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Session 50: Epidemiology and Laboratory Science: Revealing the Social Body in Prewar Japan
Organizer: Alexander R. Bay, Stanford University
Chair: Akihito Suzuki, Keio University
Discussant: William Johnston, Wesleyan University
Keywords: Japan, Meiji, Taisho, Showa, public health, epidemiology, vital statistics, contagious disease, medicine.
This panel looks at the role of scientific medicine in the public health movement from 1868 to 1941. With the development of public health in Japan, we know that bacteriology became central to the war on contagious disease. Also, epidemiology, based on medical statistics, was a science that identified causal connections to the origin and spread of various diseases. Hitherto an unexplored topic, our panel highlights the importance of statistical knowledge to the history of public health in modern Japan. Combining intellectual, institutional, and social histories, the papers examine how laboratory scientists and vital statisticians identified and addressed afflictions of the social body.
Nagashima looks at the bureaucratic battles of Nikaido Yasunori (1865–1925) and his struggle to institutionalize medical statistics as the foundation for public health knowledge.
Bay focuses on the history of the science behind leprosy prevention, showing how doctors, using both microbes and medical statistics, convinced government leaders that leprosy threatened the health of the nation.
Ichikawa explores the work of local public health officials, and examines the connections between these local practitioners and central public health laboratories.
Suzuki uses a 1939 Ministry of Health survey to reveal the extent of the scientization of medicines and treatments for common afflictions.
Together, the four papers reveal the numerous negotiations that scientific knowledge passed through in order to have a broad social impact, moving from laboratory into institutional practice, and then to the local physician, health official, or urban denizen.
Professional Epidemiologists and Vital Statisticians: The Politics of Preventative Medicine in Meiji Japan
Takeshi Nagashima, Keio University
My paper examines the career of Nikaido Yasunori and the founding of the Naikaku Tokeikyoku (Bureau of Statistics). I ask two questions: "When do we see the development of statistics-based epidemiology in Japan?" and "How effective was numerical knowledge in influencing the direction of public health policy?" In England in the latter half of the 19th century, the public health profession developed in tandem with advances in epidemiology and bacteriology. These new technologies enabled local medical officers, practitioners of preventative medicine, to displace clinical doctors and monopolize the management of the health of the nation. Statistical knowledge was crucial to public health, allowing sanitation officers to pinpoint origins of disease and disease-causing factors.
An unexplored topic in the development of the history of public health in Japan, my paper focuses on Nikaido Yasunori and his efforts to establish epidemiological studies of disease transmission based on analyses of vital statistics as the basis for the Meiji public health movement.
Leprosy as Enemy of the State
Alexander R. Bay, Stanford University
My paper examines the role of Japanese scientists in the establishment of a public health law enacted in 1907 that confined those suffering from Hansen’s disease to leprosaria. Although amended at various times, this law remained in force until 1996. Why did doctors focus on leprosy in the early twentieth century, when other diseases, such as tuberculosis, were far more dangerous? It was a part of a larger war on contagious disease: with the institutionalization of bacteriology in Japan, the laboratory moved to the center of new definitions of etiology and pathology, becoming central to identification and eradication of microbes, and the isolation of those who carried them.
The reigning historiographical paradigm in public health studies maintains that politics, not science, determined the form of a nation’s public health regime.l My approach is different. I argue that the politics of implementation did not simply facilitate the adoption of current scientific knowledge, but rather, the opposite. The Meiji state was at first reluctant to enact any anti-leprosy legislation. Most believed that leprosy was hereditary, not contagious. Doctors, wielding microbes and statistics, had to first convince government leaders that leprosy was contagious. Doctors then had state officials create a network of government enforcement agencies, leprosaria, and lepers, all organized around the laboratories of medical experts. In short, doctors used the power of the lab to transform the leper from a social outcast into a germ carrier who threatened the health of the nation.
1
Erwin H. Ackerknecht, "Anticontagionism between 1821 and 1867," Bulletin of the History of Medicine 22:5 (Sept–Oct., 1948): 589–92.Crossing the Distance between the Medical Laboratory and Practical Application Epidemiology in the Prewar Showa Era
Tomo Ichikawa, Yokohama National University
The last archipelago-wide smallpox epidemic in Japan occurred in 1908. Throughout the prewar Showa period (1926–1941), however, there were a number of outbreaks, but due to the policy of infant vaccination, the intensity of the outbreaks was limited. When there was an outbreak, how did public health officials use lab-based science to combat this disease?
My paper examines the relationship between the Institute for Infectious Disease (a subsidiary of Tokyo University) and the Tokyo Metropolitan Police Department’s Quarantine Bureau. Based on public health reports, we see that the Police Quarantine Bureau Chief Iguchi Jokai employed Institute for Infectious Disease lab technicians during Quarantine Bureau bacteriological and epidemiological investigations. Iguchi’s doctoral dissertation on smallpox, which he based on field data collected with the help of these laboratory specialists, also reveals an extended network of scientists and public health officials. My paper explores these networks, and I argue that scientific knowledge informed the practice of public health at the local level in prewar Japan through the work of epidemiologists such as Iguchi.
Drugs, Consumer Choice, and the Westernization of Medicine in Japan
Akihito Suzuki, Keio University
This paper approaches history of medicine in modern Japan from the patient’s point of view, attempting to offer a new perspective in the historiography of the acceptance of Western medicine in the non-Western world. The introduction and establishment of Western medicine in Japan from the late nineteenth century has been told in the framework of "from above." Whether as enlightenment into more effective treatment of disease or as coercive destruction of a traditional medical culture, the credit or the blame for the Westernization of medicine has been put on the state, reformers, or medical professors. A major question remains: what was the role of the patient in this process? Studying consumer choice of therapeutic measures provides a key to our understanding of the Westernization of medicine in Japan. Since the majority of medical practitioners trained in Western medicine made their living through private medical practice, they worked in a competitive medical marketplace. In short, it was a buyer’s market.
I examine the role of the patient and the medical consumer in the process of modernization of Japanese medicine. Based on an analysis of a Ministry of Health survey of 2,000 persons’ medical preferences in Tokyo in 1938–39, I contrast two types of traditional therapeutics, massage/acupuncture and pharmaceuticals, and argue that patent medicine played an important role, a "bridge" between traditional medical therapies and Western medicine ones.