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Hygienic Modernity: Reflections on the current pandemic from a historical perspective

Published: 5 March 2021 - Bobby Tam

What does ‘being modern’ mean? The current pandemic brings this perennial question once again to the fore. Is a strong centralised state that enforces strict public health measures to save lives ‘modern’? Or is a free society where people can make their own choices and control their own body ‘modern’? Is a population that firmly believes in science over all other values ‘modern’? Or is a society where there is no single fundamental assumption, but only constant scepticism and debate ‘modern’? When observing the situation in the UK, Hong Kong and Singapore during this pandemic, I cannot provide an answer to such questions, but complicate the idea of what ‘modern’ is.

Recently, as I was studying Ruth Rogaski’s iconic work Hygienic Modernity (2004) in the course of my research, I reflected upon the work’s implication on the current pandemic. In Hygienic Modernity, Rogaski studies the changing meaningof the term weisheng衛生in treaty-port China, specifically the semi-colony of Tianjin. Weisheng, which has the literal meaning of ‘guarding life’, underwent a shift in meaning in the Chinese-speaking world throughout the last one and a half century. Before the mid-nineteenth century, weisheng had a range of meanings associated with the techniques an individual could employ in improving personal health. Weisheng was not associated with cleanliness, nor was it associated with the state, nation, or the public.[1] The premodern meaning of weisheng was thus similar to yangsheng 養生. It was about an individualised holistic approach towards health, including regular diet and lifestyle.

Cover of Hygienic Modernity by Ruth Rogaski (2004)

The arrival of Western imperialism in Treaty-port China brought Western medical science and ideas of public sanitation to these colonial spaces. At the turn of the century, Chinese elites began to view the old meaning of weisheng as deficient in coping with such modernising impulses. Weisheng started to absorb meanings of public health and sanitation – the focus shifted from the individual to the collective. In the early twentieth century, as Chinese intellectuals searched for ways to strengthen the nation, weisheng came to embody both cleanliness of bodies and the fitness of race and nation. Personal health was further collectivised and individual bodies were more scrutinised.

So how could such history shed light on the current pandemic? At present, all modern states around the world enforce strict public health measures in dictating people’s lives – quarantine, lockdown, mask-wearing, vaccination etc. In Western countries like the UK, in response to the public health measures, there has been on-going criticism of the over-emphasis on collective health security from diseases, while overlooking individual holistic approaches towards health, such as mental well-being and regular lifestyle. Depression, loneliness, poor diet, lack of exercises all increased in times of lockdown, social-distancing and economic recession. Such critique is particularly relevant to the questions raised in Hygienic Modernity. The modern meaning of weisheng has completely eclipsed the older one. Individuals’ body control was sacrificed for the collective security of the society.

This tension between individual body control and collective health security is indeed evident throughout Rogaski’s work as well as during the current Covid crisis. The idea that public health was tied to the fitness of nation raised in Hygienic Modernity also parallels the rhetoric of many governments today. The mantra of the UK government - ‘Stay Home, Protect the NHS, Save Lives’ – essentially entails that an individual has the duty to sacrifice his personal freedom to protect all the lives of the nation. The NHS is not just a health service; it has become the patron saint of Britain. In return all citizens have the duty to guard it. If you do not comply with the rules, you are harming the NHS, and weakening the nation. I am sure that in Mainland China, similar slogans and rhetoric, probably in a much stronger tone, also exist, since Weisheng has penetrated into every aspect of lives in the PRC.[2] In former colonies like Hong Kong or Singapore, while there might not be such slogans, the underlying mindset of such rhetoric is also very much in place. In Hong Kong, when a Covid-positive patient escaped quarantine last December, there was a city-wide search to capture that patient.[3] That patient was seen as ‘an enemy of the people’, and was regarded as a selfish person who harmed the welfare of the whole city.

But should this so-called hygienic modernity - this strong sense of collective health – be the only governing principle of all nations amid this global pandemic? Is hygienic modernity itself an objective goal that could be pursued? The notion of hygienic modernity could be deconstructed if we compare the experiences in Western countries and former colonies during the current crisis. Hygienic or scientific modernity is not an objective standard, in which nations could achieve it through linear progression. Instead, they are subjective and ambiguous concepts that can be challenged all the time. We see this when we compare the experiences of Hong Kong, Singapore and the UK. Despite the geographical proximity and close economic ties with mainland China, neither Hong Kong nor Singapore experienced severe outbreaks in early 2020 following the initial outbreak in Wuhan.[4] The two cities were both cosmopolitan hubs with endless movement of people and goods. They were the most densely populated places in the world, where people are packed like sardines in public transport, and live closely with each other in tiny apartments. Nevertheless, numbers of cases in these two cities were significantly lower than most Western countries throughout the pandemic. To what can we attribute their relative ‘success’?

Many would say that the SARS outbreak in 2003 is a stark collective memory of the Hong Kong people, making them exceptionally cautious and prepared during this pandemic. Some would argue that the governments of Hong Kong and Singapore were executive-led and semi-authoritarian, while also maintaining a certain level of transparency at the same time. Such regimes enable prompt public health measures while the public is generally informed. In contrast, the pandemic ravaged across Western countries; London and New York have suffered from many dozen times more cases and deaths than Hong Kong and Singapore, and their governments were often criticized for indecision. The argument that semi-authoritarian executive-led governments would serve better in times of a pandemic however does not stand, since the public health measures in Western liberal countries also did not go through a democratic process. They were enforced top-down without the consent of the citizens just as in Hong Kong or Singapore. It seems that one major difference lies in the psyche of the people. I would contend that Hong Kong and Singapore are fundamentally shaped by ‘colonial modernity’, rendering their citizens to be most in line with the behaviours of ‘hygienic modernity’ in the whole world.

In 1894, bubonic plague devastated Hong Kong. The British colonial government enforced draconian measures; colonial authorities carried out house-to-house inspections; they quickly buried all the bodies and removed all the furniture. In the end, the whole plague-ridden crowded Chinese neighbourhood of Taipingshan district was entirely razed to the ground. The local Chinese population was very hostile to these severe measures. Rumours spread about the malevolent intention of the colonial medical intervention; thousands simply fled the colony to escape from the medical measures.

The Shropshire Regiment "Whitewash Brigade" removing and burning items from houses in Taipingshan, Hong Kong

(Source: Photo number: L0022366, Wellcome Image, Wellcome Collection)

In subsequent years, the colonial government was much more interventionist in public sanitation. The native Chinese hospital, Tung Wah Hospital, was more regulated by the colonial state.[1] Traditional Chinese medicine was pushed to the side by Western medicine. Medical institutes in Hong Kong became the forefront of researching bacteriology in the world. Hong Kong gradually became a city with world-class public health services. A century later, Hong Kong and Singapore’s people take pride in their public health consciousness and the overall sanitary standard of their city. When seeing the disaster in the UK, they lamented or even ridiculed their former colonial master for being ‘ignorant’ in not wearing masks or not wearing them properly, just as the British denigrated traditional Chinese medical practices a century ago.

Legislation can barely change the behaviour of the general population if they have not acquired the ‘right’ mindset. This is why cases in the UK continue to be high despite months of lockdown and enforced mask-wearing. In the UK, if one does not wear a mask or wear it properly in public indoor spaces, most bystanders will be nonchalant about it. In Hong Kong however, if one fails to wear a mask properly in public indoor spaces, he or she will be publicly shamed and pressured by others to comply.[2] Similarly, in most Western countries, there have been constant anti-lockdown protests, and coronavirus-scepticism remains popular in public discourse. In contrast, anti-medical intervention protests and coronavirus-scepticism were virtually non-existent in these former colonies. In Foucauldian terms, biopower – our internalised discipline in controlling our own body – was much more dominant in the formerly-colonised modern cities than in liberal Western countries. The panopticon described by Foucault was much more in place in these formerly colonised cities than in Western countries, as people in the formerly colonised societies monitor each other to protect the health of their own and of the collective society. But can we therefore say Hong Kong and Singapore are more advanced than Western countries?

Today, in all of the Chinese speaking world, weisheng has completely assumed the meaning of public sanitation without any trace of the premodern meaning of self-medication based on personal lifestyle. This transformation of meanings of health, manifested in vocabulary, was the result of Western scientific modernity. Western imperialism did not just bring Western medicine to colonies, but fundamentally transformed people’s notions of health. The irony comes, when today the formerly-colonised people appear to be more ‘modern’ in their mindset about public health than the people of former imperial nations. Such irony helps to deconstruct the very notion of scientific modernity itself.

As historians we know very well that ‘modernity’ is always an elusive concept – a relative or even a normative one. When we deride others for being ‘unhygienic’ or ‘unscientific’, and make judgements solely based on our faith in medical science, are we falling into the trap of the arrogance of ‘being modern’, just like Western imperialists a century ago? Reading Hygienic Modernity and relating it to the current pandemic make me reflect on the ambiguity between tradition and modernity, and the constant tension between the individual and the collective.

Bobby Tam is a third-year PhD student in the Department of History at the University of Warwick. He did his BA and MPhil previously in the University of Hong Kong. During his MPhil, he has written a thesis on how death was managed in colonial Hong Kong from 1841 to 1913. His current PhD research focuses on the history of death from an emotional perspective, exploring emotional expressions to death in multiple British colonial contexts in nineteenth-century China. He explores how emotions of death were expressed and discussed in a context where cultural norms were actively contending. This includes looking into emotional expressions from both the public collective and private individual perspective. Aside from history of death and history of emotions, Bobby is interested in history of youth and history of music.

[1] Elizabeth Sinn, Power and Charity (Hong Kong: Hong Kong University Press, 2003), pp. 184 - 208.

[2] There are also many photos and videos circulating on the Internet to shame individuals who are uncooperative in mask-wearing in Hong Kong, whereas in the UK, the most widely circulated videos are usually the ones negatively depicting police officers intruding the lives of people in the name of public health.

[1] Ruth Rogaski, Hygienic Modernity: Meanings of Health and Disease in Treaty-Port China (Berkeley: University of California Press, 2004), 22.

[2] Rogaski, Hygienic Modernity, 1 -2.

[3] ‘Hong Kong police catch fugitive COVID-19 patient’, Reuters, 21-12-2020.

[4] Singapore experienced a temporary spike in cases in late April yet the number of fatalities remained very low.