Chapter 1749: Infectious Diseases

Lin Baiguang's Comprehensive Governance Office was in fact located within the Municipal Government building. Since Wang Sangou had taken up his post as Director of the General Affairs Section, he had followed the Regulations on General Affairs Administration for Government Agencies issued by the Administrative Office and brought systematic order to what had been a chaotic, bustling government building. Now, if Liu San wished to summon local natives for questioning, he couldn't simply dispatch someone to fetch them—he had to fill out a "Summons Form" first, and then the General Affairs Section would send a messenger.

By now dusk was falling, but this was an extraordinary period—there was no such thing as working hours. All agencies operated around the clock, with staff on duty at all times. As soon as Liu San's form reached the General Affairs Section, Wang Sangou immediately issued a nighttime pass and dispatched several retained gatekeepers to find the individuals on the list.

Most of the medical officials had already retired for the night. When they heard that the newly arrived Senator and Court Physician wanted to see them, they scrambled out of bed, threw on robes and shoes, and followed the gatekeepers to the yamen. Liu San hadn't even finished his supper when all four were already waiting outside in the courtyard.

Peering out the window, Liu San saw them standing reverentially in the yard. By the standards of this timeline, all four were elderly; one sported a full head and beard of snowy white. Reluctant to keep them waiting in the cold, he asked an orderly to show them in. Because he was technically a special envoy dispatched by a ministry-level department, he had been assigned the main hall of a small courtyard. The bright central hall served as both reception room and conference room.

Liu San emerged from the inner chamber carrying his mess tin. The four medical officials stood in unison and made to prostrate themselves in the full kowtow of a court audience. Liu San quickly stopped them. "Please, no need for that. Everyone, please sit."

The medical officials noted that this Grand Song Court Physician not only dressed poorly but ate like a common laborer—taking his meal directly from an "eating bowl" that was actually a square tin container. They couldn't help but feel a trace of contempt. Yet when they had first met him a few days earlier, they had discovered that this "Court Physician" was extraordinarily learned, deeply versed in medical theory, pulse diagnosis, and pharmacology. They dared not underestimate him. Thanking him for the seats, they sat down.

Their hearts, however, were uneasy. A new emperor meant a new court. A "Medical Bureau official" required no appointment from the Ministry of Personnel—even the rank of "unclassified" was beyond their reach. Never mind a change of dynasty; even a new county magistrate could dismiss them at will. Each time a magistrate or prefect was replaced, they had to scheme and bribe to keep their posts.

Once unemployed, without the aura of "medical official" status, life as an ordinary itinerant bell-ringing physician would be utterly wretched. Though famous doctors earned decent incomes, most ordinary practitioners barely scraped by. And they knew quite well they were nowhere near the caliber of "famous physicians."

When Liu San had first received them, the medical officials had pooled their resources and presented a "collective gift" of sixty taels. But Liu San's polite refusal—and his subsequent rejection of private presents—left them unable to fathom this Court Physician's intentions.

Darkness had fallen, and now he summoned them unexpectedly. What on earth was he scheming?

Liu San set down his mess tin. "You are all longtime medical officials of Guangzhou City. You've seen many patients over the years, and you've managed the government's medical affairs. I've just arrived and don't know much about local conditions; I must rely on your guidance."

The four hastily rose, disclaiming their worthiness, and invited Liu San to "inquire as he wished."

"Please, no ceremony. We're all in the medical profession; saving lives and alleviating suffering is our vocation." Liu San spoke with evident sincerity. "Don't concern yourselves with rank and hierarchy. Now then—tell me about the epidemic situation in Guangzhou."

Liu San wanted chiefly to learn about the various "seasonal epidemics" in spring and autumn, as well as the locally prevalent diseases encountered in medical practice.

The health authorities had harbored considerable misgivings about epidemic prevention in major medieval cities. The reason was simple: this timeline lacked any preventive or immunizing measures, and pathogens of every kind spread freely. Ever-expanding long-distance trade was carrying many regional diseases to new areas.

In the years the Ministry of Health had operated quarantine camps, the sheer variety and geographic range of infectious diseases encountered had shocked the physicians. They had seen nearly every disease listed in their textbooks: smallpox, measles, dysentery, typhoid, diphtheria, encephalitis, dengue fever, cholera, kala-azar, scarlet fever, hepatitis, tuberculosis... Among northern immigrants they had even detected the dreaded plague, which had forced them to burn down quarantine barracks at Kaohsiung more than once. Syphilis—introduced to China only recently in Ming times—had also been detected among migrants, including cases of congenital transmission. Tuberculosis was even more widespread.

Through the simple yet highly effective tool of quarantine, the Senate had largely succeeded in keeping malignant infectious diseases at bay. But in Guangzhou, matters were far more complicated—it was a continental city, open on all sides, with almost no way to control population movement. This created ideal conditions for the spread of disease.

Health authorities had originally hoped to search the Grand Library's historical records for information on Guangzhou's epidemics. But whether in officially compiled gazetteers or private jottings, such matters were scarcely documented. Simple entries like "epidemic" or "great pestilence" offered only death tolls and duration, with almost no detail—not even descriptions of symptoms. Nothing specific could be gleaned from these sparse records.

So Liu San had to turn to the local medical officials. In ancient society, the lower strata of the populace had essentially no access to medical care. Sick people either toughed it out with their natural resistance, or prayed and took a packet of incense ash from a temple, or at best collected free medicine when dispensaries and charitable institutions distributed it. The only people who could afford to summon a physician for a proper examination were those of some means. Thus, physicians of this era dealt with an extremely narrow slice of the patient population; their cases held no general significance.

But medical officials were personnel of "public medical institutions." Whether preventing or cleaning up after local epidemics—and treating wards of local charities—fell under the purview of the county Medical Bureau. Compared to private practitioners, they possessed a broader view.

Liu San was eager to understand the specific situation regarding infectious diseases in order to formulate a response as quickly as possible. The Ministry of Health's consensus was to establish a specialized infectious-disease hospital as soon as possible, where all such patients could be quarantined and contained. This was the continuation of the quarantine camp model—without medication, it remained the only viable approach.

Liu San first described his impressions from surveying the city these past few days. He knew that traditional medicine in this timeline had no clear concept of hygiene or epidemic prevention; many conditions that moderns would consider obvious disease risks were simply dismissed here. So he touched only on matters they could understand.

"...The 'returning south' season will soon be upon us. I know this weather is when epidemics most readily spread. Now that the Senate has entered Guangzhou, we bear the duty of protecting the people. If we pool our wisdom here to safeguard the wellbeing and safety of the populace—fewer illnesses, fewer deaths—that would be a boundless merit."

At these words, the medical officials were taken aback. They were old hands in the profession and had endured far too many "admonitions" from newly arrived officials: either stern and lofty platitudes that missed the mark entirely, or pointed hints to "pay respects" promptly. No one had ever spoken about the actual business of treating patients and saving lives.

Here was this foreign Australian who, upon entering the city, immediately addressed this very matter! Moreover, this true kun Senator had quietly traversed many corners of the city to inquire into suffering and disease—places so squalid and impoverished that they themselves had never set foot. A profound stirring awoke within them. Several had been practicing medicine for generations and held traditional physician's ethics in high regard. Liu San's words struck a chord. The eldest among them, a man named Hu Ziming with snowy beard and hair, rose shakily to his feet and bowed. "My lord, upon assuming office you have disregarded the fatigue of travel to concern yourself with the people's afflictions. This is a blessing for all living things! This humble student shall exert mind and body to serve you." The others joined in agreement.

Then and there, they recounted all they had observed and experienced over their years of practice. Liu San listened intently, taking notes in a small notebook. Though he himself had trained in traditional Chinese medicine, many ailments went by different names in different eras, so he asked the officials to describe symptoms as they spoke.

From their descriptions, Liu San gathered that the most common contagious disease here was influenza—no surprise. Yet flu's mortality rate was not low: influenza often triggered secondary infections, and in an era without antibiotics or antipyretics, death from a mere cold was commonplace.

Among the virulent diseases, smallpox and cholera were the most prevalent in Guangzhou. Small-scale outbreaks occurred constantly; large-scale epidemics erupted every few years. Cholera flared up massively every seven or eight years, and smallpox every five or six.

What shocked Liu San most was learning, from the officials' descriptions, that Guangzhou had already suffered multiple outbreaks of bubonic plague—some lasting a long time and highly virulent, with tens of thousands dead.

The Senate dreaded plague above all else. They had assumed it mainly afflicted the north; discovering that Guangzhou had been struck by plague was startling.

Beyond these three deadliest epidemic diseases, the symptoms described by the medical officials indicated that many other infectious diseases were also common—especially intestinal infections, with dysentery particularly widespread. The fa sha that killed so many in summer was, Liu San suspected, mostly intestinal disease as well.

From the officials' accounts, he pieced together a rough picture of locally prevalent ailments: scrub typhus, malaria, typhoid, pulmonary tuberculosis, dysentery, meningitis... and leprosy, which struck terror into the ancients' hearts.

The officials also told him of a local illness called guzhang—"drum swelling"—in which the abdomen gradually distended like a drum. Though it didn't kill immediately, death was inevitable, and no physician, however renowned, could help. In Panyu and Nanhai counties, certain villages were devastated by this disease: men, women, and children alike succumbed, and some hamlets had been wiped out entirely.

(End of this chapter)