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Journal of the History of Medicine and Allied Sciences 57.2 (2002) 177-197

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Disease And its Impact on Politics, Diplomacy, and the Military:
The Case of Smallpox and the Manchus (1613–1795)

Chia-Feng Chang

One of the most dramatic events in Chinese history was the rise of the Qing dynasty in 1644. Scholars have suggested various reasons why the Manchus successfully conquered Ming China, but one important reason has long been neglected. An infectious disease, smallpox, played a key role in the story. Smallpox might have served as a barrier, preventing the success of the susceptible Manchus, both during the time of military conquest and in the years that followed. In this essay I explore how the Manchus responded to the danger of smallpox and how smallpox shaped the Manchu military, political, and diplomatic structures during the conquest and the first half of the Qing dynasty (1644–1911).

In the late Ming dynasty (1368–1644) smallpox was rare among the peoples who lived beyond the northern borders of China, including the Manchus. For example, Zhang Jiebin (1563–1640), an eminent physician, stated that the northern peoples did not develop the disease. 1 A government official of the time, Xie Zhaozhe, also remarked that the Tartars did not suffer from smallpox. 2 As late as the Qing [End Page 177] dynasty, Zhu Chungu (1634–1718?), who was appointed to practice variolation amongst the Mongols during the Kangxi period (1662–1722), asserted that it was their nomadic lifestyle which protected them. 3 However, the Manchus did not totally escape smallpox. In 1613, the first large-scale smallpox outbreak amongst the Manchu tribes occurred, affecting 300 households of the Yehe Manchu. 4

As contacts between the northern peoples and the Chinese increased, so did reports of smallpox. In 1544, Lu Shen noted that many northern peoples coming across the Great Wall contracted smallpox and most sufferers died. 5 Similarly, according to the Mingshi (History of the Ming Dynasty), the Mongols had not had smallpox in their territories, but they contracted it after trading with the Chinese in the mid-sixteenth century. 6 Xie Zhaozhe also stated that when the Tartars traded with the Chinese in the late Ming period, they were no longer exempt from smallpox. 7 Because of economic, political, military, and cross-ethnic contacts, the broad border north of China became a hotbed for transmitting smallpox in the late Ming and early Qing period, and entering China heightened the northern peoples’ exposure to the disease. Not only did the incidence increase, but so [End Page 178] did the mortality rate from subsequent infection. Unlike most of their Chinese neighbors who had had smallpox during childhood, those northern peoples who most often fell ill with smallpox were adults, and this increased their chances of death.

From the early seventeenth century onward, Nurhaci (1559–1626), who united the Manchu tribes and laid the foundation for the Qing dynasty, and his successors enthusiastically expanded their power. They conquered Korea, Mongolia, and China, establishing a vast empire throughout Asia. One might wonder, then, whether during the Manchu invasion of China smallpox ever played a determinate role as it did in the case of the Spanish Conquest of Mexico. 8 Unlike the Mexicans, for whom smallpox was a completely new disease, the Manchus already knew about smallpox and its contagiousness by the time they devised their ambitious scheme of conquest. When they started to have close contacts with China, how did the Manchus protect themselves from this disease and defeat the Chinese troops at the same time? After they took over China, how did they wage their long and intense campaign against smallpox? What role did smallpox play in the early Qing history? These are the questions I answer in this essay.

The Great Fear of Smallpox

The Manchus originally lived in the northeast of China where smallpox was rare. Therefore, the majority of the population was not immune to the disease. A great variety of Chinese documents...