80. 20. Xi Jinping, “Haobu fangsong zhuajin zhuashi zhuaxi fangkong gongzuo” [Never relax, and conduct prevention and treatment work urgently, intensively, and meticulously], RMRB, February 24, 2020.

BIBLIOGRAPHY

Archives Chun’an County Archives, Qiandaohu Town, Zhejiang Province, China (CAA) Chun’anxian weisheng fangyizhan [Chun’an County Sanitation and Epidemic Prevention Station]. “Guanyu fuhuoluan yisi bingren yidian chuli qingkuang huibao” [Report on the management of cholera suspects]. September 6, 1965, CAA, Vol. 37-11-7. Zhejiangsheng fangyi zhihuibu [Zhejiang Provincial Epidemic Prevention Headquarters]. “Guanyu fuhuoluan fangzhi qingkuang he jinhou yijian de baogao” [Report on cholera prevention and treatment and instruction for the work in the future]. September 26, 1962, CAA, Vol. 1-1-137. Fuyang District Archives, Hangzhou City, Zhejiang Province, China (FYA) Fuyangxian fangyi zhihuibu [Fuyang County Epidemic Prevention Headquarters]. “Guanyu diyili fuhuoluan yisi bingli chuli ji jingguo qingkuang de baogao” [Report on the treatment process for the first cholera suspect]. May 27, 1963, FYA, Vol. 74-1-7. Fuyangxian weishengju [Fuyang County Health Bureau]. “Guanyu 1963nian fuhuoluan fangzhi gongzuo de zongjie” [Summary of cholera prevention and treatment in 1963]. 1963, FYA, Vol. 74-1-7. Fuyangxian weishengju [Fuyang County Health Bureau]. “Guanyu dangqian zhuyao jibing qingkuang he fangzhi gongzuo yijian de baogao” [Report on current situations of major diseases and instructions on prevention and treatment]. August 29, 1963, FYA, Vol. 74-2-12. Fuyangxian weishengju [Fuyang County Health Bureau]. “Qing zuohao huoluan yufang jiezhong gongzuo zongjie he jiaqiang yiqing baogao de tongzhi” [Circular on preparing the summary of cholera preventive inoculation work and strengthening epidemic disease reporting]. April 27, 1963, FYA, Vol. 74-2-12. Hangzhou Prefectural Archives, Hangzhou City, Zhejiang Province, China (HZA) Weishengbu dangzu [Party Leadership Group of the Ministry of Health]. “Guanyu yufang he xiaomie fuhuoluan de guihua” [Cholera prevention and eradication plan]. December 1962, HZA, Vol. 1-28-6. Zhonggong Zhejiangsheng weishengting dangzu [Party Leadership Group of Zhejiang Provincial Health Department]. “Guanyu jiaqiang yufang huoluan shuru wosheng de jinji baogao” [Urgent circular on strengthening the prevention of the spread of cholera in our province]. June 1, 1962, HZA, Vol. 1-28-7. Zhonggong zhongyang, guowuyuan [Central Committee of the Chinese Communist Party and the State Council]. “Pizhuan huadongju weishengbu dangzu guanyu huadong diqu he Guangdongsheng weisheng gongzuo jinji huiyi qingkuang de baogao” [Forward the Eastern China Bureau and the Party Leadership Group of the Ministry of Health’s report concerning the

269

270

bibliogr aphy urgent meeting on health work in Guangdong Province and eastern China]. September 1, 1962, HZA, Vol. 1-28-6. Keqiao District Archives, Shaoxing City, Zhejiang Province, China (KQA) Shaoxingxian weishengju [Shaoxing County Health Bureau]. “Guanyu jiaqiang dui fuhuoluan fabing diqu de wailai ji waichu renkou de jianyi he guanli gongzuo de tongzhi” [Circular on strengthening quarantine management work over populations coming into and going out of cholera-affected areas]. April 7, 1965, KQA, Vol. 105-8-13. Zhejiangsheng caizhengting, Zhejiangsheng weishengting [Zhejiang Provincial Finance Department and Zhejiang Provincial Health Department]. “Guanyu fuhuoluan fangzhi jingfei kaizhi fanwei, biaozhun ji youguan zhidu guiding de tongzhi” [Regulations on scope, standards, and other issues of cholera epidemic prevention costs]. June 7, 1964, KQA, Vol. 105-7-9. Zhejiangsheng fangyi zhihuibu [Zhejiang Provincial Epidemic Prevention Headquarters]. “Bayue qiri quansheng fangyi zhihui dianhua huiyi jiyao” [Minutes of the provincial epidemic prevention telephone conference on August 7]. August 14, 1963, KQA, Vol. 105-6-21. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Guanyu jiaqiang chuanranbing tongji ji yiqing baogao de tongzhi” [Instruction on strengthening epidemic statistics and reporting]. December 21, 1960, KQA, Vol. 105-3-16. National Archives of Australia, Canberra (NAA) Australian Embassy in Jakarta. “Chinese Ambassador to Indonesia.” August 1950, NAA, A1838, 406/9/2/12. Australian Embassy in Jakarta. “The Chinese in Indonesia.” December 15, 1952, NAA, A1838/280, 3034/2/5/1. Australian Embassy in Jakarta. “Indonesian-Chinese Dual Citizenship Agreement.” April 30, 1955, NAA, A11604, 407/1/1. Australian Embassy in Jakarta. “The Sino/Indonesian Dual Nationality Treaty.” 1957–1962, NAA, A1838/280, 3034/2/5/1 part 2. Department of External Affairs, Canberra, Australia. “Report to the Secretary.” October 6, 1956, NAA, A11604, 407/1/1. Horne, D. J. “Chinese Communists Representative Leave for Indonesia.” July 19, 1951, NAA, A1838, 406/9/2/12. Lee, Charles. “Report to the Secretary, Department of External Affairs.” November 26, 1954, NAA, A11604, 407/1/1. Loe, Charles. “Chinese in Indonesia.” January 23, 1956, NAA, A11604, 407/1/1. Pingyang County Archives, Kunyang Town, Zhejiang Province, China (PYA) Guo Quanqing. “Guanyu zigong tuochui de baogao” [Report on prolapsed uterus]. 1962, PYA, Vol. 10-14-165. Pingyangxian bingyiju [Pingyang County Military Service Bureau]. “Guanyu 58niandu zhengbing tijian gongzuo zongjie pingbi cailiao” [Summary and assessment documents of medical examination for conscription in 1958]. October 27, 1959, PYA, Vol. 10-11-69. Pingyangxian fangyi zhihuibu [Pingyang County Epidemic Prevention Headquarters]. “Guanyu fuhuoluan fangzhi gongzuo qingkuang he jinhou gongzuo yijian de baogao” [Progress report on cholera prevention and treatment work, and instructions for work in the future]. August 22, 1962, PYA, Vol. 10-14-28.

bibliogr aphy Pingyangxian liangshiju [Pingyang County Grain Bureau]. “Guanyu dangqian fangyi gongzuo zhong youguan liangshi wenti de lianhe tongzhi” [Joint circular on the grain issue in current epidemic prevention work]. October 11, 1962, PYA, Vol. 10-14-119. Pingyangxian Qiaodunqu weishengsuo [Pingyang County Qiaodun District Health Clinic]. “Guanyu benqu qiuji zhongdou gongzuo zongjie baogao” [Summary report on autumn smallpox inoculation in the district]. December 12, 1956, PYA, Vol. 10-9-273. Pingyangxian renmin weiyuanhui [Pingyang County People’s Commission]. “Guanyu choudiao mingong canjia Tengjiao zhi Zhangji gonglu de tongzhi” [Circular on allocating peasant laborers to participate in the construction of the road between Tengjiao and Zhangji]. July 9, 1962, PYA, Vol. 10-14-41. Pingyangxian renmin weiyuanhui [Pingyang County People’s Commission]. “Guanyu shishi jiaotong jianyi de jinji tonggao” [Urgent notice on implementing transport quarantine]. August 2, 1962, PYA, Vol. 10-14-28. Pingyangxian renmin weiyuanhui [Pingyang County People’s Commission]. “Guanyu zhizhi renkou ziyou liudong de gongzuo yijian” [Work instruction on stopping free population movement]. January 7, 1962, PYA, Vol. 10-14-47. Pingyangxian renmin weiyuanhui [Pingyang County People’s Commission]. “Guanyu zuohao budui junxu gongying gongzuo de jidian zanxing guiding” [Temporary regulations on the provision of military supplies to the army]. July 10, 1962, PYA, Vol. 10-14-41. Pingyangxian renmin weiyuanhui weishengke [Health Division of Pingyang County People’s Commission]. “Guanyu fangyi jingfei wenti de tongzhi” [Circular on the epidemic prevention budget]. August 21, 1962, PYA, Vol. 10-14-120. Pingyangxian renmin weiyuanhui weishengke [Health Division of Pingyang County People’s Commission]. “Guanyu zhixing shengweishengting dangzu jiaqiang fangzhi xiaji chuanranbing de jinji tongzhi de tongzhi” [Instruction on implementing the party leadership group of the Zhejiang Provincial Health Department’s urgent directive on strengthening the prevention and treatment of infectious diseases in the summer]. August 4, 1961, PYA, Vol. 10-13-50. Pingyangxian renmin zhengfu [Pingyang County People’s Government]. “Guanyu buzhi yijiuwusinian chunji zhongdou gongzuo de tongzhi” [Circular on assigning smallpox inoculation work in the spring of 1954]. December 8, 1954, PYA, Vol. 10-6-132. Pingyangxian renmin zhengfu [Pingyang County People’s Government]. “Guanyu nongcun renkou wailiu qingkuang de diaocha baogao” [Investigative report on outflows of rural populations]. May 13, 1962, PYA, Vol. 10-14-10. Pingyangxian renwei weishengke [Health Division of Pingyang County People’s Commission]. “Guanyu fuhuoluan fangzhi gongzuo zongjie baogao” [Summary report on cholera prevention and treatment]. November 30, 1962, PYA, Vol. 10-14-28. Pingyangxian weisheng fangyizhan [Pingyang County Sanitation and Epidemic Prevention Station]. “Guanyu 1956nian weisheng fangyizhan gongzuo zongjie” [Summary of sanitation and epidemic prevention work in 1956]. December 19, 1956, PYA, Vol. 10-8-225. Pingyangxian weisheng fangyizhan [Pingyang County Sanitation and Epidemic Prevention Station]. “Guanyu kaizhan yiyuan jiansuo he changdao menzhen gongzuo de tongzhi” [Circular on launching the search for cholera bacterial sources and work at outpatient departments for intestinal diseases]. May 3, 1976, PYA, Vol. 116-3-2. Pingyangxian weisheng fangyizhan [Pingyang County Sanitation and Epidemic Prevention Station]. “Guanyu Pingyangxian fuhuoluan fangzhi gongzuo zongjie baogao” [Summary report on cholera prevention and treatment work in Pingyang County]. November 30, 1962, PYA, Vol. 10-14-28.

271

272

bibliogr aphy Pingyangxian weisheng fangyizhan [Pingyang County Sanitation and Epidemic Prevention Station]. “Pingyangxian 1980–1984nian fuhuoluan ziliao zongjie” [Compiled data on cholera in Pingyang County, 1980–1984]. 1984, PYA, Vol. 116-14-2. Wenzhou diwei gongzuozu [Work Team of Wenzhou Prefectural Party Committee]. “Wanquan gongshe Baoyang shengchan dadui jingji diaocha ziliao” [Investigative materials on the economy of Baoyang Production Brigade, Wanquan Commune]. June 15, 1961, PYA, Vol. 1-13-44. Wenzhou zhuanqu zhiqian weiyuanhui bangongshi [Office of Wenzhou Prefectural Supporting Front Work Committee]. “Dui dangqian zhujun zhu fu shipin gongying jihua de shuoming” [Instructions on the provisions of staple and supplementary foods to armies stationed in the prefecture]. August 8, 1962, PYA, Vol. 10-14-156. Zhejiangsheng caizhengting [Zhejiang Provincial Finance Department]. “Guanyu dangqian fangyi renwu youguan jingfei kaizhi wenti de buchong tongzhi” [Supplementary circular on budget issues of current epidemic prevention work]. August 29, 1962, PYA, Vol. 10-14-141. Zhejiangsheng fangyi zhihuibu [Zhejiang Provincial Epidemic Prevention Headquarters]. “Guanyu fuhuoluan fangzhi qingkuang he jinhou yijian de baogao” [Report on cholera prevention and treatment and instruction for the work in future]. September 12, 1962, PYA, Vol. 10-14-141. Zhejiangsheng fangyi zhihuibu [Zhejiang Provincial Epidemic Prevention Headquarters]. “Zhejiangsheng jiaotong jianyi shixing xize” [Rules for implementation of quarantine in Zhejiang Province]. September 17, 1962, PYA, Vol. 10-14-141. Zhejiangsheng renmin weiyuanhui [Zhejiang Provincial People’s Commission]. “Guanyu jiaqiang yumin yu yuqu fangyi gongzuo shishi banfa” [Regulations for strengthening implementation of epidemic prevention among fishermen and in fishing areas]. September 10, 1962, PYA, Vol. 10-14-141. Zhejiangsheng renmin weiyuanhui [Zhejiang Provincial People’s Commission]. “Zhejiangsheng junqu guanyu banfa zhejiangsheng minbing zhanbei, zhiqing banfa zanxing guiding de tongzhi” [Zhejiang Provincial Military Region’s circular on promulgating temporary regulations for militias’ preparation for war and supporting the front work]. June 8, 1964, PYA, Vol. 10-16-13. Zhejiangsheng renmin weiyuanhui bangongting [General Office of Zhejiang Provincial People’s Commission]. “Guanyu huaqiao he gangao tongbao yi waihui zhifu lüefei, qi jiaotong zhusu feiyong shixing bazhe youdai de tongzhi” [Circular on offering 20 percent discount to overseas Chinese and Hong Kong and Macau visitors who pay transport and accommodation fees in foreign currency]. January 27, 1964, PYA, Vol. 10-16-40. Zhejiangsheng renmin weiyuanhui minzu shiwuchu [Bureau of Ethnic Minority Affairs of Zhejiang Provincial People’s Commission]. “Guanyu Pingyangxian Fanshan, Mazhanqu shezu qunzhong chumai zinü qingkuang de baogao” [Report on the masses of She ethnic minority selling off children in Fanshan and Mazhan Districts of Pingyang County]. August 24, 1962, PYA, Vol. 10-14-11. Zhejiangsheng tongjiju [Zhejiang Provincial Statistics Bureau]. “Guanyu jingjian nongcun tongji baobiao de tongzhi” [Instructions on reducing numbers of rural statistics forms]. May 25, 1960, PYA, Vol. 10-12-88. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Guanyu fangzhi fuhuoluan fasheng he manyan de jinji zhishi” [Urgent instruction on preventing the outbreak and spread of cholera]. July 27, 1962, PYA, Vol. 10-10-14. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Guanyu yange yiqing baogao de tongzhi” [Instruction on strictly implementing epidemic reporting]. July 30, 1962, PYA, Vol. 10-10-14.

bibliogr aphy Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Guanyu zengfa huoluan junmiao de tongzhi” [Circular on allocating more cholera vaccines]. August 3, 1962, PYA, Vol. 10-10-14. Zhonggong Pingyangxian nanji gongzuo weiyuanhui [Nanji Working Commission of Pingyang County Party Committee]. “Guanyu zhanbei gongzuo qingkuang de jianbao” [Brief report on the preparation for war]. June 18, 1962, PYA, Vol. 10-14-42. Zhonggong Pingyang xianwei bangongshi [General Office of Pingyang County Party Committee]. “Guanyu Wanquan diqu zhengzhi zuzhi jingji zhuangkuang de diaocha baogao” [Investigative report on political organization and economic situations in Wanquan District]. April 25–July 12, 1961, PYA, Vol. 1-13-44. Zhu Shude. “Fangwen zhujun baogao” [Report on visiting the armies]. June 15, PYA, Vol. 10-14-42. Rui’an City Archives, Zhejiang Province, China (RAA) Rui’anxian Chengguan yiyuan [Rui’an County Chengguan Township Hospital]. “Guanyu Chengzhen weisheng gongzuo qingkuang he jinhou yijian” [Health work in Chengguang Town and instruction on the work hereafter]. 1962, RAA, Vol. 142-7-12. Rui’anxian Chengguan yiyuan [Rui’an County Chengguan Township Hospital]. “Yiwu renyuan zhong de jieji douzheng yu liangtiao daolu douzheng de qingkuang” [Report on the class struggle and the two-route struggle among medical staff at Chengguan Hospital]. November 9, 1963, RAA, Vol. 142-8-18. Rui’anxian fangyi zhihuibu [Rui’an County Epidemic Prevention Headquarters]. “Guanyu fuhuoluan fangzhi baogao” [Report on cholera prevention and treatment]. August 2, 1962, RAA, Vol. 142-7-2. Rui’anxian fangyi zhihuibu [Rui’an County Epidemic Prevention Headquarters]. “Guanyu jixu zuohao fangyi gongzuo xunshu pumie chuanranbing de baogao” [Report on further conducting epidemic prevention work and quickly eradicating epidemic diseases]. October 28, 1962, RAA, Vol. 142-7-10. Rui’anxian fangyi zhihuibu [Rui’an County Epidemic Prevention Headquarters]. “Rui’anxian yijiuliusannian fuhuoluan fangzhi gongzuo jishu zhuanye zongjie” [Technical summary of epidemic prevention work in Rui’an County in 1963]. October 10, 1963, RAA, Vol. 142-8-4. Rui’anxian Gaolouqu weishengsuo [Rui’an County Gaolou District Health Clinic]. “Tizhi tiaozheng buchu fangan” [Supplementary plan for medical system adjustments]. December 14, 1961, RAA, Vol. 142-6-13. Rui’anxian renmin weiyuanhui weishengke [Health Division of Rui’an County People’s Commission]. “1963–1972nian shinian guihua” [Ten-year work plan for 1963–1972]. 1963, RAA, Vol. 142-8-11. Rui’anxian renmin weiyuanhui weishengke [Health Division of Rui’an County People’s Commission]. “Guanyu shouqu yisheng jiti ban de yiliao jigou de guanlifei peibei ganbu, jiaqiang dui jiceng weisheng zuzhi guanli de qingshi baogao” [Requesting instructions on charging management fees from collective medical units to recruit cadres and strengthening the management of grassroots health organizations]. December 26, 1964, RAA, Vol. 142-9-1. Rui’anxian renmin weiyuanhui weishengke [Health Division of Rui’an County People’s Commission]. “Guanyu xiaomie fuhuoluan de guihua” [Plan for cholera eradication]. 1963, RAA, Vol. 142-8-4. Rui’anxian renwei weishengke [Health Division of Rui’an County People’s Commission]. “Fangyi jiancha qingkuang” [Investigative report on epidemic prevention]. 1964, RAA, Vol. 142-9-4.

273

274

bibliogr aphy Rui’anxian renwei weishengke [Health Division of Rui’an County People’s Commission]. “Fuhuoluan liuxing qingkuang yu fangzhi gongzuo de zongjie baogao” [Summary report on cholera transmission and prevention and treatment]. 1962, RAA, Vol. 142-7-2. Rui’anxian renwei weishengke [Health Division of Rui’an County People’s Commission]. “Guanyu chuanranbing fasheng qingkuang de baogao” [Report on occurrence of infectious disease]. 1962, RAA, Vol. 142-7-5. Rui’anxian renwei weishengke [Health Division of Rui’an County People’s Commission]. “Guanyu chunji fangyi gongzuo qingkuang yu jinhou gongzuo yijian de baogao” [Instructions on epidemic prevention work in spring and the future]. April 30, 1963, RAA, 142–8-10. Rui’anxian renwei weishengke [Health Division of Rui’an County People’s Commission]. “Guanyu jiaqiang yiyao weisheng renyuan guanli gongzuo jixiang guiding de tongzhi” [Circular on a few regulations on strengthening management of medical staff]. July 1962, RAA, Vol. 142-7-2. Rui’anxian renwei weishengke [Health Division of Rui’an County People’s Commission]. “Guanyu yijiuliuwunian yiyuan jiansuo gongzuo yijian” [Instructions on the search for cholera bacterial sources in 1965]. February 15, 1965, RAA, Vol. 142-10-3. Rui’anxian renwei weishengke [Health Division of Rui’an County People’s Commission]. “Huling gongshe fangzhi jibing gongzuo jiancha qingkuang baogao” [Investigative report on disease prevention and treatment in Huling Commune]. March 6, 1961, RAA, Vol. 142-6-12. Rui’anxian renwei weishengke [Health Division of Rui’an County People’s Commission]. “Rui’anxian fuhuoluan fangzhi gongzuo ziliao huibian” [Compiled data of epidemic prevention and treatment work in Rui’an County]. October 1962, RAA, Vol. 142-7-2. Rui’anxian renwei weishengke [Health Division of Rui’an County People’s Commission]. “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao” [Investigative report of cholera epidemiology in Rui’an County]. August 20, 1962, RAA, Vol. 142-7-2. Rui’anxian renwei weishengke [Health Division of Rui’an County People’s Commission]. “Rui’anxian pingyuan diqu 63nian tong 64nian yufang zhushe (diyici) qingkuang” [Preventive inoculation work in plain areas in Rui’an County in 1963–1964]. August 1964, RAA, Vol. 142-9-2. Rui’anxian renwei weishengke [Health Division of Rui’an County People’s Commission]. “Wu zhi liuyue changdao ji 02bing yiqu qingli tongjibiao” [Statistics form on disinfecting areas affected by intestinal diseases and No. 2 disease in May and June]. July 1964, RAA, Vol. 142-9-2. Rui’anxian renwei weishengke [Health Division of Rui’an County People’s Commission]. “Yifeng yisu gaishan yinshui weisheng” [Changing customs and improving hygiene of drinking water]. 1963, RAA, Vol. 142-8-4. Rui’anxian renwei weishengke [Health Division of Rui’an County People’s Commission]. “Yijiuliusannian shangbannian weisheng fangyi gongzuo qingkuang yu jinhou gongzuo yijian de baogao” [Health and epidemic prevention work in the first half of 1963 and instructions for work in the future]. 1963, RAA, Vol. 142-8-5. Rui’anxian Tangxiaqu weishengsuo [Rui’an County Tangxia District Health Clinic]. “63niandu weisheng gongzuo zongjie ji jinhou gongzuo yijian” [Summary of health work and instructions for work in the future]. December 3, 1963, RAA, Vol. 142-8-18. Rui’anxian Tangxiaqu weishengsuo [Rui’an County Tangxia District Health Clinic]. “Diyi jidu gongzuo zongjie yu jinhou gongzuo yijian” [Summary of the work in the first quarter and the instructions on the work thereafter]. April 25, 1964, RAA, Vol. 142-9-11. Rui’anxian Tangxiaqu weishengsuo [Rui’an County Tangxia District Health Clinic]. “Weisheng jiancha zongjie baogao” [Summary report on sanitary check-up work]. November 7, 1963, RAA, Vol. 142-8-18.

bibliogr aphy Rui’anxian Taoshanqu Fenghe gongshe baojianzhan [Fenghe Commune Health Clinic of Rui’an County Taoshan District]. “Yufang liexing chuanranbing de zongjie” [Summary about prevention of acute infectious disease]. November 20, 1962, RAA, Vol. 142-7-12. Rui’anxian Taoshanqu weishengsuo [Rui’an County Taoshan District Health Clinic]. “1963nian fuhuoluan fangzhi zhuanti jihua” [Plan for cholera prevention and treatment in 1963]. 1963, RAA, Vol. 142-8-18. Rui’anxian Taoshan weishengsuo [Rui’an County Taoshan District Health Clinic]. “Fenghe gongshe shi zenyang kongzhi chuanranbing de” [How did Fenghe Commune control infectious disease?]. February 20, 1964, RAA, Vol. 142-9-11. Rui’an xianwei renwei [Rui’an County Party Committee and People’s Commission]. “Xiaomie fuhuoluanbing de guihua” [Plan for cholera eradication]. January 4, 1963, RAA, Vol. 1-15-68. Rui’anxian weisheng fangyizhan [Rui’an County Sanitation and Epidemic Prevention Station]. “1963nian fuhuoluan fangzhi gongzuo qingkuang de baogao” [Report on cholera prevention and treatment work in 1963]. 1963, RAA, Vol. 142-8-4. Rui’anxian weisheng fangyizhan [Rui’an County Sanitation and Epidemic Prevention Station]. “Gei quanxian renmin de yifengxin” [A letter to the people across the county]. January 3, 1963, RAA, Vol. 142-8-5. Rui’anxian weisheng fangyizhan [Rui’an County Sanitation and Epidemic Prevention Station]. “Rui’anxian fuhuoluan liuxing bingxue diaocha baogao (chugao)” [Investigative report on cholera epidemiology in Rui’an County (draft)]. October 20, 1962, RAA, Vol. 142-7-2. Rui’anxian weisheng fangyizhan [Rui’an County Sanitation and Epidemic Prevention Station]. “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao” [Investigative report on cholera epidemiology in Rui’an County]. 1962, RAA, Vol. 142-7-2. Rui’anxian Xianjiangqu weishengsuo [Rui’an County Xianjiang District Health Clinic]. “1962 niandu weisheng gongzuo zongjie” [Summary of health work in 1962]. December 30, 1962, RAA, Vol. 142-7-12. Rui’anxian Xianjiangqu weishengsuo [Rui’an County Xianjiang District Health Clinic]. “Guanyu xiaomie fuhuoluan de guihua” [Plan for eradicating cholera]. December 28, 1962, RAA, Vol. 142-7-12. Rui’anxian Xinchengqu weishengyuan [Rui’an County Xincheng District Health Clinic]. “Lixue baojianzhan zenyang jiejue 64niandu nongcun baojianyuan baochou wenti de baogao” [Report on how Lixue health-care station solved the payment issue for health-care workers]. March 1, 1964, RAA, Vol. 142-9-11. Rui’anxian Xinchengqu weishengsuo [Rui’an County Xincheng District Health Clinic]. “Miebing gongzuo huibao” [Report on disease eradication work]. September 3, 1962, RAA, Vol. 1-14-179. Weishengbu [Ministry of Health]. “Chuanranbing guanli banfa” [Infectious disease management regulations]. May 1, 1955, RAA, Vol. 142-8-13. Wenzhou weisheng xuexiao [Wenzhou School of Health]. “Taoshanqu yiliaodui miebing gongzuo zongjie” [Work summary of disease eradication by Taoshan District medical team]. November 30, 1962, RAA, Vol. 142-7-11. Xu Wuzhi. “Guanyu weisheng gongzuo de fayan” [Speech about health work]. 1962, RAA, Vol. 142-7-1. Zhejiangsheng fangyi zhihuibu [Zhejiang Provincial Epidemic Prevention Headquarters]. “Guanyu youguan yinzhang kezhi wenti de yijian” [Instructions on carving relevant official seals]. July 30, 1963, RAA, Vol. 142-8-12. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Changdao chuanranbing

275

276

bibliogr aphy zhuanke menzhen zanxing banfa” [Temporary regulations on outpatient departments for infectious intestinal diseases]. September 19, 1963, RAA, Vol. 142-8-13. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Guanyu diaohui canjia sheng fangbing zhibing gongzuodui ji jianyanyuan de tongzhi” [Circular on recalling provincial epidemic prevention and treatment teams and technicians]. December 28, 1965, RAA, Vol. 142-10-12. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Guanyu jianjue zhizhi lanfa weisheng tongji baobiao de tongbao” [Circular on resolutely forbidding the over-issuing of health statistics forms]. January 21, 1965, RAA, Vol. 142-10-13. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Guanyu jianyizhan, liuyansuo jigou shezhi, renyuan peibei ji jingfei kaizhi deng wenti de tongzhi” [Circular on setting up, personnel, facilities, and expenditure for quarantine stations and detention and observation centers]. April 30, 1963, RAA, Vol. 142-8-13. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Guanyu yange yiqing baogao de tongzhi” [Circular on strict epidemic reporting]. July 30, 1962, RAA, Vol. 10-10-14. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Guanyu yaoqiu dui xianggang, aomen diqu rujing renyuan chushi youxiao huoluan yufang jiezhong zhengshu de jinji tongzhi” [Urgent circular on requiring Hong Kong and Macau visitors to produce valid cholera inoculation certificates]. August 12, 1965, RAA, Vol. 142-10-12. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Guanyu Zhejiangsheng 1965nian xiaomie fuhuoluan jihua youguan wenti de shuoming” [Instructions on relevant issues regarding cholera eradication in Zhejiang Province in 1965]. March 10, 1965, RAA, Vol. 142-10-12. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Zhejiangsheng yijiuliuwunian weisheng gongzuo yaodian de tongzhi” [Circular on key issue of health work in Zhejiang Province in 1965]. January 20, 1965, RAA, Vol. 142-10-12. Zhonggong Rui’an xianwei [Rui’an County Party Committee]. “Guanyu fuhuoluan chuanranbing fangzhi qingkuang de baogao” [Report on cholera prevention and treatment]. August 9, 1962, RAA, Vol. 1-14-28. Wenzhou Prefectural Archives, Wenzhou City, Zhejiang Province, China (WZA) Disan zhanqu Wenzhou jingbei silingbu [Wenzhou Garrison Command of the Third War Zone]. “Wei pubian yufang zhushe gao gejie renshishu” [Open letter to all walks of life regarding comprehensive preventive Inoculation]. 1938, WZA, Vol. 204-1-17. Disan zhanqu Wenzhou jingbei silingbu [Wenzhou Garrison Command of the Third War Zone]. “Zhushedui gongzuo baogao” [Work report of inoculation team]. 1938, WZA, Vol. 204-1-17. Hou Xingjiang and Gu Zonglian. “Rui’anxian fuhuoluan liuxingbingxue diaocha baogao” [Investigative report on cholera epidemiology in Rui’an County]. August 1962, WZA, Vol. 118-11-64. Jiaotongbu junguanhui, weishengbu [Military Commission of the Ministry of Transport and the Ministry of Health of the People’s Republic of China]. “Guanyu xiugai jiaqiang dui suxiu dengguo chuanbo jinchu gangkou jiancha wenti de tongzhi” [Instructions on revising and strengthening regulations on checking the entry and exit of Soviet Union revisionist boats in ports]. April 2, 1968, WZA, Vol. 38-12-7. Li Tiefeng. “Xuexianjin, zhuajianduan, xianqi qunzhongxing gaogongxiao yundong de gaochao” [Launch a mass campaign to learn from activists, focus on excellence, and pursue a tide of high efficiency]. April 5, 1959, WZA, Vol. 1-10-22.

bibliogr aphy Liu Yinlong. “Kongzhi he xiaomie nüeji de celüe he cuoshi” [Strategies and measures for malaria control and eradication]. December 1962, WZA, Vol. 118-11-59. Pingyangxian fangyi zhihuibu [Pingyang County Epidemic Prevention Headquarters]. “Guanyu liji jinxing huoluan yufang zhushe jiancha gongzuo de tongzhi” [Circular on immediately launching check-ups on preventive cholera inoculation work]. March 22, 1963, WZA, Vol. 118-12-30. Pingyangxian gongye jiaotongju [Pingyang County Industry and Transportation Bureau]. “Guanyu xunshu zhuansong huayanxiang de lianhe tongzhi” [Joint circular on quickly transferring test boxes]. June 7, 1963, WZA, Vol. 118-12-5. Qian Xinzhong. “Fuhuoluan fangzhi gongzuo de qingkuang ji jinhou renwu” [Cholera prevention and treatment and future work]. December 12, 1962, WZA, Vol. 38-14-7. Rui’anxian fangyi zhihuibu [Rui’an County Epidemic Prevention Headquarters]. “Xinchengqu weisheng dajun tupo yidian quanmian pukai” [Health personnel of Xincheng District made a breakthrough to start the work]. Weisheng gongzuo jianbao [Wenzhou health work bulletin]. March 6, 1963, WZA, Vol. 118-12-31. Rui’anxian weisheng fangyizhan [Rui’an County Sanitation and Epidemic Prevention Station]. “Guanyu kaizhan yiqing yuce yubao gongzuo de jige wenti” [A few issues on the implementation of epidemic disease prediction]. November 7, 1963, WZA, Vol. 118-12-5. Shanghaishi weishengju gongzuozu [Work Team of Health Bureau of Shanghai Municipality]. “Fuhuoluan liuxingbingxue jianggao” [Brief introduction to cholera epidemiology]. 1962, WZA, Vol. 118-10-140. Weishengbu [Ministry of Health]. “Dui jianyi chazheng yudao de wenti chuli yijian” [Instructions on handling problems during quarantine]. April 10, 1968, WZA, Vol. 38-12-7. Wenzhoushi baomi weiyuanhui [Wenzhou City Secrecy Protection Commission]. “Wenzhoushi baomi gongzuo zanxing guiding (caogao)” [Temporary regulations on the work of secret protection in Wenzhou City (draft)]. May 23, 1963, WZA, Vol. 212-8-5. Wenzhoushi Chengdong fangyi zhihui fenbu [Chengdong Epidemic Prevention Subheadquarters of Wenzhou City]. “Guanyu 1963nian 2haobing fangzhi gongzuo de zongjie baogao” [Summary report on No. 2 Disease prevention and treatment work in 1963]. October 19, 1963, WZA, Vol. 38-15-12. Wenzhoushi danganguan [Wenzhou Prefecture Archives]. “Guanyu benshi chengshi jiben jianshe dangan qingkuang he jinhou yijian de baogao” [Report on archival work of city infrastructure construction and instructions for the future work in this city]. November 6, 1961, WZA, Vol. 51-12-13. Wenzhoushi fangyi zhihuibu [Wenzhou City Epidemic Prevention Headquarters]. “Guanyu fu Hangzhoushi huo shengwai renyuan shixing dabian jianyan de jinji tongzhi” [Urgent circular on conducting stool tests among staff leaving for Hangzhou City and other provinces]. December 12, 1963, WZA, Vol. 118-12-32. Wenzhoushi fangyi zhihuibu [Wenzhou City Epidemic Prevention Headquarters]. “Guanyu jinji jiaqiang fuhuoluan fangzhi gongzuo de tongzhi” [Circular on urgently strengthening cholera prevention work]. August 10, 1963, WZA, Vol. 118-12-31. Wenzhoushi fangyi zhihuibu [Wenzhou City Epidemic Prevention Headquarters]. “Guanyu jishui weisheng gongzuo de tongbao” [Circular on health work for the water supply]. March 22, 1963, WZA, Vol. 118-12-31. Wenzhoushi fangyi zhihuibu [Wenzhou City Epidemic Prevention Headquarters]. “Guanyu zai yijiuliusinian jianjue xiaomie fuhuoluan de baogao” [Report on completely eradicating cholera in 1964]. February 25, 1965, WZA, Vol. 38-16-4.

277

278

bibliogr aphy Wenzhoushi fangyi zhihuibu [Wenzhou City Epidemic Prevention Headquarters]. “Liming gongzuozu fangzhi ’02’ gongzuo huibao” [Report of Liming Commune Work Team on prevention and treatment of No. 2 Disease]. October 1963, WZA, Vol. 38-15-12. Wenzhoushi jihua jingji weiyuanhui [Wenzhou City Planned Economy Commission]. “Zhejiangsheng wenzhoushi shehui zhuyi jianshe de weida chengjiu, 1957–1960” [Great achievements of socialist constructions in Wenzhou City, Zhejiang Province, 1957–1960]. 1961, WZA, Vol. 2-1-145. Wenzhoushi jinjiao yiyuan [Jinjiao Hospital of Wenzhou City]. “Jinjiao 1963nian 02hao bing de fangzhi gongzuo zongjie” [Summary of prevention and treatment of No. 2 disease in Jinjiao in 1963]. April 26, 1963, WZA, Vol. 38-15-12. Wenzhoushi renmin weiyuanhui [Wenzhou City People’s Commission]. “Guanyu chuli shiqu jiaoqu hedao wushui de jinji tongzhi” [Urgent circular on dealing with polluted water in waterways of urban and suburban areas]. February 11, 1958, WZA, Vol. 51-9-35. Wenzhoushi renmin weiyuanhui [Wenzhou City People’s Commission]. “Guanyu zuzhi yiwu laodong duse hedao de tongzhi” [Circular on organizing voluntary work to block waterways]. March 12, 1958, WZA, Vol. 51-9-24. Wenzhoushi renmin zhengfu weishengju [Wenzhou City People’s Government Public Health Bureau]. “Wenzhoushi yijiuwuyinian yinshui xiaodu gongzuo zongjie baogao” [Summary report on water disinfection work in Wenzhou City in 1951]. 1952, WZA, Vol. 38-4-17. Wenzhoushi Sanxiqu fulian [Wenzhou City Sanxi District Women’s Federation]. “Sanxiqu sannianlai funü gongzuo zongjie baogao” [Summary report on women’s work in Sanxi District over the past three years]. October 27, 1961, WZA, Vol. 85-11-18. Wenzhoushi weisheng fangyizhan [Wenzhou City Sanitation and Epidemic Prevention Station]. “Wenzhoushi jiaotong jianyi gongzuo zongjie” [Work summary of transport quarantine in Wenzhou City]. October 25, 1962, WZA, Vol. 51-37-X. Wenzhoushi weishengju [Wenzhou City Health Bureau]. “Guanyu kaizhan shuyi huojunmiao jiezhong gongzuo de tongzhi” [Circular on launching inoculations using live plague vaccine]. April 5, 1963, WZA, Vol. 118-12-30. Wenzhoushi weishengju [Wenzhou City Health Bureau]. “Guanyu kaizhan yufang xiaji changdao chuanranbing gongzuo de baogao” [Instructions on launching prevention work against intestinal infectious diseases in summer]. April 28, 1961, WZA, Vol. 118-11-64. Wenzhoushi weishengju [Wenzhou City Health Bureau]. “Guanyu xiaomie fuhuoluan de guihua (caoan)” [Plan for eradicating cholera (draft)]. November 1962, WZA, Vol. 38-14-7. Wenzhoushi weishengju [Wenzhou City Health Bureau]. “Wenzhoushi jiaotong jianyi gongzuo zongjie” [Summary of transport quarantine in Wenzhou City]. October 25, 1962, WZA, Vol. 38-14-8. Wenzhoushi weishengju [Wenzhou City Health Bureau]. “Wenzhoushi yijiuliusinian huoluan junmiao yufang zhushe tongjibiao” [Statistical forms for preventive cholera inoculation in Wenzhou City in 1964]. June 30, 1964, WZA, Vol. 38-16-5. Wenzhoushi Wuma fangyi zhihui fenbu [Wenzhou City Epidemic Prevention Headquarters Wuma Sub-Branch]. “Guanyu 1–9 yuefen weisheng fangyi gongzuo de zongjie baogao” [Summary report on sanitation and epidemic prevention work from January to September]. November 30, 1963, WZA, Vol. 38-15-12. Wenzhou weisheng xuexiao [Wenzhou School of Health]. “Fangyi gongzuo zongjie” [Summary of epidemic prevention work]. December 8, 1962, WZA, Vol. 38-14-10. Wenzhou zhuanqu fangyi zhihuibu [Wenzhou Prefectural Epidemic Prevention Headquarters]. “Fangyi gongzuo jianbao” [Bulletin of epidemic prevention work]. August 10, 1962, WZA, Vol. 118-11-65.

bibliogr aphy Wenzhou zhuanqu fangyi zhihuibu [Wenzhou Prefectural Epidemic Prevention Headquarters]. “Fangyi gongzuo jianbao” [Bulletin of epidemic prevention work]. September 6, 1962, WZA, Vol. 118-11-65. Wenzhou zhuanqu fangyi zhihuibu [Wenzhou Prefectural Epidemic Prevention Headquarters]. “Fangyi gongzuo jianbao” [Bulletin of epidemic prevention work]. October 4, 1962, WZA, Vol. 118-11-65. Wenzhou zhuanqu fangyi zhihuibu [Wenzhou Prefectural Epidemic Prevention Headquarters]. “Guanyu zhixing shengrenwei jiaotong jianyi de mingling de tongzhi” [Circular on implementing the transport quarantine orders issued by the Provincial People’s Commission]. September 29, 1962, WZA, Vol. 38-12-7. Wenzhou zhuanqu weisheng fangyizhan [Wenzhou Prefectural Sanitation and Epidemic Prevention Station]. “Chusihai, jiangweisheng, xiaomie jibing cankao ziliao” [Reference materials for eliminating four pests, stressing hygiene and eradicating diseases]. October 1963, WZA, Vol. 118-12-26. Wenzhou zhuanqu weisheng fangyizhan fangyi zhihuibu [Wenzhou Prefectural Sanitation and Epidemic Prevention Station Epidemic Prevention Headquarters]. “Guanyu jinyibu kaizhan yidian qingli gongzuo de yijian” [Instructions on further conducting disinfection work in cholera-infected areas]. February 8, 1963, WZA, Vol. 118-12-7. Wenzhou zhuanqu weisheng huiyi mishuchu [Secretariat of Wenzhou Prefectural Health Work Meeting]. “Yinshui weisheng” [Drinking water hygiene]. December 30, 1963, WZA, Vol. 118-12-105. Wenzhou zhuanshu [Wenzhou Prefectural Commission]. “Wenzhouqu dierge wunian jihua qijian jiaotong yunshu guihua” [Blueprint of traffic and transport development in the second FiveYear Plan in Wenzhou Prefecture]. February 6, 1958, WZA, Vol. 12-9-58. Wenzhou zhuanyuan gonshu [Wenzhou Prefectural Commission]. “Guanyu guoyou shuili dianli shigong shebei shiyong guanli de jixiang guiding” [A few regulations on the use and management of state-owned hydraulic and electricity generation construction equipment]. November 12, 1959, WZA, Vol. 104-11-6. Wenzhou zhuanyuan gongshu [Wenzhou Prefectural Commission]. “Guanyu jinyibu jiaqiang zhanbei zhufu shipin jihua chubei tongzhi” [Instructions on further strengthening the storage of staple and supplementary food for the Preparation for War]. August 20, 1959, WZA, Vol. 104-11-11. Yongjiaxian renmin weiyuanhui weishengke [Health Division of Yongjia County People’s Commission]. “Buzhi yijiuliuyinian gexiang yufang jiezhong renwu de tongzhi” [Circular on assigning preventive inoculation work in 1961]. January 16, 1961, WZA, Vol. 118-10-53. Yunhexian aiguo weisheng yundong weiyuanhui [Yunhe County Patriotic Health Campaign Committee]. “Guanyu kaizhan fuhuoluan yufang zhushe youguan shixiang de tongzhi” [Circular on some issues about launching preventive cholera inoculation]. March 4, 1963, WZA, Vol. 118-12-30. Zhejiangsheng minzhengting, caizhengting [Zhejiang Provincial Health Department and Finance Department]. “Guanyu gongfei yiliao zhong cunzai de wenti he gaijin yijian de baogao” [Report on the problems of free medical services and suggestions for improvement]. September 4, 1963, WZA, Vol. 51-14-50. Zhonggong Wenzhou diwei [Wenzhou Prefectural Party Committee]. “Guanyu kaizhan yi jifei wei zhongxin de chunji aiguo weisheng tuji yundong de tongzhi” [Circular on launching spring Patriotic Health Campaign centering on manure collection]. March 9, 1960, WZA, Vol. 1-11-33.

279

280

bibliogr aphy Zhonggong Wenzhou diwei [Wenzhou Prefectural Party Committee]. “Guanyu renzhen anpai dangqian liangshi kucun de jinji baogao” [Urgent instruction on seriously arranging grain storage]. July 5, 1962, WZA, Vol. 87-14-40. Zhonggong Wenzhou diwei [Wenzhou Prefectural Party Committee]. “Guanyu Wenling xianwei yong mingma dianbao paifa baogao xielou guojia jimi de tongbao” [Circular on Wenling County Party Committee using unencoded telegraph communications to issue epidemic information reports and causing the leak of national secrets]. November 21, 1960, WZA, Vol. 87-12-71. Zhonggong Wenzhou diwei [Wenzhou Prefectural Party Committee]. “Guanyu yijiuliuernian zhengbing gongzuo de buchong zhishi” [Supplementary instruction on the conscription work in 1962]. February 18, 1963, WZA, Vol. 87-15-49. Zhonggong Wenzhou diwei [Wenzhou Prefectural Party Committee]. “Guanyu zuohao funü laodong baohu gongzuo de tongzhi” [Circular on labor protection for women]. August 30, 1960, WZA, Vol. 87-12-6. Zhonggong Wenzhou diwei [Wenzhou Prefectural Party Committee]. “Wenzhouqu yijiu liuernian jingjian zhigong yu yasuo chengzhen renkou gongzuo de zongjie (caoan)” [Summary of streamlining employees and reducing the size of urban populations (draft)]. February 2, 1963, WZA, Vol. 87-15-15. Zhonggong Wenzhou diwei bangongshi [General Office of Wenzhou Prefectural Committee]. “Guanyu dui Xincheng gongshe guanliqu yiji nongye tongji gongzuo de diaocha baogao” [Investigative report on Xincheng Commune and agricultural statistical work]. September 18, 1959, WZA, Vol. 87-11-78. Zhonggong Wenzhou diwei gongzuozu [Work Team of Wenzhou Prefectural Party Committee]. “Guanyu Pingyangxian Wanquan gongshe 1960nian huang, e, bing, si shijian de jiancha baogao” [Investigative report on famine, hunger, disease, and death in Wanquan Commune of Pingyang County in 1960]. April 7, 1961, WZA, Vol. 87-13-103. Zhonggong Wenzhou diwei shenghuo fuli weiyuanhui [Life Welfare Committee of the Wenzhou Prefectural Party Committee]. “Guanyu nongcun renkou mangmu liuru Wenzhoushi qingkuang he chuli yijian de baogao” [Report on dealing with the problem of rural populations swarming blindly into Wenzhou City]. September 29, WZA, Vol. 87-12-87. Zhonggong Wenzhou diwei tongzhanbu [Department of United Front Work of Wenzhou Prefectural Party Committee]. “Guanyu dangqian qiaohui qingkuang he huiyi yijian de baogao” [Report on the current situation of overseas Chinese remittances and the meeting’s instructions]. August 6, 1959, WZA, Vol. 87-11-59. Zhonggong Wenzhou shiwei [Wenzhou City Party Committee]. “Diaodong qiaojuan, guiqiao, huaqiao de jijixing, zhengqu wancheng 1959nian qiaohui renwu de baogao” [Report on fully mobilizing families of overseas Chinese, returned overseas Chinese, and overseas Chinese to fulfill the remittance targets in 1959]. August 11, 1959, WZA, Vol. 1-10-32. Zhonggong Wenzhou shiwei [Wenzhou City Party Committee]. “Guanyu chuqihai jiangweisheng de baogao” [Circular on eradicating seven pests and stressing health]. March 22, 1958, WZA, Vol. 1-9-51. Zhonggong Wenzhou shiwei [Wenzhou City Party Committee]. “Guanyu jinji fangzhi fuhuoluan de baogao” [Report on urgent cholera prevention and treatment]. July 22, 1962, WZA, Vol. 1-13-12. Zhonggong Wenzhou shiwei [Wenzhou City Party Committee]. “Guanyu liji kaizhan yi fangzhi fuhuoluan wei zhongxin de aiguo weisheng yundong de jinji baogao” [Urgent circular on

bibliogr aphy immediately launching the Patriotic Health Campaign centered on cholera prevention and treatment]. April 18, 1963, WZA, Vol. 1-14-42. Zhonggong Wenzhou shiwei [Wenzhou City Party Committee]. “Guanyu tiaozheng shijiao shedui guimo wenti de qingshi baogao” [Request for instructions on adjusting the size of communes and brigades in suburban areas]. May 27, 1961, WZA, Vol. 1-12-49. Zhonggong Wenzhou shiwei [Wenzhou City Party Committee]. “Guanyu xunshu chuli gongkuang qiye shiye danwei zhaoshou de nongmin de zhishi” [Instructions on laying off peasants recruited by factories, mines, enterprises, and public service departments]. April 22, 1959, WZA, Vol. 1-10-38. Zhonggong Wenzhou shiwei [Wenzhou City Party Committee]. “Guanyu zuzhi sanji ganbu jiancha shengwei ‘dangnei tongxin’ guanche zhixing qingkuang de baogao” [Report on organizing cadres at three levels to check the implementation of the provincial party committee’s “internal letter”]. February 5, 1963, WZA, Vol. 1-14-37. Zhongguo renmin jiefangjun zongzhengzhibu [People’s Liberation Army General Political Department]. “Jinji dongyuan qilai, zuohao zhandou zhunbei, chedi fensui jiangfeibang de jinfan yinmou” [Actively mobilize, prepare for the war, completely crush the invasion plot of Chiang Kai-shek’s bandit gang]. June 5, 1962, WZA, Vol. 87-14-89. Archives of the WHO Western Pacific Regional Office, Manila, Philippines (WPRO) WPRO. “Paracholera El Tor in the Philippines, 1961–1962.” Presentation at the Meeting for the Exchange of Information on El Tor Vibrio Paracholera, Manila, Philippines. April 16–19, 1962, WPRO. Yangjiang City Archives, Guangdong Province, China (GYJA) Guangdongsheng fangyi zhihuibu Yangjiang gongzuozu [Yangjiang Work Team of Guangdong Provincial Epidemic Prevention Headquarters]. “Liuxingbing diaocha baogao” [Investigation report of the epidemic in Yangjiang County, Guangdong Province]. August 24, 1961, GYJA, Vol. X38. A12.1.36. Yangjiangxian fangyi zhihuibu [Yangjiang County Epidemic Prevention Headquarters]. “Guanyu Yangjiang yiqing de zonghe baogao” [Comprehensive report on the epidemic in Yangjiang County]. July 17, 1961, GYJA, Vol. X38.A12.1.36. Yangjiangxian wenjiao weishengju [Yangjiang County Culture and Education Bureau]. “Yangjiang xiaomie sihai zongjie” [Summary of four-pest eradication work in Yangjiang County]. August 7, 1958, GYJA, Vol. X38.A12.1.34. Zhonggong Yangjiang xianwei fangyi zhihuibu [Yangjiang County Party Committee Epidemic Prevention Headquarters]. “Fangzhi fuhuoluanbing gongzuo zongjie” [Summary of cholera prevention and treatment work]. October 23, 1961, GYJA, Vol. X38.A12.1.35. Zhonggong Yangjiang xianwei Yu Xin shuji [Yangjiang County Party Chief Yu Xin]. “Liuxingbing diaocha baogao” [Investigative report on the epidemic]. 1961, GYJA, Vol. X38.A12.1. 36. Yongjia County Archives, Shangtang Town, Zhejiang Province, China (ZYJA) Weishengbu dangzu [Party Leadership Group of the Ministry of Health]. “Zai yijiuliusannian weishengtingjuzhang huiyi shang de jianghua” [Speech at the national meeting for directors of provincial health departments and bureaus]. April 18, 1963, ZYJA, Vol. 1-9-63.

281

282

bibliogr aphy Yongjiaxian qiaowuke [Overseas Chinese Affairs Division of Yongjia County]. “1961niandu diyi jidu qiaowu gongzuo xiaojie” [Summary of overseas Chinese affairs work in the first quarter of 1961]. May 2, 1961, ZYJA, Vol. 7-11-31. Yongjiaxian renmin weiyuanhui weishengke [Health Division of Yongjia County People’s Commission]. “Guanyu zhuajin zuohao dangqian fuhuoluan yiyuan jiansuo deng gongzuo de yijian” [Instruction on hastening the work of the search for cholera bacterial sources at present]. August 31, 1964, ZYJA, Vol. 7-21-26. Yongjiaxian renmin weiyuanhui weishengke [Health Division of Yongjia County People’s Commission]. “Yijiuliusinian dongji zhengbing tijian gongzuo zongjie” [Summary of medical examination for winter conscription in 1964]. January 20, 1965, ZYJA, Vol. 7-21-26. Yongjiaxian renmin weiyuanhui weishengke [Health Division of Yongjia County People’s Commission]. “Yongjiaxian 1963nian fuhuoluan fangzhi gongzuo zhuanye chubu zongjie” [Preliminary summary on cholera prevention and treatment in Yongjia County in 1963]. October 9, 1963, ZYJA, Vol. X-52-38. Zhejiangsheng renwei huaqiao shiwuchu [Bureau of Overseas Chinese Affairs of Zhejiang Provincial People’s Commission]. “Yijiuliuyinian qiaowu gongzuo zongjie” [Work summary of overseas Chinese affairs in 1961]. February 28, 1962, ZYJA, Vol. 7-11-53. Zhonggong Yongjia xianwei [Yongjia County Party Committee]. “Guanyu gongan gongzuo zhanbei bushu de baogao” [Report on the public security work and the deployment of the Preparation for War]. June 25, 1962, ZYJA, Vol. 1-85-16. Zhonggong Yongjia xianwei [Yongjia County Party Committee]. “Guanyu yijiuliusiniandu minbing gongzuo renwu wenti de baogao” [Report on militia work in 1964]. April 20, 1964, ZYJA, Vol. 1-10-38. Zhonggong yongjia xianwei [Yongjia County Party Committee]. “Zhanbei baogao dongyuan huiyishang jianghua cankao” [Reference materials about the speech at the Preparation for War meeting]. June 23, 1962, ZYJA, Vol. 1-8-65. Yuhang District Archives, Hangzhou City, Zhejiang Province, China (YHA) Yuhangxian weishengju [Yuhang County Health Bureau]. “Guanyu sibing fangzhi gongzuo jixiang zhengce chuli wenti de diaocha baogao” [Investigative report on prevention and treatment policies for four diseases]. May 25, 1962, YHA, Vol. 87-3-74. Zhejiang Provincial Archives, Hangzhou City, Zhejiang Province, China (ZJA) Gonganbu, Neiwubu [Ministry of Public Security and the Ministry of Internal Affairs]. “Guanyu jianjue zhizhi renkou ziyou liudong de baogao” [Report on resolutely stopping free population movement]. October 31, 1961, ZJA, Vol. J103-14-40. Guangdongsheng fangyi zhihuibu, Shantou zhuanqu weisheng fangyizhan [Guangdong Provincial Epidemic Prevention Headquarters and Shantou Prefectural Epidemic Prevention Station]. “1962nian fuhuoluanbing linchuang zongjie” [Clinical summary of cholera treatment in 1962]. October 31, 1962, ZJA, Vol. J166-2-160. Guowuyuan [The State Council]. “Guanyu anzhi ziyou liudong renkou de jixiang banfa” [A few regulations on custody of free-floating populations]. February 14, 1962, ZJA, Vol. J101-13-57. Hangzhoushi renmin weiyuanhui waishi bangongshi [Foreign Affair Office of Hangzhou City People’s Commission]. “Dui waibin he huaqiao cheliang tongguo ke mianjian fangxin de yijian” [Instructions on exemption for quarantine examination and clearing vehicles carrying foreign guests or overseas Chinese]. October 14, 1963, ZJA, Vol. J166-2-175.

bibliogr aphy Li Lanyan. “Zai shengweisheng ganxiao huiyi shang de baogao” [Report from the Provincial Health Cadre School meeting]. December 25, 1962, ZJA, Vol. J165-12-98. Pingyangxian fuhuoluan liuxingbingxue diaochazu [Pingyang County Cholera Epidemiological Investigation Team]. “Pingyangxian fuhuoluan liuxing yinsu de fenxi” [Analysis of cholera epidemiology in Pingyang County]. October 1962, ZJA, Vol. J166-2-162. Pingyangxian liuxingbingxue diaochazu [Pingyang County Cholera Epidemiology Investigation Team]. “Pingyangxian fuhuoluan liuxingbingxue diaocha baogao” [Investigative report of cholera epidemiology in Pingyang County]. October 1962, ZJA, Vol. J166-2-162. Pingyangxian renmin yiyuan [Pingyang People’s Hospital]. “Fuhuoluan 381li linchuang fenxi” [Clinical analysis of 381 cholera cases]. October 22, 1962, ZJA, Vol. J166-2-162. Pingyangxian Yishanqu weishengsuo [Pingyang County Yishan District Health Clinic]. “Yishan geli yiyuan 02bing 174li linchuang fenxi” [Clinical analysis of 174 cases of No. 2 disease in Yishan Isolation Hospital]. October 8, 1962, ZJA, Vol. J166-2-162. Qian Xinzhong. “Fuhuoluan fangzhi gongzuo huiyi zongjie” [Summary of cholera prevention and treatment meeting]. December 1964, ZJA, Vol. J166-1-80. Rui’anxian renmin yiyuan [Rui’an County People’s Hospital]. “Fuhuoluan 300li linchuang fenxi” [Clinical analysis of 300 cholera cases]. September 1962, ZJA, Vol. J166-2-162. Rui’anxian renwei weishengke [Health Division of Rui’an County People’s Commission]. “Rui’anxian weisheng baojianyuan gongzuo qingkuang zongjie” [Work summary of Rui’an County Health-Care Hospital]. May 1965, ZJA, Vol. J166-1-86. Rui’anxian weisheng fangyizhan [Rui’an County Sanitation and Epidemic Prevention Station]. “1964nian Rui’anxian kaizhan yiqing yuce yubao gongzuo qingkuang” [Report on implementing epidemic prediction in 1964]. December 1964, ZJA, Vol. J166-2-206. Rui’anxian weisheng fangyizhan [Rui’an County Sanitation and Epidemic Prevention Station]. “Youguan liuxingbingxue de ziran dili yinsu ji renkou zucheng qingkuang” [Natural geographical factors and demographic composition of cholera epidemiology]. May 30, 1964, ZJA, Vol. J166-2-206. Sanmenxian weishengju [Sanmen County Health Bureau]. “Guanyu 6406 budui mouban bu jieshou jiaotong jianyi wuli qunao yaoqiu diaocha chuli de baogao” [Report on requesting investigation into and handling of PLA Squad 6406 for not accepting quarantine examination and making trouble for no good reason]. November 23, 1962, ZJA, Vol. J166-2-134. Wang Zhaoyuan. “Shengwu zhipin shengchan he yufang jiezhong gongzuo huiyi zongjie” [Summary of biological product production and preventive inoculation work]. September 25, 1962, ZJA, Vol. J166-2-156. Weishengbu [Ministry of Health]. “Fuhuoluan fangzhi jingyan zongjie huiyi” [Meeting summary of cholera prevention and treatment]. November 11, 1962, ZJA, Vol. J166-2-159. Weishengbu [Ministry of Health]. “Fuhuoluan xueshu wenti zhuanjia zuotanhui jiyao” [Minutes of cholera epidemiological expert symposium]. January 18, 1964, ZJA, Vol. J166-2-166. Weishengbu [Ministry of Health]. “Guanyu fuhuoluan yiqing xiemi de tongbao” [Circular on leaking cholera pandemic information]. May 27, 1963, ZJA, Vol. J166-2-165. Weishengbu [Ministry of Health]. “Guanyu Guangdongsheng fuhuoluan yiqing qingkuang de tongbao” [Notice on the cholera epidemic in Guangdong Province]. May 18, 1962, ZJA, Vol. J166-2-126. Weishengbu [Ministry of Health]. “Guanyu jiaqiang shijie weisheng zuzhi bianyin ‘yiqing zhoubao’ deng weisheng ziliao de guanli de tongzhi” [Instructions on strengthening management over health documents like Epidemic Information Weekly compiled by the World Health Organization]. June 2, 1965, ZJA, Vol. J166-1-85.

283

284

bibliogr aphy Weishengbu [Ministry of Health]. “Hanfa fuhuoluanbing ziliao huibian” [Issuing compiled data on cholera]. March 5, 1962, ZJA, Vol. J166-1-71. Weishengbu [Ministry of Health]. “Youguan xielou yiqing de qingkuang” [Report on epidemic information leakage]. September 28, 1962, ZJA, Vol. J166-2-126. Weishengbu gongzuozu [Work Team of the Ministry of Health]. “Jin 25nianlai shijie fuhuoluan de liuxing he fangzhi gaikuang (1937.9–1962.9)” [Survey of cholera transmission, prevention, and treatment in the past twenty years (September 1937–September 1962)]. November 1962, ZJA, Vol. J166-2-160. Weishengbu, jiefangjun zonghouqinbu weishengbu [Ministry of Health and Health Department of the General Logistics Department of PLA]. “Guanyu jiaqiang zhanqu junmin weisheng fangyi gongzuo de lianhe tongzhi” [Joint circular on strengthening the work of sanitation and epidemic prevention of soldiers and civilians in the war zone]. June 23, 1962, ZJA, Vol. J166-2-126. Weishengbu, tiedaobu [Ministry of Health and the Ministry of Railways]. “Weizai jingguang, jinghu tielu yanxian zhongdian chezhan huifu liuzhizhan de tongzhi” [Circular on resuming major observation stations on the Beijing–Guangzhou and Beijing–Shanghai railway lines]. July 30, 1962, ZJA, Vol. J166-2-134. Wenzhoushi chuanranbing yiyuan [Wenzhou City Infectious Disease Hospital]. “230li fuhuoluan linchuang fenxi” [Clinical analysis of 230 cholera cases]. October 1962, ZJA, Vol. J166-2-162. Wenzhoushi Dongtou renmin yiyuan [Wenzhou City Dongtou People’s Hospital]. “Dongtou yugang linshi lianhe jianyizhan” [Temporary joint quarantine station in Dongtou fishing port]. December 25, 1963, ZJA, Vol. J166-2-194. Wenzhoushi Meiao jiaotong jianyizhan [Wenzhou City Meiao Transport Quarantine Station]. “Gongzuo zongjie” [Work summary]. November 16, 1962, ZJA, Vol. J166-2-158. Wenzhoushi shuichanju [Aquatic Products Bureau of Wenzhou City]. “Guanyu Fujiansheng Fudingxian Qinyu gongshe Jianguo dadui zai dongtouyang jinxing qiaogu zuoye de konggao” [Allegation against Fuding County Qinyu Commune Jianguo Production Brigade of Fujian Province for conducting qiaogu fishing in the sea area around Dongtou Island]. August 20, 1962, ZJA, Vol. J122-14-117. Wenzhoushi weisheng fangyizhan [Wenzhou Prefectural Sanitation and Epidemic Prevention Station]. “Wenzhou zhuanqu fuhuoluan liuxingbingxue diaocha baogao” [Investigative report of cholera epidemiology in Wenzhou Prefecture]. November 1963, ZJA, Vol. J166-2-198. Yongjiaxian weisheng fangyizhan [Yongjia County Sanitation and Epidemic Prevention Station]. “Yongjiaxian 1963nian huoluan yufang zhushe gongzuo zongjie” [Summary of preventive cholera inoculation in Yongjia County in 1963]. June 20, 1963, ZJA, Vol. J166-2-185. Yueqingxian renmin weiyuanhui weishengke [Health Division of Yueqing County People’s Government]. “1963nian 02junmiao yufang zhushe gongzuo zongjie” [Work summary of preventive inoculation against No. 2 disease in 1963]. June 6, 1963, ZJA, Vol. J166-2-185. Yuhangxian weishengju [Yuhang County Health Bureau]. “Guanyu peizhi yiqing baogao shidian gongzuo jianbao” [Brief report on a pilot scheme for training in epidemic reporting]. May 5, 1964, ZJA, Vol. J166-2-206. Zhejiangsheng aiguo weisheng yundong weiyuanhui [Zhejiang Provincial Patriotic Health Campaign Committee]. “Yufang fuhuoluan zhishi koutou xuanchuan cankao” [Reference materials of cholera prevention knowledge for oral dissemination]. September 21, 1962, ZJA, Vol. J166-27-60. Zhejiangsheng fangyi zhihuibu bangongshi [General Office of Zhejiang Provincial Epidemic Prevention Headquarters]. “Guanyu fuhuoluan yiqing yingzuo juemijian chuli de tongzhi” [Instructions on cholera pandemic information should be processed as top-secret materials]. July 8, 1973, ZJA, Vol. J166-2-165. Zhejiangsheng fangyi zhihuibu bangongshi [General Office of Zhejiang Provincial Epidemic Pre-

bibliogr aphy vention Headquarters]. “Qing zhuyi juemijian de baomi chuli” [Careful protection of top-secret documents]. July 18, 1964, ZJA, Vol. J166-2-79. Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan [Zhejiang Provincial Cholera Prevention and Treatment Technical Supervision Central Station]. “Fuhuoluan liuxingbingxue” [Cholera epidemiology]. November 7, 1962, ZJA, Vol. J166-2-129. Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan [Zhejiang Provincial Cholera Prevention and Treatment Technical Supervision Central Station]. “Zhejiangsheng 1962nian fuhuoluan 1982li linchuang fenxi” [Clinical analysis of 1,982 cholera cases in Zhejiang Province in 1962]. November 1962, ZJA, Vol. J166-2-129. Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan [Zhejiang Provincial Cholera Prevention and Treatment Technical Supervision Central Station]. “Zhejiangsheng 1962nian fuhuoluan liuxing qijian xijunxue gongzuo gaikuang” [Survey of bacteriological work during the cholera epidemic in Zhejiang Province in 1962]. November 1962, ZJA, Vol. J166-2-129. Zhejiangsheng fangzhi fuhuoluan jishu zhidao zhongxinzhan [Zhejiang Provincial Cholera Prevention and Treatment Technical Supervision Central Station]. “Zhejiangsheng 1963nian fuhuoluan liuxingbingxue” [Cholera epidemiology in Zhejiang Province in 1963]. November 1963, ZJA, Vol. J166-2-198. Zhejiangsheng fangyi zhihuibu bangongshi [General Office of Zhejiang Provincial Epidemic Prevention Headquarters]. “Junche bushou jianyi shili de huibao” [Reports on military vehicles not accepting quarantine examination]. October 24, 1962, ZJA, Vol. J166-2-126. Zhejiangsheng minzhengting [Zhejiang Provincial Civil Affairs Department]. “Guanyu chuli wailiu lingdao xiaozu huiyi jiyao” [Minutes of leadership team on dealing with population outflow]. December 15, 1960, ZJA, Vol. J103-13-54. Zhejiangsheng minzhengting [Zhejiang Provincial Civil Affairs Department]. “Guanyu Zhejiangsheng he Fujiansheng huxiang dongyuan qianfan ziyou liudong renkou de xieyishu” [Agreement between Zhejiang Province and Fujian Province on mobilizing to repatriate free-floating population]. February 7, 1962, ZJA, Vol. J103-13-54. Zhejiangsheng renmin weiyuanhui [Zhejiang Provincial People’s Commission]. “Guanyu zai bensheng jingnei de zhegan, hangyong tielu shezhi linshi liuzhizhan de tongzhi” [Circular on setting up temporary observation stations on Zhejiang–Jiangxi railway line and Hangzhou– Ningbo railway line within the province]. September 17, 1962, ZJA, Vol. J166-2-134. Zhejiangsheng weisheng fangyizhan [Zhejiang Provincial Sanitation and Epidemic Prevention Station]. “Yijiubalingnian fuhuoluan fangzhi gongzuo yaodian” [Key instructions on cholera prevention and treatment work in 1980]. April 1, 1980, ZJA, Vol. J166-X-X. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “6406 budui bu jieshou jiaotong jianyi chuli qingkuang de fuhan” [Reply to the report on PLA Squad 6406 not submitting to quarantine examination]. January 5, 1963, ZJA, Vol. J166-2-134. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Fenfa fangzhi fuhuoluan ziliao youguan shixiang de tongzhi” [Circular on issuing cholera prevention and treatment materials]. December 29, 1962, ZJA, Vol. J166-1-71. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Fuhuoluan yufang jiezhong gongzuo zongjie” [Summary of preventive cholera inoculation work]. May 14, 1963, ZJA, Vol. J166-2-140. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Guanyu bensheng fuhuoluan liuxing qingkuang de huibao” [Report on the prevalence of cholera in Zhejiang Province]. July 31, 1962, ZJA, Vol. J166-2-126.

285

286

bibliogr aphy Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Guanyu bensheng fuhuoluan liuxing qingkuang de huibao” [Report on the spread of cholera in Zhejiang Province]. August 3, 1962, ZJA, Vol. J166-2-126. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Guanyu dui huaji chuanyuan, guiguo huaqiao, gangao tongbao he shuqi fanxiao shisheng kaizhan yiyuan jiansuo de tongzhi” [Circular on launching the search for cholera bacterial sources among overseas Chinese merchant seaman, returned overseas Chinese, Hong Kong and Macau residents, and students on summer vacation]. July 24, 1964, ZJA, Vol. J166-2-206. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Guanyu dui nike bayue qiri wei fangzhi di 288hao tongzhi de liangdian yijian” [Two instructions on file No. 288 concerning epidemic prevention from your department dated August 7]. September 11, 1964, ZJA, Vol. J166-2-206. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Guanyu liji huifu changdao zhuanke menzhen de tongzhi” [Instruction on resuming outpatient department for intestinal diseases immediately]. March 26, 1964, ZJA, Vol. J166-2-206. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Jinnianlai de huoluan yiqing” [Cholera epidemics in recent years]. December 21, 1954, ZJA, Vol. J166-2-30. Zhejiangsheng weishengting [Zhejiang Provincial Health Department]. “Qing jiancha fuhuoluan fangzhi ziliao baomi he junzhong baocun qingkuang de tongzhi” [Instructions on checking secrecy protection of cholera prevention and treatment material and the storage of cholera vibrio]. January 11, 1963, ZJA, Vol. J166-2-165. Zhemin fenshuiguan lianhe jiaotong weisheng jianduzhan [Zhejiang Fujian Province Fenshuiguan Gate Joint Sanitation Supervision Station]. “Jiaotong jianyi gongzuo zongjie” [Summary report on transport quarantine work]. November 10, 1963, ZJA, Vol. J166-2-194. Zhenhaixian fangyi zhihuibu [Zhenhai County Epidemic Prevention Headquarters]. “Qing zhuyi juemijian de baomi chuli” [Protecting top-secret documents carefully]. July 22, 1964, ZJA, Vol. J166-2-79. Zhonghua renmin gongheguo Shanghai weisheng jianyisuo [Shanghai Institute of Health and Quarantine of the People’s Republic of China]. “Shijie huoluan yiqing de zhangwo, fenxi yu yingyong” [Collection, analysis, and application of the global cholera pandemic]. October 1963, ZJA, Vol. J166-2-199. Primary and Secondary Sources Amrith, Sunil S. “The Internationalization of Health in Southeast Asia.” In Histories of Health in Southeast Asia: Perspectives on the Long Twentieth Century, edited by Tim Harper and Sunil S. Amrith, 161–79. Bloomington: Indiana University Press, 2014. Amrith, Sunil S. Migration and Diaspora in Modern Asia. Cambridge: Cambridge University Press, 2011. Amrith, Sunil S. “Migration and Health in Southeast Asian History.” The Lancet 384, no. 9954 (2014): 1569–70. Anderson, Benedict. Imagined Communities: Reflections on the Origin and Spread of Nationalism. London: Verso, 1983. Anderson, Warwick. Colonial Pathologies: American Tropical Medicine, Race, and Hygiene in the Philippines. Durham, NC: Duke University Press, 2006. Andrews, Bridie. The Making of Modern Chinese Medicine, 1850–1960. Vancouver: UBC Press, 2014. Andrews, Bridie, and Mary Brown Bullock, eds. Medical Transitions in Twentieth-Century China. Bloomington: Indiana University Press, 2014.

bibliogr aphy Arnold, David. Colonizing the Body: State Medicine and Epidemic Disease in Nineteenth-Century India. Berkeley: University of California Press, 1993. Ba Lüede. “Shanghai huoluan liuxing zhi yanjiu” [The study of cholera in Shanghai]. Zhonghua yixue zazhi [China medical journal] 30, no. 4 (1944): 157–62. Barnes, Nicole Elizabeth. Intimate Communities: Wartime Health Care and the Birth of Modern China, 1937–1945. Oakland: University of California Press, 2018. Barua, Dhiman. “Laboratory Diagnosis of Cholera.” In Cholera, edited by Dhiman Barua and William Burrows, 85–126. Philadelphia: W. B. Saunders, 1974. Barua, Dhiman, and B. Cvjetanovic. “Cholera during the Period 1961–1970.” In Principles and Practice of Cholera Control, edited by the World Health Organization, 15–21. Geneva, 1970. Bashford, Alison. Imperial Hygiene: A Critical History of Colonialism, Nationalism and Public Health. Basingstoke, England: Palgrave Macmillan, 2004. Bashford, Alison, and Hobbins Peter. “Rewriting Quarantine: Pacific History at Australia’s Edge.” Australian Historical Studies 46, no. 3 (2015): 392–409. Benedict, Carol. Bubonic Plague in Nineteenth-Century China. Stanford, CA: Stanford University Press, 1996. Bianzhe [editor]. “Yangbing diyi, yingyang diyi” [Raising the army first, nutrition first]. Tujidui yuekan [Commando monthly] 1, no. 6 (October 1944): 20. Bray, David. Social Space and Governance in Urban China: The Danwei System from Origins to Reform. Stanford, CA: Stanford University Press, 2005. Brazelton, Mary Augusta. Mass Vaccination: Citizens’ Bodies and State Power in Modern China. Ithaca, NY: Cornell University Press, 2019. Briggs, Charles L. Stories in the Time of Cholera: Racial Profiling during a Medical Nightmare. Berkeley: University of California Press, 2003. Brown, Jeremy. City versus Countryside in Mao’s China: Negotiating the Divide. Cambridge: Cambridge University Press, 2012. Brown, Kate. Manual for Survival: A Chernobyl Guide to the Future. New York: Norton, 2019. Brown, Kate. Plutopia: Nuclear Families, Atomic Cities, and the Great Soviet and American Plutonium Disasters. Oxford: Oxford University Press, 2015. Bu, Liping. Public Health and the Modernization of China, 1865–2015. London: Routledge, 2017. Caballero-Anthony, Mely. “SARS in Asia: Crisis, Vulnerabilities, and Regional Response.” Asian Survey 45, no. 3 (2005): 475–95. Cai, Yongshun. “Between State and Peasant: Local Cadres and Statistical Reporting in Rural China.” China Quarterly 163 (September 2000): 783–805. Cao Shuji. “Guojia yu difang de gonggong weisheng—yi 1918nian Shanxi feishuyi liuxing wei zhongxin” [Central and local-level public health as seen in the 1918 plague in Shanxi Province]. Zhongguo shehui kexue [Social science in China] 1 (2006): 178–90. Cao Shuji. “Shuyi liuxing yu huabei shehui de bianqian (1580–1644nian)” [The spread of plague and of social changes in northern China, 1580–1644]. Lishi yanjiu [Historical study] 1 (1997): 17–32. Chan, Shelly. Diaspora’s Homeland: Modern China in the Age of Global Migration. Durham, NC: Duke University Press, 2018. Chen Chaochang. “Zhejiangzhu xuexichongbing de fangzhi” [Schistosomiasis in Zhejiang Province]. Yiyaoxue [New pharmacology] 2, no. 10 (1949): 13–16. Chen Yecheng. Danche qi shenzhou [Riding around China on a bicycle]. Pingyang, 2011. Chen Zhichuan. “Ruiping wanquan pingyuan yu tanghe shuixiang” [Ruiping and Wanquan Plains and the canal region]. Wenzhou shizhi [Historical record of Wenzhou] 111, no. 2 (2015): 48–52.

287

288

bibliogr aphy Cheng, Tiejun, and Mark Selden. “The Origins and Social Consequences of China Hukou System.” China Quarterly 139 (September 1994): 644–68. Courtney, Chris. The Nature of Disaster in China: The 1931 Yangzi River Flood. Cambridge: Cambridge University Press, 2018. Cvjetanovic, Branko. “Cholera as an International Health Problem.” In Principles and Practice of Cholera Control, edited by the World Health Organization, 9–13. Geneva, 1970. Dangdai zhongguo de Guangdong bianji weiyuanhui [Editorial Board of Guangdong Province in Contemporary China]. Dangdai zhongguo de Guangdong [Guangdong Province in contemporary China]. Vol. 2. Beijing: Dangdai zhongguo chubanshe, 2009. Dangdai zhongguo de minbing bianji weiyuanhui [Editorial Board of Militia in Contemporary China], ed. Dangdai zhongguo de minbing [Militia in contemporary China]. Beijing: Dangdai zhongguo chubanshe, 2009. Dangdai zhongguo de weisheng shiye bianji weiyuanhui [Editorial Board of Health Development in Contemporary China], ed. Dangdai zhongguo de weisheng shiye [Health development in contemporary China]. Vol. 1. Beijing: Dangdai zhongguo chubanshe, 2009. Dangdai zhongguo de Zhejiang bianji weiyuanhui [Editorial Board of Zhejiang Province in Contemporary China], ed. Dangdai zhongguo de Zhejiang [Zhejiang Province in contemporary China]. Vol. 1. Beijing: Dangdai zhongguo chubanshe, 2009. Delaporte, François. Disease and Civilization: The Cholera in Paris, 1832. Cambridge, MA: MIT Press, 1986. Deng Tietao. Zhongguo fangyishi [History of epidemic prevention in China]. Nanning: Guangxi kexue jishu chubanshe, 2006. Diamant, Neil J. “Why Archives?” In Contemporary Chinese Politics: New Sources, Methods, and Field Strategies, edited by Allen Carlson, Mary E. Gallagher, Kenneth Lieberthal, and Melanie Manion, 33–50. Cambridge: Cambridge University Press, 2010. Didelot, Xavier, Bo Pang, Zhemin Zhou, Angela McCann, Peixiang Ni, Dongfang Li, Mark Achtman, and Biao Kan. “The Role of China in the Global Spread of the Current Cholera Pandemic.” PLOS 11, no. 3 (2015): 1–14. Ding Xueliang. “Yingdui SARS weiji de sanzhong tizhi: Qiangzhi, fazhi, ruozhi” [Three systems responding to the SARS crisis: Mandatory, legal, and weak methods], 2003. Accessed April 2, 2020. http://www.aisixiang.com/data/7243.html. Echenberg, Myron. Africa in the Time of Cholera: A History of Pandemics from 1817 to the Present. Cambridge: Cambridge University Press, 2011. Echenberg, Myron. Plague Ports: The Global Urban Impact of Bubonic Plague, 1894–1901. New York: New York University Press, 2007. “Egypt: Pilgrimage to Mekka Declared Cholera-Infected: Measures Adopted to Prevent Introduction of Cholera into Egypt.” Public Health Reports (1896–1970) 23, no. 6 (February 7, 1908): 154–55. Evans, Richard J. Death in Hamburg: Society and Politics in the Cholera Years, 1830–1910. Oxford: Clarendon Press, 1987. Fan, Fa-ti. “‘Collective Monitoring, Collective Defense’: Science, Earthquakes, and Politics in Communist China.” Science in Text 25, no. 1 (2012): 127–54. Fan, Ka-Wai. “Epidemic Cerebrospinal Meningitis during the Cultural Revolution.” Extrême-Orient Extrême-Occident 37 (2014): 197–232. Fang, Xiaoping. “Bamboo Steamers and Red Flags: Building Discipline and Collegiality among China’s Traditional Rural Midwives in the 1950s.” China Quarterly 230 (June 2017): 420–43.

bibliogr aphy Fang, Xiaoping. Barefoot Doctors and Western Medicine in China. Rochester, NY: University of Rochester Press, 2012. Fang, Xiaoping. “The Global Cholera Pandemic Reaches Chinese Villages: Population Mobility, Political Control, and Economic Incentives in Epidemic Prevention, 1962–1964.” Modern Asian Studies 48, no. 3 (2014): 754–90. Feith, Herbert, and Daniel S. Lev. “The End of the Indonesian Rebellion.” Pacific Affairs 36, no. 1 (1963): 32–46. Fei Xiaotong. Jiangcun jingji: Zhongguo nongmin de shenghuo [Peasant life in China: A field study of country life in the Yangtze Valley]. Beijing: Shangwu yinshuguan, 2002. Feiyunjiangzhi bianzhuan weiyuanhui [Editorial Board of Feiyun River Gazetteer], ed. Feiyunjiangzhi [Feiyun River gazetteer]. Beijing: Zhonghua shuju, 2000. Felsenfeld, Oscar. “Review of Recent Trends in Research and Control of Cholera.” Bulletin of World Health Organization 34, no. 2 (1966): 161–95. Felsenfeld, Oscar. “Some Observations on the Cholera (El Tor) Epidemic in 1961–1962.” Bulletin of World Health Organization 28, no. 3 (1963): 289–96. Fen Jian, ed. Wenzhou jishi [Chronicle of Wenzhou City]. Wenzhou: Wenzhoushi fudan daxue xiaoyouhui, 2005. Fewsmith, Joseph. “China and the Politics of SARS.” Current History 102, no. 665 (2003): 250–55. Foucault, Michel. Discipline and Punish: The Birth of the Prison. New York: Vintage Books, 1979. Fujiansheng difangzhi bianzhuan weiyuanhui [Editorial Board of Fujian Provincial Gazetteers], ed. Fujian shengzhi: Haiguanzhi [Fujian provincial gazetteers: Customs gazetteer]. Beijing: Fangzhi chubanshe, 1995. Fujiansheng difangzhi bianzhuan weiyuanhui [Editorial Board of Fujian Provincial Gazetteers], ed. Fujian shengzhi: Weishengzhi [Provincial gazetteers: Health gazetteer]. Beijing: Zhonghua shuju, 1995. Gao Hua. Hongtaiyang shi zenyang shengqi de: Yan’an zhengfeng yundong de lailong qumai [How the Red Sun rose: The origin and evolution of the Yan’an Rectification Movement]. Hong Kong: Chinese University of Hong Kong Press, 2011. Gao, Xi. “Foreign Models of Medicine in Twentieth-Century China.” In Medical Transitions in Twentieth-Century China, edited by Bridie Andrews and Mary Brown Bullock, 173–211. Bloomington: Indiana University Press, 2014. Ghosh, Arunabh. “Lies, Damned Lies, and (Bourgeois) Statistics: Ascertaining Social Fact in Midcentury China and the Soviet Union.” Osiris 33, no. 1 (2018): 149–68. Ghosh, Arunabh. Making It Count: Statistics and Statecraft in the Early People’s Republic of China. Princeton, NJ: Princeton University Press, 2020. Godley, Michael R. “The Sojourners: Returned Overseas Chinese in the People’s Republic of China.” Pacific Affairs 62, no. 3 (1989): 330–52. Greenhalgh, Susan, and Edwin Winckler. Governing China’s Population: From Leninist to Neoliberal Biopolitics. Stanford, CA: Stanford University Press, 2005. Gross, Miriam. Farewell to the God of Plague: Chairman Mao’s Campaign to Deworm China. Oakland: University of California Press, 2016. Guangdong difang shizhi bianzhuan weiyuanhui [Editorial Board of Guangdong Provincial Gazetteers], ed. Guangdong shengzhi: Weishengzhi [Guangdong provincial gazetteers: Health gazetteer]. Guangzhou: Guangdong renmin chubanshe, 2003. Guangdongsheng weisheng fangyizhan xuanchuan ziliaoke [Document Dissemination Section of Guangdong Province Sanitation and Epidemic Prevention Station], ed. Fuhuoluan de liuxingbingxue [Epidemiology of cholera]. Guangdong, 1978.

289

290

bibliogr aphy Hanson, Marta. Speaking of Epidemics in Chinese Medicine: Disease and the Geographic Imagination in Late Imperial China. Abingdon, England: Routledge, 2011. Harrison, Mark. Contagion: How Commerce Has Spread Disease. New Haven, CT: Yale University Press, 2012. He, Baogang. “SARS and Freedom of Press: Has the Chinese Government Learnt a Lesson?” In The SARS Epidemic: Challenges to China’s Crisis Management, edited by John Wong and Yongnian Zheng, 181–98. Singapore: World Scientific, 2004. Hershatter, Gail. The Gender of Memory: Rural Women and China’s Collective Past. Berkeley: University of California Press, 2013. Hong Kong Museum of Medical Sciences Society, ed. Plague, SARS and the Story of Medicine in Hong Kong. Hong Kong: Hong Kong University Press, 2006. Hong Tiansui. “Wunianlai fangyi ganxiang” [Reflection on epidemic prevention over the past five years]. In Zhejiangsheng weishengchu chengli wuzhounian jinian tekan [Special issue commemorating the fifth anniversary of the founding of the Zhejiang Provincial Health Department], edited by Zhejiangsheng weishengchu [Zhejiang Provincial Health Department], 145–46. Hangzhou, 1945. Hsu, Francis Lang Kwang. Religion, Science and Human Crises: A Study of China in Transition and Its Implications for the West. London: Routledge and Kegan Paul, 1952. Hu, Dalong, Bin Liu, Lu Feng, Peng Ding, Xi Guo, Min Wang, Boyang Cao, Peter R. Reeves, and Lei Wang. “Origins of the Current Seventh Cholera Pandemic.” Proceedings of the National Academy of Sciences of the United States of America 113, no. 48 (2016): E7730–39. Huang, Philip C. C. The Peasant Family and Rural Development in the Yangzi Delta, 1350–1988. Stanford, CA: Stanford University Press, 1990. Huang Shuze and Lin Shixiao. Dangdai zhongguo de weisheng shiye [Health development in contemporary China]. Vol. 2. Beijing: Zhongguo shehui kexue chubanshe, 1986. Huang Xiuqing, ed. Longwan minsu [Longwan folk customs]. Beijing: Zhongguo yanhuang wenhua chubanshe, 2011. Huber, Valeska. “The Unification of the Globe by Disease? The International Sanitary Conferences on Cholera, 1851–1894.” Historical Journal 49, no. 2 (2006): 453–76. Islam, M. Sirajul, M. H. Zaman, M. Shafiqul Islam, Niyaz Ahmed, and J. D. Clemens. “Environmental Reservoirs of Vibrio Cholera.” Vaccine 38, no. 1 (2020): A52–A62. Jiang Yutu. “Fuhuoluan de liuxingbingxue wenti” [Issues on cholera epidemiology]. In Fuhuoluan fangzhi ziliao huibian [Compiled data of cholera prevention and treatment], edited by Zhonghua renmin gongheguo weishengbu fangyisi [Sanitation and Epidemic Prevention Department of the Ministry of Health of the People’s Republic of China], 69–78. Beijing, 1962. Jiankangbao shelun [Editorial of Health Bulletin]. “Fahui geti kaiyeyi de liliang” [Fulfill the role of independent medical practitioners]. Xinzhongyiyao [New Chinese medicine] 8, no. 5 (1960): 243–44. Kamal, Ahmed M. “Endemicity and Epidemicity of Cholera.” Bulletin of World Health Organization 28, no. 3 (1963): 277–87. Kamal, Ahmed M. “The Seventh Pandemic of Cholera.” In Cholera, edited by Dhiman Barua and William Burrows, 1–14. Philadelphia: W. B. Saunders, 1974. Katz, Paul. Demon Hordes and Burning Boats: The Cult of Marshal Wen in Late Imperial China. Albany: State University of New York Press, 1995. Kaul, P. M. “Trends of Cholera.” American Journal of Public Health 56, no. 7 (1966): 1010–12. Kotar, S. L., and J. E. Gessler. Cholera: A Worldwide History. Jefferson, NC: McFarland, 2014.

bibliogr aphy Kraus, Richard. “China in 2003: From SARS to Spaceships.” Asian Survey 44, no. 1 (2004): 147–57. Ku, Agnes S. “Immigration Policies, Discourses, and the Politics of Local Belonging in Hong Kong (1950–1980).” Modern China 30, no. 3 (2004): 326–60. Kuhn, Philip A. Chinese among Others: Emigration in Modern Times. Singapore: NUS Press, 2008. Kuhn. Philip A. Soulstealers: The Chinese Sorcery Scare of 1768. Cambridge, MA: Harvard University Press, 1990. Ku Ya Wen. “Anti-Malaria Policy and Its Consequences in Colonial Taiwan.” In Disease, Colonialism, and the State: Malaria in Modern East Asian History, edited by Yip Ka-che, 31–48. Hong Kong: Hong Kong University Press, 2009. Lam, Tong. A Passion for Facts: Social Surveys and the Construction of the Chinese Nation State. Berkeley: University of California Press, 2011. Lampton, David. The Politics of Medicine in China: The Policy Process, 1949–1977. Boulder, CO: Westview Press, 1977. Laodong renshibu laodong kexue yanjiusuo [Labor Research Institute of the Ministry of Labor and Personnel], ed. Zhonghua renmin gongheguo laodong fagui xuanbian [Collected labor laws and regulations of the People’s Republic of China]. Beijing: Laodong renshi chubanshe, 1988. Lary, Diana. “The ‘Static’ Decades: Inter-provincial Migration in Pre-reform China.” In Internal and International Migration: Chinese Perspectives, edited by Frank N. Pieke and Hein Mallee, 29–48. Surrey, England: Curzon Press, 1999. Lee, Kelley. The World Health Organization. London: Routledge, 2008. Lee, Kelley, and Richard Dodgson. “Globalization and Cholera: Implications for Global Governance.” Global Governance 6, no. 2 (2000): 213–36. Lee, Sung. “WHO and the Developing World: The Contest for Ideology.” In Western Medicine as Contested Knowledge, edited by Andrew Cunningham and Bridie Andrews, 24–45. Manchester, England: Manchester University Press, 1997. Leung, Angela Ki Che. Leprosy in China: A History. New York: Columbia University Press, 2009. Leung, Angela Ki Che. “Weak Men and Barren Women: Framing Beriberi/Jiaoqi/Kakke in Modern East Asia, ca. 1830–1940.” In Gender, Health, and History in Modern East Asia, edited by Angela Ki Che Leung and Izumi Nakayama, 195–215. Hong Kong: Hong Kong University Press, 2017. Li, Baisheng, Rongfeng Chen, Duochun Wang, Hailing Tan,  Bixia Ke,  Dongmei He,  Changwen Ke,  and Yonghui Zhang. “Distribution and Molecular Characteristics of Vibrio cholerae O1 El Tor Isolates Recovered in Guangdong Province, China, 1961–2013.” Infection, Genetics and Evolution 37 (January 2016): 70–76. Li, Lillian M. Fighting Famine in North China: State, Market, and Environmental Decline, 1690s–1990s. Stanford, CA: Stanford University Press, 2007. Liang Yingming. Jinxiandai dongnanya, 1511–1992 [Modern Southeast Asia, 1511–1992]. Beijing: Beijing daxue chubanshe, 1994. Lin’anxian weishengzhi bianzhuan weiyuanhui [Editorial Board of Lin’an County Health Gazetteer], ed. Lin’anxian weishengzhi [Lin’an County health gazetteer]. Lin’an, 1992. Lin Hsiao-ting and Zhao Xiangke. “1962nian ‘Taihai weiji’ beijing tanyin” [Exploration of the cause of the “Taiwan Strait Crisis” background in 1962]. Dangdai zhongguoshi yanjiu [Contemporary China history studies] 20, no. 4 (2013): 63–75. Lin Yixiu. Wenzhou zuqun yu quyu wenhua yanjiu [Studies on the Wenzhou ethnic group and regional culture in Wenzhou]. Shanghai: Shanghai sanlian shudian, 2014. Liu, Hong. China and the Shaping of Indonesia, 1949–1965. Singapore: NUS Press, 2011.

291

292

bibliogr aphy Liu Shaohua. Mafeng yisheng yu jubian zhongguo: Hou diguo shiyanxia de jibing yinyu yu fangyi lishi [Leprosy doctors in China’s postimperial experimentation: Metaphors of a disease and its control]. Xinbei: Weicheng chuban, 2018. Long, John G. “The Quarantine Camp at El Tor.” Public Health Reports (1896–1970) 17, no. 2 (1902): 1156–59. Lü, Xiaobo, and Elizabeth J. Perry, eds. Danwei: The Changing Chinese Workplace in Historical and Comparative Perspectives. Armonk, NY: M. E. Sharpe, 1997. Lucas, AnElissa. Chinese Medical Modernization: Comparative Policy Continuities, 1930s–1980s. New York: Praeger, 1982. Lynteris, Christos. Ethnographic Plague: Configuring Disease on the Chinese-Russian Frontier. London: Palgrave Macmillan, 2016. Lynteris, Christos. “Skilled Natives, Inept Coolies: Marmot Hunting and the Great Manchurian Pneumonic Plague (1910–1911).” History and Anthropology 24, no. 3 (2013): 303–21. MacFarquhar, Roderick, and Michael Schoenhals. Mao’s Last Revolution. Cambridge, MA: Belknap Press of Harvard University Press, 2006. MacPherson, Kerrie L. “Cholera  in China, 1820–1930: An Aspect of the Internationalization of Infectious Disease.” In Sediments of Time: Environment and Society in Chinese History, edited by Mark Elvin and Liu Tsui-jung, 487–519. Cambridge: Cambridge University Press, 1997. MacPherson, Kerrie L. A Wilderness of Marshes: The Origins of Public Health in Shanghai, 1843–1893. Lanham, MD: Lexington Books, 2002. Madokoro, Laura. Elusive Refuge: Chinese Migrants in the Cold War. Cambridge, MA: Harvard University Press, 2016. Manderson, Lenore. “Wireless Wars in the Eastern Arena: Surveillance, Disease Prevention and the Work of the Eastern Bureau of the League of Nations Health Organization, 1925–1942.” In International Health Organizations and Movements, 1918–1939, edited by Paul Weindling, 109–33. Cambridge: Cambridge University Press, 1995. Manning, Kimberley. “Marxist Maternalism, Memory, and the Mobilization of Women during the Great Leap Forward.” China Review 5, no. 1 (2005): 83–110. Mason, Katherine A. “The Correct Secret: Discretion and Hypertransparency in Chinese Biosecurity.” Focaal: Journal of Global and Historical Anthropology, no. 75 (2016): 45–58. Mason, Katherine A. Infectious Change: Reinventing Chinese Public Health after an Epidemic. Stanford, CA: Stanford University Press, 2016. Matsura, Akira. Wenzhou haishang jiaotongshi yanjiu [Historical studies of Wenzhou maritime transport]. Beijing: Renmin chubanshe, 2016. Mayne, Alan. “Guardians at the Gate: Quarantine and Racialism in Two Pacific Rim Port Cities, 1870–1914.” Urban History 35, no. 2 (2008): 255–74. McKeown, Adam M. “Conceptualizing Chinese Diasporas, 1842 to 1949.” Journal of Asian Studies 58, no. 2 (1999): 306–37. Merli, M. Giovanna. “Underreporting of Births and Infant Deaths in Rural China: Evidence from Field Research in One County of Northern China.” China Quarterly 155 (September 1998): 637–55. Meyskens, Covell. Mao’s Third Front: The Militarization of Cold War China. Cambridge: Cambridge University Press, 2020. Meyskens, Covell. “Third Front Railroads and Industrial Modernity in Late Maoist China.” Twentieth Century China 40, no. 3 (2015): 238–60. Miu Tianshun. “Nanwang liangpiao” [Unforgettable grain coupons]. In Pingyang wenshi ziliao

bibliogr aphy [Cultural and historical data of Pingyang County], vol. 27, edited by Pingyangxian zhengxie wenshi ziliao weiyuanhui [Committee of Cultural and Historical Data of the Chinese People’s Political Consultative Conference of Pingyang County], 129–32. Pingyang, 2009. Mooney, Graham. Intrusive Interventions: Public Health, Domestic Space, and Infectious Disease Surveillance in England, 1840–1914. Rochester, NY: University of Rochester Press, 2015. Mosley, W. H. “Epidemiology of Cholera.” In Principles and Practice of Cholera Control, edited by the World Health Organization, 23–27. Geneva, 1970. Mozingo, David. Chinese Policy toward Indonesia, 1949–1967. Ithaca, NY: Cornell University Press, 1976. Mozingo, David. “New Development in China’s Relations with Indonesia.” Current Scene: Developments in Mainland China 1, no. 24 (1962): 3–4. Nakajima, Chieko. Body, Society, and Nation: The Creation of Public Health and Urban Culture in Shanghai. Cambridge, MA: Harvard Asia Center, 2018. Ong, Willie T. “Public Health and the Clash of Cultures: The Philippine Cholera Epidemics.” In Public Health in Asia and the Pacific: Historical and Contemporary Perspectives, edited by Milton J. Lewis and Kerrie L. MacPherson, 206–21. Abingdon, England: Routledge, 2008. Paltemaa, Lauri. Managing Famine, Flood and Earthquake in China. London: Routledge, 2015. Peckham, Robert. Epidemics in Modern Asia. Cambridge: Cambridge University Press, 2016. Peckham, Robert. “Infective Economies: Empire, Panic, and the Business of Disease.” Journal of Imperial and Commonwealth History 40, no. 2 (2013): 211–37. Pelling, Margaret. Cholera, Fever and English Medicine, 1825–1865. Oxford: Oxford University Press, 1978. Perry, Elizabeth J. Patrolling the Revolution: Worker Militias, Citizenship, and the Modern Chinese State. Lanham, MD: Rowman & Littlefield, 2007. Pingyang weisheng fangyizhanzhi bianzhuan weiyuanhui [Editorial Board of the Pingyang Sanitation and Epidemic Prevention Station Gazetteer], ed. Pingyang weisheng fangyizhanzhi: 1956–2000 [Pingyang Sanitation and Epidemic Prevention Station gazetteer: 1956–2000]. Pingyang, 2001. Pingyangxian diming weiyuanhui [Pingyang County Geographic Name Committee], ed. Zhejiangsheng pingyangxian dimingzhi [Zhejiang Province Pingyang County Geographic Name Gazetteer]. Pingyang, 1985. Pingyangxian minzhengju [Pingyang County Civil Affairs Bureau], ed. Pingyangxian minzhengzhi [Civil affairs gazetteer of Pingyang County]. Beijing: Haiyang chubanshe, 1994. Pingyang xianzhi bianweihui [Editorial Board of Pingyang County Gazetteer], ed. Pingyang xianzhi [Pingyang County gazetteer]. Shanghai: Hanyu dacidian chubanshe, 1993. Poon, Shuk-Wah. “Cholera, Public Health, and the Politics of Water in Republican Guangzhou.” Modern Asian Studies 47, no. 2 (2013): 436–66. Purdey, Jemma. Anti-Chinese Violence in Indonesia, 1996–1999. Singapore: NUS Press, 2005. Qiu Weixing. Fenghuang cunzhi [Fenghuang Village gazetteer]. Beijing: Zhongguo wenshi chubanshe, 2011. Raška, Karel. “Surveillance and Control of Cholera.” In Principles and Practice of Cholera Control, edited by the World Health Organization, 115–25. Geneva, 1970. Ricklefs, M. C. A History of Modern Indonesia since c. 1200. Basingstoke, England: Palgrave, 2001. Robertson, Frank. “Refugees and Troop Moves—A Report from Hong Kong.” China Quarterly, no. 11 (July–September 1962): 111–15. Rogaski, Ruth. Hygienic Modernity: Meanings of Health and Disease in Treaty-Port China. Berkeley: University of California Press, 2004.

293

294

bibliogr aphy Rogaski, Ruth. “Nature, Annihilation, and Modernity: China’s Korean War Germ-Warfare Experience Reconsidered.” Journal of Asian Studies 61, no. 2 (2002): 381–415. Rosenberg, Charles E. “Cholera in Nineteenth-Century Europe: A Tool for Social and Economic Analysis.” Comparative Studies in Society and History 8, no. 4 (1966): 452–63. Rosenberg, Charles E. The Cholera Years: The United States in 1832, 1849, and 1866. Chicago: University of Chicago Press, 1987. Rui’anshi difangzhi bianzhuan weiyuanhui [Editorial Committee of Local Gazetteers of Rui’an City], ed. Rui’an shizhi [Rui’an City gazetteer]. Beijing: Zhonghua shuju, 2007. Rui’anshi jiaotongju [Public Transport Bureau of Rui’an City], ed. Rui’anshi jiaotongzhi [Public transport gazetteer of Rui’an City]. Beijing: Tuanjie chubanshe, 1992. Rui’anshi weishengzhi bianzhuan weiyuanhui [Editorial Board of the Rui’an City Health Gazetteer], ed. Rui’anshi weishengzhi [Rui’an City health gazetteer]. Shanghai: Huandong shifan daxue chubanshe, 1999. Schmalzer, Sigrid. Red Revolution, Green Revolution: Scientific Farming in Socialist China. Chicago: University of Chicago Press, 2016. Shapiro, Judith. Mao’s War against Nature: Politics and the Environment in Revolutionary China. Cambridge: Cambridge University Press, 2004. Shen Jia. Xunzhao Su Weilian [In search of William Edward Soothill]. Beijing: Xinxing chubanshe, 2013. Shijie weisheng zuzhi [World Health Organization], ed. Huoluan de kongzhi zhinan [Guidance for cholera control]. Beijing: Renmin weisheng chubanshe, 1997. Sidel, Victor, and Ruth Sidel. Serve the People: Observations on Medicine in the People’s Republic of China. Boston: Beacon Press, 1973. Simpson, Bradley R. Economists with Guns: Authoritarian Development and U.S.-Indonesian Relations, 1960–1968. Stanford, CA: Stanford University Press, 2010. Smith, Hillary A. Forgotten Disease: Illness Transformed in Chinese Medicine. Stanford, CA: Stanford University Press, 2017. Snowden, Frank M. Epidemics and Society: From the Black Death to the Present. New Haven, CT: Yale University Press, 2019. Snowden, Frank M. Naples in the Time of Cholera, 1884–1911. Cambridge: Cambridge University Press, 1995. Soon, Wayne. “Coming from Afar: The Overseas Chinese and the Institutionalization of Western Medicine and Science in China, 1910–1970.” PhD diss., Princeton University, 2014. Soothill, Lucy. A Passport to China: Being the Tale of Her Long and Friendly Sojourning amongst a Strangely Interesting People. London: Hodder & Stoughton, 1931. Soothill, William Edward. A Mission in China. Edinburgh: Oliphant, Anderson & Ferrier, 1907. Stern, Alexandra Minna. Eugenic Nation: Faults and Frontiers of Better Breeding in Modern America. Berkeley: University of California Press, 2005. Summers, William C. “Congruence in Chinese and Western Medicine from 1830–1911.” Yale Journal of Biology and Medicine 67, no. 1–2 (1994): 23–32. Summers, William C. The Great Manchurian Plague of 1910–1911: The Geopolitics of an Epidemic Disease. New Haven, CT: Yale University Press, 2012. Szonyi, Michael. Cold War Island: Quemoy on the Front Line. Cambridge: Cambridge University Press, 2008. Tagliacozzo, Eric. “Hajj in the Time of Cholera: Pilgrim Ships and Contagion from Southeast Asia to the Red Sea.” In Global Muslims in the Age of Steam and Print, edited by James L. Gelvin and Nile Green, 103–20. Berkeley: University of California Press, 2014.

bibliogr aphy Tagliacozzo, Eric. The Longest Journey: Southeast Asians and the Pilgrimage to Mecca. New York: Oxford University Press, 2013. Tagliacozzo, Eric. “Pilgrim Ships and the Frontiers of Contagion: Quarantine Regimes from Southeast Asia to the Red Sea,” In Histories of Health in Southeast Asia: Perspectives on the Long Twentieth Century, edited by Tim Harper and Sunil S. Amrith, 47–60. Bloomington: Indiana University Press, 2014. Thaxton, Ralph A., Jr. Catastrophe and Contention in Rural China: Mao’s Great Leap Forward Famine and the Origins of Righteous Resistance in Da Fo Village. New York: Cambridge University Press, 2008. World Health Organization. Guidelines for Cholera Control. Geneva, 1993. World Health Organization. Principles and Practice of Cholera Control. Geneva, 1970. Thune, Mette. “Moving Stone from China to Europe: The Dynamics of Emigration from Zhejiang to Europe.” In Internal and International Migration: Chinese Perspectives, edited by Frank N. Pieke and Hein Mallee, 159–80. Surrey, England: Curzon Press, 1999. Tomba, Luigi. The Government Next Door: Neighborhood Politics in Urban China. Ithaca, NY: Cornell University Press, 2014. Townsend, James R., and Brantly Womack. Politics in China. Boston: Little, Brown, 1986. Vann, Michael G. “Hanoi in the Time of Cholera: Epidemic Disease and Racial Power in the Colonial City.” In Global Movements, Local Concerns: Medicine and Health in Southeast Asia, edited by Laurence Monnais and Harold J. Cook, 150–70. Singapore: NUS Press, 2012. Von Kispal-van Deijk, Gabrielle. “Ubiquitous but Elusive: The Chinese of Makassar in VOC Times.” Journal of Asian History 47, no. 1 (2013): 81–103. Walder, Andrew G. China under Mao: A Revolution Derailed. Cambridge, MA: Harvard University Press, 2015. Walder, Andrew G. “Organized Dependence and Cultures of Authority in Chinese Industry.” Journal of Asian Studies 43, no. 1 (1983): 51–76. Wang, Fei-ling. Organizing through Division and Exclusion: China’s Hukou System. Stanford, CA: Stanford University Press, 2005. Wang Changming and Zhou Baoluo. Wenzhou Lianhuaxin kangri zhanshi yanjiu [Research on the history of anti-Japanese battles in Lianhuaxin, Wenzhou]. Beijing: Shehui kexue wenxian chubanshe, 2018. Wang Guowei, ed. Rui’an huaqiaozhi [Overseas Chinese gazetteer of Rui’an City]. Beijing: Zhonghua shuju, 2011. Wang Huning. Dangdai zhongguo cunluo jiazu wenhua: Dui zhongguo shehui xiandaihua de yixiang tansuo [Family culture in the contemporary Chinese village: An exploration of Chinese social modernization]. Shanghai: Shanghai renmin chubanshe, 1991. Watt, John. Saving Lives in Wartime China: How Medical Reformers Built Modern Healthcare Systems amid War and Epidemics, 1928–1946. Leiden, Netherlands: Brill, 2014. Watts, Sheldon. Epidemics and History: Disease, Power and Imperialism. New Haven, CT: Yale University Press, 1997. Weishengbu weisheng fangyisi [Sanitation and Epidemic Prevention Department of the Ministry of Health]. Guowai huolua fuhuoluan wenzhai [Digest of cholera and El Tor cholera in foreign countries]. Beijing, 1963. Wemheuer, Felix. Famine Politics in Maoist China and the Soviet Union. New Haven, CT: Yale University Press, 2015. Wemheuer, Felix. A Social History of Maoist China: Conflict and Change, 1949–1976. Cambridge: Cambridge University Press, 2019.

295

296

bibliogr aphy Wen Guangyi, ed. Erzhanhou dongnanya huaqiao huarenshi [History of overseas Chinese in Southeast Asia during World War II]. Guangzhou: Zhongshan daxue chubanshe, 2000. Wenzhou diqu geweihui shengchan zhihuizu [Wenzhou Prefectural Revolutionary Committee Production Leadership Team], ed. Wenzhou diqu guomin jingji tongji ziliao huibian, 1952–1970 [Compiled data on national economy in Wenzhou Prefecture, 1952–1970]. Wenzhou, 1970. Wenzhou zhuanshu bangongshi [General Office of Wenzhou Prefectural Government], ed. Wenzhouqu guomin jingji tongji ziliao, 1949–1961 [Statistical data of Wenzhou national economy, 1949–1961]. Wenzhou, 1962. Wenzhoushi jihua jingji weiyuanhui [Planned Economy Commission of Wenzhou Prefecture]. Zhejiangsheng Wenzhoushi guomin jingji tongji ziliao huibian [Compiled data of national economy in Wenzhou Prefecture, Zhejiang Province]. Wenzhou, 1962. Wenzhoushi junshizhi bianzhuan weiyuanhui [Editorial Board of Military Affairs Gazetteer of Wenzhou City], ed. Wenzhoushi junshizhi [Military affairs gazetteer of Wenzhou City]. Beijing: Jiefangjun chubanshe, 2003. Wenzhoushi liangshizhi bianzhuan weiyuanhui [Editorial Board of Wenzhou City Grain Gazetteer], ed. Wenzhoushi liangshizhi [Wenzhou City grain gazetteer]. Beijing: Zhonghua shuju, 2000. Wenzhoushi weishengzhi bianweihui [Editorial Board of Wenzhou City Health Gazetteer], ed. Wenzhoushi weishengzhi [Wenzhou City health gazetteer]. Shanghai: Huadong shifan daxue chubanshe, 1998. Wenzhoushi wenrui tanghe baohu guanli weiyuanhui [Wenzhou Prefecture Wenrui Canal Protection and Management Committee], ed. Wenrui tanghe zhishi duben [Reader in the knowledge about Wenrui Canal]. Wenzhou, 2010. Wenzhou zhuanshu jihua jingji weiyuanhui [Planned Economy Commission of Wenzhou Prefecture], ed. Wenzhouqu 1963nian guomin jingji tongji ziliao huibian [Compiled data of national economy in Wenzhou Prefecture in 1963]. Wenzhou, 1964. Will, Pierre-Étienne. Bureaucracy and Famine in Eighteenth-Century China. Stanford, CA: Stanford University Press, 1990. Worth, Robert M. “The Current Cholera Pandemic.” Journal of the National Medical Association 56, no. 1 (1964): 55–57. Wu Guang and Xu Bangxian. “Wuguo xuexichongbing zhi dagai: (VII) Bingyinxue” [A survey on schistosomiasis in our country: (VII) Etiology]. Zhonghua yixue zazhi [China medical journal] 28, no. 3 (1942): 97–101. Wu Lien Teh. “Zhongguo huoluan liuxing shilüe jiqi gudai liaofa gaikuang” [The general history of cholera in China and its treatment therapies in ancient China]. Tongren yixue [Tongren medical journal] 8, no. 4 (1935): 21–28. Wu Lien-Teh. Plague Fighter: The Autobiography of a Modern Chinese Physician. Cambridge: W. Heffer, 1959. Wu Xike. “Jinnianlai fuhuoluan liuxing de yixie wenti” [Some issues concerning the spread of cholera over the past few years]. Anyi xuebao [Anhui medical journal] 7, no. 3 (1964): 175–79. Wu Yuanzhang. “Ningbo jibing shihua pianduan” [History of disease and epidemics in Ningbo]. In Ningbo wenshi ziliao [Cultural and historical data on Ningbo], edited by Ningboshi zhengxie wenshi ziliao weiyuanhui [Committee of Cultural and Historical Data of the Chinese People’s Political Consultative Conference of Ningbo City], vol. 15, 174–80. Hangzhou: Zhejiang renmin chubanshe, 1994. Wu, Yi-Li. Reproducing Women: Medicine, Metaphor, and Childbirth in Late Imperial China. Berkeley: University of California Press, 2010.

bibliogr aphy Xiao Hong. Shengsichang [Matter of life and death]. Beijing: Renmin wenxue chubanshe, 1987. Xu Yuangen, ed. Fuyangxian weishengzhi [Fuyang County health gazetteer]. Beijing: Zhongguo yiyao keji chubanshe, 1991. Yangjiangshi difangzhi bianzhuan weiyuanhui [Editorial Board of Yangjiang County Gazetteer], ed. Yangjiang xianzhi [Yangjiang County gazetteer]. Guangzhou: Guangdong renmin chubanshe, 2000. Yang Xiangyin and Wang Shaoyang. “Haiguan yibao yu jindai Wenzhou de jibing” [Medical report of the customs office and disease in modern Wenzhou]. Zhejiang xuekan [Zhejiang academic journal] 4 (2012): 67–72. Yeoh, Kheng-Har Maureen. “Cholera: A Study of Its Changing Trends, and the Outbreaks in Singapore in 1963 and 1964.” PhD diss., University of Singapore, 1969. Yongjiaxian weishengju [Yongjia County Health Bureau], ed. Yongjiaxian weishengzhi: 1991–2010 [Yongjia County health gazetteer: 1991–2010]. Beijing: Fangzhi chubanshe, 2015. Yongjiaxian zhengfu [Yongjia County Government]. “Gaishan Yongjia chenghe jihua” [The work plan for improving the waterways of Yongjia City]. Zhejiangsheng jianshe yuekan [Zhejiang Province construction monthly] 7, no. 10 (1934): 6–15. Yueqingxian Hongqiao renmin zhengfu [Hongqiao Town People’s Government of Yueqing County], ed. Hongqiao zhenzhi [Hongqiao Town gazetteer]. Beijing: Zhongguo guoji guangbo chubanshe, 1993. Yueqingxian weishengju [Yueqing County Health Bureau], ed., Yueqingxian weishengzhi [Yueqing County health gazetteer]. Beijing: Dangdai zhongguo chubanshe, 1995. Yuhangxian weishengju weishengzhi bianzhuanzu [Editorial Team of Yuhang County Health Gazetteer], ed. Yuhangxian weishengzhi [Yuhang County health gazetteer]. Yuhang: Yuhangxian weishengju, 1988. Zhang Jingfei. “Yongjia shuyi liuxing jianshi” [Brief history of the plague in Yongjia County]. Ouhai yikan [Medical journal of Ou-Hai Hospital] 7, no. 2 (1947): 37–55. Zhao Shengzhong. “Yuejinxing tongji tizhi de xingcheng he houguo” [The establishment and result of the Great Leap Forward statistics system]. Ershiyi shiji [Twenty-first century] 60 (2000): 47–55. Zhao Xiaowei, trans. and ed. Jindai Wenzhou shehui jingji fazhan gaikuang: Ouhaiguan maoyi baogao yu shinian baogao yibian [Social and economic development survey of modern Wenzhou: Selected collections of translated trade reports and decennial reports of Wenzhou Maritime Customs Services]. Shanghai: Shanghai sanlian shudian, 2014. Zhejiang minsu xuehui [Association for Zhejiang Folklore], ed. Zhejiang fengsu jianzhi [Brief gazetteer of Zhejiang folklore]. Hangzhou: Zhejiang renmin chubanshe, 1986. Zhejiangsheng danganguan [Zhejiang Provincial Archives], ed. Zhejiang ershi shiji tujian [Illustrated handbook of Zhejiang Province in the twentieth century]. Beijing: Zhongguo dangan chubanshe, 2009. Zhejiangsheng danganguan [Zhejiang Provincial Archives], ed. Zhejiangsheng ziran zaihai dashiji (1949.5–1967.3) [Chronicle of natural disasters in Zhejiang Province, May 1949–March 1967]. Hangzhou, 1983. Zhejiangsheng huaqiaozhi bianzhuan weiyuanhui [Editorial Board of Zhejiang Province overseas Chinese gazetteer], ed. Zhejiangsheng huaqiaozhi [Zhejiang Province overseas Chinese gazetteer]. Hangzhou: Zhejiang guji chubanshe, 2010. Zhejiangsheng liangshizhi bianzhuan weiyuanhui [Editorial Board of Zhejiang Province grain gazetteer], ed. Zhejiangsheng liangshizhi [Zhejiang Province grain gazetteer]. Beijing: Dangdai zhongguo chubanshe, 1999.

297

298

bibliogr aphy Zhejiangsheng nongyeting [Zhejiang Provincial Agricultural Department], ed. Nongcun renmin gongshe shengchandui kuaiji jiaocai [Textbook for production team accountants of rural people’s commune]. Hangzhou: Zhejiang renmin chubanshe, 1963. Zhejiangsheng nongyezhi bianzhuan weiyuanhui [Editorial Board of Zhejiang Province agriculture gazetteer], ed. Zhejiangsheng nongyezhi [Zhejiang Province agriculture gazetteer]. Beijing: Zhonghua shuju, 2004. Zhejiangsheng waishizhi bianzhuan weiyuanhui [Editorial Board of Foreign affairs gazetteer of Zhejiang Province], ed. Zhejiangsheng waishizhi [Foreign affairs gazetteer of Zhejiang Province]. Beijing: Zhonghua shuju, 1996. Zhejiangsheng weisheng fangyizhan [Zhejiang Province Sanitation and Epidemic Prevention Station], ed. Fuhuoluan ziliao huibian [Compiled data on cholera]. Hangzhou, 1982. Zhejiangsheng weisheng fangyizhan [Zhejiang Province Sanitation and Epidemic Prevention Station], ed. Zhejiangsheng sichongbing ziliao huibian (1950–1987) [Compiled data of filariasis in Zhejiang Province, 1950–1987]. Hangzhou, 1988. Zhejiangsheng weisheng fangyizhan [Zhejiang Province Sanitation and Epidemic Prevention Station], ed. Zhejiangsheng yiqing ziliao huibian, 1950–1979 [Collections of epidemic disease data of Zhejiang Province, 1950–1979]. Hangzhou, 1982. Zhejiangsheng weisheng fangyizhan [Zhejiang Province Sanitation and Epidemic Prevention Station], ed. Zhejiangsheng yiqing ziliao huibian, 1950–1979 (changdaobing fence) [Collections of epidemic disease data in Zhejiang Province, 1950–1979 (intestinal diseases)]. Hangzhou, 1983. Zhejiangsheng weisheng fangyizhan [Zhejiang Provincial Sanitation and Epidemic Prevention Station]. “Zhejiangsheng 1980nian fuhuoluan liuxing bingxue fenxi” [Epidemiological analysis of the prevalence of cholera in Zhejiang Province in 1980]. In Fuhuoluan ziliao huibian [Compiled data on cholera], edited by Zhejiangsheng weisheng fangyizhan, 10–19. Hangzhou, 1982. Zhejiang shengwei [Zhejiang Provincial Party Committee]. “Guanyu lunxun nongcun jiceng ganbu de zhishi” [Instructions on training rural grassroots cadres in rotation], November 11, 1961. In Zhonggong Zhejiang shengwei wenjian xuanbian (1961.01–1966.04) [Selections of documents by the Zhejiang Provincial Committee of the Communist Party of China, January 1961–April 1966], edited by Zhonggong Zhejiangshengwei dangshi yanjiushi, Zhejiangsheng danganguan [Party History Research Center of the Zhejiang Provincial Committee of the Communist Party of China and the Zhejiang Provincial Archives], 146–49. Hangzhou: Zhonggong Zhejiang shengwei bangongting, 1991. Zhejiang shengwei zhengbian jingjian weiyuanhui [Zhejiang Provincial Reorganization and Streamlining Committee]. “Guanyu sannianlai jingjian gongzuo de baogao” [Report on reorganization and streamlining work in the past three years], October 15, 1964. In Zhonggong Zhejiang shengwei wenjian xuanbian (1961.01–1966.04) [Selections of documents by the Zhejiang Provincial Committee of the Communist Party of China, January 1961–April 1966], edited by Zhonggong Zhejiangshengwei dangshi yanjiushi, Zhejiangsheng danganguan [Party History Research Center of the Zhejiang Provincial Committee of the Communist Party of China and Zhejiang Provincial Archives], 586–91. Hangzhou: Zhonggong Zhejiang shengwei bangongting, 1991. Zhonggong Pingyang xianwei dangshi yanjiushi [Party History Research Center of the Pingyang County Committee of the Communist Party of China], ed. Zhongguo gongchandang Pingyang lishi dashiji (1919.5–2010.12) [Major events of the history of the Communist Party of China in Pingyang County (May 1919–December 2010)]. Beijing: Zhonggong dangshi chubanshe, 2011.

bibliogr aphy Zhonggong Wenzhou shiwei dangshi yanjiushi [Party History Research Center of the Wenzhou Prefectural Committee of the Communist Party of China], ed. Zhongguo gongchandang Wenzhou lishi, dierjuan (1949–1978) [History of the Communist Party of China in Wenzhou Prefecture, vol. 2, 1949–1978]. Beijing: Zhonggong dangshi chubanshe, 2016. Zhonggong zhongyang dangshi yanjiushi [Party History Research Center of the Communist Party of China Central Committee]. Zhongguo gongchandang lishi, dierjuan (1949–1978) [The history of the Communist Party of China, vol. 2, 1949–1978]. Beijing: Zhonggong dangshi chubanshe, 2011. Zhonggong zhongyang wenxian yanjiushi [Literature Research Office of the Central Committee of the Communist Party of China], ed. Jianguo yilai zhongyao wenxian xuanbian [Collections of important documents since the founding of the People’s Republic of China]. Vol. 3. Beijing: Zhonggong zhongyang wenxian chubanshe, 1992. Zhongguo xinwenshe [China News Service], ed. Yindunixiya huaqiao he yindunixiya jiben qingkuang [Basic situations of Indonesian Chinese and Indonesia]. Beijing, 1959. Zhonghua renmin gongheguo rishi bianweihui [Editorial Board of the Daily history of the People’s Republic of China], ed. Zhonghua renmin guoheguo rishi (1961) [Daily history of the People’s Republic of China (1961)]. Chengdu: Sichuan renmin chubanshe, 2003. Zhonghua renmin gongheguo weishengbu fangyisi [Sanitation and Epidemic Prevention Department of the Ministry of Health of the People’s Republic of China], ed. Fuhuoluan fangzhi shouce [Manual for El Tor cholera prevention and treatment]. Beijing, 1964. Zhonghua renmin gongheguo weishengbu fangyisi [Sanitation and Epidemic Prevention Department of the Ministry of Health of the People’s Republic of China], ed. Huoluan, fuhuoluan fangzhi shouce [Manual for cholera and El Tor cholera prevention and treatment]. Beijing, 1982. Zhongyang renmin zhengfu weishengbu [Ministry of Health of the Central People’s Government]. “Guanyu yanfang huoluan de lianhe zhishi” [Joint circular on seriously preventing cholera]. Fujian zhengbao [Fujian provincial political bulletins] 2, no. 5 (1950): 70–71. Zhou, Taomo. “Ambivalent Alliance: Chinese Policy towards Indonesia, 1960–1965.” China Quarterly 221 (2015): 208–28. Zhou, Taomo. Migration in the Time of Revolution: China, Indonesia and the Cold War. Ithaca, NY: Cornell University Press, 2019. Zhoushanshi Putuoqu weishengzhi bianzhuan weiyuanhui [Editorial Board of Putuo District health gazetteer of Zhoushan Prefecture], ed. Putuo weishengzhi [Putuo health gazetteer]. Beijing: Fangzhi chubanshe, 2012. Zhoushanshi weishengzhi bianzhuan weiyuanhui [Editorial Board of Zhoushan City health gazetteer], ed. Zhoushanshi weishengzhi [Zhoushan City health gazetteer]. Beijing: Zhonghua shuju, 2002. Zweig, David. Agrarian Radicalism in China, 1968–1981. Cambridge, MA: Harvard University Press, 1989.

299

INDEX Note: Page numbers in italics refer to figures. accounting registers, 23, 171; household, 152–54, 156 administrative systems, 112, 114, 119, 158, 160, 166, 198, 227, 228, 230; centralization of, 235; medicalization of, 23, 190, 192 Agreement on the Issue of Dual Nationality (1960), 32, 33 Agricultural Collectivization Campaign, 193, 194 agricultural production, 10, 52, 53, 59, 67, 71, 73, 102, 123, 126, 152–53, 154, 158, 160, 163, 165, 171, 193, 216; gender roles in, 101, 109; management of, 153; rhythms of, 72; social epidemiology and, 13; typhoons and, 74; women and, 95–96, 100–101, 253n67 Alibaba Group, 235 Anderson, Benedict, 176 Anderson, Warwick, 16 Anhui Province, agricultural production in, 96 Anti-Japanese War, 81, 102, 103, 111 antibiotics, 37, 184 anticholera campaigns, 43, 77, 140, 156, 172, 187, 201; clandestine, 6–7; integration of, 23 Ao River, 65, 69 area classifications, map of, 117 bacteria, 37, 38, 83, 190, 214, 268n17 Bandung Conference, 46 Bashford, Alison, 14, 15 Beiji Island, 54, 55, 64, 64–65 Beijing Radio, 33 “Big Clean-Up” campaigns, 228 borders: administrative, 119–21, 139; crossing, 133–39; drawing, 116–19; geographic, 119; internal, 14; invisible, 113–16; isolation and, 15, 22–23; militia, 119–21, 139; multiple, 139;

quarantine, 15, 22–23, 119–21, 127–32, 134, 139, 141; social divisions and, 6, 11–16 broadcasting system, 154, 156 Brown, Kate, 231 Buddhism, 203 Bulletin of Epidemic Prevention Work, 210 bureaucracy, 192–98, 230, 233; statistical, 194 canals, 28, 29, 65, 66, 69, 83, 84, 85, 91, 92, 93, 108 Cao Shanzheng, 134 carriers, 4, 10, 42, 47, 64, 131, 139; asymptomatic, 38, 45; convalescent, 38, 73 Center for Disease Control (China), 234 Central Committee (CCP), 58, 119, 207, 212, 214, 220 Central Epidemic Prevention Bureau, 226 Central Java, cholera in, 38 Central People’s Government, disease control and, 202 ceremonies, 228; burial, 74; funeral, 74; marriage, 72; memorial, 72; religious, 203; wedding, 73 Chen Azhu, 3, 4, 64, 68, 92, 178 Chen Chengye, 132 Chernobyl, 231 Chiang Kai-shek, 3–4, 6, 20, 55, 56, 57, 102, 213, 222 China Medical Journal, 95–96 China News Agency, 219 Chinese Civil War (1945–1949), 9, 81, 260n81 Chinese Communist Party (CCP), 19, 58, 62; governance by, 8, 46 Chinese People’s Armed Force, 137 Chinese Red Cross Society, 213 Chinese State Council, 33, 53, 197 chlorinated lime, purifying with, 92, 94

301

302

Index cholera: classical, 37, 38, 184; controlling, 199, 212, 219; diagnosis of, 4, 45, 64, 178, 180; fighting against, 29, 112, 113, 156, 157, 230; gender distribution of, 97 (table), 101–2, 101 (table); geographic distribution of, 13, 22, 49, 64–65, 67–69, 71, 82, 95, 124 (table); incidence of, 20, 90–91, 92–93, 93 (table), 94, 96, 102, 108–9, 110, 166, 172, 179, 191, 215; infection with, 38, 101, 187, 246n90; mild, 65, 131; outbreak of, 4, 41, 50, 85, 92, 103, 107, 113, 114, 116, 118, 120, 121, 123, 140, 145, 147, 159, 169, 176, 185, 186–87, 194, 196, 204, 208, 209, 213, 232–33; preventing, 6, 16, 42, 116, 121, 140, 157, 172, 182, 184, 196, 197, 202, 213, 215, 216, 217, 220, 221; reporting, 19, 187, 188; spread of, 7, 8, 9, 11, 14, 21, 23, 28, 30 (table), 41–42, 44–45, 54, 64, 65, 67, 68, 69, 71, 72–73, 74, 75, 81, 85, 92, 108, 113, 117, 125, 126–27, 132, 133, 146, 156, 173, 176–77, 179–80, 185–86; symptoms of, 77, 131; temporal rhythm of, 64, 71–75; treating, 121, 122, 123, 184, 185–86, 216, 217. See also El Tor cholera Cholera Epidemiological Investigation Team, 125, 127 coastal front: cholera concerns and, 102; tension of, 55–58 coastal societies, 49, 54–64 Cold War, 5, 10, 20, 32, 221, 231 collectivization, agricultural, 1, 50, 53–54, 77, 90, 96–97, 99, 109, 114, 226 commercialism, medical, 176, 182, 183, 186 Committee for Hosting and Accommodating Returning Overseas Chinese, 33 communication, 18, 150, 154; national secrets and, 206; public health, 151 Communist Party, 138, 139, 195, 203, 217, 226; challenges for, 204; information structuring by, 205; militias and, 120 Compiled Data of Cholera Prevention and Treatment, 209 conscription schemes, 102–3, 104 control schemes, 15, 141, 192, 199, 205, 207, 208, 223, 227, 228, 229 coolies, 9, 31, 62 COVID-19 pandemic, 23, 234, 235

cropping systems, 96, 97–98 Cultural Revolution (1966–1976), 5, 7, 10, 21, 23, 105, 192, 201, 221, 226; epidemics and, 232 Dachen Islands, 55 “Daily Statistical Report on Inoculation Certificate Checks and Supplementary Inoculation,” 131 data: analysis of, 198; biostatistical, 150, 236; collecting, 18, 176; demographic, 159, 168, 171, 236; epidemic, 192, 198, 199; epidemiological, 23, 81, 168, 171; financial, 236; inoculation, 151; movement, 236; patient, 194; population, 199; production, 16, 171; social structure and, 6–7, 16–19, 171; statistical, 127, 176, 190, 192, 193, 209 Department of Overseas Chinese Affairs, 62 Department of Sanitation and Epidemic Prevention, 220 Dianbai County, 215; cholera in, 212, 219; paracholera in, 213 diarrhea, 4, 37, 38, 40, 69, 122, 123, 178, 179, 185, 196, 198 diaspora, 138, 141; Chinese, 22, 31, 36–43, 46, 47; cholera and, 36–43; Muslim, 28 diphtheria, 149, 208 disease: controlling, 16, 17, 112, 140, 202, 212; distribution of, 11, 12, 13, 83, 109, 192; encoding, 205–12; epidemic, 188, 192, 194, 199; history of, 20–21, 31; infectious, 8, 13, 101, 109, 181, 188, 192, 197, 198, 207–8, 210, 228, 234; intestinal, 92, 176–81, 179, 186, 187, 196, 197 (table), 198; mobility and, 6, 8–11; outbreak of, 83, 103; parasitic, 228, 253n67; politics and, 7, 225; resistance to, 100; social restructuring and, 6, 141, 226; sociopolitical change and, 225; spread of, 8, 121, 232–33; waterborne, 82; women and, 95–102 division of labor, 120; gendered, 95–102 Dongguan County, cholera in, 43 Dongtou Fishing Port Temporary Joint Quarantine Station, 129 Dongtou Hospital, 122 Dongtou Island, 50, 54, 61, 129 Dongtou Wharf, 129

Index Double Ninth Festival, 74 Dragon Boat Festival, 85 Du Kangping, 140 Duanwu, 85, 237 Dutch East India Company, 31, 36

epidemiologists, 64, 68, 140, 172 epidemiology, 6, 18, 40, 41, 42, 140, 190–92, 198–99, 219, 228; cholera, 72, 90, 91; urban, 12 Evans, Richard, 11, 225

East China Bureau, 214 East China Sea, 54, 65, 116, 118 East China Southbound Cadre Columns, 50 Eastern Bureau (League of Nations Health Section), 217 Echenberg, Myron, 19 ecological factors, 13, 67, 71, 77. See also human ecology economic issues, 4, 5, 18, 53, 113, 115, 123, 176, 233, 245n58 economic reforms, 165, 181, 232 edema, spread of, 51 education, 133–34, 135, 206, 254n5; hygiene, 216; political, 216 egalitarianism, 205; economic, 14, 114, 115, 116 El Tor, 29, 30 El Tor cholera (Vibro cholerae El Tor), 4, 178, 184, 212, 213, 215; and classical cholera compared, 37; examination of, 40; outbreak of, 12, 28; spread of, 20, 28–30, 37–38, 41–42, 44, 46 emergency disciplinary state, 113, 176, 200, 228, 229; features of, 233, 234–35; rise of, 110, 231, 234 encirclement, 116–19, 121 environmental issues, 8, 13, 245n62 Epidemic Information Weekly, 220, 221 epidemic prevention, 13, 103, 120, 121, 125, 157, 158, 163, 168, 175, 182, 201, 203, 204, 209, 216, 226, 227, 233; departments, 190–91, 192, 236; drawings depicting, 107; inoculation and, 257n15; schemes, 106, 181, 211, 229, 230; stations, 21, 22, 123, 157, 162, 178, 186, 190, 191, 198; systems, 189, 195 epidemics: ghosts/demons of, 203; history of, 8, 20–21, 43; outbreak of, 158, 203, 229; responding to, 94, 227, 231; social/political changes and, 110; vulnerability to, 13 Epidemiological Intelligence Station (WHO), 218

famine, 7, 10, 23, 31, 44, 47, 50, 54, 75, 77, 95, 100, 158, 208, 226, 229; information on, 207; population movement and, 52 Fanshan District, 162 Feiyun River, 65, 69, 87, 118 Felsenfeld, Oscar, 12 Fenshuiguan Gate Joint Quarantine Station, 118, 130, 131, 132, 133, 134, 140; quarantine statistical data for, 132 (table) festivals, 71, 72, 73, 74, 75, 77, 203 filariasis, 51, 253n67 First Epidemic Prevention Hospital, 96 fishermen, 63; cholera spread by, 65; flow of, 59–61, 77 fishing activities, 55, 59, 60–61; sketches of, 60 food, 100, 132; cholera and, 73; contaminated, 204; delivering, 111; schemes, 104–5 Foreign Affairs Office of Hangzhou City, 138 Foucault, Michel, 176 Fuding County, 61, 130, 140; quarantine in, 118, 132 Fujian Province, 51, 53, 54, 55, 105, 130, 133, 140, 209; agricultural production in, 96; cholera in, 4, 20, 232; deaths in, 201; development of, 67; infectious disease in, 106; migrants to, 52; offshore fishing at, 61; quarantine in, 118, 131, 132 (table); as war zone, 57–58 Gao Chunchai, 85 Gao Hua, 205 Gaojian station, 136, 137 Gaolou District, 182 gastroenteritis, 40, 178 Ge Changrong, 73 gender: agriculture and, 101, 109; cholera and, 97 (table), 101–2, 101 (table); disease and, 13; infection rates in, 96; roles, 82, 101, 109 General Line for Socialist Construction, 48 General Logistics Department (PLA), 106 General Political Department (PLA), 56

303

304

Index germ warfare, 216 Ghosh, Arunabh, 18, 192 globalization, 8, 233, 234 Gomes Candau, Marcolino, 220 Gotschlich, Felix, 30 grain: coupons, 115; distribution of, 153; population mobility and, 49; production of, 3, 50, 73, 247n6; sale of, 115; shortage of, 50, 51, 72, 105; surplus, 50 grain-purchasing certificates, 169 Great Famine (1959–1961), 21, 49, 56, 192, 204, 207; cholera and, 104; impact of, 3; migration during, 54–55; persistence of, 4–5 Great Leap Forward (1958–1960), 4, 5, 7, 10, 13, 21, 23, 28, 47, 48, 51, 56, 63, 75, 77, 119, 164, 167, 193, 194, 225; labor shortage and, 96; social restructuring and, 6; women’s diseases and, 100 “Great Link-Up,” 232 “Great Networking Movement,” 232 Guangdong Province, 40, 41, 49, 54, 59, 116–17, 149, 214, 218, 220, 232; agricultural production in, 96; cholera in, 4, 20, 42, 43, 44–46, 64, 71, 106, 112, 202, 208–9, 212, 213, 215, 219; deaths in, 201; infectious disease in, 39, 106; map of, xi; migration from, 44; offshore fishing at, 60–61, 64–65; pandemic in, 43–46; paracholera in, 215; as war zone, 57 Guangdong Provincial Epidemic Prevention Headquarters, 41, 42 Guangdong Provincial Health Department, 40 Guanghua (ocean liner), 39 Guangzhou, 8, 12, 27, 33, 35, 39; cholera in, 213; plague in, 45 Haikou Hygiene and Quarantine Institute, 220 Han Yonggang, 101, 203 Hangzhou City, 58, 63, 75, 116, 199; health code and, 235; Marshal Wen cult in, 203; medical units in, 157; observation station at, 117; repatriation station in, 52 Hao River, 91 He Nangao, 101, 105, 114, 207; on health workers, 106; immobile society and, 254n12 health bureaus, 21, 89, 177, 195

health care, 103, 134, 165, 197, 203–4; metaphors for, 204; rural/urban divide in, 182, 200 health-care clinics, 139, 180, 192 health-care stations, 162, 166, 191, 192, 194, 195 health-care workers, 13, 106, 162, 189; cholera reporting by, 187, 188; inoculation by, 165–66; mobilization of, 164–65, 166 health emergency response models, 6, 226, 231, 233 Hejaz, cholera in, 28, 29, 30 hepatitis, 164, 208 High Institute of Public Health, 245n70 H1N1 pandemic, 234 Hong Kong, 28, 35, 58, 62, 63, 138, 218, 219; cholera in, 41, 44–45, 202, 213, 221; immunization in, 45; migration to, 20, 43, 44; plague in, 45; refugees in, 47 Hong Tiansui, 174, 175 hookworm, 51, 253n67 hospitals: county, 122, 123; isolation, 123, 124, 125, 126, 127; location of, 121–27 household registration system, 5, 10, 17, 23, 54, 110, 114, 153, 164, 167, 169, 170, 230 Hu Dezhong, 137 Huang, Philip C. C., 97 Huangpu port, return through, 27, 35, 39 Huangyan County, 98 Hangzhou City, cholera in, 81 Huian County, 61 Huichang Lake, 83 human ecology, 22, 49; disease spread and, 64; dynamics of, 64–65, 67–69, 71; natural ecology and, 13 hunger, 3, 10, 31, 46, 49, 54, 100, 207, 208 Hungry Ghost Festival, 72, 74, 75 Huzhou Prefecture, medical units in, 157 hygiene, 16, 91, 103, 105, 108, 216; city/country compared, 82–85, 87–95; dietary, 72; environmental, 228; improving, 106 immunity, 104, 128, 147, 149, 163, 172 incidence rates, 12, 51, 69, 71, 81, 82, 92, 93, 93 (table), 96, 108, 109, 110, 172, 179, 202, 215 indoctrination, 202; political, 5, 6, 186, 217, 223, 227 Indonesian Chinese, 64, 138; Chinese govern-

Index ment and, 32; cholera spread and, 41–42, 43; farewell party for, 34; identity dilemmas among, 28, 30–33, 35; movement of, 22, 31, 46; nationality issue of, 6; retail businesses of, 33; return of, 27–28, 35, 35, 36–43, 36 Indonesian Communist Party (PKI), 33 industrialization, 9, 46, 62, 77, 87, 231; national, 50, 226; urban, 53–54; women and, 96 Infectious Disease and Public Health Emergency Online Reporting System, 234 information: accounting, 23; analyzing, 195, 205, 235–36; cholera, 207, 208, 209, 211–12, 214, 215, 220, 221, 223; collecting, 19, 205, 220; controlling, 16, 18, 19, 21, 202, 204, 205, 207, 220, 223; demographic, 153; epidemic, 16, 19, 21, 174, 177, 192, 195, 200, 204, 214, 218, 220, 221, 223, 227; hierarchical, 205–12; household, 23, 148–52, 169; inoculation, 167; pandemic, 7, 19, 21, 202, 205, 210, 211, 215, 218, 222, 223, 227; patient, 198, 199; sharing, 175, 207 inoculation, 134, 172, 197, 205, 223, 228; cholera, 106, 156, 161 (table), 171, 173, 221; compulsory, 145, 146, 220; effectiveness of, 17; emergency, 156–60, 162–63, 164, 167, 169, 171, 230; mass, 145, 147, 160, 162–67, 169, 170–71, 173; preventive, 121, 128, 131, 146, 159, 162, 216, 217; rates, 162, 167, 168; rural/ urban, 169; smallpox, 168; village, 148–52; waivers, 168 inoculation campaigns, 16, 19, 45, 163, 166, 169–70, 173; comprehensive, 17–18; control through, 171; speed of, 167 inoculation certificates, 23, 128, 129, 167–70, 222, 236; checking, 169; health codes and, 236; as identity documents, 171; issuing, 170, 260n81 inoculation programs, 16, 17, 149, 150, 151, 159, 160, 163, 165, 166, 169, 172; accuracy of, 164; issues for, 167; transformation of, 149 inoculation registers, 17, 23, 159, 160, 162, 164, 165, 167–70, 199 institutionalization, 176, 181, 230; medical, 19, 23, 150, 187, 190, 192, 195, 196, 227 International Health Convention, 220 isolation, 6, 11, 14, 134, 141, 205, 223, 227, 228,

305 236; borders and, 15, 22–23; forms of, 121–27; implementation of, 16, 112, 113, 127; process, 15, 16, 140, 235; quarantine and, 15; strict, 121, 140

Jakarta, 32, 39; cholera in, 38 Java, 33, 37; cholera in, 38, 39 Jeddah, 28, 29 Jiangmen County, 43 Jiangsu Province, 58, 105, 108, 209, 215; cholera in, 4, 20; medical units in, 157 Jiaxing Prefecture, 117, 157 Jinhua County Station, 116, 117 Jinhua Prefecture, 116, 117; medical units in, 157; repatriation station in, 52 Jinshui Village, 83, 111 Kalimantan, cholera in, 39 Kamal, Ahmed Mohammed, 38, 245n70 Katz, Paul, 203 Kaul, P. M., 172 Kennedy, John F., 55 Koch, Robert, 29 Kuhn, Philip, 31 Lam, Tong, 18 Lampton, David, 226 League of Nations Health Section, 218 Lee Hui Ying, 245n58 Leung, Angela, 95, 112 Li Chengqin, 125, 180 Li Lanyan, 75, 182, 194 Li Wenhui, 182 Liao Chenzhi, 27 Lin Gensheng, 216–17 Lin Tongfa, on agricultural production/ women, 100–101 Lin Yongkui, on river water/springwater, 84 Lin Yuncheng, 209–10 Lingxi District, 92 Linhai Quarantine Station, 118, 134 Lucas, AnElissa, 226 Macau, 28, 62, 63, 138, 218, 219; cholera in, 41, 44–45, 202, 221; migration to, 20, 43, 44; refugees in, 47

306

Index MacPherson, Kerrie, 8, 82 Makassar, 30, 32, 36, 39; cholera in, 4, 20, 28, 37, 46; economic development in, 38; Indonesian Chinese in, 37; map of, xi; pandemic in, 217–18 malaria, 51, 104, 106, 228 Malaysian Chinese, 39 Manila, cholera in, 45, 46, 219 Mao Zedong, 5, 8, 10, 13, 17, 19, 21, 48, 54, 58, 110, 133, 134, 152, 173, 176; leadership of, 109; pandemics and, 231–32; population mobility and, 9 Maoming County, cholera in, 43 Marianna (ocean liner), 39 Mason, Katherine, 16, 17, 234 Masses of Southern Zhejiang, 48, 59, 63, 214 materials, 201; health, 221; internal, 210; reference, 210; secret, 209 Mecca, 28–30, 46 media, 201, 218, 234; control over, 212, 223; silent, 212–17 medical campaigns, 4, 103, 104, 110, 203–4 medical care, 13, 110, 197; soldiers/civilians and, 102–9 medical practitioners, 13, 166, 187, 196, 201, 227, 230; control over, 183–84; prevention work and, 182; rural, 186 medical services, 12, 183, 197, 199 medical staff, 121, 139, 159, 185, 186, 209; prevention work and, 182; secrecy and, 219; speculation/profiteering by, 183 medical systems, 106, 160, 166, 175, 176, 198, 228, 230; defragmenting, 181–87; institutionalization of, 19, 23, 190, 192, 227; reshuffling, 157–58; rural, 150, 157, 158, 186; urban, 157, 158 medical teams, 104, 159, 160, 162 medical units, 123, 139, 221, 234; collective, 195, 196; district, 198 medicine, 121, 128, 149, 165, 168, 196, 197, 216, 230; Chinese, 184, 185, 186; history of, 7; practicing, 183; rural, 182; Soviet influence on, 254n5; state, 8 Meiao Quarantine Station, 118, 130, 131–32, 133, 134, 135, 136 meningitis, 23, 208, 232, 268n17

Mid-Autumn Festival, 72, 74, 75 migrants, 9, 46, 52, 53, 62, 67, 77, 139; contacting, 17; epidemic and, 28; voyages of, 31 migration, 8, 43, 62; famine-related, 9, 54–55; limiting, 53 militias, 113, 119, 120, 121, 228 Ministry of Chemical Industry, 211 Ministry of Health (PRC), 111, 172, 183, 201, 208, 211, 213, 214, 220, 221, 230; criticism by, 40; critique of, 12; disease control and, 202; inoculation and, 163; instructions from, 194; investigation by, 43; PLA and, 106; regulations by, 210; report by, 209 Ministry of Public Security and Internal Affairs, 52–53 Miu Tianshun, 115 mobility, 127, 236; controlling, 77, 199; long-distance, 133; restricting, 183; transnational, 233 morbidity rates, 12, 22 “More work, more income,” 155 mortality rates, 11, 81, 171, 208, 215 Municipal Center for Disease Control, 17 Nanhai County, cholera in, 43 Nanji Island, 54, 55, 56, 58, 64 nation-building, 8, 15, 18, 103, 226, 228 Nationalist army, 55, 67, 102, 103 Nationalist government, 3–4, 20, 111, 112, 213, 217, 229; conscription by, 102–3; negligence of, 214 new villagers, sketch of, 156 Ningbo City, 117, 136 Ningbo Prefecture, 116; cholera in, 75, 118; epidemic prevention plan for, 211 Ningbo Station, 18, 52 No. 2 disease, 19, 23, 202, 223 Non-Aligned Movement, 10 North Borneo, cholera in, 39, 45 North Sumatra, cholera in, 39 nutrition, 13, 100, 102, 103, 104, 105 ocean liners, 34, 35, 36, 39 Ou River, 65, 69 outpatient departments, 176–81, 184, 187, 195, 196, 198; establishment of, 186

Index Overseas Chinese Affairs Committee, 27 Overseas Chinese Affairs Department, 139 pandemics, 7, 11, 13, 17, 21, 41, 43, 47, 63, 147, 167, 170, 184, 201–2, 226; decline of, 162; outbreak of, 8, 37, 38, 203, 229; responding to, 227, 235; social/political changes and, 110; statistics from, 174. See also COVID-19 pandemic paracholera, 213, 215, 219 Party Leadership Group, 183 patients, 69, 73, 83, 139, 157, 180, 196, 198–99, 211; admission/discharge of, 125, 127; archiving work on, 190–92, 194; contact with, 128, 131, 191, 199; distribution of, 121–27; identifying, 128, 177–78, 181; rural/urban ratio of, 124, 127; treating, 122, 123, 178, 184, 185, 186, 191; underregistration of, 197 (table) Patriotic Health Campaigns, 87, 90, 91, 149, 228 Pearl River Delta, 43 peasants, 4, 9, 10, 50, 77, 55, 69, 71, 72, 73, 85, 87, 95, 97, 101, 106, 110, 115, 123; daily life of, 154; discrimination against, 12; mobilization of, 51; relocation of, 52, 53; repatriation of, 49, 54; rich, 58, 119 Peckham, Robert, 13 Pelling, Margaret, 11–12, 225 People’s Commission of Fujian Province, 33–34 People’s Commission of Guangdong Province, 33–34 People’s Commission of Zhejiang Province, 147 People’s Communes, 5, 10, 11, 48, 52, 62, 63, 112–13, 114, 115, 116, 119, 129, 168–69, 189, 207, 230, 232; formation of, 152–53; institutionalization of, 54 People’s Daily, 212, 213, 214, 215 People’s Liberation Army (PLA), 4, 6, 10, 49, 50, 55, 56, 63, 64, 102, 109, 116, 133, 134, 141; cholera and, 106, 107–8, 110; coastal defense/patrol of, 57; epidemic prevention work for, 107; food/nutrition scheme of, 104; grain supply for, 105; infectious diseases and, 106; inoculation for, 106; medical system for, 106; movement of, 58, 59; nutrition for, 104, 105; quarantine and, 136, 137; schistosomiasis and, 103

pharmaceutical staff, 183, 185, 221 Philippines Red Cross Society, 213 Ping’ao Canal, 66, 83 Pingyang County, 51, 52, 55, 58, 59, 64, 69, 83, 85, 91, 92, 95, 98, 100, 116, 125, 126, 127, 130, 157, 173, 177, 178, 180, 182; canals in, 93; cholera in, 20, 40, 65, 68, 73, 74, 81, 93, 93 (table), 108, 109, 118, 160, 162; data from, 124; fishing at, 61; hospitalization in, 126 (table); inoculation in, 147, 167; interviews in, 21; labor from, 68; militia in, 119; overseas Chinese from, 63; pilgrims from, 204; PLA in, 105; population of, 67; quarantine in, 118, 132; soldiers from, 104; stool sample collecting in, 181; vaccination in, 151; water in, 94 Pingyang County Cholera Epidemiology Investigation Team, 73 Pingyang County People’s Commission, 52 Pingyang County People’s Hospital, 122, 124, 142, 174 Pingyang County Sanitation and Epidemic Prevention Station, 72, 108, 132, 150, 180 Pingyang Plain, 95 PLA. See People’s Liberation Army plague, 11, 149, 150, 203, 210, 225; spread of, 9, 111, 226 political discipline, 7, 195, 205–12, 223, 227, 228 political legitimacy, 42, 42–43, 222; pandemics and, 202–5 political power, 133, 230, 231, 234, 235 politics, 4, 5, 8, 11, 21, 31, 109, 173, 204, 216, 228, 230, 245n58; Cold War, 8; disease and, 7, 225; domestic, 23; epidemic, 19; international, 23; national, 11, 46; statistical, 6, 176, 192–98, 199, 200, 228; transnational, 22, 46–47 pollution, 40, 90; industrial, 68; water, 68, 75, 89, 91, 92, 109 population movement, 5, 28, 37, 75, 114, 115, 127, 128, 130, 141, 169, 170, 232, 233; chaotic, 81; cholera spread and, 9, 47, 49, 53–54, 67–68; controlling, 9, 17, 53, 54, 77, 147; disease and, 6, 8–11; famine and, 52; grain and, 49; impact of, 49, 50, 71; long-distance, 64; reduction of, 9, 58; social restructuring and, 226; transnational, 8; villager, 113

307

Index

308

Prefectural Committee to Support the Front, 104 “Preliminary Report on Epidemiological Efficacy Observations on the Cholera Vaccines” (Su Delong), 172 “Preparation for War” campaign, 13, 49, 56, 57, 58, 64, 68, 102, 104, 105, 107, 108, 119, 134, 136, 137 Presidential Regulation No.10 (1959), 33 production brigades, 129, 152, 159, 187, 188, 189, 191, 193, 227, 230 production teams, 73, 129, 152, 154, 159, 188, 189; cholera reporting by, 187; rural, 167 propaganda, 6, 62, 146, 154, 212, 223, 229 public health, 17, 148, 149, 151, 173, 226; quarantine and, 15 public health emergencies, 4, 15, 77, 232, 234; information regarding, 231; outbreak of, 234; responding to, 16, 231, 233, 235 public health systems, 228, 230 Qamaran Island, quarantine on, 29 Qian Xinzhong, 42, 177, 201, 204 Qianku District, 127 Qiantang River, 75 Qing River, 118 Qingtian County, 62, 134 quarantine, 6, 11, 111, 116, 118, 205, 223, 227, 228, 236; borders and, 15, 22–23; coordinating, 120, 121; criticism of, 221; evading, 133–39; examinations, 133, 134, 135, 138, 141, 170; implementing, 16, 112–13, 125, 129, 130, 132, 136, 235; inoculation certificates and, 129, 136; national administration and, 14–15; political relations and, 222; process for, 16, 127, 128, 129–30, 131, 133, 140; transport, 129, 134, 135, 213; waivers, 138, 139 quarantine partition, 116–19, 121 quarantine staff, 121, 131, 133, 134–35, 136, 137, 138 quarantine stations, 29, 121, 127, 128, 129, 131, 132, 133, 134, 136, 137, 139–40; establishing, 118; map of, 117 Quxian, observation station at, 117 Railway Corps, 231 “Raising the Army First, Nutrition First,” 103

“Reclaim the Mainland” campaign, 4, 6, 55, 102 refugees, 77; Chinese, 47; epidemic and, 28; pandemic and, 43–46 “Regulations on Protecting National Secrets Issued by the Commission for the Protection of National Secrets of the Central Committee of the Communist Party of China,” 205–6 religious practices, 31, 222; pandemics and, 202–5 “Report on Resolutely Stopping Free Population Movement” (State Council), 53 reporting, 174, 196, 198; cards, 191, 192; networks, 175, 187–88, 218; reference, 175; regionalized, 177 reporting schemes, 176, 187, 188, 192, 194; extension of, 189; medical, 175 resource distribution, 95, 192–98; medical, 12, 197–98, 230 rice cropping, 97, 98, 98, 99 right of the soil, 32 Rogaski, Ruth, 82 Rosenberg, Charles E., 11 Ruffer, Armand, 243n20 Rui’an County, 3, 51, 55, 59, 64, 83, 90, 91, 94, 102, 121, 122, 148, 152, 159, 162, 166, 177, 178, 180, 182, 183, 184; canals in, 93; cholera in, 4, 20, 21, 65, 68, 69–70, 73, 74, 75, 81, 93, 93 (table), 101, 108, 109, 116, 118, 126–27, 167, 179, 185; connections to, 67; epidemic prevention in, 158; health-care workers in, 189; hospitalization in, 126 (table); inoculation in, 147, 151, 161 (table), 170; labor from, 68; militia in, 119; passengers/ sea travel from, 130, 130; patients in, 157, 197 (table); pilgrims from, 204; quarantine in, 125; reporting scheme in, 187; treatment in, 217; vaccination in, 151; water in, 87 Rui’an County Epidemic Prevention Headquarters, 182 Rui’an County Health Division, 126, 127, 188 Rui’an County People’s Commission, 75, 126, 127, 191 Rui’an County People’s Hospital, 68, 92, 122, 124, 174, 178 Rui’an County Sanitation and Epidemic Prevention Station, 64, 131, 191, 195, 196, 216

Index Rui’an County Town, 73, 91, 92 Ruiping Canal, 65, 69, 83 Ruiping Plain, 65, 90 rural/urban divides, 5, 10, 81–82, 95, 110, 127, 200 sanitation, 12, 109, 163, 193; cholera and, 93; county, 162, 168; environmental, 39–40, 82 Sanitation and Epidemic Prevention Station, 91 sanitation stations, 21, 22, 91, 157, 178, 186, 190, 191 Sanmen County, 136, 137 Sanmen County Culture and Health Bureau, 138 Sarawak, 4, 38–39 SARS pandemic, 18, 23, 233, 234, 235 schistosomiasis, 95, 96, 103, 104, 228, 253n67 Schmalzer, Sigrid, 22 Second Taiwan Strait Crisis, 104 secrecy, 207; communication and, 206; epidemic, 19; national, 202, 206; protecting, 18, 206 Secrets Protection Commission, 211–12 sedentary society, 133, 170; controlling, 77; fragile bodies and, 49–54; mobility of, 140 Semarang, cholera in, 38 “Seven Celestial Princesses,” 98 Seven Pest Eradication Campaign, 193 Seven Women Generals, 100 sewer system, 88, 89 Shanghai, 12, 63, 64, 82, 83, 100, 116, 117, 209, 215; cholera in, 4, 20; schistosomiasis and, 103 Shanghai Hygiene and Quarantine Institute, 220 Shanghai Institute of Biological Products, 172 Shanghai Medical University, 140, 172 Shanghai Municipality, 3, 75, 100, 116; cholera in, 81, 82 Shanghai Municipality Sanitation and Epidemic Prevention Station, 140 Shanxi Province, bubonic plague in, 226 Shaoxing Prefecture, 75, 138 Shenzhen, return via, 33 Sinai Peninsula, 29, 243n20 Singapore, 37, 62, 63, 218 smallpox, 148, 168, 172, 210, 228, 255n25

social classes, 11, 15, 83 social control, 7, 8, 15, 17, 58, 113, 141, 192, 227 social customs, 22, 49, 64, 77, 196; tenacity of, 71–75 social distancing, 235 social divisions, 81; borders and, 6, 11–16 social epidemiology, 7, 11, 12, 16, 22, 82, 83, 94, 102, 109, 110; agricultural production and, 13 social issues, 8, 22, 39, 204, 216, 233 social order, 10, 14, 19, 222; pandemics and, 202–5 social organization, 8, 14, 203, 233 social restructuring, 5, 7, 11, 14, 15, 16, 17, 19, 23, 47, 95, 102, 110, 113, 140, 147, 160, 171, 176, 181, 192, 199, 200, 225, 228, 234; disease and, 6, 141, 226; domestic, 22; population mobility and, 226; process, 6, 83, 227; strengthening, 12–13; undergoing, 151 social structure, 8, 11, 12, 14, 23, 54, 141, 169, 170–71, 233, 236; data and, 6–7, 16–19 socialism, 8, 33, 228 socialist construction, 33, 48, 57, 63, 110 Socialist Education Campaign, 183, 186 sociopolitical campaigns, 46, 192 sociopolitical change, 5, 49, 82, 110, 225 sociopolitical control, 22, 46, 198, 232 sociopolitical structure, 10, 19, 153, 229, 233; transformation of, 152, 189, 230 sociopolitical units, 14, 167–70 South China Morning Post, 218, 219 south gate wharf, 36, 86, 87 Southeast Plague Prevention Center, 111 statistics, 190, 192, 193, 194–95; epidemic, 18, 19, 198, 199, 200 Stern, Alexandra Minna, 15 stool samples, 176–81, 191, 198; collecting, 180, 181, 184 stool tests, 180, 181, 186, 190–92, 196, 199 Su Delong, 172 Suez Canal, 28 Sulawesi Island, 36, 38; cholera on, 4, 28, 30 (table), 46; Indonesian Chinese on, 37 Sulu Island, cholera in, 45 Sun Fuzhi, 107, 108 surveillance, 120, 127, 130, 140, 176, 198, 210, 223; disease, 15, 174–75, 220; economic, 227;

309

Index

310 epidemic, 175, 187–90, 196, 219; medical, 189, 190; political, 14, 114, 116, 190, 228; social, 5, 147 Szonyi, Michael, 229

Tagliacozzo, Eric, 29 Taishun County, 67, 114; cholera in, 43; quarantine in, 118, 132 Taiwan, 54, 55, 85, 222, 229; cholera in, 213, 215; Indonesian Chinese in, 35 Taiwan Strait, 55, 56, 104, 229 Taizhou Prefecture, 116, 134; cholera in, 75, 145; quarantine in, 118 Tangxia District, 90, 167, 180, 196; inoculation in, 170 Taoshan District, 68, 159, 180 Tarbagan marmot, 9 technology, 198, 201; communication, 154; governance, 18; medical, 186, 230, 232; telecommunication, 230 Ten-Flower Team, 98, 100 Third Front, 231 Thirteen Sisters Team, 98–99 three gates, controlling, 128–29 Tianjin, 12, 82, 83 toilets, 40, 89, 90, 139 Townsend, James, 212 trade, pandemic and, 43–46 transportation, 8, 38, 120, 150, 236; land-andriver, 83; quarantine and, 129, 134, 135, 213; sociopolitical class and, 133 tuberculosis, 149, 164 Twenty-Sixth World Health Assembly, 260n86 typhoid fever, 149, 208 union clinics, 181, 182, 183, 184, 188, 192, 194, 195 United Front Work Department, 62, 138 United Nations, 4 urban/rural balances, 53, 54 U.S. Border Patrol, 15 vaccines: administering, 169, 170; cholera, 163, 166, 171, 172, 173, 213; dosage of, 168; effectiveness of, 147, 171, 172; meningitis, 232; plague, 150; preventing, 149; production of, 151, 163, 230; smallpox, 148, 172

Vibrio cholerae, 29, 30, 225, 243n20; persistence of, 245n62; strains of, 243n17 vomiting, 4, 69, 179, 184, 185, 186, 198 Wang Changming, on canals, 65 Wang Jingfu, 122, 123, 148, 168 Wang Renshu, 32 Wanquan Commune, 51 Wanquan District, 68, 95, 180 Wanquian Plain, 66 water: access to, 95; cholera and, 82, 90, 91 (table), 93; contaminated, 91, 204; delivering, 111; drinking, 83, 84, 85, 87, 89, 91, 92, 94, 109; river, 84, 94; running, 89, 95, 109; spring, 84; tap, 83; well, 87, 94, 109 water boats, 85, 87 water systems, 82, 83, 92 waterways, 86, 89, 91, 109 Watts, Sheldon, 185 Wei Shanhai, 122, 125, 184 Wei Xihua, report by, 172–73 welfare resources, 5, 12, 115, 116, 141, 153, 169 wells, 85, 92, 94 Wen, Marshal: cult of, 203 Wencheng County, 114 Wenling County, 136, 208 Wenrui Canal, 65, 69, 83 Wenrui Plain, 65, 90 Wenzhou City, 13, 51, 55, 59, 61, 65, 85, 99, 103, 111, 112, 113–14, 116, 122, 123, 129, 133, 134, 148, 151, 152, 157, 177, 178, 181, 186; canals/ public wells in, 83, 93; cholera in, 20, 49, 68, 69, 74, 81, 90–91, 93 (table), 96, 100, 108, 109, 117, 118, 126, 156, 187, 214, 215; connections to, 67; damming in, 94; dredging by, 88–89; eradication campaign in, 193; guerrilla armies in, 49–50; inoculation in, 147, 169, 170, 171, 172; interviews in, 21–22; labor from, 68; Marshal Wen cult in, 203; migrants from, 52; militia in, 119; Patriotic Health Campaigns in, 91; pilgrims from, 204; production teams in, 73; quarantine in, 131, 134; sanitation standards in, 89; sewer system for, 88; south gate wharf in, 86, 87; water in, 85, 87, 89, 90, 91 (table); waterways in, 84, 86; wells in, 92

Index Wenzhou City Environmental Sanitation Department, 87 Wenzhou City Health Bureau, 87, 89, 194 Wenzhou City Infectious Diseases Hospital, 122, 124 Wenzhou City People’s Commission, 88 Wenzhou Garrison Headquarters, 145 Wenzhou Maritime Customs Service, 85 Wenzhou Military Region, 107 Wenzhou Ouhai Hospital, 174 Wenzhou Prefectural Committee, 108, 182, 193 Wenzhou Prefectural Epidemic Prevention Headquarters, 199, 210 Wenzhou Prefectural Health Work Meeting, 94 Wenzhou Prefectural Party Committee Work Team, 99 Wenzhou Prefectural Sanitation and Epidemic Prevention Station, 178, 209 Wenzhou Prefecture, 3, 48, 49, 54–55, 58, 62, 90, 108, 116, 117, 121, 132, 134, 136, 147, 152, 153, 157, 158, 164, 176; agricultural production in, 96, 97, 154; archives in, 21; cholera in, 4, 20, 64, 65, 68, 69, 70, 71, 72–73, 74, 75, 81, 83, 93 (table), 97 (table), 100, 102, 109, 110, 124 (table), 145, 191, 201, 214, 232; coastal society in, 64; ecological system in, 67; emergency response in, 201; famine in, 50, 100; fishermen from, 61; geopolitical importance of, 56; health-care workers in, 165; human ecology/social customs in, 22; inoculation in, 145, 148, 162, 170; map of, xi, xii, xiii; Marshal Wen cult in, 203; militia in, 119; overseas Chinese in, 63; PLA in, 104, 105, 107; pollution in, 68; population movement in, 50, 59; population of, 54, 67; quarantine in, 118; transport networks of, 66; wells in, 84 Wenzhou Prefecture Culture and Health Office, 177 Wenzhou Prefecture Epidemic Prevention Headquarters, 210 Wenzhou Prefecture Party Committee, 95 Wenzhou School of Health, 158, 159 Western Pacific Regional Office (WHO), 46, 219

Womack, Brantly, 212 World Health Organization (WHO), 5, 14, 17, 19, 113, 172; cholera information to, 220; Epidemiological Intelligence Station of, 218; Expert Committee on Cholera of, 38; as intergovernmental organization, 218; oral cholera vaccines and, 260n85; pandemic and, 219; Western Pacific Regional Office of, 46 Wu Lien Teh, 8 Wuhan City, 234, 235 Xiamen, landing in, 55 Xianjiang District, 69, 122, 125, 158, 217; cholera in, 68, 73 Xianju County, 100 Xin’anjiang Hydraulic Station, 138 Xincheng District, 73, 193, 216 Xishan Water Plant, 89 Xu Yunbei, 140, 146, 201 Yan’an Rectification Movement, 205 Yangchun County, cholera in, 202, 212, 213, 215, 219 Yangjiang County: cholera in, 4, 41–42, 43, 112, 202, 212, 219; criticism of, 40; map of, xi; paracholera in, 213, 215; settlement in, 39 Yangjiang County Archives, 42 Yangjiang County Culture and Education Bureau, 39 Yangjiang River, 43 Yangtze River, 8, 20, 58, 75, 95, 97; pollution in, 68 Ye Degui, 95 Ye Yuguang, 50, 122 Yijiangshan Island, 55 Yingtan-Xiamen rail line, 55 Yishan District, 92 Yongjia County, 58, 85, 146, 240; cholera in, 111; grocer incident, 112; inoculation in, 145; militia in, 119; pilgrims from, 204; plague in, 111; population of, 67 Yongjia County People’s Commission, Health Division of, 150 Yongjia County Sanitation and Epidemic Prevention Station, 162

311

Index

312 Yongjia Epidemic Disease Hospital, 85 Yongqiang District, 74, 91, 94 You Rongkai, 94 Youth Service League, 146 Yueqing County, 68, 119, 165, 240

Zhang Wenzhong, 105 Zhanjiang City, 33, 39; cholera in, 43, 213 Zhejiang Military Region, 134, 138 Zhejiang Province, 3, 39, 48, 49, 52, 53, 55, 58, 61, 65, 85, 89, 108, 113–14, 130, 133, 138, 139, 152, 153, 173, 175, 176, 178–79, 181, 187, 190, 191, 193, 197–98; cholera in, 4, 20, 64, 69, 70, 71, 74 (table), 75, 81, 101, 101 (table), 116, 145, 162, 166, 201, 202, 219, 232; crackdown by, 183; development of, 67; epidemic prevention and, 157; fishing grounds in, 59; health-care workers in, 165; health circular in, 208; health units in, 194; inoculation in, 128, 147, 148, 164, 168; map of, xi, xii, xiii; Marshal Wen cult in, 203; offshore fishing at, 61; outpatient departments in, 196; population movement in, 59; population of, 54, 67; quarantine in, 117, 117, 118, 131, 132, 132 (table), 134; remittances and, 62–63; report summaries for, 162–63; Secrets Protection Commission of, 211–12 Zhejiang Province Cholera Prevention and Treatment Technical Supervision Central Station, 90, 123–24

Zhejiang Provincial Committee Supporting Front Week Leadership Team, 58 Zhejiang Provincial Epidemic Prevention Headquarters, 135, 210 Zhejiang Provincial Foreign Affairs Commission, 63 Zhejiang Provincial Health Cadre School, 75 Zhejiang Provincial Health Department, 75, 135, 182 Zhejiang Provincial Medical and Epidemic Prevention Brigade, 174 Zhejiang Provincial Military Region, 135 Zhejiang Provincial People’s Committee, 135–36 Zhejiang Provincial Prevention and Treatment Team, 121 Zhejiang Provincial Sanitation and Epidemic Prevention Station, 211 Zheng Jinzhu, 156, 166 Zhenhai County, warning circular for, 211 Zhenhai County Epidemic Prevention Headquarters, 211 Zhenhai County Health Bureau, 211 Zhongshan County, 218 Zhou Baoluo, 50, 67, 89, 95, 100 Zhoushan Prefecture, 59, 75, 116, 173 Zhu Meiting, 136–37