China's post-Mao embrace of market socialism has transformed its society over the past forty years, and modernization has become the prime directive in almost every realm of life. Yet in this headlong embrace of modernity, there is little space for a healthy critique of the processes and unintended consequences of modernization. Modernity has arguably offered increased wealth and comfort for millions in China, but the increased convenience of life has not necessarily led to an increased quality of life—we need only look to the dramatic health effects of pollution on all residents in cities like Beijing as an example. Interestingly, this headlong turn to praise modernization has led to a reevaluation of China's semicolonial past. While the twentieth century largely saw the historical disparagement of foreign missionaries and other foreign physicians as agents of imperialism, the turn toward modernization as the goal (rather than the means to an egalitarian socialist society) has resulted in most Chinese-language accounts today praising the contributions of medical missionaries and other foreign builders of public health systems. This, despite the complicated impact of such systems on the lives of Chinese people of all classes and their arrival under the unequal conditions of foreign imperialism. Yet our histories of public health must not merely be paeans of praise to the pioneers of public health; they must also recognize the sacrifices that these measures forced on ordinary people. Although something was gained by increased hygiene, much was also lost. This chapter is a reflection on the empirical findings in my recent book, Qingdai weisheng fangyi jizhi jiqi jindai yanbian (Qing-era hygienic prevention mechanisms and their modern transformation), where I elaborate on the issues of quarantine and the management of water and night soil in the rapidly growing urban centers at the end of the Qing dynasty. For all that was gained in disease management, whole economies and livelihoods were disrupted, while personal freedoms were severely restricted.

In the late nineteenth and early twentieth centuries, Western conceptions of health and hygiene that were designed primarily to avoid the spread of epidemic disease by ship or train gradually began to infiltrate port cities of China where unequal treaties allowed foreigners to trade, reside, and establish local settler governments.