[Photo story] The Manchurian plague outbreak and the Malayan doctor Wu Lien-teh

The current coronavirus outbreak is not the first epidemic in China. Photo collector and Taiwanese writer Hsu Chung-mao, looks at a plague outbreak in Manchuria over a century ago and the role played by a Malaya-born doctor and Nobel Prize nominee.
The plague outbreak in late 1910 spread with the use of railways. There were many cases and deaths in northeast China, and the Qing dynasty government pumped in plenty of medical resources. In this photo, medical staff gather in front of an inn. At the time, there were many confirmed and suspected cases, and there was a serious lack of medical spaces, leading to the use of inns as medical facilities.
The plague outbreak in late 1910 spread with the use of railways. There were many cases and deaths in northeast China, and the Qing dynasty government pumped in plenty of medical resources. In this photo, medical staff gather in front of an inn. At the time, there were many confirmed and suspected cases, and there was a serious lack of medical spaces, leading to the use of inns as medical facilities.

(All photos courtesy of Hsu Chung-mao unless otherwise stated.)

In late 1910, China’s region of Manchuria faced a plague outbreak of an unprecedented scale. The method of disease transmission was seen as unusual at that time: apart from rats carrying the Yersinia pestis bacterium, it also resided in human lungs. Healthy people were infected through droplets from those who were sick. Usually, if one person in a household became ill, the other family members would also get infected. The plague raged for over a month before it was identified, and was only brought under control after six months. Wu Lien-teh (Goh Lean Tuck/Ng Leen Tuck, 伍连德), a doctor from Penang, Malaya, played a key role.

The earliest cases were two Chinese miners who returned to China from Russia. Their symptoms included fever, coughing up blood, and skin lesions. They died within a few days. Soon, nearby residents also showed symptoms such as headaches, cough, and fatigue. They soon started coughing up blood and experiencing symptoms of pneumonia — just like the miners — and died within days. The illness was not initially identified as plague, and because the early symptoms were similar to the common cold, it was not given due attention. The plague quickly spread through Manchuria with the movement of people.

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Malaya-born Wu Lien-teh was English-educated and deeply influenced by British culture. For his work on the pneumonic plague, he became the first Chinese to be nominated for a Nobel Prize.

About a month after the outbreak, Dr Wu Lien-teh was put in charge of the anti-plague efforts in Manchuria. The Malaya-born, Europe-educated, Cambridge medical doctorate holder quickly headed to Harbin to investigate. It was Christmas Eve when Dr Wu and his assistants arrived, over a month after the plague first broke out. With the Trans-Manchurian Railway and the South Manchuria Railway bringing people across the region, it had spread rapidly throughout Manchuria. The situation was critical.

At first, it was unclear what sort of infectious agent was causing the plague. So, to unveil the face of the epidemic, Dr Wu took blood and cell samples from the deceased, and with a powerful microscope, finally found the plague bacterium.

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Dr Wu Lien-teh and a colleague carrying out fieldwork. To understand the effect of diseases on the body, they had to carry out live experiments, while being careful not to get infected themselves.
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Bodies lie in the snow. (Internet)
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Healthcare workers with patients. (Internet)

At the time, measures were taken to kill rats that were identified as the medium of transmission, but the plague showed no signs of stopping. Dr Wu made careful observations and analysed plague cases. He found out that unlike previous outbreaks, the current plague could be transmitted through the air. He immediately got the imperial court to impose a lockdown on Harbin, and laid down measures to cut off the channels of transmission. The homes of the infected were sterilised with sulphur and carbolic acid, the sick were quarantined in specialised facilities, while doctors and government staff in the frontline were ordered to wear masks. Because the bacteria remained in the corpses, these were cremated to eliminate all remaining sources of the infectious agent.

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On 19 February 1911, French publication L’Illustration carried a report on the plague, titled The Plague in Manchuria. The plague in northeast China from late 1910 to early 1911 killed over 60,000 people, even wiping out whole villages and towns. This watercolour shows a harrowing scene of empty streets and smoke from burning corpses, with hungry dogs eating uncollected bodies.
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A report titled Street Scene in Harbin: Arrest of a Chinese Infected by the Plague, in L'Illustration, 25 March 1911. To stop the spread of the plague, medical teams from China, Japan, and Russia took to the streets to carry out inspections, disinfect the place, and administer vaccines. The photo shows a Russian doctor pointing a sword at a Chinese man showing signs of a fever on a street in Harbin.

The measures were successful and the outbreak was contained after a six-month battle. Dr Wu gained much credit and was highly respected for his work. If he had not found out that the bacteria was airborne and taken appropriate actions, the epidemic would have affected more people over a wider area, and a longer period.

After the plague, Dr Wu continued to work in China, actively driving the development of medical studies there. Besides setting up the North Manchurian Plague Prevention Service in Harbin and its affiliated hospital, in 1915, he and other medical practitioners established the Chinese Medical Association and the National Medical Journal of China, and advocated setting up the Peking Central Hospital (now the Peking University People’s Hospital).

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Dr Wu Lien-teh's autobiography, first published in 1959. (SPH)
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A book co-written by Wong Chi-min (王吉民) and Dr Wu Lien-teh, first published in 1932. (SPH)

Subsequently, he led several teams in efforts against epidemics: plague in Suiyuan in 1917, cholera in Harbin in 1919, plague in northeastern China in 1920, and cholera in Shanghai in 1932. In 1935, Dr Wu became the first Chinese to be nominated for the Nobel Prize in Medicine for his work on the pneumonic plague. After his passing, Harbin Medical University (formerly Harbin Special Medical School, founded by Dr Wu) held several memorial sessions for him. A hall in the school was named after him, bronze statues were erected, and in 2008, a commemorative museum was set up.

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Dr Wu Lien-teh in Ipoh. (SPH)

Digital colouring: Chen Yijing, Manuel Fuentes

Related reading: Sun Yat-sen and the Xinhai Revolution: A pictorial journeyA bygone era: Chinese New Year celebrations during the time of the Republic of China