A Plague Tale from China: Part 2. Trial By Death: Father of the N95 Masks 伍连德

A month ago, even at most, there was only 1 death per day. A month later, it was 100 per day. The prayers to God and Lord Buddha did not help. The invisible killer spared neither kins nor enemies, and slaughtered families of men, women, and children. It cut down the Japanese, the Russians, blondes, redheads, and will cut down any stranger it yet encounters. The whole of the north was on the brink of collapse. And they only have a stranger on their behalf in this unequal fight.

He would have to perform miracles while in the -22ºF (-30ºC) temperatures of northeastern China.  More than 95 per cent of infected patients had died and nearly all died within 24- 48 hours. To fight death itself, all of northern China's fate was placed on the shoulders of a foriegner- a 31 year old Chinese who cannot even speak proper Chinese. All he had with him was a briefcase- sized medical bag and a Bakers Microscope. The same medical bag, and the microscope he had from back when he attended Cambridge as a student. His only shadow, a 20 year old assistant and translator. This is who the imperial court in Beijing trusted, and placed the mantle of responsibility upon, this is all China got against the winding clock, this vile disease, and grim Death itself.

1910 French Edition of Le Petit Journal, "The Manchurian Plague"

Music: Last Rites

A WORLD ON THE BRINK

On the night of Dec. 18, 1910, Dr. Wu Liande - (traditionally spelled as "Wu Lien-teh") was just sitting down to have dinner in Tianjin (near Beijing) when he received a telegram from China's Ministry of Foreign Affairs. It was a dire alert and a summons- written from his personal friend Councillor Alfred Sze. The note contained a dreadful warning: a fatal and rapidly spreading plague had raced across all of the northern provinces and no one else in Qing China has a chance of sending the beast into remission. Wu immediately left his family and rode the train for 3 days northward, with just a Bakers microscope, his old medical bag and the company of his assistant/ translator. When he descended on the train platform on Christmas Eve of 1910 the whole north was in a state of pandemonium.

Wu would later wrote in his memoirs: "As [we] entered the town, [we] could sense an air of tenseness and foreboding among the inhabitants,""Everywhere there were guarded talks and whispers of fever, blood-spitting and sudden deaths, of corpses abandoned by roadsides and open fields." This is also reflected in the memoirs of his friend and superior: Alfred Sze personally recorded in his memoirs that Harbin by this point was suffering hundreds of deaths daily. The whole of northern China was in lock down but it was already too late, all along the Russian railroad, the major towns along the tracks have been stricken by the plague.

THE RAPID KILLER-  A RACE AGAINST DEATH ITSELF

"Emergence of Plague in Harbin" Print from a Russia newspaper depicting the 

plague in Harbin. 

The first case of fatality was recorded in November, on the outskirts of the giant city of Harbin, but in just over 20 days, the plague had spread throughout the three of the most important provinces in the north. By Christmas of 1910, the death toll had reached tens of thousands. Many families were killed by the disease carried by their own infected family members. Some villages soon became "ghost villages". Of the 30 qualified doctor in Harbin alone, 17 had already died from the plague.

North in Danger. A plague on the move: in just over 20 days, the plague had spread throughout the three most important provinces in the north. Despite nearly hundreds of deaths in many of the major cities and thousands of deaths across the north, In January 1911 the situation worsened as the disease picked up speed. Soon after Harbin was stricken, the plagued moved south. 1st, the large city of Changchun fell in early January, then, Shenyang fell in mid January. All along the railroads, the plague was picking up speed and barrelled southward like an avalanche toward Beijing and the heart of China. Tens, even hundreds of millions of lives were at stake.

Wu immediately began coordinating the relief efforts. After introducing himself as the chief medical officer in charge of north eastern China, he took command of the assistants provided to him. After establishing his lab, he began conducting a private investigation as to the nature of the disease.

The 31 year old Dr. Wu Liande (Center Right) -marked by his short statue, his army uniform, and his spectacled gaze was placed in charge of an international team of Qing's best doctors sent to Harbin to combat the plague. Here, people (and hats) of many nations gathered to combat the rampant disease that was killing throughout northeastern China.

At the time many foreign doctors who observed the crisis thought of the disease as a classic outbreak of the Bubonic Plague. However Wu though that there might be something more than the traditional plague- mainly because this disease is spreading much faster than it would normally suggest. Especially the initial mortality rate that more than 95 per cent of infected patients died. He needed 3 points to effectively tackle the plague. 1. Diagnosis of the disease and unravel its model of spread, 2. Gain the confidence of the Qing court and requisition the appropriate resources to apply to the plague stricken area. 3. Alleviate the stricken population, isolate and reduce infections- leading to its eradication.

ONE. INVESTIGATION- DIAGNOSIS

Music: Buried Secrets- Whispers

Wu's thoughts lingered on the 1st 2 fatalities of the plague, the two fur trappers who died in a traveler's lodge on the outskirts of Harbin. The 2 deaths from Fujia Dian 傅家甸 spent much of their time as hunters- more specifically marmot hunters, and it is their profession that intrigued Wu. As someone who had studied the spread of tropical diseases, Wu's education made him want to examine deeper as to the titillating connections between the hunters and the current pandemic. It's vital to point out that Wu's deductions are critical to his operations, as his reports back to Beijing will greatly affect the scale of Beijing's support and supplies to Wu's operations.

More than 95 per cent of infected patients died. At the time, people believed that it was the Bubonic Plague and the disease is fatal upon contact. Many people barricaded themselves within their homes. Superstition and rumors were rife and people believed that opium, the sound of fire-crackers, or gunpowder could ward off the plague. The interpretations of the international doctors vary, there are theories that the disease was spread through paper money, others suspected it was caused by contaminated water. 

HOW IT SPREADS:

Soon, another piece of the puzzle came to light that reinforced Wu's suspicions. In digging through the backlog of information related to the 1st days of the outbreak it was discovered that in late October about a week before the death of the 2 trappers near Harbin, another 2 trappers had died in a far western town on the Chinese- Russian boarder. The boarder town was called Manzhouli, and before these 2 trappers died, they also violently coughed up blood and had a purpling death- hue. Predictably, that town was also stricken by the plague.

Bubonic Plague was transmitted from rat borne- flea bites, but seeing the extremely rapid spread of the disease Wu had a hunch something was different. Its not waterborne because unlike diseases like cholera, it was not local and rooted to one contaminated water source like a pool, reservoir or a pond- instead its something very rapidly. In examining the profiles of the plague victims he found very little that connected them to each other. The old, the young, Chinese, Russians etc. Their lifestyles were of different stripes and there's very little overlap in the same activities. But as Wu retraced back toward patient zero, a similar patter began to emerge among the 1st victims.

NARROWING OF THE SUSPECTS

At this time, Dongbei- the Northeastern region was full of migrant workers. A growing demand in the West for the pelt of marmots and wild rodents bloomed in Manchuria and Siberia, as the thick fur could pass for sable when suitably dyed. This flourishing fur trade brought in a huge number of emigrant hunters from the southern province of Shandong, by September 1910, there were about 10,000 hunters in the forests of Manchuria. The rapid industrialization of the region through aggressive exploitation of mines and minerals also led to a boom of prospecting craze similar to the Old West of the United States. So...how does this all connect together? On the 3rd day after Wu's arrival, the world unveiled Wu an opportunity that he did not pass.

Dongbei- the Northeastern region  saw a massive boom of migrant workers at the beginning of the 20th century. Because the Russians and Japanese had set up many heavy industry and businesses, many impoverished migrants flooded the north seeking opportunities. Though some were permanent settlers who came with their families. Many more were migrant workers eager to take advantage of the mining and hunting operations. They came as railroad workers, labors, and prospectors. After a year of business many would return to their homes in other part of China to deliver their gains among their family members.

Music: The Water Dragon

A SACRILEGE

On the 3rd day of Wu's arrival, a Japanese woman, wife to one of the local Chinese men in Harbin died from the plague.  After confirming that the woman had indeed died from the Manchurian plague, Wu requested that an autopsy to be done on the body. It should be pointed out that in 1910, China was still very much entrapped within its very conservative Confucian culture (almost all people still wore the long pigtail ques) and China was still in its last imperial dynasty. To compound this fact- China simply did not have had a medical dissection before, the idea was (and truly was) utterly foreign to most people. So the death- taboo associated with what was seen as desecration of a corpse was almost a sacrilege. 

Regardless, Wu did not let the old taboos and old traditions hinder his efforts. Two things stuck out in his mind, one is that autopsy is very common in the western traditions, and is critical to uncover the source of many bodily problems. Another is that he must have something conclusive to report back to the international medical community and the court in Beijing. Without information they would be left in a standstill while the plague engulfed China. But despite these rationalizations. Wu and the other doctors still chose to conduct the autopsy in total secrecy at night. And thus, the 1st medical dissection/ autopsy in modern China was performed that night. 

Europe long since the Renaissance was familiar with human anatomy, even Japan had almost a full century of head start from studying the anatomical information from Rangaku (Netherlands)- and after opening up their country conducted their own truly modern dissection in the 1870s. Wu- even as the 1st Chinese doctor to graduate in the West, 1st to be among the medical titans of the 1st world, still needed to cover the gaps of centuries. During the autopsy, Wu found his answer which confirmed his long suspicions. After extracting the blood from the lung, the heart, and examine them under his Bakers microscope, Wu  saw oval shaped microbes (bacillus) confirming that the disease was a form of Bubonic Plague- but a unique one at that. In just 4 days since Wu's arrival, he had unravelled the disease.

Above: Dissection of a woman conducted in Japan, late 19th century. On the night of December 27, 1910, Wu, along with the rest of his doctors performed the first medical dissection in China.

However the discovery of this strain of the Plague also raised other questions. Since isolating sample of the Bubonic Plague Bacillus pestis in 1894, the consensus among the learned medical minds was that the Plague was mostly spread through rat-borne fleas. The accepted form of transmission was that sick rats would carry the fleas and when the flea bit the person he would become infected. But seeing the condition of the lung and the rapid rate in which this plague spread. Dr.Wu gave this plague a new name 肺鼠疫 Literally, "Pneumonic Plague." It was Black Death spreading as easily as a flu. He was more alone than ever, for no other doctor in the world had experience with this.

After multiple autopsies uncovered the deterioration of the patient's lungs and confirming that the disease was indeed a form of Bubonic Plauge (exemplified by its oval shaped bacillus) Dr. Wu came to the deeply troubled realization that the Black Death that once killed 1/3 of Europe is now airborne all around northern China. But how did this previously undiscovered strain explode out of no where???

Music: Bitter Steppes of the West

NATURE OF THE BEAST

Was it because of the rodents that the fur trappers were selling? The connection between the lifestyle of the 1st victims and the disease became closer in Wu's mind. Bubonic was rat- borne, and Wu suspected that something they encountered caused this Pneumonic Plague.

It was discovered that the fur hunters who died were not local northern men, but migrant from the south. The Mongolian Marmot or the Tarbagan Marmot were huge rodents and some grew to the height of a person's knees. They were a fixture in Mongolian fur trade. The local hunters were aware that healthy marmots roam open fields emitting a shrill cry, whereas sick marmots are mute and stay inside their burrows to die. However, many new hunters, anxious to collect enough pelts, dug out sick marmots from their burrows. 

The discovery that the Bubonic Plague is airborne and that it has extremely high mortality and spread rates was dangerously unnerving. There simply was no vaccines or cures for the Bubonic Plague and its mortality rate and its ability to kill almost instantly (24- 48 hours) was effectively a touch of death. Worse yet, Dr. Wu stood at ground zero of this maelstrom. Because of the complete NEW nature of this new plague. He has to think on his own feet, because the rest of the international community of doctors- just like him, have never encountered this kind of monster before. Wu lived in a time when antibiotics were not available, nor have had knowledge in setting up quarantine units, imposing travel bans, and convincing the Russian and Japanese authorities who ruled the north to shut railway services to Harbin.

A Horrifying discovery for Wu. A week after Wu's arrival there were so much dead bodies that many were left on the roadsides or on the outskirts of towns. Because the ice had made it nearly impossible to dig into the hardened earth, the piles of bodies soon became a grim and ever expanding monument to the plague in the north. Hundreds died daily in the big towns and cities. To compound Wu's situation, every breathing human was a fatal threat to the next person beside him. By Mid January, the great metropolis of Shenyang also fell to the plague with mounting daily deaths.

To add to Wu's troubles, many of his contemporary doctors completely rejected the notion that the Bubonic Plague could become airborne at all. Like a herald struck with curses, he was scrutinized by his colleagues. The existence and profiling of this brand new "Pneumonic Plague" was staunchly rejected by Dr. Hoffkine, the director of the Russian hospital and by a Frenchman, Dr. Gérald Mesny, they were among the respected cadre of doctors sent to Harbin by the Qing court as Wu's reinforcements. By all means they are his subordinates, however many flatly rejected his findings. If Wu hoped that due to his discover that his allied doctors would come to his aid, he was grievously mistaken. Instead - it became a pretext for them to try to strip him of his command. 

TWO: CONTAINMENT AT ALL COST

Although barely able to speak Chinese, through his translator Dr. Wu immediately ordered that transportation cease across the whole of the north. The long stretch of Russian railroad was stopped and all of the inns and lodges within the area immediately ordered into quarantine. He further stipulated that doctors across all major northern cities be held in reserve and they shouldn't expose themselves while the various properties of the plague are being figured out. With the approaching Lunar New Year celebrations, there was a strong risk that the Plague would race toward Beijing and the heartland of China. It must be stopped at all cost. (X)

Artwork by Chris Reed Tattoo 

Quarantine: Qing soldiers (distinguished by their prominent pigtail ques) stopping traders 

coming into the Great Walls. At the time, it was slowly approaching the extremely busy 

Chinese New Years. To ensure that the disease does not escape beyond the north

all travels between the major provinces in the north were restricted.

A REVOLUTIONARY MASK

Wu was faced with several key limitations, the inability to cure the disease, high mortality rate once infected, and the critical shortage of doctors and nurses. In recognizing very early on that there is no cure for the disease, that the disease kills within 24- 48 hours, the 2nd best option is prevention at all cost. Thus slowing the plague became his number 1 priority. The quarantine measures will slow the spread of the disease on a macro level, and the quarantine of inns and hotels will further slow down the spread on the local level. On a personal level, Wu introduced the face mask to prevent contamination. This was crucial, as in total, Wu only had some 50 medical students, doctors and assisting personnel combined.

Healthcare workers in “anti-plague masks” during the 1911 Manchurian plague

Having seen surgical masks used in the west before, Wu sought to improve this concept developing a hardier mask from gauze and cotton, which wrapped securely around one’s face and added several layers of cloth to filter inhalations. This new, strengthen mask allowed just enough oxygen to safely pass through to the wearer while drastically increasing the stoppage of unwanted airborne threats from entering through its filters.

The most ingenious part was that the mask was also a great design. It could be constructed by hand out of materials that were cheap and in ready supply. This allowed these masks to be almost universally worn by all. People were soon encouraged to wear these gauze-and-cotton masks. His invention was a breakthrough, but some doctors still doubted its efficacy.

Music: Valse de la Fermeture Définitive (Valse musette)

SUBVERTED - THE RESPECTED FRENCH DOCTOR

The figure that sought to strip Wu of his station was one of the medical heavyweights in China. His name was Doctor Gerald Mesny, a veteran French doctor who had long worked in the Qing army. He was Beiyang Imperial Medical College's head professor in Tianjin (city where Wu was also stationed) but unlike Wu, Mesny had long already made his name. A decade ago, he successfully defeated a small outbreak of Bubonic Plague at Tangshan in 1908 and saved Tianjin. This time, he heard the desperate call and volunteered to venture to Harbin to help with plague relieving efforts. 

Beaten, in the 1910s China was a beaten dragon. Having lost the Boxer Rebellion to the Eight Nations Alliance in 1901 and in the last 70 years lost at the hands of nearly all of its foreign invaders the Qing was in no position to argue with any of its foreign occupiers. In the wake of China's forced opening, many westerners came to China as prospectors or as specially hired experts.

Although he had spent decades in China, he was not content with having been assigned under a junior doctor who was barely a decade out of medical school. Most of all, Mesny utterly rejected the absurd notion that the plague could be airborne. He believes that the primary task is to eliminate rodents, which is a world apart from Wu Liande;s policies in concept. They frequently came to heated arguments about the causes of the plague. 

After having chafed under the inexperienced commanding doctor (one who in some respects- he could probably even beat in speaking Chinese) and having heard the wild suggestion of the possibility of a "Pneumonic Plague" he wrote to Beijing, arguing that Wu had wrongfully diagnosing the plague and that the whole effort was endangered by him foolishly heading in this new direction. He stated that Wu be should be removed and having himself replace Wu as the head doctor in the north. 

Clear contrasts, the French Doctor Gerald Mesny and Wu Lainde. Tall, authoritative, and with a decade of exceptional medical experience behind him, Mesny looked every part of a leader. He wore expensive mink fur coats and due to his position did not mince words. Wu by contrast was bookish, unassuming and diminutive. 

However, in a surprising move, the Qing swiftly rejected his petition. Frustrated, Mesny again wrote the the court in Beijing, this time with the full backing of the French Legation in China. The threat was very real, for at that time, nearly all of the major western nations who had a foothold in Qing China had already successfully beaten the Qing in the years prior. According to the historian Dr. Christos Lynteris,  “the French guy humiliates him . . . and in very racist terms saying, ‘What can we expect from a Chinaman?’ 

Realizing that there is no time to be dragged into this power struggle, and that hundreds of lives are lost daily, Wu tendered his resignation in an attempt to resolve the conflict. Again, surprisngly, the Qing government rebuffed Mesny (and the French Legation's) threats. 

Despite mounting pressures from the Russians, the Japanese, as well as many prominent empires the Qing government rejected Wu's resignation and relieved Mesny of his duty instead. The Councillor of Foriegn Affairs, Alfred Sze- who was a long time personal friend of Wu did not waver in his support and sent several seal- imprinted edicts confirming the Qing government's support of him as the supreme medical authority in the north. It was precisely at that moment of tension that something totally unexpected happened, Mesny became sick with fit of violent coughs. 

ALONE ALONE ALONE

On the afternoon of his suspension, Mesny had visited a nearby hospital to check on 4 patients. Mesny wore white overalls, a hat and a pair of rubber gloves, but because he had staunchly refused to wear Wu's mask during his visit, he was exposed to the disease. He then shopped in several department stores. On January 8th, the feverish Mesny was wracked with headache and cannot stop his violent coughs and became bed- ridden. After that, the telltale purple shade darkened his features. Mesny died on the 11th of January. Wu Liande had only been in the north for 18 days and it already was like an eternity. The death of the respected French doctor sent waves of fear in Harbin. The Russians closed the hotel where he had lived and burnt all his belongings. Wu’s initial diagnosis turned out to be correct and masks were soon extensively produced and adopted. Now- the burden of facing against the plague was Wu's alone to bear.  

Music: Anthem of a Tyrant

TRIAL BY DEATH

But he was only 1 doctor, at the head of no more than 50 doctors in total- in all of Harbin. A doctor who cannot speak his native language and only barely commanded the begrudging respect of his  international colleagues. He would have to perform miracles, millions of lives are still in his hands. He remembered that last few times when the Bubonic Plague erupted across the world. In the 6th century it killed 1/4 of the Eastern Roman empire and killed some 100,000,000 people globally for the next 2 centuries. He also remembered that when the famous Black Death erupted over Europe it killed 1/3 of all Europe, then killed some 200,000,000 for the next 4 centuries. He only knew one thing, if they do not contain the plague in the north, all of China and the world is doomed, and he must set himself resolutely to oppose the coming, snowballing boulder, even if its an inevitable fight to the death. What could he do? He became the Plague Fighter.

He became the father of the N95 Masks, and waged an all out war against death itself. Join us next chapter in the final story of Wu Liande. See how the little Nanyang- born Chinese doctor became a savior that the world forgot. 

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