Ku Ya Wen. Disease, Colonialism, and the State: Malaria in Modern East Asian History. Hong Kong University Press, 2009.
In 1965, the World Health Organization registered Taiwan on its list of areas where malaria eradication had been achieved. This remarkable achievement has often been presented as a story of scientific conquest, and modern anti-malaria measures undertaken during the colonial period from 1895 to 1945 have been hailed simply as a positive legacy of Japan’s medical and public health work. Recent studies, however, have not been satisfied with viewing these events in abstract scientific terms, but have tried to interpret medical developments within an existing colonial context. They have criticized the heroic narrative of the progress of science (or medicine), and emphasized the close relationship between medicine and colonial power. Medicine as “the tool of empire,” is a dominant theme in the historiography of colonial anti-malaria policy and its practice. These studies consider colonial malaria countermeasures and modern malariology as “tools” used to ensure the well-being of the Japanese colonial government and the home country by protecting the health of Japanese elites and settlers, eliminating obstacles to natural resource development, and demonstrating the efficacy of colonial rule. In addition, they emphasize that the malaria countermeasures were “imposed from above,” rather than “evolved from below” through interaction with the colonized Taiwanese people. In this view, the hegemonic and coercive power of the colonial administrative system made possible the effectiveness of malaria control.
These studies have sketched the contours of anti-malaria policy in colonial Taiwan, yet many questions remain. First, they tend to paint a static picture of the development of anti-malaria policy in Taiwan, shaped by concern for short-term effectiveness and the economic or political interests of the colonizers at a particular time, without carefully examining policy changes that occurred during the entire colonial period. In fact, the making of anti-malaria policy was a dynamic process; whereas the initial objective was suppression of malaria through modern biomedical science, the motive of eradicating malaria appeared in the 1920s. This led to a policy change which should be understood in the context of the Japanese cultural perception of the disease as well as the subtle change of relationship that took place between the colonizer and the colonized after the initiation of Japan’s assimilation policy in 1919. In the 1920s, the colonial government began to mobilize the local population to destroy mosquitoes.
Second, the response of the colonized to the anti-malaria policy was seldom discussed but when it was, the response was portrayed as belonging to a powerless community which passively observed the coercive anti-malaria measures, or embraced modern explanations of the disease. In actuality, implementation of the policy resulted in a tense relationship between the colonizer and the colonized during the 1920s. This tension came about from a difference in cultural understanding of malaria between the Japanese and Taiwanese, and could not be appreciated without recognizing that the change in anti-malaria policy in the 1920s was combined with an intention on the part of the Japanese to reform a “pre-modern” people and change the “uncivilized” environment in Taiwan. The resistance of the Taiwanese people showed that modern anti-malaria knowledge and methods could not permeate the entire colonial society easily when implementation clashed with elements in the traditional culture. It was also one of the obstacles that prevented malaria eradication. During the 1930s, it seems that the enthusiasm of anti-mosquito mobilization had gradually dissipated. The establishment of the Malaria Therapy Laboratory in 1929 reflected the government’s anxiety about the existing policy and its intention to change direction.
The purpose of this chapter is to discuss the dynamics of change in anti-malaria policies in colonial Taiwan and their consequences. I shall first examine how the Taiwanese and Japanese formed their respective understanding of the etiology and perception of malaria, and how the Japanese created a discourse of “othering” to define malaria. I shall then discuss the initial process of anti-malaria policymaking in the 1910s and the real concerns behind malaria as a health issue. In the third section, I shall identify the facts—neglected in studies of colonial Taiwan medicine—associated with the change of anti-malaria policy direction beginning in 1919, and suggest that the promulgation of assimilative reform is the key to understanding this change. Instead of merely targeting the parasite in the human body or the mosquitoes, the effort to eradicate the colonial disease came to involve the attempted transformation of the Taiwanese people and environment. Since direct government social intervention was more complicated than previously thought, we also have to examine the social response to this policy. Finally, I shall study the Japanese colonizers’ self-assessment of the anti-malaria policies. The obvious decrease of malaria mortality had always been used to prove their success. However, it could not explain the government’s anxiety about malaria control as reflected in the frequent policy changes. In fact, the colonial government was very much concerned with the malaria morbidity situation. I shall therefore analyze the statistical data on malaria morbidity in order to reconsider the question of the “effectiveness” and “ineffectiveness” of anti-malaria measures within the historical context. I argue that the adoption of anti-malaria strategies and the consequences of their implementation are not determined by a universal, scientific truth, but should be understood in the context of the interaction between empire and local society.
The Redefinition of Malaria: A Disease that should be Feared
Malaria is an old disease in Taiwan. Owing to its easily recognizable clinical symptoms, it is believed that most of the descriptions of nue (a term derived from traditional Chinese medicine for tertian chills and fever) and zhang (foul air) in Qing literature referred to malaria. Nue, according to the descriptions of symptoms, generally denoted the non-malignant type of tertian fever which resulted from the invasion of “evil qi ” or ” nue devil.” Moral living, prayer or herbal medicine had been considered ways to protect one from, or drive out, nue. Zhang, on the other hand, was considered to be the poisonous vapor that caused malignant fever. In early records, zhang was portrayed as a terrible ailment for migrants moving to virgin lands, and land reclamation was believed by the Taiwanese people to be the only means to eliminate zhang and avoid getting sick. But in the nineteenth century, a new perception emerged. The growth and prosperity of the island was accompanied by a relative decline in zhang and Taiwan actually became a “promised land” for some officials and agricultural migrants from the Chinese mainland. Historical records reveal that for the Taiwanese people, malaria was not viewed as such a serious threat from the nineteenth century onward, although it is hard to give a satisfactory explanation for this apparent change.
On the other hand, the Japanese colonizers’ understanding of malaria was formulated within a totally different social context and was based on their own experience of the disease. In Japan, only a non-malignant type of malaria existed. Since the Meiji Restoration in 1868, the Meiji government had endeavored to achieve rapid modernization in Japan under the slogans fukoko kyohei (rich nation and strong army) and shokusan kogyo (nurturing and stimulating domestic industrial development). In order to create and maintain a strong military and labor force, health care was no longer considered an individual problem but became a national responsibility. All diseases, including malaria, were viewed as national enemies.
In 1879, when the Meiji government abolished the Ryukyu Kingdom and forcibly established the prefecture of Okinawa, Japanese authorities became well aware of the threat to settlers’ health posed by the malignant type of malaria, which they had never encountered in inland Japan. As Iijima’s chapter shows, Okinawa provided a laboratory for the Japanese to develop their form of malariology. Although researchers dispatched to Okinawa generally accepted the Western miasma theory, which held that invisible mists and vapors given off by swamps and decaying organic matter produced malaria, they tried to learn more of the disease through investigation and experimentation. Once the association of malaria with its causative parasites was made by a French military surgeon Charles A. Laveran in 1880, the focus of investigation shifted to finding out how the parasites invaded the human body.
Meanwhile, the Japanese colonial government encountered another serious malaria problem when their occupation of Taiwan commenced in 1895. Many Japanese officials and soldiers succumbed to the disease at this time. Miura Moriharu, a professor of pathology at the Tokyo Imperial University Medical School and an authority on Okinawa’s endemic diseases, was puzzled by the indigenous people’s apparent immunity to the disease. He thought that it was related to the local custom of drinking only boiled water or not getting wet while crossing rivers, and theorized that plasmodium was taken into the human body through water. Miura proposed a list of preventive measures, recommending that all water, whether used for drinking, bathing, or washing dishes, should be boiled. This principle became the initial health guideline for the garrison stationed in Taiwan.
After the anopheles transmission of malaria was demonstrated in the late 1890s, the mosquito as vector theory was introduced to Japan and soon influenced the Japanese medical community in Taiwan. In 1899, the Committee on Local and Infectious Diseases in Taiwan was established. Extensive epidemiological studies on anopheles mosquitoes and malaria pathology were carried out. These investigations further solidified the position of modern imperial malariology as the indigenes’ conception of the disease came to be viewed as pre-modern. Imperial doctors rejected local knowledge of malaria etiology, treatment, and prevention as backward or superstitious. Adhering to prevailing malariology and microscopy techniques, the imperial medical community redrew the boundary between health and illness based on the authority of the new interpretation of the disease. The Taiwanese people, who had previously been considered healthy, were redefined as “pasty-faced, potbellied because of splenomegaly, and suffering from devastating malaria.”
Ironically, while the colonized were depicted as disease-stricken, they were also criticized for their seemingly indifference to malaria. For example, Takagi Tomoki, Chief of the Sanitation Section of the Governor-General’s government, critically stated in the Congress of the Formosan Medical Association in 1904 that a large number of people did not believe in anopheles transmission, and were not afraid of the disease. He emphasized that the people “should realize that malaria is a barrier to production, and an obstacle to industrial development.” This kind of assertion stemmed from an “othering” process that depicted the colonized people as ignorant and of low intelligence—indeed were seen as the very reason for the prevalence of malaria in Taiwan. Malaria should be feared. Thus, the “othering” process applied to Taiwanese society helped define and bolster the Japanese explanation of malaria etiology.
Furthermore, the development of modern malariology also included the construction of “otherness” of the colonial environment. It was the lethal combination of heat and humidity that appeared to create the pathogenic environment in which malaria could flourish. To Japanese colonizers from the temperate zone, Taiwan’s forest, creeks, and marshes, together with its hot and humid climate, seemed to provide a prototypical example of the savage aspects of a hostile environment. Whether the threat from the environment came from disease-generating miasma, plasmodium-carrying water, or habitat favorable to the breeding of anopheles, malaria was still thought to be a byproduct of the intrinsically hostile environment.
For the local population, however, malaria was an accepted way of life. For the Japanese colonizer, malaria was a national enemy that should be feared, for it resulted in huge losses of military strength and economic production. The “othering” of colonial society and environment held that the cause of this disease was the “intrinsic evil” of Taiwan itself. This reasoning affected the development of Japanese colonial anti-malaria policy with significant consequences.
The Promulgation of Anti-malaria Policy and the Human Approach in 1911
The focus of the Second Congress of the Formosan Medical Association held in 1904 was malaria. Contemporary anti-malaria policies in the West and their colonies were the main topics discussed. Ever since the discovery of how malaria was transmitted in the late nineteenth century, malariologists and medical officials in the West were eager to find a solution to this problem either in their home countries or in their colonies. Ronald Ross was enthusiastic about destroying the habitat of mosquitoes in British colonies. On the other hand, Robert Koch who conducted experiments German New Guinea, claimed that periodic quinine treatment for people carrying plasmodium in their blood would be effective in controlling the disease. He thought it was beyond human power to destroy or reduce a species of insect in large geographical areas. Scholars in Italy offered a different view by stressing that the proposed anti-mosquito measures overlooked the suffering patient. They promoted traditional methods of land reclamation, use of mosquito nets, and the taking of quinine. They considered malaria a social disease and tried to raise living standards by improving housing conditions and increasing the food supply.
The Japanese medical community finally settled on one of two choices; the first was human-targeted, and was based on blood testing and quinine treatment. Borrowing a Japanese official, Tsukiyama Kiichi’s term, I will refer to it as the “human approach.” The other was mosquito-targeted, and included all available methods used to kill mosquitoes or reduce their population. I will refer to this as the “mosquito approach” in this chapter. Japanese officials discussed the relative effectiveness of these two approaches throughout the entire colonial period.
In 1911, the Governor-General in Taiwan convened a special meeting to decide the direction of malaria control and a series of laws were promulgated in 1913. The laws gave the Governor-General and local commissioner the right to create anti-malaria districts. The local police and a local self-policing system called the hoko were used to carry out the human approach to malaria control in these districts. Policemen and headmen of hoko were to round up residents and visitors and force them to take blood test. Anyone whose blood was found to carry plasmodium was to take quinine for 18 days in the presence of a policeman.
Compared to other regions of the contemporary world, Taiwan’s anti-malaria policy of government-directed quinine treatment was noteworthy. Yet, considering the vigorous research on anopheles mosquitoes since the 1900s, the application of the human approach in the 1910s was regarded as “a little abnormal” by Morishita Kaoru, one of the most famous malariologists of the colonial period. Liu and Liu have pointed out that since the colonial government tended to use the smallest possible amount of financial and labor resources to deal with the health problem in Taiwan, the human approach was chosen because the government considered large-scale environmental improvements to be too expensive and not very effective.
Other studies by Iiijma and Wakimura have compared differences between anti-malaria policies of colonial India and Taiwan, emphasizing the political factors in the formulation of policies. The Indian colonial government, for example, made an effort to segregate colonists from the local society in order to protect the former. The authors have also noted that the policy in Taiwan followed “Koch’s way,” which enabled the colonial government to intervene in local society and extend its control over the Taiwanese people. By practicing the human approach to policy, the colonial authority thoroughly permeated local Taiwanese society, even to the point of controlling the body of the individual.
Although these studies have highlighted some important characteristics of anti-malaria policy in Taiwan, some aspects have been neglected while others need to be elaborated. First, most recent studies tend to present the overly simplistic picture that the anti-malaria policy in Taiwan focused almost entirely on the use of the human approach and that there was no controversy associated with its implementation. However, the attempt to eradicate malaria took place in the 1920s when the mosquito approach was emphasized. The initial human-targeted policy was based on several pilot programs launched in the 1900s which were carried out under precise cost-benefit analysis, reflecting the economic considerations underlying the policy.
In 1906, Kinoshita Kashichiro, a professor at Taibei Medical School, was commissioned by the Monopoly Bureau to proceed with an anti-malaria project in Jiasian for the camphor industry, one of the most important products of the Japanese empire at that time. There was no official report of the Jiasian experiment probably because Kinoshita died in 1908 shortly after the project ended. Nevertheless, the project was seen as a notable achievement and publicized widely in NichiNichiShinpo—the official newspaper with the widest circulation in colonial Taiwan, and these reports provide us with many details of this project.
Trained in protozoology at the Bernhard Nocht Tropical Disease Institute in Germany, Kinoshita performed blood tests on the workers at Jiasian, analyzed the morbidity rate, and concluded that over 50,000 working days had been lost because of malaria. He argued that it would be impossible to destroy the anopheles mosquitoes since the rice paddy was their major habitat. Also, the beneficial results of using mosquito netting or window screens would be minimal as a great deal of capital and good discipline would be needed for these measures to be effective. Considering the factors of cost-benefit and social conditions, he settled on quinine-taking as a treatment for patients and a preventive for the healthy. Since the average incubation period—the time required for plasmodium to reproduce within the human body—was about 14 days, the reproducing plasmodium would be killed completely and transmission interrupted if the patient could take enough quinine during this period and repeat the course of treatment during the entire month (e.g., taking 1g of quinine every 9-10 days for a month). By the time the Jiasian experiment ended, the number of patients with malaria had decreased by half, and the average cost of treatment was only 1.4 yen per capita.
Kinoshita’s project was highly regarded even though the morbidity rate increased again after the project ended. Other malariologists conducted experiments in different areas. In 1909, Hatori Shigero was appointed as a medical official to continue Kinoshita’s mission. Hatori carried out his anti-malaria experiments in a military sanatorium located in a hot spring area, Beitou. In order to use quinine more efficiently, he launched compulsory blood tests of residents and treatment with quinine only for plasmodium-carrying cases.
Based on the results of these experiments, Takagi Tomoki presented an anti-malaria memorial to Governor-General Sakuma Samata in 1910. Takagi’s plan revealed clearly the primacy of economic concerns. He argued that as a result of malaria, a total of 150,416 working days per year for the Japanese living in Taiwan, and 3,365,896 working days per year for the Taiwanese people, were lost. Assuming a treatment fee of 0.3 yen per capita per day, the total cost would be 2,254,893 yen a year. Furthermore, if the estimated value of human lives was included with output value, the loss would be 4,609,267 yen per year. Thus, malaria control was an urgent task since the economic loss caused by malaria would be at least 6,800,000 yen each year.
In fact, the Japanese colonial government faced considerable financial difficulties until the mid-1910s. Takagi’s memoir indicated that Governor-General Ando Teibi, newly appointed in 1915, planned to allocate a hundred million yen to solve the malaria problem. However, Takagi argued that eradicating malaria over the entire island of Taiwan would yield only half of the benefit expected from the sum allocated and effort invested. He suggested suppressing malaria only in areas where public offices were located because the cost would be lower. Thus, although the anti-malaria program officially began in 1911, malaria eradication was not part of the initial design. Using precise cost estimates, the human approach was adopted to reduce outlay and economic loss.
As Takagi suggested, the human approach was in fact only introduced in assigned areas and treatment was limited to certain “selected” groups. Figure 1 shows the anti-malaria districts and malaria mortality rate maps overlaid with geographic information system (GIS) data. The dots represent the distribution of anti-malaria districts respectively in the 1910s, 1920s and 1931 (the location of anti-malaria districts after 1932 is not available) where the human approach was practiced. The shaded areas show different levels of malaria mortality in each gun (county). Not surprisingly, initial malaria districts in 1911 were located in centers where the Japanese resided, such as urban areas and natural resource development sites. As can be seen, although the number of districts increased gradually over the years, these districts did not correspond to the spatial distribution of the risk of malaria. The increase in the number of districts in the 1920s and 1930s still did not suggest a general, island-wide program, as new districts remained restricted to specific areas, especially to work sites of natural resource development, such as camphor lands, farms with large-scale irrigation, and waterpower stations. This indicates that the colonial government’s interest in the human approach was wedded to the development of natural resources, rather than to considerations of relieving the suffering of victims of the disease, or to attempts to extend its control over the people of Taiwan.
As noted, although the human approach continued to be implemented until the end of the colonial period, it was never widely employed. In 1921, 1931 and 1944, the number of districts in which it was used increased to 77, 153, and 197 respectively. The size of the population that accepted blood tests had never exceeded 10% of the total population in Taiwan. Besides, not all residents or visitors living in the anti-malaria districts took the compulsory blood tests. Older people over 50 and children under 2 years of age were considered to be “low malaria risk” and were usually excluded.
More importantly, while the colonial government did pay more attention to the human approach initially, there was an important change of policy in 1919. This change attempted to establish the mosquito approach as the primary line of attack in the anti-malaria effort, and malaria eradication became the goal at this time. To be specific, in those areas designated as anti-malaria districts, anti-mosquito tasks were to be performed as a new obligation in addition to taking blood test and receiving quinine treatment. In the non-designated areas, local authorities began to mobilize and organize people against mosquitoes. Thus, anti-mosquito work was promoted by the Japanese colonial government much more intensively than quinine prophylaxis during the 1920s although, as I shall discuss later, the mosquito approach would gradually become more nominal in the 1930s.
From Man to Mosquito: A Change of Anti-malaria Policy in 1919
Unlike previous studies, we have to probe more deeply into the relationship between policy, society, and colonial rule in order to better understand policy change as a dynamic process. We need to know why the change to the mosquito approach occurred, and how it was implemented. An analysis of this process reveals that the application of the mosquito approach was intertwined with the colonial government’s political intentions to “reform” the people and the environment of Taiwan.
The year 1919 was indeed a turning point in the development of anti-malaria policies in Taiwan. Adopting the mosquito approach as the primary method to eradicate malaria, the Japanese colonial government enacted anti-mosquito laws. According to these laws, residents living in anti-malaria districts had new responsibilities to eliminate anopheles mosquitoes, such as removing weeds from irrigation ditches, draining ponds, cutting plantain leaves, or covering up puddles and swamps with earth. The county chiefs were empowered to impose restrictions on land use for the purpose of mosquito eradication. In addition, local governments published detailed regulations for the anti-mosquito effort in the 1920s, mandating that such activities should be carried out in both designated anti-malaria districts as well as in other areas. In other words, while the human approach targeted very limited areas, the mosquito approach marked the beginning of a much broader spatial campaign in the early 1920s.
The ineffectiveness of the existing human approach was the ostensible reason for the change in policy. Medical practitioners such as the president of the Medical School of the Governor-General Government, Horiuchi Tsugio, were aware of the rising total mortality rate since 1914, and attributed the increases to uncontrollable deaths caused by malaria since 1912, the second year after the anti-malaria policy was introduced. Such criticism seems to have contributed to the change in policy later.
In the meantime, the clamor for malaria eradication and scientific optimism about the mosquito approach steadily increased during the late 1910s. Some medical officials began to assert that the human approach was merely a means to meet an urgent need, and only the mosquito approach could solve the malaria problem in Taiwan.
Scientific thinking in Taiwan during this time should be put in the broad historical perspective of global malariology. One of the important characteristics of contemporary tropical medicine was the combination of biology and medical science. Based on Ronald Ross’s work on mosquito transmission, a majority of malariologists, especially in the British Empire and later in America, believed that by simply eliminating the species that transmit malaria, the disease could be eradicated as well. The British colonial government consulted Ross and his proponents on how and where to attack malarial mosquitoes in the Caribbean Islands, Central America, and Africa. First, they conducted a survey under the guidance of an entomologist in order to accurately locate breeding places of anopheles mosquitoes. Then, paid workers were recruited into “Mosquito Brigades”, “Drains Brigades”, or “Petroleum Brigades” to clear standing water, drain basins, and put oil on larger bodies of water. These mosquito-targeting methods and their positive results were reported frequently in the Journal of the Formosan Medical Association, the most prestigious medical journal in colonial Taiwan. Meanwhile, stories about successful malaria countermeasures from the West were hailed as a demonstration of the integrated mosquito-control program, including the use of larvicide and adulticide to eradicate mosquito sources. It is reasonable to assume that the success of the U.S. government in controlling malaria during the construction of the Panama Canal contributed to the broad acceptance of the mosquito approach.
For example, Suzuki Shintaro, Chief of the Sanitation Section, used an equation designed by Ross to estimate the malaria infection rate in Taiwan. He argued that if the number of anopheles mosquitoes was fewer than 7.4 per person, the infection would eventually cease of its own accord even when there were many existing patients. On the other hand, if the number of anopheles mosquitoes was greater than 7.4, the number of patients would increase rapidly even if there was only one patient initially. He thus concluded that the infection rate was mainly decided by the number of anopheles mosquitoes rather than the number of patients. Suzuki asserted that anti-malaria policy should make more of an effort to kill anopheles mosquitoes rather than treat the disease because it would be impossible to eradicate malaria with the human approach according to the Ross model.
Ross’s theory and its applications were highly praised by the imperial medical community in Taiwan in the late 1910s. However, the practice of the mosquito approach in Taiwan differed from the “Ross version,” as revealed in a report written by Shimomura Hachigoro, a local hygiene technician. Shimomura was an active participant in the anti-malaria effort in the Tainan state from 1923. He criticized the limitations of existing anti-malaria policy in Tainan which targeted only 60,000 people living within the anti-malaria districts and excluded the other 900,000 residents. The local government decided to accept his recommendations and published detailed regulations on how to execute the mosquito approach policy across the entire region. After 1924, the state was divided into small regions according to police precincts, and an executive director was assigned to every gun to train the police. Residents in each precinct were required to weed, cut clumps of bamboo, drain ponds, sweep streets, and collect trash under the command and supervision of the police. In addition, influential leaders, such as school principals or hoko headmen were appointed to the anti-malaria committee, and were expected to act as role models for the populace. The region judged to have done its work best would win a medal and be designated as an anti-malaria model area.
Unlike the Ross version of mosquito control that relied on a bureaucracy of specialists and trained, paid workers, the colonial government transformed anti-malaria work into a routine duty of the Taiwanese people. In fact, this strategy combined mosquito control with an altogether different intention to transform the people and environment of Taiwan to meet a “Japanese standard.” Shimomura explained:
In the anti-malaria districts, we had published pamphlets, hung posters, held exhibitions and given speeches in order to offer hygienic knowledge to the [Taiwanese] people, but they paid no attention to these things and forgot them immediately … People are lacking of knowledge. Some even don’t believe the fact that malaria is transmitted by mosquito… But we believe that while mobilizing people to carry out anti-malaria work, the knowledge can be infused (emphasis in the original) into ignorant people through their hands, feet, eyes and ears.”
Clearly, Japanese medical officials denied the validity of the Taiwanese perception of malaria and tended to view the Taiwanese as ignorant laypeople in need of enlightenment through education provided by the colonizers. A region selected to be a model of anti-malaria work was inevitably considered to be more “civilized.” Officials insisted that each place should “become neat and beautiful like a grand park” after anti-malaria work had been carried out. This view corresponded to the colonizers’ understanding of malaria etiology: the prevalence of malaria resulted from the “intrinsic evil” of the Taiwanese people and their environment and “civilizing” the people and the environment was the ultimate means to eradicate this disease.
Interior Extensionism and Malaria Eradication
My contention is that the colonial government’s intention to eradicate malaria in late 1910s reflected not only the controversy over scientific validity, but also changes in the political environment. The strong interest in reform coincided with the new political objectives of the assimilation policy during the 1920s. In 1919, Den Kenjiro became the first civilian Governor-General of Taiwan, and the colonial government adopted “interior extensionism” as a principle of colonial rule.
To appreciate the significance of the concept, it is necessary to examine more closely the structure of Japanese colonial rule. Taiwan had been governed under so-called “biological principles” established by Civil Affairs Bureau Chief Goto Shinpei since 1898. Trusted by the Governor-General, Goto, who had a background of medical training, had a broad latitude of authority to manage the civil affairs of the colonial administration. Well-versed in principles of biology, he argued that grafting all the institutions directly from Japan onto pre-modern Taiwan would be like transplanting the eyes of a bream onto a flatfish. Thus he rejected absolute assimilation and called for an investigation of local customs as the groundwork for colonial governance. By the late 1910s, however, colonial leaders increasingly embraced the idea of interior extensionism, believing it to be a policy through which Japanese colonialists would be able to cultivate Taiwanese support in light of the rise of global movements of national self-determination after World War I. Prior to Den’s departure for Taiwan, he and Prime Minister Hara Takashi agreed to pursue an assimilation policy wherein Taiwan would be viewed as an extension of the home islands and the Taiwanese would be educated to understand their role and responsibilities as Japanese subjects.
There is a large body of literature on interior extensionism and its consequences— positive or negative—for Taiwan. My focus here is on how the colonizers endeavored to transform the lifestyle and thinking of the Taiwanese people so that they could conform to Japanese cultural norms. Educational reforms were carried out, and the colonial government promoted “racial co-education” at the post-elementary level and implemented an integrated school system for Japanese and Taiwanese students. Education was intended to cultivate loyalty, morality, and civility, and a Social Education Section was established within the central and local governments. Traditional customs were portrayed as undesirable or superstitious. Local elites were urged to form committees with financial support from local governments in order to lead people toward the goals of speaking Japanese, and changing their native religion, customs, or habits. Similarly, the anti-malaria policy was framed within the context of pre-modern Taiwan versus modern Japan. The colonizers’ etiology of malaria and the intentions of assimilation reinforced one another. Imperial authorities viewed Taiwanese social traditions as backward and Taiwan’s environment as uncivilized. These factors were seen as the root cause of malarial prevalence, and in need of reform. A discourse was framed which suggested that malaria could be eradicated through reforming the “bad” environment and people’s “pre-modern” lifestyle, and the mosquito approach policy (modified from the Ross version to a Taiwanese version that relied strongly on the structure of local society for implementation) was construed as the device to achieve this goal.
Resistance and Indifference to the Mosquito Approach
Not everyone, however, agreed with the application of the mosquito approach. Koizumi Tan, a parasitologist and entomologist who was sent to Taiwan in 1914 and who established the Medical Zoology and Malaria Laboratory in the Central Research Institute of the Governor-General Government, believed that imported anti-mosquito ideas might not necessarily be suitable for the environmental conditions in Taiwan. After returning to Tokyo in 1923 as Professor of Parasitology at Keio University, Koizumi continued his criticism, arguing that official publications had overestimated the achievements of the anti-malaria policy. Despite the investment of money and labor, the result of malaria control fell short of expectations, and he attributed the unsatisfactory performance to a number of scientific shortcomings. These included the failure to do a good job of locating and surveying the breeding places of anopheles mosquitoes before the start of anti-mosquito work, and the difficulty of sustaining what had been accomplished in environmental transformation in a tropical climate subjected to the destructive power of wind, rain, and vegetation. Moreover, he pointed to such human factors as the residents’ dwindling financial resources because of misguided anti-malaria work, and the “lack of wariness and fear of malaria” on the part of the Taiwanese people.
Koizumi’s evaluation revealed that the unsatisfactory result of the mosquito approach was related not only to alleged scientific shortcomings, but also in part to local resistance and apathy toward the policy. As noted earlier, the target of the new policy was to reform people’s behavior and the living environment, not the destruction of mosquitoes per se. Thus, we also have to examine the causes of “ineffectiveness” within the social context, and to consider how the policy was received by local society.
Public resistance and apathy toward the anti-mosquito policy was portrayed realistically in a novel titled Getting a Medal which described how a policeman mobilized residents of a village to win a medal in an anti-malaria competition. Written by a Taiwanese writer and published in 1931, the story showed how the execution of anti-mosquito work created problems for the local people trying to maintain their current life style. In the story, the ambitious policeman urged the residents to work harder to get rid of the mosquitoes under the supervision of the hoko headman. Most of the residents, being farmers, were reluctant to co-operate since the anti-malaria work would mean additional chores without payment and interfere with their farming duties. Although they could hire substitute workers for the anti-malaria duties, most of them could not afford to do so after paying their heavy taxes. Thus, they fulfilled their obligations halfheartedly, and even then only when the headman persuaded them to or threatened them with force. The production of rice and sugar cane suffered as anti-mosquito work occupied most of the time and energy of farmers who still had to pay their taxes when the harvests were poor. It became clear that the intrusion into their daily lives had led to the farmers’ resistance. The policeman blamed the farmers’ unwillingness to co-operate on their laziness and tried to coerce them to co-operate. At the end of the story, the village did win the medal and was selected as a model anti-malaria region. Yet once the policeman was promoted and transferred, no one in the village was willing to continue the anti-malaria work.
A statement made by the policeman in the novel summed up the colonial government’s attitude in the anti-malaria effort. He complained: “I toiled all day long just to protect your health, to improve the hygiene of you lowly people.” Imposing anti-mosquito work on the Taiwanese people was justified as a means to emancipate the people from their inescapable suffering from malaria, a disease with which the indigenes had had much experience.
Public health investigations during the 1920s provide additional historical material for examining the Taiwanese people’s understanding and perception of malaria. From 1921 to 1931, the colonial government conducted comprehensive public health studies of local areas, choosing one or two small “unhealthy” regions in each state every year, and gathering such information as birth rates, morbidity and mortality rates, physical measurements, and customs related to death. According to these reports, even leaders of hoko who were regarded as local intellectuals considered malaria to be as insignificant as a common cold, and viewed anti-mosquito activities as sheer nonsense. The colonizers’ representation of malaria as a scientific discourse was not embraced by all Taiwanese people, and since the anti-mosquito policy brought no substantial benefits while making life more difficult for them, there was passive resistance and indeed incidents of protest.
Moreover, the anti-malaria policy’s explicit condemnation of the environment of Taiwan conflicted with traditional beliefs of the local society. For example, medical officials always described villages with such statements as “dense with bamboo and trees which obstruct the sunlight and fresh air,” and they “look unclean, dark and make people gloomy. ” But bamboo was important for the local people both because of its benefits and symbolic meaning. During the Qing dynasty, houses were built with bamboo forming an outside barrier which not only protected the house as a windbreak but also kept thieves away. When there was plague, people would put an incense stick at the entrance to the bamboo forest to pray for blessings. Some believed that cutting down bamboo recklessly would bring bad luck. Public outcry became quite vocal when the new anti-malaria policy mandated the removal of bamboo fences. Application of the mosquito approach remained the colonizer’s conviction, rather than the colonized people’s necessity.
It is hard to say exactly when the mosquito approach was de-emphasized during the 1930s. The colonial government did not revise anti-malaria laws again after the 1920s. However, in 1929, a Malaria Therapy Laboratory was established in the public health section of the Central Research Institute of Governor-General Government. The declaration marking its founding insisted that the existing anti-malaria policy “should be improved,” and that the main purpose of the institute was to:
research the diagnosis and therapy of malaria patients, particularly the chronic patients, in order to provide a basis of policy making which give[s] priority to the treatment of patients and to the eradication of carriers.
It revealed the anxiety toward, and concern for, the result of the mosquito approach and the endorsement of a return to the human approach. At the same time, several construction projects ostensibly for sewers to process polluted water were initiated in the name of the anti-malaria campaign. Ironically, it was well known that larvae of anopheles mosquitoes in Taiwan exist only in clean, unpolluted water. The developments suggested that the attention paid to anti-mosquito tasks had indeed gradually become quite nominal in the 1930s.
Statistical Assessment of the Anti-malaria Policy
In this final section, I shall discuss the statistical assessment of the anti-malaria policy by the colonial government in order to reconsider how the discourse of effectiveness and ineffectiveness of each approach was formed in the historical context. To policymakers and public health practitioners, statistics were necessary to assess the effectiveness of the policy. Thus many investigations were conducted and abundant statistical data exists.
Mortality data had always been used by the colonial government to prove the success of malaria control. Malaria mortality declined quite sharply for both the Japanese and Taiwanese from 1906 to 1942. Moreover, among major causes of death in colonial Taiwan, malaria was the leading cause in 1911, but fluctuated between the first and third causes from 1912 to 1921, competing with pneumonia and diarrhea. After 1925, it had fallen out of the top four leading causes of death, taking the tenth place in 1935. Official publications such as Statistics of Malaria in Taiwan explained that the mortality rate of Japanese was initially high because of their inadaptability to the Taiwanese environment, but it soon reduced once the anti-malaria policy began. On the other hand, the slower decline in Taiwanese malaria mortality was due to “the lack of a modern concept of hygiene” among the local people. Nevertheless, official accounts claimed that the apparent drop in both rates demonstrated the achievements of anti-malaria efforts.
It is significant that malaria mortality had been sharply reduced by the end of the colonial period. However, the discourse of the colonizer alone does not fully account for why. First, the extent to which the anti-malaria policies improved the mortality rate remains to be determined. As mentioned above, according to the discussions of zhang in Qing literature, the malaria situation in Taiwan seemed to have become stable by the nineteenth century. In the early stage of the colonial era, however, population movements owing to migration, revolt and expeditions were so huge that they must have contributed to spikes in the rate of malaria infection. Therefore, the very high mortality rate in the early stages of the colony could not be interpreted as “normal,” and the overall decline in the mortality rate later might indeed represent a return to the “normal” pattern as the population structure and settlements stabilized. This might be a factor that helps to explain the overall decline of mortality due to malaria before the adoption of the human approach in 1911.
Moreover, the contrast between the colonial government’s confidence of reducing malaria mortality and their anxiety about, and vacillations in, anti-malaria policy was remarkable. From an epidemiological point of view, the drop in malaria mortality does not necessarily indicate the success of disease control since a low rate of mortality could simply result from the overall low fatality rate and cannot guarantee low morbidity. In fact, the colonial government did try to keep track of the malaria morbidity rate. In terms of the morbidity situation, there are two extant sets of regularly reported statistical data. First, from 1905, the colonial government began to collect statistical data on the number of patients who accepted malaria treatment, based on the annual reports of local public hospitals as well as public dispensaries. Second, in the anti-malaria districts, the parasite rate was recorded monthly to show the proportion of the population that had malaria parasites in their blood.
The rate of malaria morbidity closely paralleled the rate of malaria mortality before 1920. From the 1920s on, however, the two trends diverged from one another. In the anti-malaria districts, the parasite rate declined while both the mosquito approach and human approach were adopted after 1920, but dramatically increased after 1930. On the island as a whole, the malaria morbidity level was reduced slightly when the mosquito approach was promoted and employed during the 1920s, but rose again in the 1930s.
In order to understand the morbidity situation at the local level, sometimes the statistics of public hospitals and public dispensaries were analyzed separately. The former were located in cities whereas the latter almost always in the countryside; thus these statistics provide a rough comparison of the situation in urban and rural areas. An analysis reveals that in urban areas, both Japanese and Taiwanese morbidity decreased significantly before 1920, and continued to decrease after 1920. For the countryside, Japanese morbidity also dropped before 1920, while Taiwanese morbidity fluctuated between 15% and 20% and was at almost the same level for the period 1911-1929.
In fact, statistics in these hospital reports reveal only a partial picture of the situation among the Taiwanese people. According to reports of public health investigation in the 1920s, most Taiwanese people did not go to a hospital until the patient’s condition became very serious. However, since the reports included the malaria parasite rate and spleen rate (i.e., the prevalence of splenomegaly), they too provide another index showing that the prevalence of malaria did not fall in rural areas during the 1920s. In most of Tainan state, for example, the rate of parasite infection was over 3% and the spleen rate over 20%. Moreover, while many regions recorded low malaria mortality, the rate of malaria infection remained high.
The reason why malaria morbidity did not decrease, or decreased more slowly than malaria mortality, remains to be further studied. Here my focus is on how the statistical assessment affected the direction of anti-malaria policy. The colonial government’s concern for and anxiety about the policy was caused by the so-called ineffectiveness of attempts to reduce the Taiwanese morbidity level. This ineffectiveness was determined not simply by objective statistical numbers, but was also based on contemporary political and social considerations. In the 1910s while the human approach was adopted in limited districts, the total morbidity in urban areas and Japanese morbidity in rural areas decreased, but overall morbidity was not improved. After 1920, with the political objective of assimilation, the human approach was considered ineffective since the prevalence of malaria was believed to have resulted from the “intrinsic evil” of the Taiwanese people and their environment. Thus, reforming these pre-modern elements through the mosquito approach was viewed as the ultimate means to eradicate this disease. The mortality rate did decline rapidly in the 1920s during the period when the mosquito approach was applied enthusiastically. However, the decrease of morbidity did not occur as expected: it only occurred in the anti-malaria districts and urban areas, as well as among the Japanese—but not among the Taiwanese —living in the countryside. The resistance of the Taiwanese also showed that their cultural understanding and traditions could not be suppressed or transformed easily through the mosquito approach. The mosquito approach came to be considered ineffective, and that eventually resulted in the collapse of support for it.
Concluding Remarks
This chapter has tried to examine the dynamics of the development of an anti-malaria policy and its consequences in colonial Taiwan. First, the Japanese colonizers’ perception of malaria framed anti-malaria policymaking. Since malaria was considered to be a serious threat to economic development of Taiwan, the human approach was adopted as an effective way to suppress malaria in selected areas and protect economic interests. Yet it is important to point out the temporary, but important, shift in policy to the mosquito approach in the 1920s—and this fact has generally not been explored in studies of colonial Taiwan. The Japanese government portrayed the mosquito approach, developed by Ross, as an authoritative scientific truth in order to justify its adoption, although the approach was different from Ross’ version in its application. At the same time, the human approach was considered ineffective for malaria eradication, since the cause of the disease was viewed as an “intrinsic evil” of Taiwan itself. In fact, the authority and prestige of the mosquito approach was also used by the colonial government to justify its intention to reform the island and its people when the Japanese government introduced the policy of assimilation. The political assimilation propaganda of the 1920s portrayed the local people’s beliefs, traditions, and living environment as uncivilized and these undesirable elements had to be removed in order to fit the Japanese standard. Thus, I argue that the change of policy and the features of the modified mosquito approach paralleled the change of Japanese colonial policy toward Taiwan.
This chapter also suggests that the anti-malaria policy and its consequences should be reconsidered from the point of view of both the colonizer and the colonized. In previous studies of colonial medicine, the colonized Taiwanese have always been portrayed as a silent community that accepted forced modernization either actively or passively. However, as far as the anti-malaria policy is concerned, coercive measures and scientific authority did not banish the indigenous explanations and treatment of malaria. On the contrary, a different understanding of the disease led to a tense relationship between the two groups when the mosquito approach was put into practice during the 1920s. Since the target had gone beyond the mosquitoes to include local customs and the environment, local resistance emerged. The reform of indigenous lifestyles and changes to the environment disrupted people’s lives and violated long-held beliefs.
By the late 1920s, the mosquito approach was criticized as ineffective. The founding of the Malaria Therapy Laboratory revealed the plan to give pre-eminence once again to the human approach. In the latter half of the 1930s, anti-mosquito efforts were not officially abandoned but were de-emphasized in reality. Since local apathy and resistance were keys reasons for the rather weak impact of the anti-mosquito campaign, colonial health policy imposed from above met with resistance from below.
As references for self-assessment of anti-malaria policy, many investigations of malaria had been conducted providing an abundance of statistical data. As indicated, statistical analyses show that malaria morbidity, especially for the Taiwanese people, did not decrease or decreased less than malaria mortality. By the end of the 1910s, the human approach was assessed to be ineffective for malaria eradication. But after the 1920s, the discourse of the ineffectiveness of the mosquito approach was shaped to a significant extent by the fact that the Taiwanese morbidity level remained high. The high morbidity rate also suggested that the attempt to reform and assimilate the Taiwanese people through the mosquito approach had not succeeded. Thus, the adoption and efficacy of the anti-malaria policy are not, and should not, be interpreted as being determined solely by a universal scientific truth, but should be understood in the context of the interaction between the empire and local society.