This paper examines how the Chinese government’s perception of Japan before and after the pneumonic plague epidemic in Manchuria in 1910-1911 influenced China’s disease control and prevention efforts as well as how disease control measures were utilized in the context of the China-Japan relationship. During the New Policy Reform in the Late Qing, the Qing government established a government-led health care system, adopted from the Japanese model, to enhance national prosperity. In Manchuria, the central government’s plan was implemented immediately, in response to Japan’s attempt to expand its influence through disease control, which had been in place since the late 19th century.
 During the pneumonic plague in Manchuria in 1910-1911, cooperation and containment between Qing and Japan continued over the initiatives in epidemic control. The Japanese authorities approached the Qing government’s anti-epidemic efforts based on an assumed image of “Japanese assisting Chinese.” However, the Qing government sought to thwart it by implementing systematic and autonomous measures for disease control. Furthermore, at the Japan-Qing Joint Epidemic Prevention Conference, the Qing government constrained Japanese authorities’ involvement in epidemic control, and through the International Plague Conference, it internationalized the issue of pneumonic plague prevention.
 The government of the Republic of China that succeeded Qing accepted resolutions submitted by the representatives who participated in the International Plague Conference, and set up the North Manchurian Plague Prevention Service. The North Manchurian Plague Prevention Service, which had to make achievements to garner international recognition, mostly appointed members from the British-American faction, who were considered to have a higher level of medical skill than those of the Japanese faction that held the majority in the Western medical community in China at the time. This was in line with desire of the British-American faction, who sought to expand their influence in China.
 As anti-Japanese sentiments increased after Japan’s Twenty-One Demands in 1915, the central government of the Republic of China appointed members of the British- American faction as field practitioners to take leadership in epidemic prevention. Thus, China was able to distance itself from Japan by going through a wide range of options for disease control and prevention.
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