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The purpose of this paper is to analyze the process of establishing a quarantine system based on medical inspection by Shanghai Customs. England was the first to introduce a quarantine system based on medical inspection during the nineteenth century; with the majority of the Shanghai Customs administration being English, this system was able to be adopted with ease, and it was later transformed and accepted in Joseon. This paper further investigates the details of the actual medical inspection conducted by the Customs Medical Officer (CMO) who worked at the forefront of the actual quarantine as a medical inspector. In the nineteenth century, International Sanitary Conferences were held in Paris, Vienna, and Constantinople to discuss the process of quarantine and public health. Furthermore, the Public Health Act was passed in England in 1872. This Act established port sanitary authorities in each of England’s ports to carry out medical inspections. This medical inspection enabled healthy and infected people to be separated from each other instead of conventional isolation. The duties of the CMO would consist of boarding any incoming ship to check for any infected people. Any infected persons would then be sent to a non-quarantine hospital, and the ship was sanitized. This concept of quarantine based on medical inspection was borrowed by Shanghai Customs. The unique political situation in Shanghai, which consisted of multiple imperial concessions, necessitated the adaptation of England’s medical quarantine concept to suit the special environment in which the Shanghai Customs was located, and by 1875, the Shanghai Customs quarantine medical inspection system was established. In this system, patients found in the Customs quarantine medical inspection were sent to a non-quarantine hospital in the settlement. Due to the extraterritoriality, the extent of the authority of the Customs Medical Officer was dependent on agreements with the possibility to be granted a one-time or temporary position after conferring with the Shanghai local government and consuls in each country. The Treaty Ports of Joseon were similar to Shanghai with regards to the presence of the Customs system alongside different settlements. The Joseon ports went through another transformation when the Commissioner of Shanghai Customs, H. F. Merrill, who also served as the Chief Commissioner of Seoul, accepted the Shanghai Customs’ modified concept of medical inspection in 1887. The process of acceptance and transformation of the medical quarantine concept leading to the ‘England-Shanghai-Joseon’ connection shows that the concept of medical quarantine in the nineteenth century spread from England to Joseon through Shanghai Customs as a medium.

It was in 1907 when Korea was annexed by Japan in the field of health care systems as the Gwangje Hospital, Uihakgyo the National Medical School and the Korean Red Cross Hospital were merged into the colonial Daehan Hospital, and massive cholera epidemic controls by the Japanese Army were enforced.However, despite their importance, the cholera epidemic of 1907 in Korea and preventive measures taken at that time have not yet been studied extensively as a single research subject. The purpose of this paper is to contribute to a more concrete and broader understanding of the Korea-Japan annexation of health care systems under the rule of the Japanese Resident-General of Korea by revealing new facts and correcting existing errors. In 1907, cholera was transmitted to Korea from China and Japan and spread across the Korean Peninsula, resulting in a major public health crisis, perhaps one of the most serious cholera outbreaks in the twentieth century Korea. Although Busan and Pyeongyang were the cities most infected with cholera, the targets for the most intensive interventions were Gyeongseong (Seoul) and Incheon, where the Japanese Crown Prince were supposed to make a visit. The Japanese police commissioner took several anti-cholera preventive measures in Gyeongseong, including searching out patients, disinfecting and blocking infected areas, and isolating the confirmed or suspected. Nevertheless, cholera was about to be rampant especially among Japanese residents. In this situation, Itō Hirobumi, the first Resident-General of Korea, organized the temporary cholera control headquarters to push ahead the visit of the Japanese Crown Prince for his political purposes to colonize Korea. To dispel Emperor Meiji’s concerns, Itō had to appoint Satō Susumu, the famous Japanese Army Surgeon General, as an advisor, since he had much credit at Court. In addition, as the Japanese-led Korean police lacked epidemic control ability and experience, the headquarters became an improvised organization commanded by the Japanese Army in Korea and wielded great influence on the formation of the colonial disease control systems. Its activities were forced, violent, and negligent, and many Korean people were quite uncooperative in some anti-cholera measures. As a result, the Japanese Army in Korea took the initiative away from the Korean police in epidemic controls, serving the heavy-handed military policy of early colonial period. In short, the cholera epidemic and its control in 1907 were important events that shaped the direction of Japan’s colonial rule.

This paper aims to study the quarantine system established by His Corean Majesty's Customs Service (HCMCS) between 1886 to 1893, and how they responded to the influx of infectious diseases such as cholera, led by the Customs Medical Officer of Joseon. The quarantine procedure was not able to operate in the first 11 years of opening the port due to limitations within HCMCS in the P. G. von Möllendorff period. However, as the Shanghai Customs officer, H. F. Merrill concurrently served as the Chief Commissioner, Seoul, HCMCS was directly connected to Shanghai Customs which was a direct model of Chinese Maritime Customs Service. This connection caused HCMCS to build a foundation that enabled the Shanghai quarantine measures to be referred to in 1886. In alignment with this, Acting Commissioner, Jenchuan, J. F. Schoenicke developed the quarantine system of Jenchuan Customs in 1886, using the quarantine system of Shanghai Customs as reference. Jenchuan Customs introduced new concepts, such as Observation Island, Yellow Flag, Free Pratique, and also enforced quarantine inspections on vessels coming from cholera-infected areas. Based on the quarantine system of the Shanghai Customs and Jenchuan Customs, Chief Commissioner, H. F. Merrill established conditions in 1887 for enforcing quarantine inspections on vessels arriving at the ports of Joseon. HCMCS conducted quarantine inspections on vessels coming from areas of infectious diseases, such as cholera, plague, yellow fever and smallpox, adopting concepts such as Customs Quarantine Officers, Quarantine boats, and Quarantine Hospitals. Quarantine hospitals affiliated with customs were founded at each trading port in order to treat patients with infectious diseases. Although His Corean Majesty's Hospital has been known as an ‘only Western-style hospital’ operated by the Joseon government, it should be noted that also these hospitals contributed medical activities. Meanwhile, document administration was accompanied to handle quarantine tasks. This was a complicated task with the authority structure of two lines: 1) Customs Quarantine Officer - Acting Chief Commissioner, Seoul - Acting Chief Commissioner, Seoul; 2) Superintendent – Dokpan. The actual quarantine of treaty port was implemented by Superintendent - Acting Chief Commissioner, Seoul. Matters of important decisions were accompanied by lower-level reports and higher-level instructions through the document administration procedure with the central government. The efficiency of this method was therefore limited whereas systematic administrative procedures were able to perform. This became the impetus that caused the third Chief Commissioner, Seoul, J. M. Brown to reform the framework of maritime affairs established in the Merrill period.

Cholera is an acute secretory form of diarrhea caused by a potent enterotoxin (cholera toxin) after ingestion of toxigenic Vibrio cholerae of the O1 or O139 serogroups. Although cholera is very common in Africa and Asia as a whole, the incidence of cholera has been very low in recent years in Korea. Dehydration and electrolyte abnormalities due to massive watery diarrhea can lead to death, and the mortality rates in untreated patients with severe cholera can exceed 70%. Effective rehydration therapy is the cornerstone of the management of patients with cholera and can reduce the mortality rate to less than 0.2%. Antibiotics reduce the volume and duration of diarrhea, but are recommended for patients with severe disease because of the rapid emergence and spread of multidrug-resistant V. cholerae across the globe. Two oral cholera vaccines are available, and the World Health Organization recommends that these oral vaccines be considered in integrated prevention programs in endemic countries at risk for outbreaks. [ABSTRACT FROM AUTHOR]