Population and Disease

Questions such as those above have always intrigued historians of China because the Chinese population has experienced mysterious declines that were possibly caused by widespread epidemics. One such decline of population occurred in north China in the late seventh century, whereas another was a decline in the lower Yangtze region during the ninth century. Other examples are the drastic depopulation of north China during the Mongol dynasty in the fourteenth century, and the decline during the Ming-Qing transition in the mid-seventeenth century (Cartier and Will 1971; Zhou 1983; Wu 1988). Indeed, despite the nature of Chinese sources that do not permit any precise demographic reconstruction, it is generally conceded that China's population in the tenth century remained very much the same as it had been nine centuries earlier. A significant growth, however, took place during the three centuries following the tenth century and in the early thirteenth century, when the population was estimated to have reached an unprecedented high of between 100 million and 120 million people (Cartier and Will 1971). Yet the fourteenth century was one of demographic disaster. Ho Ping-ti estimates the population level at the end of the fourteenth century to have been around 65 million, although it exceeded

130 million by the turn of the following century and soared to 150 million by 1600 (Ho 1959). Another drastic decline seems to have occurred in the mid-seventeenth century, which may have reduced the population to 83 million in 1651 (Wu 1988). Momentum was regained during the eighteenth century by the end of which the population had tripled, reaching 313.2 million in 1795. By comparison, China's population in 1686 was ony 101.7 million.

Scholars have attributed some of these drastic population declines to epidemics. Twitchett (1979), for example, argues that epidemics had some effect upon demographic trends in the seventh, eighth, and ninth centuries, and might have been one major reason for population stagnation before the tenth century. It is also tempting to attribute the mysterious but real decline of population in north China during the fourteenth century to plague, as does William McNeill (1976). Some scholars would go even further by hypothesizing that plague was ravaging northern China as early as the thirteenth century. The beginning of the century saw a series of epidemics in Hebei and Shanxi, and then an epidemic struck Kaifeng (Henan) in 1232, reportedly killing nearly 1 million people within 50 or 60 days (Fan 1986).

Moving to the late Ming period, of the sixteenth and seventeenth centuries, H. Dunstan's (1975) preliminary survey of epidemics suggests that these catastrophes also had long-term effects on population growth and that the prosperity of the ensuing early and middle Qing dynasty was the result of an easing of pressure on land resources brought about by huge die-offs from disease, as well as from war and famine around the middle of the seventeenth century.

Yet the question of the impact of disease on China's population remains controversial because of different interpretations of demographic sources (Cartier and Will 1971; Bielenstein 1975; Wang 1988). Also remaining is the question of how regional differences in population development can be related to local epidemics. Natural catastrophes like epidemics or famines were usually local rather than widespread occurrences and of smaller magnitude and shorter duration than impressionistic accounts have led many to believe. In fact, it could be argued that they were unlikely to have had long-term demographic impact (Watkins and Menken 1985).

Thus, it is perhaps most reasonable to see the presence or absence of epidemic disease in China as just one of the determining factors in long-term population growth. The unprecedented upsurge in popula tion during the Song period (eleventh to thirteenth centuries) is generally believed to be closely related to a series of revolutionary changes in agriculture in the more developed southern regions, especially with rice growing. The period witnessed the introduction of early-ripening rice as well as improvements in irrigation and other agricultural technologies all of which greatly increased land productivity (Ho 1959, 1969; Bray 1984). The next upsurge in population, however, was from the eighteenth century onward, a period in which there was no comparable technological revolution. Could the "stagnation" between the two upsurges be explained by differing mortality rates in which infectious diseases had a role?

Stagnations in "preindustrialized" populations occurred when high or moderately high fertility rates were balanced by similarly high mortality rates resulting from uncertain food supplies and unavoidable diseases. It is generally agreed that in Asia, where marriage was early and nearly universal, fertility was higher than in preindustrialized western and northern Europe, where women married late and forced celibacy was more common (Coale 1986). Therefore, a stagnation in population development in China can best be explained by high "normal" mortality rates.

Subsistence crises were always a constant threat to the Chinese, which, by causing undernutrition (if not death from starvation), reduced their resistance to disease. The prevalence of dysenteries, shanghan (discussed earlier), and respiratory diseases might be an indication of general dietary deficiencies (Polunin 1976). Certainly, beriberi, which was often discussed in the family encyclopedias, could cause death directly or indirectly by leaving the individual less able to resist diseases, whereas infantile beriberi has proven to be a major killer of nursing infants in thiamine-deficient populations.

In addition, parasitic diseases probably killed millions of peasants because the use of human feces as fertilizer was a universal practice for centuries. Flooded rice fields were also breeding grounds of mosquitoes — the carriers of malaria and other infections. In addition to malnutrition and agricultural practices, poor hygienic conditions, especially in some of the southern provinces and frontier regions, must also have been an important factor in encouraging insect-borne diseases like malaria and plague. Other important factors that could account for high morbidity rates, especially in urban centers in the late Ming period, were the absence of sewage and water control, and the inflow of masses of vagrants from poorer areas to the centers who were most likely carriers of contagious diseases (Liang 1986; Leung 1987a).

Thus, with fertility rates already high, the demographic upsurge of the eighteenth century is best explained by a remarkable decline in mortality. At least the initial stage of the upsurge can be explained in terms of mortality decline, although subsequent increases in populations were likely to have been generated largely by the internal dynamics of an already huge population. The industrialization of the period was neither important nor modern enough to cause a significant rise in tuberculosis.

Ann Jannetta (1987) suggests that the practice of infanticide and abortion in Tokugawa Japan was a sign of attempts to control fertility because of an already slowly declining mortality. This may also have been the cause in China, for it was the case from the late seventeenth century onward that foundling homes were widely established, possibly reflecting increasing infanticide and child abandonment. Interestingly, the only precursor to this movement was in the thirteenth century when China experienced its first population boom (Leung 1985).

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