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    Social Network: How Shanghai Stemmed the Surge, 100 Years Ago

    An active civil society helped shape disease control in Shanghai

    To bring the Omicron variant outbreak under control, Shanghai was subjected to a citywide lockdown beginning April 1 that lasted two months. At the wave’s peak, the city reported more than 20,000 cases a day.

    In a megacity like Shanghai, however, efforts of official organizations alone have never been enough to contain the spread of contagious diseases.

    From the 1910s to the 1930s, in Old Shanghai, the general population put tremendous efforts into disease prevention, with the foreign concessions even joining hands with the Chinese community on one occasion to bring a particularly deadly outbreak under control.

    From charities to social networks, industrial and commercial societies, as well as grassroots volunteer groups, several organizations lent their strength to the battle against epidemics across Shanghai.

    First responders

    During epidemics, charities were primarily meant to organize medical assistance and treatment to the city’s poor. The vast majority of charities in Old Shanghai all played a role in the erection of temporary hospitals, such as the Shanghai Epidemic Hospital, which was founded in the summer of 1919.

    That year, a cholera outbreak caused scores of deaths across the city. In response, a number of local gentry-merchants (such as Zhu Baosan, Shen Zhongli, and Dou Yaoting) banded together to build an infectious diseases hospital.

    It was founded as a temporary establishment built specifically to treat infected citizens. Once an outbreak was contained, it could cease operations.

    In the summer and fall, they treated patients suffering from seasonal outbreaks of cholera and dysentery; and when other epidemics arose, they provided and administered medication free of charge, with no need to register.

    The hospital’s wards were divided into three levels. The special wards and head wards charged reasonable fees for accommodation and medicine, while the level three ward was completely free.

    Later, as Shanghai’s economy and population (in particular, its blue-collar workforce) boomed, so did the demand for healthcare. Once various epidemics had been brought under control, what was conceived as a temporary hospital became a permanent institution, with general medicine and surgical wards.

    Eventually, registration, treatment, and accommodation fees were charged for outpatient services, depending on the circumstances of the patient in question.

    Patients deemed to be living in poverty were exempted from registration and treatment fees, while seriously ill poor patients were given free accommodation in the level three wards.

    When a poor patient’s treatment proved ineffective and they succumbed to their illness, the hospital asked Pushan Shanzhuang, a charitable funeral organization in the early days of modern Shanghai, to send a rudimentary coffin for burial.

    At any time of the year, the hospital offered dozens of free beds, which by 1944, increased into the hundreds.

    The Shanghai Cosmopolitan Red Cross also established healthcare facilities similar to the Epidemic Hospital. During outbreaks, the Red Cross worked tirelessly to set up new facilities.

    By 1933, they had built 25 hospitals, helping cure more than 200,000 patients, thus winning the faith of the local Chinese community and expats alike.

    The Red Cross’ clinics charged registration fees, but all medication was free. As a result, patients sometimes braved the perils of traveling great distances within the city to avail their services.

    Very often, their travel expenses were far greater than the cost of registration. The Red Cross thus decided to establish a fleet of free mobile clinics in collaboration with the Shanghai Private Radio Guild.

    The mobile clinics had four stations in the north, south, east, and west of the city. At fixed intervals, the vehicles traveled from one station to another, servicing the general populace along the way.

    Social capital

    Along with charitable institutions, hometown associations, industry guilds, and chambers of commerce brought to bear their own unique resources such as regional expertise, staff, and funds.

    Take for example the Chaozhou Guild, an organization which helped merchant groups visiting from various counties across the Chaozhou region in eastern Guangdong organize conferences and conduct affairs in Shanghai.

    It was a key institution that represented these merchant groups’ interests, where fellow migrants from the Chaozhou region could provide one another with assistance, and manage their internal and external affairs. In the 1920s, this guild made several donations of at least 200 silver dollars — 25,000-50,000 yuan ($3,700-$7,500) today — each to the Shanghai Red Cross.

    In 1929, these Shanghai Chaozhou shared-hometown associations together established the fully charitable Shanghai Chaozhou Heji Hospital. Their doctrine mandated consultations and treatment to all in need, regardless of where they came from, while poor patients were treated free of charge.

    During the January 28 incident of 1932, the districts of Zhabei and Hongkou devolved into war zones. During this time, countless Guangdong natives living in these districts were wounded or killed, while the injured or ill had nowhere to go for medical assistance.

    In the wake of the violence, Wen Qinfu, the former chairman of the Guangdong Visitors to Shanghai Association, lobbied the Guangzhou-Zhaoqing Public Office to allocate several thousand yuan to establish the Cantonese Charity Hospital. It would provide Shanghai residents hailing from this region with free consultations and treatment.

    Furthermore, the hospital appointed physicians, midwives, and nurses to provide guidance and consultation services to Cantonese families in their homes, particularly those in impoverished neighborhoods.

    To improve public trust, the hospital entrusted all donations, big or small, to one of three parties: the respective savings departments of the Wing On Department Stores on Nanjing Road and North Sichuan Road; and the China Trust Company on Beijing Road. “All donations, regardless of size, are to be documented in the hospital records and handed over for examination.”

    Guilds primarily upheld the interests of their respective industries, but were also an important platform through which companies could give back to society. During epidemics, pharmaceutical guilds recognized their responsibility to society and stepped forward to help protect the population.

    In October 1934, in light of the density of Shanghai’s population, its overwhelming number of unsalubrious zones, and the inaccessibility of healthcare for impoverished residents, the New Medicine Industrial Guild decided to expand the Huang Chujiu Hospital (which they helped establish) to include an emergency epidemic center.

    In addition to the existing department of ophthalmology, which continued its original routine of treating poor patients in the mornings, the hospital gained two new departments — internal medicine and surgery — which provided consultations and medicine for free in the afternoons.

    In 1940, to render healthcare accessible to even more disadvantaged people during epidemics, Shanghai’s Pharmaceutical Guild and New Medicine Guild co-founded the No.2 Emergency Epidemic Hospital, which treated as many as 100,000 patients a year. Philanthropists from all walks of life enthusiastically sponsored this hospital.

    Treated with compassion, patients reacted in kind by either donating from their own pockets, or calling upon their friends and family to provide support, whether spiritual or material.

    The most moving example of this altruism is of a child surnamed Huang who, after being treated and released, donated all earnings made through begging one day — in total, two jiao and five fen — to the hospital.

    Other guilds used their influence to encourage leaders from their respective industries to contribute to disease prevention. When contagious diseases were rife, the Hot Water Stall Guild regularly circulated urgent notices urging guild members to adequately boil their water before selling it, to ensure its safety before consumption.

    On finding a stall selling water drawn from wells or which hadn’t been properly boiled, the guild notified local authorities, demanding that the stall’s operating license be canceled, as well as publicly enforcing strict penalties.

    The guild also demanded that the water used to infuse tea in large vats set up at these stalls be adequately boiled. As boiling water required coal, the guild negotiated with relevant authorities on several occasions to provide stall owners with coal at a discount. They also pleaded with owners to endure this strain on their finances for the benefit of public health, rather than behaving carelessly.

    Chambers of commerce were relatively influential groups in Old Shanghai that aided the treatment and prevention of contagious diseases. In 1910, the Manchurian pneumonic plague swept across the whole of China. Though it mainly affected China’s northeast, it also ravaged Shanghai.

    At the time, Shanghai was still divided into concessions on one hand and the Chinese community on the other. It left locals and expats at loggerheads when it came to the right course of action.

    Viewing Chinese people’s lifestyle habits as unhygienic, the Municipal Council wanted to forcibly examine and spray disinfectant on Chinese people living in an area around Gansu Road and Shanxi North Road, on the border of the northern concession of the Suzhou Creek.

    Cultural differences as well as the hubris of the concession authorities resulted in a serious conflict of opinions. Local chambers of commerce convened with leaders of various associations for Chinese residents in foreign concessions to write a petition to the Municipal Council, in which they proposed to “build a hospital where our compatriots could be examined.”

    The Municipal Council permitted the Shanghai Chamber of Commerce to step in and organize a conference where chairmen of various industries as well as delegates of the Council’s foreign executives negotiated the foundation of the hospital by the Chinese community.

    This involved the delegation of Chinese experts in both Western and traditional Chinese medicine to enforce preventative measures in the Chinese community. To reassure women living in the region where these measures were to be enforced, the conference appointed a female doctor to be present on site.

    The conference also determined the scale of the measures, as well as their duration: one month. Finally, it demanded that the Municipal Council notify the public in advance of all details of the measures.

    The Shanghai Chamber of Commerce then sent the Jiangsu government (Shanghai was governed by Jiangsu in the Qing dynasty) a request for funding via telegram. Almost immediately, they received confirmation that 10,000 taels of silver — then the approximate annual salary of Jiangsu’s governor — in trade tariffs collected by the Shanghai Customs had been set aside for the establishment of the hospital.

    On November 24, 1910, the Shanghai Public Isolation Hospital was officially founded. The following May, the government allocated funds that had been reserved for disease prevention in Shanghai so that the National Chamber of Commerce could build the China Epidemic Hospital in the French Concession, which further improved public health conditions in the city.

    Helping hands

    There were other charitable grassroots organizations who did their utmost to serve the community. For example, founded in February 1938, the Helpful Friend Society (Yiyoushe) was a volunteer group organized and led by the Communist Party during the War of Resistance Against Japan. Their member base was primarily composed of store employees.

    In the years after the war, the society only continued to grow, attracting over 15,000 members. Most were apprentices and floor staff in various stores, though they also included a sizable number of managerial staff, professionals working in public utilities and healthcare, and uneducated and unemployed young people.

    Early in its development, the Helpful Friend Society’s work mostly revolved around “wholesome entertainment.” However, as the state of affairs in Shanghai took a turn for the worse, store employees such as those who made up the Society’s ranks found themselves in extremely poor health.

    Therefore, the Society decided to set up a clinic that charged only 5 fen to its members, and 1 jiao to the rest of the population. This was much cheaper than the fees charged by public hospitals of the time. The clinic also offered free injections, while the cost of prescription drugs was around 30-50% cheaper than in pharmacies.

    That said, patients who were in particularly precarious circumstances (accounting for approximately 2% of all patients) were offered their entire course of treatment for free.

    Although their motivations and contributions differed, social organizations all helped make up for the inadequacies in the government’s response to epidemics, thus promoting the construction and development of healthcare in Old Shanghai.

    Only a few hospitals built 100 years ago still stand. One of those is Huashan Hospital, which houses Shanghai’s leading epidemic team — it was developed from the Red Cross General Hospital established in 1910.

    Today, as the region grapples with containing COVID-19, the legacy of Shanghai’s civil society still lives on.

    A version of this article originally appeared in the book Caring for People, Hygiene and Health in Shanghai, published by the Shanghai Local Chronicles Library. It has been translated and edited for brevity and clarity, and published with permission.

    Translator: Lewis Wright; Editors: Yang Xiaozhou and Apurva.

    (Header image: An Ambulance parked outside Tongren Hospital. The words written on the banner read “China Red Cross temporary ambulance.” From the Shanghai Local Chronicles Library)