Medical charity in northeast China evolved through the confluence of three processes: the foundation of state medicine, the legal and political transformation of private charities, and the militarized competition for influence between China and Japan. Following the plague of 1910, a series of Chinese regimes began building medical infrastructure in areas under their control, but their ultimate inability to establish a comprehensive public health program left private charities to fill the gaps. In contrast, the Japanese administered concessions in Kanto and along the South Manchuria Railway instituted a farsighted and multivalenced medical policy. The Japanese model did not merely tolerate medical charities, it reserved for them a very specific role in the larger strategic framework of healthcare provision. Under the client state of "Manzhouguo," the Japanese model further evolved to channel medical voluntarism into a hybrid state-charitable sector.