Comparison of the Attitudes and Measures of Colonial Singapore and the Government of China in the 1920s-30s towards the Flowering Willow Disease ()
1. Introduction: Research Problem, and Research Objectives
Flowering willow disease is known as the commonly used name of sexually transmitted diseases (STDs) in China and other Chinese society such as Singapore, since flower and willow here are refer to the Chinese Idiom “Seeking Flowers and Willows”, which means going to a prostitute, thus there is a tight bond between this disease and prostitution.
This research will discuss STDs from the perspective of the social history of medicine. The social history of flowering willow disease has been analyzed in articles such as Du (2008) ’s “Prostitution Prosecution and Treatment in the Modern Context from the Prevention and Treatment of flowering willow disease”, which analyzed the intellectual and institutional background of the Beijing prostitute control system from the perspective of the development of the control of venereal diseases, so as to explore the mode of operation and effectiveness of the system. Yu (2018) , a scholar of Chinese History Studies, had a discussion of how STDs have affected Chinese society’s development from the perspective of the history of the disease, in his paper “Foreign Diseases and Culture Shock: The Eastern Spread of Syphilis as an Example”, he analyzed how syphilis—as a symbol of foreign cultures—changed Chinese attitudes towards the culture of the Qing Lou (Chinese version of whorehouse), and made the quarantine of venereal diseases an important part of the modernisation in the 1920s of China. In addition, Gwee (2019) ’s “Disease, Anxieties, And Class: Responses To The 1920s Venereal Diseases Epidemic In Colonial Singapore” is more relevant to my research, which is based on Nanyang Siang Pau’s patient stories as research material, by analysing the economic and political dominance of actors in colonial Singapore, this article explained how the power holders responding to the epidemic in a way that benefits them, and then revealing the tensions between class and race.
As for my research, this article mainly focuses on exploring how the two Chinese societies deal with STDs in 1920s-30s and the reasons behind it. Colonial Singapore and China are both societies constructed mainly by Chinese, but according to their background and political forces, when it comes to deal with STDs, there were still some differences, which can be revealed in Social Hygiene Information and the Flowering Willow Disease and its Prevention. These two official public health manuals are tentatively explored by no scholar, and it is hoped that a comparative study will present the attitudes and its controlling policies towards the STDs during the 1920s-30s.
Social Hygiene Information (Volume 1 & Volume 2) are two pamphlets written by Chinese and issued in Singapore, it is about general knowledge and preventive treatment of venereal diseases (see Figure 1 and Figure 2), with English labels “Social Hygiene Information No. 1” underneath the title. Volume I was printed by The Singaporean Press, consists of 20 pages, while volume II, printed by the New National Daily News, consists of 24 pages. Both pamphlets have no information about the author, pricing date, or distributions, but based on the year of publication and the year of closure of the two newspapers, these two books were published during the 1920s and 1930s. Since the British colonial government declared an epidemic of venereal diseases in 1923, it was further concluded that their publication dates were in the above period.
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Figure 1. Cover of social hygiene information volume 1.
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Figure 2. Cover of social hygiene information volume 2.
According to the opening paragraph of Volume II: The purpose of this book is to enlighten the public about sexually transmitted diseases and to make those who suffer from such diseases aware of the importance of timely treatment1. It is assumed that the book was promoted by the Singaporean government or the Ministry of Health in the Chinese community, then Combined with the subject “this Council” in the section and “Treatment at Reduced Prices” and “the Social Welfare Department Office” in the following paragraph, it can be further concluded that both the author and the distributor of the book are the Social Welfare Department of Singapore, and that these pamphlets was distributed free of charge to promote the prevention and treatment of STDs.
Similarly, also in the 1930s of China (i.e., 1931), the Department of Health of the Ministry of the Interior of the Chinese government published a first edition of 10,000 copies of a 16-page book, titled “Flowering Willow Disease and Its Prevention”. The book was distributed by the Health Experiment Division of the National Economic Council, and the seal of the Department of Health (Figure 3) can be seen on the front cover page, while at the end of the book there are the words “Please pass it on after reading”, which means that the book was distributed by the Department of Health free of charge to the public. On the back cover of the book, the Department of Health has published many manuals on the prevention of the same type of infectious diseases, such as smallpox, cholera, etc. (Figure 4), the book is therefore one of a series of manuals on the prevention of infectious diseases published by the Department of Health.
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Figure 3. Cover of flowering willow disease and its prevention.
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Figure 4. Catalog of the disease prevention series.
Thereafter, in the 1920s and 1930s, both Colonial Singapore and the government of China issued manuals to promote the prevention and treatment of STDs by their national health departments. In this paper, I will discuss how the two countries publicize specific disease knowledge to the Public and what kinds of preventive measures did they take to control the venereal pandemic, whether the policies of the two countries are different when dealing with the Chinese group, and whether there is a difference in terms of the degree of seriousness in the public health of the two countries. Questions above will be discussed from the content of the books, value attitudes, and preventive and treating measures of the two countries respectively.
2. From the Content of the Books
2.1. Titles and Categories of Books
The title of Social Hygiene Information is a bit confusing, because general knowledge of social hygiene is a very broad concept and will remind readers of teaching children some hygiene habits. Naming a very specific pamphlet which discussing the prevention and treatment of venereal diseases as “Social Hygiene Information” is obviously quite an overstatement.
For its reason, mostly due to sexual conservatism in the Chinese community in Colonial Singapore, and the personal and sensitive nature of STDs. At that time, most Chinese were laborers or descendants of immigrant laborers, with a low level of education, and their mindset was confined to traditional Chinese ethics and morals, and they lacked a scientific understanding of STDs. It is not wrong to categorise the STD pamphlet as a general social hygiene knowledge, which also cleverly avoids the embarrassment of discussing STDs directly, and at the same time is more conducive to the government’s promotion and dissemination.
On the contrary, the title of Flowering Willow Disease and its Prevention is much clearer and direct, it is also similar to that of the same series of books on infectious diseases, such as Smallpox and its Prevention. According to the words “Twenty-two of the Twenty-two Books of the Department’s Publications” at the bottom of the cover of the book, it can be seen that the book is only one of the twenty-two books in the series published by the Department of Health, and it is the last of the sequence. Compared with Social Hygiene Information, this titile better reflects the editor’s scientific concept of disease. The reason for naming this series of manuals on disease prevention and treatment in terms of objective science is that most Chinese intellectuals in the 1920s and 1930s accepted and supported the Western view of science, including Western medical science. However, at the same time, it also reflects that the prevention and treatment of STDs did not receive special attention from the Chinese government.
Comparative analysis of the two titles shows that Singapore’s Social Hygiene Information had a very clear audience, that is, the Chinese labor group with a lower level of literacy and a more backward concept of disease, and took into account the reader’s sense of shame about STDs and used a very broad title, with a larger circulation, which reflects the depth of attention paid to the prevention and treatment of STDs by the government of colonial Singapore. In the meantime, the Chinese government did not give much consideration to the degree of acceptance of the audience, but only from the editor’s scientific point of view on the general knowledge of this disease and the prevention and treatment measures to introduce this book, it is only the last book in the series of twenty-two books on the prevention and treatment of infectious diseases, the way of “pass on after reading” also indicates that the circulation of this book will not be too large, thus reflecting that the government attached less importance to the prevention and treatment of STDs.
2.2. Scientific Introduction to Flowering Willow Disease
Both books introduce the classification and symptoms of venereal disease, but the details are different. Scholars of the beginning of the 20th century have regarded sexually transmitted diseases as gonorrhea, syphilis, and soft chancre. And according to Yu Yunxiu “Recognition of Flowering willow diseases”: Flowering willow diseases can be divided into three main forms... Why are the three? It is called syphilis, gonorrhea, and soft chancre.” ( Yu, 2006 ) Social Hygiene Information categorizes Flowering willow diseases into chancre, white fungus, and Mango, Yu Gengzhe declares in his article “Exotic Diseases and Cultural Impact: The Eastern Transmission of Syphilis as an Example”, identified white fungus as the modern meaning of gonorrhea based on its symptoms, and chancre is soft chancre while Mango is syphilis ( Yu, 2018: p. 60 ). The terminology used in Flowering Willow Disease and its Prevention is the common terminology used by scholars in 1920s-30s of China (which will be standardized hereafter for convenience), and a picture of the microscopic spirochete of the virus is appended to each disease, reflecting a more scientific approach.
The Social Hygiene Information explains the symptoms, dangers and sequelae of the disease, and describes the early, middle and late stages of the disease in detail, including cases in which the consequences of the disease are described as being extremely serious in order to instil fear in the reader, for example, “The consequences of untreated chancroid are severe, and the patient suffers from them all his life, for any part of his body is bound to develop tumors that gradually fester and darkly lose their shape, and his brain and nerves are also affected, with the result that dangerous diseases such as madness and manic-depressive psychosis.” In addition, the book is also very good at using statistics to show the extent of the harm done. For example, when it is mentioned that women suffering from the disease will transmit the virus to their heirs, thus making it impossible for them to give birth, it is listed that 42% of the women suffering from the disease will be stillborn after pregnancy, and the probability of the children born dying prematurely will be as high as 60%. Although the source of the data cannot be verified and its authenticity is doubtful, the method of listing the data can effectively and intuitively make the readers realize the great harm it can do and thus serve as a warning.
In Flowering Willow Disease and its Prevention, there is also an account of this kind of disease that eventually kills, and it also emphasizes the hereditary nature of the virus, describing in detail the dangers of the disease in the later stages and the pathology of infants who are genetically influenced to carry the virus, but it lacks data support compared to Social Hygiene Information. Instead, it chooses to use the tone of shouting at the end of the sentence to call out to the readers that sexually transmitted diseases “are a great danger that harms society. The effect of this warning is slightly more alarming! “The warning effect is slightly less effective.
2.3. Routes of Transmission and Current Status of the Disease
The opening paragraph of Volume 1 of Social Hygiene Information , “On the Facts of Sexually Transmitted Diseases”, stated the seriousness of sexually transmitted diseases in society at that time: “The rapidity and extent of the spread of sexually transmitted diseases have reached a horrifying state.” The reason for this was that the spread of the disease could not be easily seen, and the public’s understanding of sexually transmitted diseases was shallow. Immediately pointed out the danger of sexually transmitted diseases by prostitutes, and gave data to support: the United States, New York, 466 prostitutes infected with sexually transmitted diseases accounted for 89.03%, Italy, Vienna, 3341 infected with sexually transmitted diseases in prostitutes under the age of 25 years of age accounted for 83%. The above data tells the readers that the probability of prostitutes infected with philia is very high, and the younger the age, the higher the risk of infection, and it is said that according to the survey, the percentage of all the prostitutes infected with philia in Xingzhou (refers to colonial Singapore) has reached as high as 90%. This shows that the book deliberately uses data to illustrate the high risk of sexually transmitted diseases by prostitutes at the beginning of the book in order to make the readers feel fearful. Flowering Willow Disease and its Prevention does not mention the prevalence of the disease in China at the time, indicating that the publisher, the Department of Health, did not have any specific or estimated data, and only mentions that the disease was spread by sexual intercourse when introducing the disease. Again, the colonial Singaporean government placed more emphasis on STD prevention and treatment compared to the Chinese government.
3. From a Value-Based Attitude
Disease should be neutral in theory, it is only a physiological reaction that occurs in the human body, but in fact, many people will receive special treatment because of a certain disease. This phenomenon can be described by the concept of “disease portrait” proposed by Sander Gilman, which refers to the fact that people in every era will project the mainstream values of the society at that time onto the disease and the patient to create a special portrait for certain diseases, and STDs have a very typical “disease portrait”. Because of the many values in modern society, people have many normative expectations of how a person should exist in society, and when a person does not meet these normative expectations, he or she will be stigmatized, and the disease will become a kind of seemingly objective evidence at this time.
At the beginning of the first volume of Social Hygiene Information, the title “The Danger of the Infection of Sexually Transmitted Diseases by Prostitutes” is written in bold, large font. Later, the same title is used to explain the dangers of “private prostitutes” and “mistresses and lewd women” in the spread of sexually transmitted diseases. It is clear that the book binds the social identity of prostitutes to sexually transmitted diseases, that is, it “portrays” sexually transmitted diseases in the form of prostitutes, private prostitutes, and mistresses and lewd women, which implies that these four groups of people are the root cause of the danger of sexually transmitted diseases to the community. Diseases are always associated with value judgments, and the reason for this is essentially that the identities of these people do not conform to the expectations and standards of society, and in a mainstream society that promotes monogamy and family harmony, those who would affect this stability are stigmatized. In a male-dominated society, although the transmission of sexually transmitted diseases involves both men and women, and the disease attacks both sexes without distinction, however, it is the female group, mainly prostitutes, who are stigmatized and blamed. In a society that promotes health care and eugenics, mothers who are unable to give birth to a child due to a sexually transmitted disease or who give birth to a child with a hereditary disease are also condemned by the values of the mainstream society, and are burdened with a heavy sense of “disease shame”.
Flowering Willow Disease and its Prevention is more neutral in value judgment, the stigmatization of prostitutes is not obvious, and in the transmission and prevention of diseases, the term “sexual intercourse” is used more often. And it is the male more often as the target readers who are given the prevention suggestions, for example, for the prevention of syphilis, the first guideline is “pay attention to personal morality, do not get involved in the prostitution industry”, and for the prevention of gonorrhea, the first guideline is “never get involved in prostitution”. Despite the subtext behind this is still that prostitution is regarded as a taboo that needs to be avoided, and that staying away from prostitution will bring men peace of mind, it still disciplines men morally and behaviorally, and it seeks to address the spread of STDs from the perspective of men.
4. From the Perspective of Preventive and Curative Measures
The government plays a crucial role in disease control and treatment, and different socio-economic levels have led to different levels of governmental efforts in controlling infectious diseases. In the 1920s and 1930s, Singapore was under the colonial rule of the British government, with a stable social development and rising economic level, while Chinese government was in a period of warlordism, with an unstable social environment and a lower economic level.
In terms of attitudes towards the treatment of Flowering willow diseases, both books emphasize the importance of timely treatment and of abstaining from sexual intercourse after contracting the disease, and the advice on the treatment of soft chancre in chancroid is couched in very plain and caring language: “Get it treated quickly, and you can avoid a big problem, but if you are late, it will make the ulceration spread and be harder to treat.” For those suffering from gonorrhea, the advice was, “It is necessary to seek medical treatment as soon as possible, and never hide your shame.” The Social Hygiene Information says: “All venereal diseases can be cured at the first sign of the disease, and their healing function is delayed by a later cure” and that “Patients with gonorrhea must refuse and abstain from all intercourse with men and women.”
As for specific treatment methods, both books mentioned the need to inject sufficient dosage and frequency of the drug “914”, but Social Hygiene Information also gave a very detailed description of the five stages of treatment, specifying what drugs were needed for each stage and how they were to be administered, and pointing out that the drug “914” was not harmful, in an attempt to rectify the misconception held by some members of the community, so as to make the public feel at ease with the use of the drug for treatment.
Social Hygiene Information is clearly superior to the Flowering Willow Disease and its Prevention is that it offers different treatment programs for people of different means, divided into three types: “Convenient Treatment, Reduced Treatment, and Free Treatment”. In Volume II, there is a section entitled “Public Health Programs”, which points out that the most important thing to prevent and treat the disease is to provide free treatment to both men and women, because men and women in an infectious state are extremely harmful to society, and the more people who are cured the less the source of contagion will be, so only by facilitating the treatment can we effectively prevent the transmission of the disease. People who have the financial means to seek treatment from their own doctors do not need the government’s attention. Reduced-price treatment and free treatment are what the majority of the population needs to face the epidemic, and both volumes of Social Hygiene Information conclude with the specifics of these two programs, of which reduced-price treatment can be obtained by simply going to private doctors in Singapore and stating that one would like to have reduced-price treatment, because “this Council has agreed with doctors on a method of facilitation, details of which can be obtained from HSBC. For details, inquiries can be made at the Social Hygiene Department office in the HSBC building (entrance from Paddy Power).” As for free treatment, the book provides a very detailed list of medical places for patients to choose from, with the addresses and working hours of each medical office, and even provides a secret letter in English and Chinese at the end of the book for patients to send to the clinic to obtain free treatment before attending the clinic, in order to take care of the patient’s sense of shame. It can be seen that the health authorities in colonial Singapore attached great importance to the fight against socially transmitted venereal diseases. (Figure 5 and Figure 6) It is evident that the health sector in colonial Singapore has attached great importance to the fight against socially transmitted sexually transmitted diseases (STDs) and the healthcare system is sound.
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Figure 5. Chinese version of confidential letter for free treatment of patients in volume 1.
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Figure 6. English version of confidential letter for free treatment of patients in volume 2.
5. Conclusion
To sum up, the Department of Social Hygiene in colonial Singapore paid more attention to the spread and prevention of sexually transmitted diseases. On the basis of publicizing knowledge about sexually transmitted diseases through publications and culture, the Department also implemented specific policies to promote low-cost and free treatment of sexually transmitted diseases in order to effectively curb the spread of the virus on a wide scale. The government of China, on the other hand, has not paid sufficient attention to the prevention and treatment of STDs due to the unstable social situation and the low economic level. At the same time, the Chinese government was more tolerant of prostitutes and more gender-equal than the colonial Singaporean government, because the British colonial government stigmatized prostitutes more severely due to their religious beliefs, whereas the Chinese traditionally had a certain degree of good cultural imagery of Qing Lou (whorehouse) and prostitutes. In addition, the Chinese social culture emphasized changing individual behavior to change the whole society, and thus the propaganda pamphlets were mostly in the tone of appealing and exhorting the people to take precautions against STDs, while the West emphasized changing the whole social environment to change individual behavior, and thus the then Singaporean colonial government planned a more comprehensive health care system and legal measures to deal with the epidemics.
NOTES
1Social Hygiene Information, No. 2, p. 1.