Oakland, CA: University of California Press, 2016. xv, 357 pp. (Illustrations.) US$70.00, cloth. ISBN 978-0-520-28883-6.
Beyond human travail, beyond societal disruption, beyond economic disaster, widespread disease, epidemic or endemic, has its uses. Medical science advances, careers are made, and political agendas rise and fall. This interesting book provides the first detailed examination of a well-known but until now poorly documented campaign to rid China of the blood fluke, Schistosoma japonicum.Human infection with this flatworm has been commonly known as snail fever in China because of the role of freshwater snails in its life cycle and transmission. As described in this carefully researched account by Miriam Gross, in the final phases of the war between the Chinese Communist forces under Mao Zedong and the Republican Army under Chiang Kai-shek, the dominant Communist army was thwarted by the lowly parasite which infected Mao’s army as it was learning to swim in preparation for the amphibious assault on Taiwan. The choice of snail fever as an early public health target of the new PRC leaders thus had both political as well as humanitarian resonances for the new government.
One of the first mass mobilization campaigns after Mao’s victory and the establishment of the People’s Republic of China in 1949 was aimed at the problem of snail fever. Mao’s poem, used as the title for this volume, views endemic snail fever as a plague upon the Chinese people, a plague to be banished by the new socialist order. As shown by Gross, this campaign, often viewed as one of the first successes of the new Communist government, was in reality, a contest between the populist ideas of Mao and the elitist ideas of the entrenched public health authorities. It was a campaign based on mass mobilization rather than research-based, top-down approaches. Even with Mao’s support, there was considerable tension between local leadership and the central PRC government. This tension was managed rather effectively by restraint on the part of the central authorities, trying to establish the new collective socialism of the PRC.
The mass mobilization campaign at the local level used diverse means to combat old ideas and traditional superstitions and to instill new scientific ways of thinking. This campaign used approaches similar to the earlier anti-hookworm campaign of the Republican Period, waged under the auspices of the Rockefeller Foundation: village dramas, local talks, small incentives, and so on. As Gross explains, the campaign’s main success was to introduce new scientific ideas to the rural populations, especially the youth. The main weakness of the campaign was lack of financial support; in today’s jargon, it was an unfunded mandate.
The campaign had two components, prevention by snail control, and treatment with newer medicines. The prevention program was particularly problematic because it involved capturing and killing snails, mostly by burial of the snails, a very labour-intensive process. Local economies, still struggling to increase food production, were unable to devote sufficient labour to the anti-snail program and since it was run by local cadres, they rarely were enthusiastic about implementation of the prevention arm of the program, which required massive water and feces management schemes. Hygiene was seen as an urban fixation, not something of concern to rural communities.
While the actual snail-killing campaign was not particularly successful, according to Gross, the campaign did have the valuable side effect of combating superstition and introducing new scientific methods. This was later to be important in the consolidation of the collectivization program of the central government as well as to provide effective leadership during the later Cultural Revolution.
Even though the prevention campaign is famous, it was of dubious effectiveness because of local resistance from the authorities charged with its implementation. However, the treatment part of the campaign, even though based on Western medical principles and medications, was quite successful in reducing the incidence of snail fever over the course of a few years. Although the government described the rural population as backward and superstitious, most accepted Western medicine even though they distrusted Western ideas generally, and medicine specifically. The medical treatments did work, however, and that was recognized. As China transitioned from an empire to a socialist state, people came to accept more intrusion into their personal lives, including centralized mass treatment campaigns.
While elimination of snail fever was happening partly due to the revolutionary zeal of doctors armed with improved treatment, soon there was back sliding and recurrence in many places. Even though the prevention part of the program was never a great success, Mao’s authority and example were powerful incentives to accept the new treatments and some prevention. Disease was controlled but not eradicated.
At the national level, this mass mobilization campaign served other goals. Party strategy was to use health campaigns in rural areas to help develop and consolidate Party control as it aimed toward general ideas of socialist collectivization. In addition, technical skills in the villages increased because of the health campaigns, and this led to a kind of grassroots science that was of great help generally, and specifically in strengthening scientific socialism. For better or worse, as Gross argues, this was well demonstrated in the role these local youth would later play as leaders in the Great Proletarian Cultural Revolution (815).
Gross uses newly available archival sources to revise the common view that the campaign against snail fever was an unqualified success, a model of collective, grassroots hygiene that has been seen as leading to the 1978 WHO Alma Ata Declaration on Primary Health Care. As a needed antidote to this popular conception, she provides a balanced and clear-eyed analysis of an important milestone in global health and of the early days of the PRC.
William C. Summers
Yale University, New Haven, USA
pp. 571-573