While it is commonly believed that Black Death was a European calamity, the reach of the plague bacteria had played its role in decimating human populations throughout the globe. In our modern times, antibiotics can treat the disease with relative ease; however, this was not always the case even in the 20th century.
To prevent an invasion and reduce
casualties, the Chinese government immediately deployed Wu Lien-teh to
Manchuria to handle the catastrophe. He
arrived in 1910 where he promptly began researching pathology of yersenia pestis, the bacteria responsible
for all forms of plague,
and supervising the measures utilized to thwart further deterioration. One of his foremost concerns was reliving the
police from their duties of treating patients with students from the medical
college. Moreover, he implemented quarantine
upon the ailing patients and their families to obviate the growth of the
disease. Yet, his most notable
contributions were his persuasion of the Chinese population towards using
cremation as the dominant mortuary service instead of burial.
Pneumonic plagues had influenced
Chinese historical development since the beginning of Qing Dynasty, and Chinese
scholars have recorded precise data regarding the rat-borne disease circa the
18th century. By the 19th
century, the mounting frequency of pneumonic plague and the consequential
mortality rates had overwhelmed the China’s rudimentary Traditional Chinese
Medicine (hereon referred to as TCM). In
1909, pneumonic plague ravaged China again, and the severity of the outbreak in
human lives was appalling. Fortunately
for Beijing, they, previously, had employed epidemiologist Wu Lien-teh (1879 –
1960) as the Vice-Director of the Imperial Army Medical College to educate its medical
corps. Wu had acquired world-wide fame
as the first Chinese graduate from the prestigious University of
Cambridge. With Wu’s assistance, the dispersion
of the pneumonic plague was hindered then restrained swiftly thereafter. The pestilence, due to its lethalness, reallocated
the focus of the population from superstition and TCM into a modernized western
medical science predominantly revolving around the implications of the sanitation,
pathogens and hygiene.
Introduction:
The plague began its onslaught in the
Northeastern China (also known as Manchuria)
in the first winter of Xuantong (dynastic imperial Chinese dates use the era
name of their reigning emperor which, in this case, was Puyi whose era date was
Xuantong.), and in mere days, the disease had slain fifty thousand people in the
sparsely-populated stretch between Manchuria and Siberia. Despite the lack of (undisputable) figures, Dr.
Dugald Christie or Christie of Mukden, a missionary doctor who founded Mukden
Medical College, asserted that out of 43,942 cases, none survived. Besides the atrocious mortality rates, there
were also ominous political undertones for Beijing – the plague had threatened
the regional imperial powers, including Russia and Japan, who threatened
military incursions to desist the outbreak.
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| (A Russian photograph of the dead from the 1910 outbreak - Source: Thmoas H. Hahn) |
Governmental Intervention:
 |
| Bust of Dr. Wu Lien-teh - Source: channelnewsasia |
Initially, prior to Wu’s
intervention, vast amounts of caresses were exposed in the open leading to
hygienic problems which encumbered the medical efforts. To mitigate the contaminative impacts, Wu beseeched
Beijing for an imperial decree to mandate cremation. His petition was not nonsensical as there
were over two-thousand infected corpses in open air without due concern thus ameliorating
the probability of further promulgation of the plague. The imperial court reached a decision in three
days and acknowledged the necessity of cremation, and Wu immediately invited
government officials to partake in the first Chinese mass incineration of bodies. The ashes were then interned in a mass grave
and from that day onwards, all cadavers of plague victims were cremated. Wu’s avant-garde approach to burial endowed
China with the first positive outlook towards disease contro and the infection
rates began a steadfast decline. Wu’s
efforts were initiated in the end of January, 1911, and by early March, the
plague had been ceased although some isolated clusters carried on their path of
destruction for another four months. By
the end of this pandemic, the cost in human lives were estimated to be around 60,
000 people; however, it also brought modernization upon the initially primeval
medical system.
Prior to the Manchurian pneumonic
plague, the Chinese government was oblivious to outbreak-halting techniques. As early as 1894, the pneumonic plague had
devastated the Guangdong region of China as well as the British of Hong Kong,
but at the time, the TCM doctors were unconscious of the plague’s implications. Cen Chunxuan, a politican, commented that “with
an increase in population, the number of infected increases and its peculiar
symptoms have rendered both existing and ancient doctors ineffectual.” (I translated this myself, his original words,
for those who can read Chinese, were 人事愈繁, 診癘之氣亦與之俱進.
發為奇疾異微, 往往為昔人所不及知. 傳染之烈,乃至城市為墟. 若鼠疫者, 尤其甚矣) The observations from the contemporaries of
the time illustrates that TCM doctors were incompetent and inexperienced in handling
bacterial mutation and other new diseases.
Because of this, the outbreak of certain anomalous diseases often
brought along chaos and vulnerability in Chinese medical services. Without satisfactory scientific
infrastructure or proficient human resources, epidemics proliferated through China
without resistance. However, the
severity of the Manchurian plague engraved the vitality of disease prevention
and control into the government’s mind.
With Manchuria’s devastation fresh in mind along with the experience
garnered, the Chinese medical service was able to dampen the repercussions of
later diseases and limit their contagiousness.
This was highlighted by the effectively at the containment of the Second
Manchurian outbreak of pneumonic plague.
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| President Xu Shichang - Source: lishi.net |
With heightened awareness as the
epidemic’s consequence, the government implemented wide-scale procedures for its
containment and treatment. In early
1911, Beijing, with Wu’s contributions, had established the earliest modernized
public health agency, the North Manchurian Plague Prevention Service. There were five functions of the
organization: vermin-extermination, diagnosis, treatment, quarantine and
vaccinations. All suspected cases of
pneumonic plague virus were sent to the medical teams and then quarantined
where their development will be monitored by the staff. Moreover, soldiers were deployed alongside
doctors to advise the public on hygiene, and anyone who impeded their progress
or disregarded their orders was dealt with harshly. Yet, these advances came at a turbulent time as
the Qing despots were near their demise after 269 years. Medical services were not prioritized during
the tumultuous era as Beijing changed hands frequently between the years 1911 –
1918. But by the time Xu Shichang (1855 –
1939) became president in 1918, the significance of disease prevention had been
reinforced by the Spanish Influenza. Xu
then ordered Qiang Nengxun (1869 – 1924), Minister
of Interior, to establish the Central Epidemic Prevention Bureau for the
manufacture and distribution of serum and vaccines.
From the aforementioned, it
becomes conspicuous that the plague had instilled an enhanced determination in
the now-experienced government towards hampering the disease. Despite the end of the plague, the government
vigilant approach to the medical services had not been forsaken and had progressed
further than the pioneering efforts to halt diseases but instead to prevent
their occurrences through vaccination.
This sparked a turning point in Chinese medical history and instituted a
foundation for future modernization processes as China now has a qualified
medical force with plague experience.
Consequently, the desolation of the Manchurian pneumonic plague of 1910 –
1911 was not repeated when it returned to Manchuria in 1920. The death tolls were obviously decreased with
only around 8000 deaths which despite tragic, was not the same astronomical number
it was during the first outbreak.
Despite contributions by specialists,
modernization of medical sciences is influenced by people’s attitude as any
endeavors in disease prevention rest upon the acknowledgement and participation
of the population. Prior to outbreak of
plague in 1909, the population was not keen in tolerating western medical advances but the terror manifested in
people disease’s lethalness compelled their endorsement of westernized
treatments. Even during the midst of the
plague, the effectiveness of modernized medicine was still under scrutiny, but
the population was convinced by the conclusion of the 1911 outbreak. In this sense, the first plague was beneficial
to revolutionizing the perspective of the Chinese public towards disease
prevention and public hygiene.
Initially, the fatalities of pneumonic
plague’s outbreak overwhelmed the population’s burial services and bodies were
simply buried in shallow earth without coffins.
However, as the situation further deteriorated, the people did not even
bury their dead, and instead left the cadavers on the snowy earth. This effectively demonstrated people’s
obliviousness towards hygiene and failure to realize that the corpses on the
streets were escalating the contagiousness of the plague. As the pathogens responsible for pneumonic plague,
unlike bubonic plague bacteria’s pure vector-borne nature, yersenia pestis could aerosolize from corpses
and threaten more casualties but fleas from cadavers deal identical damage. When Wu saw the circumstances of the time, he
insisted upon cremating the bodies of pneumonic patients. Yet, the incineration of one’s ancestors’
body was considered to be extremely disrespectful in the filial pietous Chinese
Confucian values. According to the
Analects, “we owe our parents our body, hair and skin; therefore, the highest
principle of filial piety is ensuring no ill happens to us.” (I translated this myself, the original words
I am citing, for those who can read Chinese, are身體髮膚，受諸父母，不敢毁傷，孝之始也) With such explicit philosophy
upon the significance of one’s body, the destruction of an ancestor’s remains
would cause him/her to be un-filial piteous which, in turn, would mean that the
cremator can be accused of the same blasphemy.
 |
| Moving Bodies for Cremation - Source: Dr. Richard Pearson Strong |
However, as Wu had acquired an
imperial decree from Beijing, the population was coerced into cremating the
deceased, and with the application of cremation, the outbreak slowed. Cremation as a way of handling the dead
became appealing to the Chinese population after the Manchurian Pneumonic
plague as it was proven apposite both sanitarily and economically. In ensuring epidemics, cremation of
contaminated bodies was no longer enforced as a regulation but instead a
voluntarily practice. This demonstrated a revolution in the Chinese
mentality with an embrace of hygiene and personal wellbeing over blind
obedience to cultural philosophy after comprehending the dangers of plague.
The Limitations of Traditional
Chinese Medicine
Moreover, the concept of
pathogens and personal hygiene harming physical health was also foreign to the early
20th century Chinese, but with confidence in TCM utterly destroyed,
westernized medical science was embraced.
TCM theorized in the interactions between the ‘qi’, a concept similar to
Aristotle’s philosophy of energeia or Henri Bergson’s notion of vital impetus, and
the ‘five elements’ which are wood, fire, earth, metal and
water respectively. According to TCM, a
person’s health depends upon the qi travelling unobstructed within his meridians
and organs. Yet, homeostatic imbalances
(this can
understood as a blockage of one’s qi that disrupts or reverses the flow of flow
which in turn would negatively impacts one’s health or the
unbalance of the contradictory unity of the five symbolic elements would distress
one’s health.
This
demonstrates the extreme need for western science to enter China to prevent
further disaster. Being misinformed, TCM
doctors, initially, used treatment called ‘warm-cure’ or ‘cold-cure’ to restore
phsyical balance based on yin-yang demonstrating the originally rudimentary
nature of disease prevention. Yet, as parts
of TCM is undoubtedly superstition, their methods of treatment proved highly
ineffective.
However,
TCM was already comparatively superior the other traditional Chinese
alternative ‘medicine’. In China, superstition
with religious overtones can sometimes influence medical decisions. A belief in the ability of folk heroes’
apotheosis formed a large part of Chinese culture and its influences seep even
into medicine. An example would be Guan
Di, or other deities’, portraits placed on the doorway to ward off the ‘god of
plague’ believed to have precipitated the epidemic. They would also put words like “the gods have
left” to convince the disease-bearing god to leave alongside his peers. The contributions of TCM towards plague-control
were infinitesimal and superstition certainly did not help and therefore the
epidemic continued its deadly course through Manchuria.
Wu’s westernized
ideas were the final resort for the population thus was compelled to accept these
foreign proposals. Even the suggestion
of autopsy, shortly after the imperial decree for cremation, fell on friendly
years as the populace was willing to experiment with anatomic methods due to cremation’s
relative success. After the pneumonic
plague, the confidence in modernized medical science grew as western disciplines
such as anatomy and pathology triumphed where TCM failed. Chinese anatomy was further strengthened by youngsters’
willingness to volunteer their family’s corpses for autopsy demonstrating a
change of perspective in favor of modernization over traditional Confucianism. Applications of westernized theories not only
became widespread in governmental health care schemes, but also the peasants,
as those who may come into contact with rodents voluntarily received
vaccinations. As delineated by the
effectiveness in limiting the plague of 1920, the epidemic of the early 1910s
had been a catalyst for medical modernization thereafter.
Conclusion
However,
TCM’s lackluster performance during the plague did not remove its position as
part of mainstream medication in Asia, and also as alternative treatments in
the Western world. Acupuncture, in
particular, had been verified by the American College of Physicians as a beneficial
treatment alongside physical therapy for disorders such as oosteoarthritis. Hence, while TCM is a capable alternative
treatment prowess, when serving as plague control, it pales when compared with even
basic hygienic knowledge or the application of antibiotics. Despite the invention of modern antibiotic plague
treatments not occurring until the 1940s, insecticides for killing fleas as
well as vaccines targeting yersenia
pestis were already available during the Manchurian outbreak. If the Chinese government had vaccinated the
Manchurian population as other modernized countries had, the effects of the plague
may not have been as devastating. With
that being said, one must acknowledge the difference between the education
level of our forbearers in China at the time.
Despite the understanding in western sciences, it was fortuntate that
the Chinese governmental officials of the time were willing to acknowledge the
effectiveness of Wu Lien-teh and the western medical knowledge he possessed.
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For additional information on Chinese Traditional Medicine, you can refer to http://nccam.nih.gov/health/whatiscam/chinesemed.htm
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