Showing posts from category: Medical history
Physician Heal Thyself … Literally! The Fusion of Surgeon and Patient Together in a Polar Wasteland
Twelve men from the Soviet Union on a scientific expedition to the remotest part of planet Earth, Antarctica, in 1961, found themselves on the horn of an incredible dilemma. One of their number, none other than the expedition doctor, suddenly became acutely stricken with appendicitis. What to do? No one else was medically trained and outside medically help was thousands of kilometres away, the patient couldn’t be transported there and waiting would prove fatal. So the surgeon, Leonid Rogozov, did the only thing he could do to try to save his own life…as mind-numbingly inconceivable as it sounds he operated on himself!
Auto-appendectomy was virtually unheard of, let alone performing such an impossibly dangerous procedure in a non-hospital environment, but Dr Rogozov rolled the dice. Firstly, he planned the operation systematically and meticulously (despite being in agonising pain), choosing two members of the expedition to be his surgical assistants, their roles were to hand him surgical instruments and hold a mirror to avail him of a view of his abdomen. The degree to which he prepared the operation exceptionally well can be seen in that he had the foresight to assign a third man to be present in the makeshift operating “theatre” in the event that one of the assistants fainted. As Rogozov needed to stay conscious he submitted only to a local anaesthetic and proceeded slowly in excruciating pain. Finding the inverted view of the mirror more a hinderance than an aid he dispensed with it and operated instead by touch with his bare hands.
Somehow after nearly two hours the doctor succeeded in removing the offending appendix (while noting that its gangrenous appearance indicated it in all likelihood would burst the following day). Operation successfully completed, Rogozov stitched up his gaping wound and even had the presence of mind to instruct the assistants on how to wash the instruments properly and hygienically clean the room, before finally allowing himself a dose of antibiotics and sleeping tablets to induce sleep. After just two weeks rest the extraordinary doctor was, true to form, back at work. Truly remarkable, real Ripley’s “believe it or not” sort of stuff! [Sara Lentati, “The man who cut out his own appendix”, BBC, 05-May-2015, www.bbc.com].
The Antarctic ordeal wasn’t entirely over for Dr Rogozov. Mission completed, the expedition was meant to be picked up by a Soviet vessel about 12 months after the doctor’s self-appendectomy, however exceptionally bad weather and thick sea ice prevented it from getting close enough. Consequently there was a further lengthy delay before all the explorers were eventually evacuated by single-engine aircraft, a distinctly hairy manoeuvre in the treacherous polar conditions. Back in the USSR Leonid Rogozov was hailed as a hero of the Motherland and honoured with the Order of the Red Banner of Labour, although the good doctor did his utmost to shun the huge publicity focused on him, preferring simply to return to his medical clinic work in Leningrad.
ᨎᨐᨏᨃᨑᨎᨐᨏᨃᨑᨎᨐᨏᨃᨑᨎᨐᨏᨃᨑᨎᨐᨏᨃᨑ
Footnote: As a consequence of the 1961 Soviet expedition’s medical quasi-catastrophe, several countries including Australia made appendectomies mandatory for Antarctic explorers about to embark on an expedition to the farthest southern continent.
North Head Quarantine Station: Shielding Sydney and Surrounds from the Importation of Communicable Diseases
〝 The principle of preventing the spread of infectious disease by which people, baggage…likely to be infected or coming form an infected place are isolated at frontiers or ports until their harmlessness has been proven…〞
~ Port Nepean Q-Station‘s definition of ’Quarantine‘
Since the initial strains of Covid-19 turned the world upside down and inside out early last year, the word ‘quarantine’ has found a renewed vigour in the lexicon. In a previous blog the history of Sydney’s early animal quarantine station for imported livestock was outlined – ‘Sydney Foreshore’s Animal House of Detention and Segregation on Hen and Chicken Bay’, 21-Apr-2018. Human quarantine in Sydney has a much longer history. The story starts with governor of the colony of New South Wales Ralph Darling. In response to the cholera pandemic sweeping Europe and the risks of ship-borne disease being transported on vessels coming to the colony, Darling initiated a Quarantine Act in 1832 “subjecting Vessels coming to New South Wales from certain places to the performance of Quarantine”❅.
(Source: researchgate.net / Peter Freeman Pty. 2000)
Darling set aside the entire North Head peninsula (277 hectares)—on indigenous Gayamagal country in Manly on Sydney’s northern beaches—for the grounds of the quarantine processing centre. The exact site chosen for the Q-station, Spring Cove, overlooking Sydney Harbour, was already housing an infected and quarantined merchant ship, the Bussorah Merchant.
In the early years of the station’s operation, the practice was to keep sick passengers on board the vessels on arrival at Spring Cove. After complaints from the merchants about the delay and cost of keeping the ships tied up at North Head, the authorities started bringing the sick onshore to free up the transport ships, this required the construction of more substantial permanent accommodation and storage facilities at the Q-Station to replace the original makeshift buildings [‘North Head Quarantine Station’, Wikipedia, http://en.m.wikipedia.org].
Passengers disembarking at North Head Q-Station, 1940s (Photo: State Library of NSW)
Q-Station longevity The old Quarantine Station enjoyed a surprisingly long lifespan at the North Head site, surviving albeit with decreasing utilisation until 1984⌖, this despite periodical calls for its closure…as far back as 1923 Manly Council alderman and later mayor Percy Nolan was advocating for the Q-Station’s removal in favour of open public space [Sydney Morning Herald, ‘Quarantine Station. Proposed Removal’, 31-May-1923 (Trove)].
Slabs of cut sandstone near the station’s wharf bear the markings of passengers detailing the dates and ship names of their journey to North Head
First class expectations Conditions and facilities at the Q-station were regularly under scrutiny from the better-off passengers. First class passengers were not slow in bringing deficiencies in housing to the attention of the authorities, leading in the 1870s to the building of a new section of Q-Station passenger accommodation in what was known as “the Healthy Grounds” (Wiki).
A 1881 smallpox epidemic resulting in a large number of internee deaths❧ at North Head facility exposed major shortcomings in the management of the Q-Station, including the lack of a medical superintendent with a grasp of infection control; no clean linen and towels, soap or medical supplies for patients isolated with smallpox [Allen, Raelene, Smallpox epidemic 1881, Dictionary of Sydney, 2008, http://dictionaryofsydney.org/entry/smallpox_epidemic_1881, viewed 06 Sep 2021].
Aerial view of Nth Head Q-Station – c.1930 (Image: Office of Environment & Heritage)
Bulwark against plagues, viruses, bacteria, etc. Over the decades the Q-Station at Manly has housed the victims of numerous diseases including smallpox, typhus, scarlet fever, measles and the bubonic plague, as well as victims of natural disasters. The Q-Station provided a refuge for returning WWI veterans suffering from TB and VD. At war’s end it served as the frontline defence against the lethal assault of the Spanish Flu.
(Photo: environment.
nsw.gov.au)Gradual obsolescence Post-WWII, as air travel gradually replaced passenger ships, the Q-Station’s role diminished in importance. In its final decades of operation the quarantine station was put to diverse use…housing the unvaccinated (eg, pregnant immigrants), accommodating Vietnamese orphans and as a temporary abode for women and children evacuated from Darwin after Cyclone Tracy decimated that city in 1974 [‘The plague, smallpox and Spanish flu: How Sydney quarantined sick travellers throughout history’, Sarah Swain, 9 News, 2020, www.9news.com.au; ’Q Station on Manly’s North Head echoes with history of pandemics past’, Kathy Sharpe, Mandurah Mail, 21-Jul-2021, www.mandurahmail.com.au].
The stairway (connecting the wharf with the housing) replaced the funicular in use during Q-Station period (Photo: Sydney Coast Walks)No longer a quarantine station, the surviving 65 heritage buildings are set against the beautiful natural bush land of the Sydney Harbour National Park. Today the old Q-station is converted into a hotel complex (104 rooms including nine self-contained cottages, managed by Accor) with all the tourist trappings, including sleepovers and nocturnal “Ghost and Paranormal tours”.
Pt Nepean Q-Station (Photo: Parks Vic)Footnote: Port Nepean, North Head’s counterpart In Melbourne, that city’s historic quarantine station can be found on the Heads of Port Phillip Bay. Port Nepean Quarantine Station can point to a similar eventful history to that of the North Head facility. Like it, the Melbourne Q-Station owes it’s existence to an infected immigrant ship…the arrival of the SS Ticonderoga in 1852 with 300 passengers stricken from disease, necessitating the ship’s quarantining at Port Nepean, which led to it’s establishment as a Quarantine Station (originally called “the Sanitary Station”). By the 20th century Port Nepean Q-Station had developed a number of innovative processing features including the memorably named “Foul Luggage Receiving Store”. The station’s Disinfectant and Boiler buildings also became models for other quarantine stations in Australia [‘Quarantine Station’, Parks Victoria, www.parks.vic.gov.au]. At one point animals were also quarantined at the location. By 1978 Port Nepean had ceased operating as a quarantine facility and was closed in 1980. Subsequent uses of the site and holdings include a military encampment and a temporary refuge for 400 Kosovar refugees fleeing the Bosnian War in the early 1990s.
➿➿➿➿➿➿➿ ➿➿➿➿➿➿➿
❅ “to prevent the introduction of the disease called the malignant Cholera and other infectious disease”
⌖ during that one-and-a-half centuries the Q-Station was the initial home in Sydney for an estimated 13,000 passengers
❧ and the need to build a third Q-Station cemetery to accommodate the rise in mortality
Carleton Estate, Summer Hill: History of a Mansion-cum-Special Needs Hospital
Summer Hill, seven kilometres west of the Sydney CBD, is a small suburb with a village feel to it. Since the 1970s it has seen an increase in the concentration of medium density apartment blocks, though many Federation-era houses have been retained. One of the largest heritage properties, 46–56 Liverpool Road, a historic mansion converted into an exclusive estate, represents one of the suburb’s most interesting back stories.
In 2014 this former grand residence-cum-hospital underwent redevelopment as the Carleton Estate, the mansion, stables and grounds, were converted into 78 individual apartments located in four buildings. The gated estate offered residents a communal garden (and the option of garden plots to grow vegetables), billiards room, swimming pool, gymnasium and parklands.
What interests us though is the one hundred and thirty years preceding the creation of Carleton Estate. In 1879 Summer Hill got its own railway station on the main suburban line, prompting an influx of new residents to the suburb✱. One of these was Charles Carleton Skarratt, a prominent local hotelier (Royal Hotel, Sydney) with diverse business interests in transport, mining, insurance and a brewery. After the land here (part of the Underwood Estate) was subdivided, Skarratt amalgamated nine of the suburban lots and built the original mansion (1884) on this 12,000 sq m block on the corner of Liverpool and Gower Streets (RPA Heritage News , Vol III, Issue III (Oct 2012).
Prior to Skarratt acquiring the property it was part of the old Ashfield Racecourse, and going right back to origins this was part of Cadigal (Eora) land before 1788. The first white owner was ex-convict and jailor Henry Kable who was the recipient of early land grants (1794, 1804). Kable’s Farm was located on this property. Kable, like Skarratt, had diverse interests, merchant trading, other land holdings, a hotel, etc and was at one stage in partnership with James Underwood, an early owner of the Summer Hill estate.
CC Skarratt
After Skarratt’s death in 1900 ownership of the Victorian Italianate mansion and grounds passed from the family to leading Sydney surgeon Henry Hinder. Just after the Great War it was purchased by the Benevolent Society of NSW as the new site for its Renwick Hospital, to replace the old premises in Thomas Street, Ultimo. Officially opened in 1921 as a “lying-in hospital and a hospital for children whose parents could not afford to pay for their medical care” (‘Renwick Hospital for Infants, Summer Hill, 1921 – 1965’, https://www.findandconnect.gov.au/guide/nsw). Patient care centred round the main building and an auxiliary building in nearby Grosvenor Crescent (“Queen’s College”). Two more treatment buildings were added to the complex in 1928 and 1930. By 1937, it was reported in the Sydney Morning Herald, the hospital at Summer Hill had treated as many as 20,000 children (‘New Block at Renwick Hospital for Children, SMH, 24-June-1937).
In 1964 the state government bought the hospital from the Benevolent Society…from 1965 it was renamed the Grosvenor Hospital. It had a dual function – as an in-patients facility for children, and as an out-patients facility which “provided for the diagnosis and assessment of mentally retarded persons of all ages” (‘Find and Connect’).
There were sweeping changes to the institutional approach to the mentally ill in NSW following the Richmond Report and subsequent Mental Health Act in 1983. The new emphasis was on downsizing to small community resident units. The Summer Hill hospital was streamlined with a progressive reduction over the following years in the number of patient admitted. Renamed the Grosvenor Centre in 1985, the facility’s stated mission was the treatment of children with a “developmental disability of mind” (www.records.nsw.gov.au).
The NSW government was committed to a policy of deinstitutionalisation by 2010 and the writing was on the board for the Grosvenor Centre. From the late 1980s to the early 2000s responsibility for the Centre was shuffled from one government department to another – Health to Community Services to Ageing, The coup de grâce came in 2009…disregarding appeals by parents of the Centre’s 20 remaining child residents for a “stay of execution“, the government transferred the residents to purpose-built houses and the institution was closed (‘Find and Connect’). The path was now clear for redevelopment of the post-hospital space and the eventual creation of a gated community in the Carleton Estate.
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✱ the three decades from 1880-1910 saw the Summer Hill populace take on more of an upper class character with a stream of professionals especially from the fields of banking and finance moving to the suburb (‘Summer Hill’, Wikipedia)
Coronavirus 2.0: Déja Vu Europe – Post-Summer Fallout, Relaxing of Controls and Self-Control, Emerging New Hotspots
Late September, COVID-19 has reached the inevitable, undesired milestone of the one millionth death worldwide from the disease. With the summer holidays behind them, Europeans on a trajectory to winter are facing the backlash of a resurgence of the coronavirus. Many countries in Europe are already in the grip of what is to all intents and purposes the second wave of the 2020 pandemic. In early September infection rates in Europe as a whole passed that of the season benchmark, the USA [‘Europe overtakes U.S. as COVID-19 hotspot as infections surge’, (Thomas Mulier & Bloomberg), Fortune, 10-Sep-2020, www.fortune.com].
Pop-up statue honouring Madrid health care workers (Photo: Getty Images)
The familiar patterns are there and yet inconsistencies exist from country to country. Several countries such as Montenegro❋, North Macedonia, Albania, the Czech Republic and Bulgaria are seeing higher case numbers now than they experienced early on in the outbreak. This shouldn’t be altogether surprising as one clear explanation for such a jump simply points to the increased levels of testing now being conducted. [‘Coronavirus second wave: Which countries in Europe are experiencing a fresh spike in COVID-19 cases?’, Euronews, 29-Sep-2020, www.euronews.com].
Daily case numbers in Europe and the UK are spiking again in cities with high urban density—especially Madrid, Paris, Marseille, Brussels, Amsterdam and The Hague—leading the way◰ [Netherlands among Western Europe’s biggest Covid hot spots’, (Jasper Bunskoek), NL Times, 28-Sep-2020, www.nltimes.nl].
Paris Central (Photo: AP: Kamil Zihnioglu)
Authorities have put the recent surge down to a general relaxation over summer of measures to curb infection. Workers returning to work in many European cities after the break are suspected of dropping their guard against the pandemic. Health officials have also pinpointed young people being a significant factor in flouting the rules (noting the existence of a recorded spike in new European cases for those aged 25 to 49)[‘Coronavirus: How it all went wrong (again) in Europe as 2nd wave grips continent’, (CNN) (via 9 News), 30-Sep-2020, www.nine.com.au].
The current upward trend of infections has placed governments in a dilemma. To try to rein in the burgeoning case numbers, the unwelcome prospect facing them is the need to reintroduce unpopular restrictions on communities and gatherings. In this light one thing governments are desperate to avoid at all costs is to go back to a national (or even sectional) lockdown scenario and expose their country to a redux of the crippling effects on the economy. In Madrid the Castilian authorities have already relented and opted to introduce selective lockdowns in certain urban districts [‘Europe’s coronavirus hot spot Spain to introduce selective lockdowns in Madrid’, Daily Sabah, 16-Sep-2020, www.dailysabah.com].
On the positive side mortality rates from COVID-19 being recorded now in Europe are a fraction of the death tolls of six months ago, weekly averages in September are around 13% of the peaks recorded during April (CNN/Johns Hopkins University). Having long ago parked the idea of eradication until the emergence of an effective vaccine, governments and health authorities plumped for suppression…a reality check in this “second wave” is an understanding of just how difficult it is to keep a lid on community outbreaks, let alone stamp it out entirely (Mulier/Bloomberg).
Odessa (freepik.com)
Endnote: Odessa – beautiful one minute … hot spot the next
As summer was ushered in at this much-in-demand Ukrainian resort spot on the Black Sea, people flocked to the sanatoriums and beaches. Similarly, nightclubs and restaurants in the city were packed with vacationers. The folly of flagrantly disregarding social distancing and mask-wearing guidelines resulted in an entirely foreseeable outcome – over 12,000 virus cases erupting in the city, ⅔ of which are tourists and visitors, some of these compounding the predicament by then carrying the virus back with them to their home cities and towns [‘In Ukraine’s Odessa, summer crowds ditched their masks. It’s now a hot spot in Europe’s “second wave”’, (Natalie Gryvnyak and Robyn Dixon), Washington Post, 28-Sep-2020, www.washingtonpost.com].
𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪𝄪
❋ Montenegro catapulted to the top of hotspots on the continent with 305.4 cases per 100,000 people infected in the week of 14-20 September [‘Coronavirus: Where are Europe’s infection hotspots?’, Sky News, 24-Sep-2020, www.news.sky.com]
◰ right through this month France and Spain have vied with each other for the ‘gong’ of worst-performing country in Europe for virus hot spots. Italy conversely is one country that has managed to buck this trend, so far resisting the pandemic’s resurgence – attributed to a more concerted adherence to government health guidelines this time [‘As Covid-19 Fatigue Fuels Infections in Europe, Italy Resists Second Wave’, (Eric Sylvers & Margherita Stancati), Wall Street Journal, 22-Sep-2020, www.wsj.com]
International Conference on the Great Manchurian Plague: A Pioneering Blueprint for Public Health Advances and Safeguards
Once the authorities in Manchuria had secured a firm handle on the plague outbreak in Heilongjiang, Kirin and Fengtian provinces by February 1911, little time was wasted calling for a conference of international medical specialists to enquire into all aspects of the epidemic and promote the advancement of future disease control. Scientists including disease specialists from many countries were invited to attend the location chosen for the conference, Mukden (Shenyang), which was one of the cities in North-East China hardest hit by the pneumonic epidemic.
Despite the pressingly urgent need to canvas expert international input into the dire health catastrophe, China must have had some reservations about what it was doing. Both Russia and Japan with undisguised Manchurian ambitions already held firm footholds in N.E. China (control over railway lines, ports, territorial concessions, etc), plus other Western powers controlled Chinese treaty ports further south. But with no politicians taking part in the conference and all attendees pledging that it’s focus was to be on scientific investigation and not about imposing any further external controls on China, the central government pushed on with it [‘In 1911, another epidemic swept through China. That time, the world came together’, (Paul French), CNN, 19-Apr-2020, www.cnn.com]. Dr Wu Lien-teh, the “plague fighter-general” of Harbin, was appointed conference chairperson. There were a few “nationalistic frictions” with the Japanese mainly resulting from some anti-Chinese remarks injudiciously made by the Japanese delegate, Professor Kitasato, before leaving Tokyo for the conference, but this did not impede the cohesion of the conference [Eli Chernin (1989). “Richard Pearson Strong and the Manchurian Epidemic of Pneumonic Plague, 1910—1911” (PDF). Journal of the History of Medicine and Allied Sciences. 44(3): 296–319. doi:101093/jhmas/44.3.296. PMID 2671146].
🔻 Safety precautions at Harbin plague site
A congress of international disease experts The International Plague Conference (IPC) was a ground-breaking series of ‘firsts’, the first international scientific symposium held in China, the first time in modern history of a multi-nation approach focusing on disease control. The conference also anticipated the purpose of later world bodies dedicated to international health maintenance, the League of Nations’ Health Organisation (LNHO), established in 1923, and it’s successor, the UN’s World Health Organisation (WHO), created after the Second World War.
Scientists from ten countries joined host China at the Plague Conference in the repurposed Shao Ho Yien palace – the US, UK, France, Russia, Japan, Italy, Germany, Austro-Hungary, Netherlands and Mexico, an indication of how seriously the international medical community took the Manchurian outbreak and its implications. The delegates were drawn from several relevant and related fields including epidemiologists, virologists, bacteriologists, tropical medicine specialists and illness consultants.
🔻 Contemporary coverage of the conference in ‘The Lancet’
The conference, getting into the “nitty-gritty’ High on the conference’s agenda was the question of aetiology, what were the Great Manchurian Plague’s causal factors? American delegate Richard P Strong, who arrived prior to the conference, undertook pathological experimentation which verified the infectious role played by tarbagan marmots in the plague (which he published in the Philippine Journal of Science, 1912). The experts had to sift through a raft of unhelpful faux-scientific beliefs and assumptions to get to “the scientific root of the bacteria”, again underlining the IPC’s emphasis on science and medicine. Containment was another key issue at the conference. The discussion was around what worked best in the plague? Measures like ‘blanket’ quarantines, travel bans, face masks and ad hoc plague hospitals (swiftly assembled to isolate the infected from the healthy), all got a big tick…an endorsement of Dr Wu Lien-teh’s positive measures in the war against the pneumonic epidemic, deemed by the conference delegates as essential tools in the fight against future outbreaks and waves of plague (French).
🔺 The admirable Dr Wu
Seeds of a nationwide public health service One of the conference’s finest and far-reaching achievements was to establish the Manchurian Plague Prevention Service (under the helm of Dr Wu). The MPPS and Wu identified medical education as the “holy grail”, the service’s role was to disseminate materials to the public, promote the efficacy of sanitary conditions and health in the community, and overall playing a leading role in adopting Western medicine (Xīyào) and methods of disease control in China. MPPS provided the model for a future Chinese national health service (French).
The follow-up to the three-and-a-half week International Plague Conference put Chinese medicine on the path to modernisation. Many of the country’s medical advances began here …. the IPC laid down a blueprint for handling future plagues which included the use of autopsies, instructional dissection and cremation, all of which became institutionalised practice afterwards (Chernin).
Medicine and health before politics
The Mukden IPC in April 1911, conducted in an atmosphere free of politicising, demonstrated the cooperative humanitarian efforts of a group of medical professionals…when left to it by the politicians, they showed single-minded unity of purpose, what could be achieved, collectively and internationally, to counter the danger of a disease with immediate and future global ramifications for public health. I need not emphasise the stark contrast with the management of the world’s current pandemic in which some of the major powers, distracted from the only really important priority, are happy to engage in a ”political blame game” over the coronavirus‘ origins, instead of co-operating with each other to meet a pernicious and deadly health risk to the planet head-on and in unison.
Endnote: Lessening future shock The gains in medicine and public health protection coming out of the conference were soon put to use in China. Disease re-emerged in the 1919 malaria epidemic and the 1921 plague (again in Harbin) which was to test China’s embryonic national quarantine system. Dr Wu again took charge to guide China through these medical crises. The improvements in public health since 1911, it is estimated, reduced casualties in the second outbreak of pneumatic plague by four-fifths [‘Portraits of a plague: the 19th-century pandemic that killed 12 million people’, History Extra, 21-Jul-2015, www.historyextra.com].
Manchuria 1910-1911: North-East China’s End of Empire Frontier Plague
In 1910 the 265 year-old Qing Dynasty in China was fasting approaching its denouement. The following year it would be deposed and replaced with a republic. Over the years leading up to this point, Imperial China had been in long drawn-out decline, suffering a series of reversals – a disastrous defeat in the (1st) Sino-Japanese War (1894-95) and ensuing loss of territorial sovereignty in Manchuria; the crushing of the Peking Boxer Rebellion in 1900. In 1907 China had been beset by the latest (and one of the worst) of a series of famines (“Third Plague Pandemic”), losing an estimated 25 million of it’s population. And in late 1910, Manchuria in the midst of a tense political situation—China having to share the region with competing Russian and Japanese aspirations—a plague broke out.
The plague was first noticed in the Inner Mongolian town of Manzhouli on the Chinese-Russian border, where Russian doctors began treating patients with fever and haemoptysis symptoms. Thus began the Great Manchurian Plague which eventually took up to 60,000 lives in less than six months – with a mortality rate very close to 100 per cent [William C Summers, The Great Manchurian Plague: The Geopolitics of an Epidemic Disease, (2012)].
Vector from the rodent family Because of a past pattern of bubonic plague in China, rats and fleas were initially suspected to be the source of human infection. 50,000 rats were examined but the results proved negative [CHERNIN, ELI. “Richard Pearson Strong and the Manchurian Epidemic of Pneumonic Plague, 1910–1911.” Journal of the History of Medicine and Allied Sciences, vol. 44, no. 3, 1989, pp. 296–319. JSTOR, www.jstor.org/stable/24633015. Accessed 5 May 2020]. The disease was eventually traced to the Siberian marmot (Marmota sibirica) or tarbagan, found in Inner Mongolia, eastern Siberia and Heilongjiang. Later research by Dr Wu (see below) and others established that the plague, like the present coronavirus, was pneumonic, transmitted animal to human by respiratory droplets, and not bubonic.
A roaring trade in fake mink The European fashion for mink and ermine furs can be ‘fingered’ for being at the bottom of the preconditions leading to the 1910 plague. Mink’s popularity as one of the most prized materials for clothing accessories made it’s cost prohibitive to all but the richest Europeans. Things changed when it was discovered that the fur of the marmot when dyed passed very convincingly for mink fur. After the pelt price for marmot fur soared from 12 cents to 72 cents a hide, hordes of Chinese hunters from the central provinces swarmed into the region to join the lucrative hunt for the now in-demand creature. Mongol and Buryat hunters, long experienced in marmot-hunting knew how to select only tarbagan marmots which were not diseased for culling. The inexperienced Chinese trappers however didn’t practice safe hunting methods, failing to discern the difference, they hunted marmots indiscriminately. Thus, the infection was passed on to humans from the pelts of the disease-ridden rodents (Chernin; ‘Manchurian Plague 1910-11’, (Summers; Iain Meiklejohn), Disasterhistory.org, (April 2020), www.disasterhistory.org].
Spreading the plague by rail
Manchuria at the time was equipped with an extensive network of railroads, thanks to the vested interests of the Russians and the Japanese which the Qing Dynasty had, reluctantly, conceded. Russia controlled the Trans-Siberian Railway (TSR) and the China Eastern Railway (CER), Japan controlled the Southern Manchurian Railway (SMR)⌖. The time of the year was an important factor. From November/December, as the weather turned arctic-like, the Chinese hunters and agricultural migrant workers started to return to their home regions. The foremost consideration was to get back before the Chinese New Year. The hunters and the labourers, huddled together infecting each other in the bitter cold of the train carriages, carried the plague along the railway lines. In a short time the plague travelled from its origin point to large cities on the Dongbei line, Harbin, including the central district of Fuchiatien (Fujiandian), Changchun and Mukden (today Shenyang). Compare this to what happened with the coronavirus outbreak which spread from Wuhan to other Chinese cities by airplane.
In the disease’s wake mortality proceeded at an alarming rate, Harbin in the far north was the initial epicentre. In November 5,272 died in the city. It then spread along the tracks to cities further south, Mukden recorded a death toll of 2,571 by January 1911, and Changchun was losing over 200 a day to the plague (Meiklejohn). The plague was sustained and promoted by the prevailing conditions it encountered – dense population, high human mobility and poor hygiene environments (Cornelia Knab, cited in Meiklejohn). Eventually the plague reached Peking and as far as central China〲.
Enter Dr Wu The authorities, in desperation, turned to a migrant, Penang-born doctor working at the time in Tianjin, Wu Lien-Teh. Cambridge-educated Wu took immediate charge of the medical emergency in Harbin. Enforcing a strict quarantine in the city, Wu put in place a series of comprehensive measures to contain the disease, including:
● converting railway freight cars to makeshift quarantine centres and turning a bathing establishment into a plague hospital
● establishing “sanitary zones” in the city
● closing down the railways in Manchuria, impose blockades, border controls and so stop infected people from travelling (Wu needed to secure the co-operation of the Russian and Japanese rail companies to achieve this)
● burning the lodgings of those infected
● monitoring the population by checking households for new cases
● advocating the wearing of face masks (Wu had more effective masks with extra gauze padding made)
● carrying out mass cremations of the infected dead (considered a sacrilege in Chinese society, Wu had to petition the emperor for permission)✪
● undertaking post-mortem examinations of the victims (again, a Chinese taboo that Wu had to overcome objections to)✲
Temperature check, Fuchiatien ⟱ (www.Flickr.com)
With no vaccine for pneumatic plague available, Wu’s quarantine measures involved isolating people for a five to ten day period, if no symptoms present, they are released with a wire band attached to their wrist signifying they have been cleared of the disease [‘In 1911, another epidemic swept through China. That time, the world came together’, (Paul French), CNN, 19-Apr-2020, www.cnn.com; ‘The Chinese Doctor Who Beat the Plague’, (Jeremiah Jenne), China Channel, 20-Dec-2018, www.chinachannel.org].
⟱ Old plague hospital, Harbin. When the epidemic was suppressed, the hospital was burnt down to eliminate any residual risk of contamination
(Photo: www.avezink.livejournal.com)
Keeping the ports plague-free The concerted efforts of Japanese, Russian and Chinese managed to prevent the epidemic from reaching the eastern seaboard. Several towns close to the major port city Dalian reported cases, but Dalian itself (by this time under Japanese control, known as Dairen), initially undertook mass inspections of train and ship passengers, before closing the South Manchurian line altogether. With such strictures in place Dalian was wholly spared from the plague (French). The Russians were able to similarly stem the outbreak’s movement along the CER rail line and stop it from reaching Russia’s vital Pacific port, Vladivostok.
Racing against catastrophe What added even more pressure to Wu’s task in trying to control the plague was that he was working against a tight deadline. The plague needed to be contained before 30th January which was Chinese New Year’s Eve. Thousands of migrant workers would be returning home to their families for this most important annual celebrations in China via the Manchurian railway network, which Wu knew would make it almost impossible to rein in the outbreak. The conscientious and thorough measures implemented in northern China made it possible for Wu to be able to declare the epidemic virtually suppressed by the end of January. Decisive action in N.E. China also prevented the plague from spreading to near-by (Outer) Mongolia and Russian Siberia. By March all the region’s shops, factories and schools were reopened and the only lingering infection was confined within the specially established plague hospitals (Meiklejohn).
Endnote: Dr Wu Many Chinese medical personnel including epidemiologists and other physicians contributed to preventing the plague spreading throughout China, and to suppressing it all together within a short period. But if anyone should be called a hero of the Great Manchurian Plague of 1910-11, certainly that mantle should land on Dr Wu Lien-Teh, whose decisive leadership, organisation and enterprise saved China’s North-East provinces from a much higher casualty toll and from the regional plague developing into a nationwide epidemic.
꧙꧙꧙꧙꧙꧙꧙꧙꧙꧙꧙꧙꧙꧙꧙꧙꧙꧙꧙꧙꧙꧙꧙꧙
⌖ China for it’s part controlled the Imperial Railways of North China, which linked Peking with Mukden
〲 one case was recorded in Shanghai, 2,000 miles away
✪ thousands of bodies were still above ground in coffins because the relatives were waiting for the spring thaw to bury the dead…ideal incubators for the plague bacillus to magnify the contamination [‘Dr Wu Lien-Teh, plague fighter and father of the Chinese public health system’, (Zhongliang Ma & Yanli Li), www.ncbi.nim.nih.gov; Jenne)
✲ Wu performed the first autopsy in Harbin, identifying the disease as the bacterium Yersinia pestis of the pneumonic variant [‘Wu Lieh-Teh: Malaysia’s little-known plague virus fighter’, Star Online, 11-Feb-2020, www.msn.com]