A Curious Ceremony in the Forbidden City

In the winter of 1874, the Forbidden City witnessed an unusual spectacle. Empress Dowager Cixi ordered a grand procession to honor the Smallpox Goddess, complete with the full imperial regalia normally reserved for the emperor himself. Nine elaborately crafted paper dragon boats, accompanied by countless paper replicas of gold, silver, jade, and silk, were paraded through the palace grounds with musical accompaniment. The procession moved toward the Great Qing Gate, where a temporary earthen altar had been constructed. Prince Dun, leading the ceremony, performed the rituals before setting the paper offerings ablaze. The flames leaped skyward, scattering ashes in a ritual that closely resembled the Manchu funeral customs known as “small paper burning” and “great paper burning.”

This ceremony, while ostensibly meant to honor the Smallpox Goddess during Emperor Tongzhi’s illness, carried ominous undertones to those familiar with court rituals. The Manchu tradition of “paper burning” typically accompanied imperial deaths—the “small paper burning” occurring immediately after an emperor’s passing when his personal effects were burned, and the “great paper burning” taking place when his coffin was transported to the imperial tombs. The similarity between these funeral rites and the ceremony for the Smallpox Goddess did not escape notice, with court officials whispering about yet another inauspicious sign for the young emperor’s recovery.

The Historical Context of Imperial Illness

The Tongzhi Emperor, born Zaichun, had ascended to the throne as a child in 1861 following the death of his father, the Xianfeng Emperor. His reign occurred during a turbulent period known as the Tongzhi Restoration, when the Qing Dynasty attempted to modernize and strengthen itself against foreign encroachment. However, real power lay with his mother, Empress Dowager Cixi, who ruled as regent alongside Empress Dowager Ci’an.

In late 1874, the nineteen-year-old emperor contracted smallpox, a disease that had plagued Chinese emperors throughout history. The court responded with traditional rituals alongside medical treatment, reflecting the blend of spiritual and practical approaches to healing that characterized imperial medicine. The ceremony for the Smallpox Goddess represented one such spiritual intervention, drawing on longstanding Chinese traditions of appeasing disease deities.

Smallpox had a particularly fearsome reputation in China, where it was known as “heavenly flowers” (天花). The disease had influenced imperial succession multiple times in Chinese history, most notably during the early Qing period when the Kangxi Emperor survived smallpox as a child, which actually strengthened his claim to the throne since survivors were believed to have divine protection.

The Eighteen Dangerous Days

According to medical understanding at the time, smallpox presented an eighteen-day critical period. By the sixteenth day of the emperor’s illness, the court began to breathe more easily, as the most dangerous phase appeared to have passed. The final stage involved the scabs falling off and skin flaking away, which was considered equivalent to being out of danger.

However, on the sixteenth day, unusual developments occurred at the palace medical office. No daily medical report, prescription, or record of imperial activities was issued—a significant departure from standard procedure. Even more curiously, the eunuch Meng Zhongji conveyed an oral decree: “No need to pay respects!” This suggested the emperor had recovered without needing medicine, yet the chief physician Li Deli continued his daily visits to examine the emperor. The absence of official medical documentation raised questions about what might be hidden from view.

A Scholar’s Suspicion

Among the court officials, Weng Tonghe, a respected scholar and official known for his meticulous attention to detail, noticed these irregularities. Sensing that something was amiss, he sought to investigate further. Weng considered approaching two potential sources of information: Ronglu, the newly appointed Minister of the Imperial Household who had become a favorite of Empress Dowager Cixi, or Li Hongzao, a grand councilor and the emperor’s tutor.

Finding Ronglu constantly moving between the Palace of Eternal Spring and the Hall of Mental Cultivation, Weng turned to Li Hongzao instead. Preparing for their meeting, Weng consulted obscure medical texts and copied prescriptions for post-smallpox recovery, planning to ask Li to present them to the emperor.

Upon meeting Li Hongzao, Weng immediately noticed his troubled expression—furrowed brows, tightly pressed lips, and an appearance of enduring pain. When Weng presented the medical prescriptions, Li received them without enthusiasm, clearly preoccupied with graver concerns.

The Shocking Revelation

After some hesitation, Li Hongzao confided the truth to Weng Tonghe: while the smallpox was indeed improving, another medical crisis had emerged. He showed Weng copies of three medical reports that had been kept secret from most court officials.

The first report described symptoms including a floating and rapid pulse, seven-tenths of smallpox scabs fallen away, reddish skin tone, but also emissions of red turbidity, lower back pain, leg soreness, and muscle spasms—attributed to toxic heat disturbances internally.

The second report noted that while scabs had fallen and emissions had slowed, the emperor suffered from dizziness, fever, heavy pain in the waist and legs, constipation, and continued muscle spasms—diagnosed as kidney deficiency with food retention and cold exposure.

The most alarming third report, from that very evening, described swollen and painful abscesses on the lower back that had begun suppurating, with additional ulcerations on the neck, arms, and knees. The diagnosis pointed to residual toxins attacking the sinew channels, with treatment focusing on preserving vitality while countering toxins, supplemented with medicinal plasters.

The Unspeakable Diagnosis

When Weng Tonghe expressed confusion about how such abscesses could develop from smallpox, Li Hongzao revealed the physicians’ private conclusion: these were not complications from smallpox but rather symptoms of syphilis. The emperor’s condition represented a venereal disease reaching its critical stage.

This explanation, while shocking, aligned with rumors that had circulated about the young emperor’s behavior. During the summer, Ronglu had privately mentioned that the emperor had visited not only the respectable entertainment quarters but also disreputable establishments. According to Li Deli, symptoms had actually appeared as early as August, making the current outbreak not sudden but the culmination of a progressing disease.

The physicians had remained silent about this diagnosis, only recently confiding in Prince Gong. Now, with the condition becoming impossible to conceal, the truth began to emerge among the inner circle of officials. The combination of smallpox and syphilis created a medical crisis that even the best physicians could not effectively treat.

The Dilemma of Disclosure

The revelation created an impossible dilemma for court officials: how to inform the empress dowagers about this embarrassing and potentially scandalous diagnosis. The stigma surrounding venereal diseases, particularly when contracted by an emperor, made disclosure extraordinarily difficult. Yet continued concealment risked improper treatment and potential disaster.

Weng Tonghe argued against maintaining the secrecy, suggesting that early disclosure might have allowed for better management of the condition. The concurrent outbreak with smallpox recovery represented a particularly dangerous combination that required specialized treatment. Yet the social and political implications of acknowledging the emperor’s condition seemed almost as frightening as the disease itself.

The officials debated who might deliver this uncomfortable truth to the empress dowagers. Even the physician Li Deli hesitated to take on this responsibility, leaving the court in a state of anxious uncertainty as the emperor’s condition continued to deteriorate.

Cultural Implications of Imperial Illness

The emperor’s dual illness reflected broader tensions within late Qing society. The smallpox represented a traditional affliction that the court addressed through established rituals and medical practices. The suspected syphilis, however, pointed to the changing social environment of Beijing, where imperial figures increasingly interacted with entertainment districts that facilitated the spread of venereal diseases.

This medical crisis also highlighted the conflict between public ceremony and private reality in imperial life. While public rituals continued to project an image of stability and traditional order, behind the scenes, officials grappled with problems that challenged the moral authority of the throne. The emperor’s behavior and resulting illness undermined the Confucian ideal of the ruler as a moral exemplar.

The medical response itself illustrated the transitional state of Chinese medicine in the late nineteenth century. Physicians like Li Deli employed traditional diagnostic methods and treatments while possibly recognizing conditions that required different approaches. The secrecy surrounding the diagnosis prevented potentially beneficial exchanges with foreign physicians who might have offered alternative treatments.

The Political Consequences

The emperor’s deteriorating health created a political crisis that extended beyond the medical concerns. The Tongzhi Emperor had only recently begun to rule in his own right after the regency of the empress dowagers. His illness threatened to cut short this personal rule and create another succession crisis.

Court factions positioned themselves for whatever might follow. Officials loyal to Empress Dowager Cixi likely considered how to maintain her influence, while others might have seen an opportunity to shift power dynamics. The uncertainty surrounding the emperor’s condition paralyzed decision-making on important state matters, as attention focused on the imperial sickroom.

The need to conceal the true nature of the emperor’s illness created additional complications for court rituals and communications. The missing medical reports represented just one aspect of a broader pattern of obfuscation that affected how the court functioned during this crisis.

A Winter of Anxiety

The following day brought heavy snowfall, blanketing the Forbidden City in white. Despite the weather, Weng Tonghe proceeded to the palace to pay his respects, first stopping at the palace medical office to check for any new reports. Finding the situation unchanged from the previous day, he decided to seek out Ronglu at the Imperial Household Department offices to learn what further developments might have been concealed from official documents.

The physical environment mirrored the emotional climate within the palace—beautiful on the surface but cold and uncertain beneath. The snow-covered courtyards and buildings presented a serene appearance that belied the anxiety gripping those who understood the gravity of the emperor’s condition.

As officials went through their routines, many remained unaware of the double medical crisis affecting their emperor. Those in the know carried their knowledge as a heavy burden, uncertain how events would unfold and how the truth would eventually emerge.

Legacy and Historical Significance

The illness and eventual death of the Tongzhi Emperor in January 1875 had profound consequences for China’s future. His passing without an heir led to a controversial succession that brought the Guangxu Emperor to the throne as another child emperor, extending the regency of Empress Dowager Cixi and her influence over Qing politics for decades to come.

The medical details that emerged from palace records and officials’ diaries have provided historians with valuable insights into late Qing court life, medical practices, and the challenges of leadership during a period of decline. The episode illustrates how personal health of rulers could influence national history, particularly in imperial systems where power concentrated in a single individual.

The tension between traditional rituals and emerging medical understanding reflected broader patterns in nineteenth-century China, where ancient practices coexisted with new knowledge, often uneasily. The court’s response to the emperor’s illness—combining spiritual ceremonies with medical treatment while concealing uncomfortable truths—epitomized the challenges of maintaining imperial authority during a period of internal and external pressures.

The story of the Tongzhi Emperor’s final illness remains a compelling chapter in Chinese history, illustrating the complex interplay between personal behavior, medical knowledge, political power, and historical contingency that shaped the closing decades of imperial rule in China.