Maoist public-health campaigns, Chinese medicine, and SARS.

www.thelancet.com Vol 372 October 25, 2008 1457 Public-health posters are a window into the history of medicine and the politics of public health. Developed out of mid-19th-century mass media campaigns to sell products, announce performances, and propagandise in western and central Europe, they were intended to promote healthy behaviours among individuals and so strengthen the body politic. By the early 20th century, this visual culture spread to mainland China through new forms of advertisements, political propaganda, and public-health posters. Propaganda posters reached their heyday during the Great Leap Forward (1958–60) and the Cultural Revolution (1966–76). Publichealth posters were an integral part of the mass political and public-health campaigns of those movements to enforce conformity, test loyalty, and designate enemies. Although the political Maoist propaganda posters have subsided since the 1980s with the new economic reforms of the Deng era, public-health posters continue to have a role in modern China. During national crises, such as the 2003 epidemic of severe acute respiratory syndrome (SARS), the propaganda and public-health posters of the past merged with renewed political campaigns calling for national unity in the present. On Labour Day May 1, 2003, The Beijing Times published a poster titled Declare War on SARS! (fi gure 1). The fi ve-character phrase grammatically recalls the fi ve-character slogan of the Communist Revolution “Serve the People!”. A young man dressed in proletariat blue raises his right fi st and breaks through the top border calling the masses to unite behind the government to conquer SARS. His posture mirrors that of a young barefoot doctor in a 1970 public-health poster for the prevention of respiratory tract infections (fi gure 2). The red cross has moved from the barefoot doctor’s fi rst-aid satchel to a surgical cap replacing the old red star on Maoist military caps. A white face mask, which became the international symbol of the SARS epidemic, now covers his mouth. “It is most important for people to wear face masks everywhere and clothe [themselves] completely with disinfected [clothing]”, states the poster. Further recommendations to open windows to circulate air, report illness to the local public-health offi ce, isolate the sick, and seek early treatment found in the 2003 SARS poster could have been plucked from the earlier 1970 respiratory illnesses poster. One of the only elements of the Maoist poster missing from the 2003 one is the list of Chinese herbal formulas to prevent the spread of respiratory tract infections; comparable formulas were nonetheless provided in many other mainland Chinese media during the SARS crisis. Even the grammatical structure of the 14-character lines of verse suggests inspiration not only from lushi “regulated verse” of classical poetry, but also from Chairman Mao’s famous poem Farewell to the God of Plague. Written in 1958 in response to a People’s Daily article on the alleged eradication of schistosomiasis, Mao’s poem was reprinted a decade later on a public-health poster titled We Must Eradicate Schistosomiasis, which had a political subtext to discredit Mao’s rival Liu Shaoqi. Other visual clues in the SARS poster suggest this earlier confl ation of pest eradication campaigns with political purges. The revolutionary red background, proletariat doctor, fi ve-character slogan, and 12 lines of paired seven-character phrases visually and literally link the Declare War on SARS! poster to Maoist public-health campaigns. Yet the four black-ink images of the fountain pen, shovel, sickle, and rifl e behind the verses on the SARS poster are what clinch the Maoist political undertones of this new campaign. In the Maoist era, the pen was mightier than the sword: words inspired, reformed, and purged. The pen, shovel, sickle, and rifl e depicted in the 2003 SARS poster were borrowed from a 1967–68 political cartoon in which these four “toolweapons” attack a prostrate Liu Shaoqi (fi gure 3). There was a symbolism behind these images: the pen signifi ed students, the shovel represented workers, the sickle stood for peasants, and the World War II Garand for soldiers. This same image of tool-weapons appears in the We Must Eradicate Schistosomiasis poster, in which a local cadre who has allegedly followed the capitalist path of Mao’s rival Liu stands hunched over in shame before a peasant tribunal. Liu is also shown being violently stabbed by a fountain pen in a poster behind the cadre. Although the shovel usually threw out rats of plague and snails of schistosomiasis, in the next panel of We Must Eradicate Schistosomiasis a