CASE 2:  Medicine and Childbirth

The history of medicine is a fascinating and important part of human history. Medical ideas never evolve in isolation, but are constantly being influenced by other spheres of activity and thought. At the same time, medicine provides a set of techniques and ideas that can shape the way that people see the world. A good example of this is the ongoing debate in the United States regarding abortion, which involves many medical, religious, political, and economic issues. Therefore, one important reason for studying old medical texts is to use these as a tool for understanding how past societies functioned. We want to understand how people created and disseminated medical knowledge, why they valued certain ideas over others, and how these value judgments changed over time. To do this properly, we need to avoid certain analytical pitfalls.One common mistake is to “overgeneralize” and assume that a single text is typical of an entire period or an entire country. But we would not conduct a political poll by asking only one person her opinion. Likewise, we should avoid judging a medical system based on a single text. In this case, it would be a mistake to think that everybody in China agreed with Jizhai’s claim that childbirth was easy and required no intervention. In fact, Jizhai spends almost the entire first chapter of his book trying to convince his readers that his approach is correct. So he knew that a lot of people would probably be skeptical that childbirth could be as easy as he claimed.At the same time, we should not assume that Jizhai’s beliefs are so unique that they tell us nothing about traditional Chinese medical beliefs. For example, not everyone in the United States drives an SUV, but the fact that we can drive an SUV says something about the society we live in. Likewise, we need to ask: what were the beliefs that existed in China that made it possible for Jizhai to develop his theories? Well, one important idea in traditional Chinese cosmology was that the fundamental dynamic of the universe was to produce life. Furthermore, since everything in the universe was governed by the same dynamics of yin and yang,human birth should be as easy as the birth of animals or plants. Many important medical authors referred to this belief, and they basically agreed with Jizhai’s assumption that the basic nature of childbirth was that is should be easy. But, unlike Jizhai, most authors thought that it was extremely difficult to prevent people from making mistakes and causing the birth to go wrong.

Finally, we should avoid defining older medical techniques primarily in terms of “did it really work?” When we ask this question, what we are really asking is “are these older observations validated by modern science”? If older texts agree with modern findings, we tend to romanticize it and say, “Wow, the Chinese are so smart that they already knew this hundreds of years ago.” And if there is something that is not validated by what we currently believe, we dismiss it as “Chinese people back then were too ignorant to know any better.” These views are “anachronistic,” that is, they judge the past according to the values of the present. This is an unproductive approach because it prevents us from understanding the internal logic of a past culture.

Remember that medical history is a type of history, and the point is to understand the behavior of people who lived in a specific time and place. You can probably think of some medical therapies that Americans use today that are painful and harmfu, and frequently do not produce the desired results. It is quite possible that people a hundred years from now people will look back at us and say, “How ignorant!” But, for the time being, treatments like chemotherapy make sense to us. Likewise, we also need to remember that Chinese people of the eighteenth century used certain remedies because they made sense in terms of the way that they understood the world. If we only judge it through the lens of modern science, then we will be unable to understand fully how people in the past were thinking.

So how should we assess the significance of a book like Treatise on Successful Childbirth? We should start by asking the following. What were the medical problems in the eighteenth century with which Chinese people were concerned? What types of resources did they have at their disposal, and how did they employ these resources? How does this particular set of ideas fit into the repertoire of ideas that they had access to? Here we see that the Chinese were trying to find a solution to the problem of women and babies being injured or dying in childbirth. If the baby got stuck, then its life and the mother’s life would both be in danger, and the available remedies of prayer, medicines, and manual manipulation were not always effective. So authors like Jizhai tried to teach people how to prevent a difficult childbirth. They recognized that there were a number of factors that commonly led to difficult childbirth. Some of these were due to human error and they tried to teach people how to avoid these errors. Jizhai looked through all the older discussions on childbirth and tried to simplify their explanations so that even poorly educated people without any medical knowledge could understand them. Ultimately, he focused on the one problem of forcing pressure down on the baby too early. Although other medical writers disagreed with some of his ideas, many other people thought he had something valuable to say. As a result, they reprinted and distributed his book throughout China.

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