China in the early twentieth century

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I n early twentieth-century China, there was a popular fascination with diet, perhaps as a result of the images of "famine" that marked Western and Chinese views of the pathological body in the nineteenth century (Edgerton 2002; Mallory 1926). Indeed, when you systematically read the standard "Western" medical journal published in China, the China Medical Journal, from the beginning of the twentieth century to the Japanese invasion of China, the central medical discourse concerning "diet" and the body is that of famine and starvation. In a 1912 article in the China Medical Journal, the physicians of the Chinese Medical Missionary Association are concerned that the food made available in their hospitals has sufficient protein and fat, to the extent that they advocate "crossing foreign and native cows," or the introduction of canned milk to improve the local diet. That diet seems to be regionally differentiated. One physician notes that the "rich have rice, vegetables, and meats. The poor have rice, vegetables, and substitutes for meat." It is only "when floods overtake the people year in and year out that so many are driven to our doors for charity" (Stone 1912: 299). It is the distribution of foods that seem to be at the heart of famine from the standpoint of the physicians. In this rather contemporary view, it is the poor distribution network that causes famine (Read i92i). Amartya Sen's 1981 Poverty and Famines: An Essay on Entitlement and Deprivation argues that famine occurs not from a lack of food, but from inequalities built into mechanisms for distributing food (Sen 1981). But there is also some suspicion that the indigenous foods may not be "suitable" enough to maintain a healthy diet (Embrey and Wang 1921). Though the soybean is proposed over and over again as an adequate substitute for other forms of protein in the form of local foods such as "Toh fu" (Adolph and Kiang 1920; Adolph 1923), when the concern is starvation, the sense is that "Western" cures, such as a rich, milk-based diet are most appropriate. The physicians see the child as most at risk from the effects of famine. They are at risk both in terms of their mortality and morbidity as well as their social status. The selling of children is seen as a major result of the famine culture of China (Dow 1922). "Cannot the famine relief associations . . . take this matter into consideration and put an end to it," writes one irate physician (Sargent 1920). In all of the myriad concerns about the pathological effects of the "Oriental" diet, not a single word is spent on the dangers or effects of obesity.

Yet, the concern with obesity appears in Chinese popular magazines, where it is already seen as a response to the past and contemporary, allopathic medicine view of China as a famine culture (Beahan 1975; Nivard 1986). This is not to say that there has not been a constant and intense concern with the "immoderate body" in the medical and dietetic literature of traditional Chinese medicine. In the sixteenth century, Li Shizhen (1518-93) wrote in his Bencai gangmu (Systematic Materia Medica) that the consumption of fresh crabs was healthy "in small quantities," but "gluttons will consume a dozen or more at a sitting together with various kinds of meat and other foods. They eat and drink twice as much as they need . . . then blame [their upset stomachs on] the crabs. But why blame the crabs?" (Lo and Barrett 2005: 417). The culture of excess in the world of traditional Chinese medicine became a hallmark of the degenerate Chinese body in need of regeneration by the early twentieth century.

Immediately before the revolution that overthrew the Qing dynasty on October 10, 1911, the word "reform" was everywhere, and a new fantasy of the body had begun to emerge in China. Obesity came to be viewed as one of the signs of the degenerate Chinese body, a body clearly in need of reform. Following the model of "regeneration" that captured most of the ideologies of the day (from Zionism to Marxism to social Darwinism to colonialism), obesity defined the ability of the society to reform the individual. In one of the most widely read columns "Ziyoutan" (Unfettered Talk) in the renowned newspaper Shenbao, the author Wang Dungen explored the reform of the body. He was a well-known writer who was a key figure in the "Mandarin Ducks and Butterflies School," attacked by the May Fourth progressive writers in the late 1910s and early 1920s, and in 1914 created the comic journal Saturday. In this comic essay, "Reforming the Human Body," Wang Dungen envisions a grotesque ideal of the "new" body. He imagines a body with newly configured mouth, tongue, ear, eyes, nose, skin, eyebrows, hair, teeth, neck, shoulders, arm, hands, fingers, and feet. He sees it as having hundreds of mouths so that a person can eat more and still be able to talk (Wang Dungen 1911). This is an ironic response to the starved body, which desires a reform that can consume more. "Western" models of regeneration, such as structured physical exercise, become the means of reforming the too fat body. Such an approach was advocated by the leader of the New Cultural Movement, Chen Duxiu, and in i9i7 Mao Zedong published a full-scale manual of physical activity to reform the body (Mao Zedong 1992).

By 1913, the classical Chinese medical literature on obesity was beginning to be summarized for an intellectual readership in China. The essay "On Obesity," by Shuhui and Weiseng, was written in classical Chinese for a leading women's magazine. Such magazines arose to shape and be shaped by the images of the so-called New Woman (xin nuxing) and Westernized Modern Girl (modeng nulang) who came into prominence in the first decade of the twentieth century in China as well as in the West. They were defined in many ways, and to no little extent by their "thin" body form. The essay presents the argument that obesity is an illness that women must not take lightly (Shuhui and Weiseng 1913). The authors refer to male figures and texts from ancient China, such as a man named "Zilong" who lived in the warring-state period. Zilong felt he was too fat, so he took Phragmites communis Trirn (a traditional medicine) to lose weight. The authors use this example to prove that obesity is an illness treatable by medical intervention even in the premodern period. One source they mention is Hanshu (The History of the Former Han Dynasty) written by the historian Bangu. They argue that according to Hanshu, too much body fat is the cause of obesity. But there are two kinds of obesity: one is obesity with too many blood cells and the other not enough blood cells. The causes the former are (1) not eating appropriately; (2) not having a balanced life style; and (3) not enough sex. Not eating appropriately means that one eats too many foods such as flour, sugar, and alcohol that contain water. Obesity of the second type is caused by external injury, overworking, stress, or sometimes after giving birth.

As with the Western literature of the late nineteenth century, there are stages of obesity. For the authors, obesity has three phases. Initially, when the person looks acceptably plump, this indicates prosperity and others admire him; then he looks overtly obese and funny; and finally, he is in danger and others take pity on him. This final stage of obesity presents with symptoms including sweating, fatigue, backache, heart disease, sexual incompetence, etc. The "cure" for obesity is a balanced eating and lifestyle: Avoid eating things that contain too much fat; don't sleep more than eight hours; take a warm bath two or three times a week; walk two or three hours everyday; and be persistent. In terms of medication, one should take either traditional medication such as wodu or, better yet, thyroid tablets. The later are the classical pharmaceutical intervention which certainly can reduce weight by making the individual hyperthyroidic, increasing basal metabolism. This will lead to weight loss but can lead to a wide range of other pathological symptoms, such as Grave's disease, with its physiological and psychological symptoms.

The modern creeps into this world of classical Chinese view on the obese with the suggestion of treating it as an endocrinological deficiency, one of the most up-to-date views in early twentieth-century medicine. The obese body is the antithesis of the beautiful and healthy body. And this is a special problem for contemporary women.

In an essay "Keep the Body Slim," published in a women's magazine in 1922, the author, Daizuo, stresses that people with obesity are not beautiful, especially women: "A person who is too fat looks very ugly. Women especially can't be fat. If a woman gains too much weight and became fatty, where can one find her beauty?" (Daizuo 1922). In addition, obesity is an important medical problem. Obesity is seen as the result of faulty metabolism, the result of hormone imbalance. Yet, obesity is not a random occurrence, as some people are more at risk: Specifically, people who eat rich and abundant food, people who are not physically active, people with a family inheritance of obesity and alcoholics.

Obesity is dangerous as it leads to heart disease. People with obesity have shortness of breath and rapid heartbeats even after walking a few steps. They are more likely to have stroke. People with obesity have urinary and kidney problems. Dieting is, again, the solution. One should not overeat; one should avoid foods that contain too much fat; and one should eat less meat. Other suggestions the essay gives for weight loss are physical exercises, the use of laxatives, and electric steam therapy to reduce body fat, which, according to the essay, is very popular abroad. Electrotherapy was a standard late-nineteenth-century Western treatment for the "failure or perversion of nutrition," including diabetes (Hedley 1921: 209-20).

It is clearly women who are the target of the growing anti-obesity anxiety of Republican China. In one essay, the author, Zhou Zhenyu, states that he is a doctor who often has female patients who need help to lose weight (Zhenyu 1926). Zhou Zhenyu comments when I was a doctor in Beiping, I often had women patients come asking for the method of losing weight. I would tell them the method, some of them went home and practiced following my suggestions, others would come visit again and want medication. The effects differ because the causes of their obesity vary.

(Zhenyu 1926)

"The cause and danger of female obesity" is seen either in overindulgence and the absence of exercise or imbalance of hormones. This is the classic argument about obesity that dominated the late-nineteenth-century discussion of the causes of obesity. By 1924, the editors of the Journal of the American Medical Association published an editorial entitled "What Causes Obesity?" In it they argue, following a powerful antipsychological strand in obesity research that began in the late nineteenth century, for its etiology in malfunctions of normal metabolic processes. Seeing obesity as a "scientific problem," they write, will free the "fat woman" from the stigma that she "has the remedy in her own hands—or rather between her own teeth" (Anon. "What Causes Obesity?"). That new object of scientific interest is the fat woman, who had been charged with carrying "that extra weight about with her unless she so wills" (Anon. "What Causes Obesity?"). Women, not "men" or "people" are at risk from obesity, a far cry from the evocation of Falstaff as the exemplary sufferer from obesity in the mid-nineteenth century. According to the anonymous Chinese physician in 1922, although fat people usually eat less than thin people, they do not burn enough calories. There are still large amounts of fat accumulated and stored in their body. While the obese do not eat much every meal, they snack often. Women specifically can suffer from hypothyroidism, hypopituitarism, or a loss of estrogen. Pregnant women are especially at risk. One woman, after giving birth, had to get up and eat every night. She quickly gained weight and became obese.

The danger of female obesity is the collapse of one's health and thus one's ability to bear children. This remains the classic definition of women's health. Obese women have compromised immune systems, are likely to catch cold and coughs, which lead to tuberculosis. They have heart disease. There is danger to their nervous systems. The obese are usually slow and lazy, but often they laugh and seem happy. Obese women have problems conceiving, have problems when having sex, and are likely to have miscarriages.

By 1941, as the war raged and famine haunted China, a public discourse on obesity remained part of the popular register of the changes of Chinese attitudes toward the body. They come to be labeled as a "tragedy at the dinner table" (Qihui 1941). The essay with this title seems to be a free adaptation of a number of foreign medical and popular articles, especially American ones. It presents the harm of overeating and its pathological consequences. The author identifies middle-aged people as being most at risk, because they seem to be more easily taken by the desire for fine eating. The essay defines pathology by quoting a saying attributed to an American congressman: "fifty, fifty, fifty," which means if a 50-year-old person is 50 pounds overweight, his life span will be reduced 50 percent. The author also quotes statistics by an American doctor that out of 2,000 cases of sudden death, 90 percent of people died of heart disease. "Most of them eat too much, are overweight, which causes heart disease." While other foreign cases of overeating are mentioned, such as the ancient Romans, the American Thanksgiving is picked out as a moment of public gluttony:

Around Thanksgiving time, there are often a few cases of death caused by overeating in the mortuary. People in charge of postmortem examinations are often busy rushing to luxurious banquets to do their work. It's also quite dangerous to eat too much after fasting. One should definitely divide all the nice dishes into several meals, and never eat everything up at once. It is nice to be able to enjoy a full table of luxurious food, but one should remember not to gamble with one's own life. Otherwise, tragedy would take place in the holiday season, and one would sadly fall into the bosom of the death.

(Qihui 1941)

The result of such gluttony is death, through sudden death, chronic heart disease or diabetes. A litany of diseases is the result of obesity: High blood pressure, lung disease, cancer, even suicide and accidental death. For, according to the author, people with obesity often have psychological problems and are very slow in reacting to what is going on—thus, they are susceptible to accidents. The overweight should consult qualified doctors to decide his or her individual diet. Yet, the "cure" proposed in the essay of 1941 is to pay minute attention to what and how much one eats. The formula does not have much to do with any specific type of food; rather, as one gets older, one should eat less. When one gets very old, one should only eat light and simple food, returning to the diet proscribed to infants. Being a child is being in the state of health.

See also Electrotherapy; Genetics; Metabolism

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