The Great Manchurian Plague of 1910–1911: The Geopolitics of an Epidemic Disease by William C. Summers (review)

Sandwiched between Russia, Japan, and then China to the south, and rich in minerals and farm land, it was inevitable that Manchuria would become a nexus for political intrigue during the early twentieth century. Russia had pushed east all the way to Vladivostock, via Harbin in Manchuria, by adding the Chinese Eastern Railway to its Trans-Siberian Railway in 1901. After occupying Korea, Japan had won the Russo-Japanese War in 1905, thereby further strengthening its presence on the Asian mainland. The ineffective Qing (Manchu) Dynasty in China would fade into history in 1911. Summers uses the plague epidemic of 1910/11 in Manchuria, which largely followed the routes of the Russian-controlled Chinese Eastern Railway and the Japanese-controlled South Manchuria Railway, to focus on the politics, epidemiology, and medical aspects of plague (Yersinia pestis).

Plague had been prevalent in its sylvatic form in rodents in Siberia and Manchuria for all of recorded history, occasionally infecting humans with the bubonic, lymph node, form of the disease, but rarely leading to more than a few hundred subsequent human infections. The first cases of plague in humans in the Manchurian epidemic were in Manchouli, in October 1910, in Chinese marmot hunters. The marmot (Marmota sibirica), locally known as the tarbagan, is a fur-bearing rodent, the hide of which, when dyed, bears a striking resemblance to mink fur. Marmot hides were shipped by the thousands to Europe at that time and marmots and their hunters were scattered widely throughout Manchuria and Siberia. There is no evidence that these hides carried plague to Europe. Of particular interest is that the first two cases, confirmed by autopsy and bacterial culture, and the thousands following, were of the pneumonic form, thus, a bacterial pneumonia destructive of lung tissue and eventuating rapidly in death. The epidemic, which claimed between forty-five thousand and sixty thousand lives, was largely spent by March 1911.

The author makes clear that the Russians, through quarantine and public health measures, did a reasonable job of containing the disease along route of their railroad, actually keeping the disease from reaching Vladivostock on the Sea of Japan. The Japanese, from their coastal presence, principally Korea, were spared much exposure to the epidemic but used it, through medical, educational, and technical programs, to penetrate Manchuria. The Chinese, in spite of several highly competent Western-trained physicians, Drs. Wu Lien Teh and Ch’uan Shao Ching, dealt poorly with containment of the epidemic with much indecision and equivocating.

The core chapter of this work is the description of The International Plague Conference in Mukden in April 1911. In addition to the delegates from Russia, Japan, and China, there were British, Italian, American, and a variety of minor delegations present, official delegates all being medically qualified. Thus, the focus of the conference was clinical and bacteriological, with a strong public health theme. However, Summers is clear in his argument that the conference was seminal in not only changing medicine and public health in East Asia but it also allowed China, Japan, Russia, and the United States to redefine their diplomatic postures in Asia, reorganizing colonial alignments. Thus, Britain saw the beginning of its decline and Japan saw the beginning of its rise, culminating in their occupation of Manchuria in 1932 and in the ultimate tragedy of the Second World War. Russia lost any meaningful claim to Manchuria and America, with its Open Door Policy, stood hopefully in the wings. And, 1911 saw the end of the Qing dynasty and a new China led by the physician, Dr. Sun Yat Sen. The formation of the North Manchurian Plague Prevention Service in China was the beginning of effective public health activity in a modernizing China which lasts to this day.

The author attempts to pinpoint the origin of plague...