"The Chinese winter of 1910-1911 was one of death and discontent: an epidemic of pneumonic plague—the greatest since the Black Death of the fourteenth century—scourged China's three Eastern Provinces (Manchuria), and famine afflicted the Central Provinces. The Manchurian plague claimed some fifty thousand lives in four months, and the famine took thousands more. Not all the hungry died, but no one sick with plague survived; there were, claimed one source, 43,942 cases and 43,942 deaths. While famine neither affected the foreigners in China nor menaced international frontiers, plague threatened to do both. World powers held privileged positions in a backward China, and some, especially Russia and Japan, feared that the plague would endanger their resident populations, compromise commercial interests, and spread to contiguous national territories. The epidemic also provided Russia and Japan with a potential excuse to take over plague control—and perhaps more—in Chinese territory, incursions the Chinese Government obviously wished to avoid. Thus did mortality and diplomacy confront each other in Manchuria during 1910-1911.

In need of medical help, but needing also to fend off growing political and military pressures, the Imperial Chinese Government at first requested assistance and then called for an International Plague Conference, a step unprecedented in China's history. Richard Pearson Strong became the chief United States delegate to the conference which was held in Manchuria at Mukden in April 1911,3 and his three-month stay in China brought him into prominence" (Chernin, Richard Pearson Strong and the Manchurian epidemic of penumonic plague, 1910-1911, " J. Hist. Med. All. Sci, 44 (1989) 296-319; quote from p. 296).