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When plague broke out in Manchuria in 1910 as a result of transmission from marmots to humans, it struck a region struggling with the introduction of Western medicine, as well as with the interactions of three different national powers: Chinese, Japanese, and Russian. In this fascinating case history, William Summers relates how this plague killed as many as 60,000 people in less than a year, and uses the analysis to examine the actions and interactions of the multinational ...
When plague broke out in Manchuria in 1910 as a result of transmission from marmots to humans, it struck a region struggling with the introduction of Western medicine, as well as with the interactions of three different national powers: Chinese, Japanese, and Russian. In this fascinating case history, William Summers relates how this plague killed as many as 60,000 people in less than a year, and uses the analysis to examine the actions and interactions of the multinational doctors, politicians, and ordinary residents who responded to it.
Summers covers the complex political and economic background of early twentieth-century Manchuria and then moves on to the plague itself, addressing the various contested stories of the plague’s origins, development, and ecological ties. Ultimately, Summers shows how, because of Manchuria’s importance to the world powers of its day, the plague brought together resources, knowledge, and people in ways that enacted in miniature the triumphs and challenges of transnational medical projects such as the World Health Organization.
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"Human activity in this place seems to have completely died out; the streets are empty and deserted and all the houses are left desolate. Those who were not struck by the plague in the town itself fled terror-stricken and were overtaken by the black epidemic outside the town. The bazaars and markets are closed. Dogs alone roam in the streets, howling and feeding on the corpses of their former masters. The stench is horrible. The hospitals are abandoned. There are no ill people any more and no medical men—all have died. Only on a few beds lie the dead bodies of those who expired last."
This depressing account of disease and devastation is not about Boccaccio's Florence of the fourteenth century or Defoe's London of the seventeenth century, but about a thriving commercial region of major concern to the Great Powers in the twentieth century. Beginning in October 1910, a major epidemic of pneumonic plague swept through Manchuria (fig. 1); by the spring of 1911 it had killed between forty-five thousand and sixty thousand people. The plague and its aftermath were to play an important role in the geopolitical events leading up to the Japanese takeover of Manchuria and the complex causes of World War II. The concentrated force of this epidemic, its mortality rate of nearly 100 percent, and its occurrence in a region of international competition and diplomatic struggle all contributed to the importance of and interest in the Manchurian plague. The "Manchurian Question" was of immense concern to the United States, which had just enjoyed its first taste of successful international leadership: Theodore Roosevelt's brokering the peace treaty of 1905 that ended the Russo-Japanese War over territorial hegemony in Manchuria and Korea. Russia, on the other hand, was intent on retaining what it could of its centuries-old foothold in East Asia. Japan, modernizing after the Meiji Restoration in 1868, was flush with international ambition and expansionism in Korea and Manchuria, responding to its own version of Manifest Destiny. China, under the yoke of war reparations owed both to the Western powers and to Japan as a result of the disastrous Sino-Japanese War of 18941895 and the ill-fated Boxer uprising in 1900, was struggling with its first efforts at modernization while still governed by the decaying and increasingly ineffective Qing dynasty.
Was the Manchurian plague just another unfortunate tragedy of humankind? Or did it play a more pivotal role in history? I shall examine the particular local contexts of this epidemic: the geopolitics of national ambitions in Manchuria, the dynamics of power, and the legacies of past encounters between nations and cultures. I shall also explore the interplay between technology, history, and disease, as well as the role of railroads, agricultural markets, and the new microbiology of the nineteenth century. Furthermore, I shall consider the various "uses" of disease: as a tool of political machinations, as a vehicle to study nature and medical science, and lastly as an opportunity for fame and fortune.
First, I consider plague and its periodic pandemics to set the scene for the specific conditions, local contexts, and scientific advances that were part of the Manchurian plague of 19101911. I then focus attention on this great plague itself. Chapters 2, 3, and 4 will examine, in turn, the local Manchurian environment, the political conflicts, the developing technological changes in China, particularly the railroads and the burgeoning industrialization of this region of East Asia, followed in Chapter 3 by a detailed account of the epidemic itself, how it affected the three major cities, each with a different culture and background, as well as the intervening hinterlands. Chapter 4 will study the accounts of the Plague Conference in Mukden both as a window on the scientific, medical, and public health knowledge at the time, but also as an exemplar of geopolitics of the Great Powers in the Far East and the fragile Sino-Japanese balance at the twilight of the Qing dynasty and on the eve of the Japanese expansionism that, in the 1930s, led to the occupation and takeover of Northeast China by Japan under the Manchukuo regime.
With a clear picture of this specific plague before us, Chapter 5 will revisit ongoing historical controversies surrounding the biology of the plague and its origins in Northeast China and Central Asia. Finally, in Chapter 6 this great plague will be situated in the larger context of both colonial and post-colonial histories of disease, but also in the more general medical history of plague, epidemics, and national interest.
Plague is a word that conjures up fear and mystery along with images of hopelessness and social chaos. All these reactions have historical validity. Although the word has a general meaning consistent with the historical reality, since the late nineteenth or early twentieth century and the advent of germ theories of disease, the term has taken on a more specific meaning. With the identification of the microbe responsible for the cause of the disease recognized by Western medicine as "The Plague" (French: la peste; German: die Pest), most writers identify plague as the illness associated with infection with the bacterium Yersinia pestis. Medical historians are in general agreement that in the last two millennia there were three great, almost worldwide pandemics of plague. The first, known as the Plague of Justinian, probably arose in central Africa and then spread to the Mediterranean countries through Egypt in the sixth century. Although not all the deaths can be attributed to plague, the mortality in this pandemic has been estimated at 2030 percent of the population. The second pandemic originated in central Asia, spread to the Crimean ports in the fourteenth century, and then invaded all of North Africa and much of Europe. This was the pandemic subsequently known as the "Black Death." The most recent pandemic stared in Yunnan province in China in the nineteenth century and reached Hong Kong in 1894.5 Modern transport systems such as the steamship and the railroad promoted the spread of this outbreak to new areas and established the organism in countries previously uninfected by the plague germ.
Early medical writers such as Guy de Chauliac (13001368) recognized that there were two manifestations of what seemed to be the same epidemic illness: one with primarily respiratory symptoms and another with more systemic manifestations, especially swelling in the armpit and groin regions. The prominence of swelling in the groin, called bubo in Latin, from the Greek [TEXT NOT REPRODUCIBLE IN ASCII] (groin), gave the name to the bubonic form of plague. The illness with prominent lung symptoms was termed the pneumonic form.
Traditional explanations for these periodic epidemics recognized the contagious aspect of plague as well as its indiscriminate devastation. During the Black Death of 13481349, contagion was attributed to physical contact with infected individuals or their belongings, to poisons in the water supplies, and to "evil looks" from suspicious people. The causes of the plague ranged from divine retribution to rare celestial happenings and particular meteorological conditions.
Although the great pandemics were rare, there have been regular and rather frequent local outbreaks of plague in many areas of the world. These have attracted less attention as historical events, yet they have been important in local contexts. For example, five major epidemics of bubonic plague struck northern Italy in the fourteenth century and are primarily reported in local chronicles. In other places and at other times, plague has been a recurrent phenomenon as well. The famous journalist and storyteller Daniel Defoe chronicled the 1665 Plague of London in A Journal of the Plague Year (written as a work of fiction in 1722). Even in our own time, epidemic plague is not unknown: in 1994 there was an outbreak of what was alleged to be plague centered in the city of Surat in Gujarat state in India, with 5,150 suspected cases and 53 deaths.
Our current understanding is that the same bacterium (Yersinia pestis) is the "causative agent" (in the sense of Robert Koch) of both the bubonic and pneumonic forms of plague. Both humans and other animals are susceptible. One form of the disease results from infection by the bite of an infected flea. Bacteria are thus introduced directly into the body at the site of the bite and are carried centrally in the lymphatic channels. They are then trapped in the regional lymph nodes, where they establish a fulminate infection with abscesses and sometimes retrograde infections.
The swollen lymph nodes, most obvious in the groin and armpits, the buboes, gave rise to the modern name of bubonic plague. The patient experiences the effects of systemic bacterial infection with shock, fever, and circulatory collapse. If, instead of being inoculated by the bite of a flea, one is infected by an inhaled aerosol, the primary site of infection is the lung; rapid growth of the bacteria and destruction of lung tissue produces first a bloody cough, rapid loss of lung capacity, then fever and death. This form is called pneumonic plague.
Plague in the bubonic form was well known in China and was often associated with an epizootic among rats prior to the appearance of the disease in humans. A widely quoted Chinese poem from the late eighteenth century describes the situation vividly:
Dead rats in the east,
Dead rats in the west!
As if they were tigers,
Indeed are the people scared.
A few days following the death of the rats,
Men pass away like falling walls!
Deaths in one day are numberless,
The hazy sun is covered by somber clouds.
While three men are walking together,
Two drop within ten steps!
People die in the night,
Nobody dares weep over the dead!
The coming of the demon of pestilence
Suddenly makes the lamp dim,
Then it is blown out,
Leaving man, ghost, and corpse in the dark room.
The crows caw incessantly,
The dogs howl bitterly!
Man and ghost are as one,
While the spirit is taken for a human being!
The land is filled with human bones,
There in the fields are crops,
To be reaped by none;
And the officials collect no tax!
I hope to ride on a fairy dragon
To see the God and Goddess in heaven,
Begging them to spread heavenly milk,
And make the dead come to life again.
Western medicine at the end of the nineteenth century, however, was quite unfamiliar with bubonic plague. The epidemic of 18941895 spread from Guangdong province into Hong Kong, and Western doctors could only guess that this was the same disease that had devastated London two centuries earlier: they searched old texts and read Defoe's description of the London plague in an effort to learn more about the disease.
This was the era of "microbe hunters," and emissaries of the two great bacteriologic powers went on safari to Hong Kong in search of the fearsome germ of plague. Alexandre Émile Jean Yersin (18631943) came from the Pasteur Institute, and Kitasato Shibasaburo (18521931), a protégé of Koch, from Japan. Both were able to isolate and characterize a bacterium that was consistently associated with plague in Hong Kong. Convincing evidence that inoculation of these organisms into humans could result in plague, of course, was absent. They relied on the constant association of the organism and the disease and animal inoculations to support their claim to have identified the plague germ. It may be noted that Yersin's isolate eventually was shown to be the cause of the epidemic, while many investigators believe that the organism eventually identified by Kitasato was simply a common contaminant. Interestingly, this controversy and error has lingered for over a century, but Kitasato himself, in 1905, acknowledged that his isolate was not the true pathogenic organism, noting that Yersin isolated bacteria from the buboes, while Kitasato and Tanemichi Aoyama erroneously believed that the organism should be isolated from the blood of plague victims. Later, after Yersin's discovery of a different organism from the buboes, Aoyama confirmed that Yersin's isolate was, indeed, the authentic plague bacillus. In spite of this clear evidence, modern writers, both historians and scientists, persist in crediting both Yersin and Kitasato as "co-discoverers."
About this same time Paul-Louis Simond (18581947), another Pastorian, was conducting animal experiments in Asia that strongly supported the idea that rat fleas were a vector in transmission of plague, at least from rat to rat, and probably to humans. Plague had evolved, conceptually, from a contagious disease to an infectious one. Until the Manchurian epidemic, however, the pneumonic form was rare, and Western physicians had little experience or knowledge of this form of plague. Thus, this later epidemic supplied modern science with an opportunity for investigation as well as prevention and treatment.
Although sporadic outbreaks of bubonic plague were common in China, most were limited to a small region or a single village with several to a few hundred deaths. In the fall of 1910, for example, a few cases were reported in Shanghai, which engendered intense public discussions, new regulations, and near riots. Still, it was not an epidemic.
PLAGUE ALONG THE AMUR
Bubonic plague was well known to the local peoples of Transbaikalia and China bordering the Amur River. Yearly outbreaks were expected by the local population. In 19011902, 114 deaths were reported in the Russian-controlled areas of North Manchuria, and by 1905, plague started to appear in the western regions of the Chinese Eastern Railway (CER) near the town of Ta Shih Chiao (Dashiqiao), but these outbreaks were limited and appeared self-contained. Almost as soon as the Russians undertook railway construction in this region, they encountered cases of plague. In 1898 the first reported cases were described in the Baicheng region, about 185 miles due west of Harbin. The Russian plague authority D. K. Zabolotny (18661929), writing about plague in Manchuria, noted that in 18981899 there were 558 cases with 400 deaths in this region. The local missionaries claimed that the plague "came from the north" and was well known among the native populations, with yearly outbreaks expected. In the winter of 19011902, for example, there were 114 plague deaths registered by the Russian authorities. Local knowledge pointed to the tarbagan, a common burrowing rodent hunted for food and fur, as the source of these outbreaks, and some local Russian physicians began experimental investigations of plague in tarbagans. For safety reasons, at first a few sick Mongolian tarbagans were sent to Russian researchers in Odessa, where it was found that they died with all the signs of plague. Later, one Dr. Chousef in Manchuria experimentally infected captive tarbagans with cultured plague bacilli and was able to demonstrate animal-to-animal transmission in the same cage. Whether this was effected by fleas as the vector or by cannibalism was uncertain from these rather limited studies.
The Russian railway brought surprisingly modern and extensive medical services along with it. By the first decade of the twentieth century, Russia reported twenty medical stations with ten hospitals along the Chinese Eastern Railway, with an estimated ten to thirty beds per one thousand individuals in the population.
Plagues and massive epidemics, along with wars and natural disasters, have long captured our imaginations, provoking our anxieties about causes, responses, and consequences, as well as our own vulnerabilities to future recurrences. In the Western mind, many of our most fearsome threats seem to have come from that vague and mysterious part of the world: "the East." Asiatic cholera, Hong Kong flu, Japanese encephalitis, Korean hemorrhagic fever, Ichang fever, Madura foot, and Oriental sore are names that remind us of the early Asian associations of these diseases. Plague, documented from the time of the Byzantine emperor Justinian in the sixth century, was, by contemporary accounts as well as current molecular paleopathologic investigations, believed to originate in Central Asia or China. By the fourteenth century, "the East" was taken as the unproblematic source of what came to be called the Black Death. Repeated waves of plague, or plague like epidemics, ravaged Europe and Asia with varying degrees of severity.
Excerpted from The Great Manchurian Plague of 19101911 by WILLIAM C. SUMMERS Copyright © 2012 by Yale University. Excerpted by permission of Yale University Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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