Table Of ContentTHE MODERN EPIDEMIC
Harvard East Asian Monographs, 162
THE MoDERN EPIDEMIC
A
HisTORY OF TuBERCULOSIS IN jAPAN
WILLIAM JOHNSTON
Published by the COUNCIL ON EAST ASIAN STUDIES, HARVARD UNIVERSITY,
and distributed by HARVARD UNIVERSITY PRESS, Cambridge (Massachusetts)
and London 1995
Copyright © I995 by the President and Fellows of Harvard College
Printed in the United States of America
The Council on East Asian Studies at Harvard University publishes a monograph
series and, through the Fairbank Center for East Asian Research and the Reischauer
Institute of Japanese Studies, administers research projects designed to further schol
arly understanding of China, Japan, Korea, Vietnam, Inner Asia, and adjacent areas.
Library of Congress Cataloging-in-Publication Data
Johnston, William, I955-
The modern epidemic: a history of tuberculosis in Japan I William
Johnston.
p. em. - (Harvard East Asian monographs ; r6z)
Includes bibliographical references and index.
ISBN o-674-579r2-7 (hardcover)
r. Tuberculosis-Japan-History-r9th century. 2. Tuberculosis-
Japan-History-2oth century. I. Title. II. Series.
RC3I7.J26J64 I995
6r4·5'42'0952-dczo 95-5509
CIP
Index by William Johnston and Julia Perkins
Preface
..
It is very naive to claim to understand men without knowing what
sort of health they enjoyed.
Marc Bloch, Feudal Society
Marc Bloch wrote this as a lament: he found lacking both the evi
dence and the methods necessary to explore the health and diseases of
medieval Europeans. Historians of modern societies lack neither; but
many, and especially those who study Japan, seem to have missed the
importance of Bloch's assertion. This book attempts, at least in part,
to weave a net of understanding over this hole in our knowledge of
modern Japan. It examines the most common cause of death and larg
est single health problem in Japan during the first half of the twenti
eth century. In doing so, it shows that epidemics are far more than
objectively measurable biological events or episodes of importance to
medical scientists: they are also political events in which the strings of
power determine how a society responds to a widespread threat to
health; and they are cultural events that reflect a society's most deeply
held valves and beliefs. We cannot, in other words, depend on any sin
gle thread of analysis to understand epidemics. Rather we must follow
many threads which, although spun of different materials, create a sin
gle fabric.
This was not, however, the image I had in mind when I undertook
this work. Initially, I had based it on a model of challenge and re
sponse: the challenge presented by the rise of tuberculosis in Japan dur
ing the late nineteenth and early twentieth centuries to which the
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PREFACE
Japanese government and medical establishments had responded.
Numerous sources promised to illuminate the relationships among
disease, social change, medical science, and public health policies. The
Japanese government compiled statistics for consumption from r884
and specifically for tuberculosis from 1900. During the early part of
the twentieth century Japanese researchers published careful studies
that showed how the spread of tuberculosis was tied to social changes
that accompanied the development of modern industry. Continuous
runs of Japanese medical journals, which contained numerous articles
on tuberculosis, were available from the late nineteenth century, as
was a whole mountain range of monographs on the disease. And gov
ernment documents provided sources by which the development of
public health policies in response to the disease could be mapped.
The statistical data, however, were difficult to interpret. Mortality
statistics from the late nineteenth and early twentieth centuries in
cluded many deaths from pleurisy and bronchitis, which by them
selves are rarely fatal, as well as from respiratory diseases I had never
heard of such as caseous pneumonia, pleural pneumonia, apical pul
monary catarrh, and infiltration of the lungs. Fortunately, Obayashi
Hideharu, a spry octogenarian who had spent his career as a specialist
in tuberculosis, informed me that before World War II physicians
often gave these disease names as causes of death because the families
of persons who had died of tuberculosis did not want the true cause
recorded on death certificates. As a result they used not only these
names but others such as pneumonia, influenza, and even "stomach
disease." The stigma attached to tuberculosis, Dr. Obayashi informed
me, often made it difficult for members of the family of the deceased
to find marriage partners.
Clearly, the mortality statistics for tuberculosis were reliable as an
index only of the rise and decline of rates of mortality from the disease
and not of the actual number of deaths. It was impossible to extract
accurate figures from categories such as "bronchitis" and "pneumonia,"
which included significant numbers of deaths from tuberculosis. But
this difficulty revealed another approach integral to the social and cul
tural history of this disease. For without understanding the signifi
cance of tuberculosis to the people who experienced its epidemic in
modern Japan, it would be impossible to comprehend the medical and
public health responses to ~t. Physicians and public health officials, as
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PREFACE
much as the people who suffered from the illness, were children of
their cultural milieu. This history of tuberculosis in modern Japan
would be incomplete had I relied solely on statistical data, medical trea
tises, and government documents; a historical understanding of this
epidemic required a knowledge of what the disease meant to the Japa
nese people with their heterogeneous social and cultural backgrounds.
Like The Arabian Nights, the story of an epidemic contains within
it many tales: of growing scientific knowledge, but a growth that does
not always lead in a straight line to what we know in the present; of
increased governmental intervention in the lives of people with the
objective of improving their health, but not always for benevolent pur
poses; of the reception of the afflicted and suffering, but a reception
often marked by a coldness engendered of fear.
By coincidence, as I researched the history of this epidemic in Japan,
yet another chronic, infectious disease was becoming epidemic world
wide. In 1982, the year before I went to Japan to begin research for this
book, that disease acquired a name: AIDS. The more I have learned
about tuberculosis and its epidemic in Japan, and the more AIDS has
unfolded as a major health problem, the more I have been surprised by
the resemblances between the two epidemics and the ways in which
people have reacted to them. I experienced deja vu when governments
were slow to respond to AIDS; when persons with AIDS received cold
hearted treatment in society; when medical researchers, despite their
determined efforts, remained unable to cure this disease, leading per
sons with AIDS to try unconventional and quack treatments. But my
surprise was, it seemed, virtually mine alone; others reacted as though
it were the first time in modern history that an epidemic had caused
these problems. By the 198os many Japanese and most people in other
industrialized countries had forgotten not only that tuberculosis had
constitu~ed a serious epidemic in twentieth-century Japan but also
what that epidemic had meant in terms of medical practices, govern
mental policies, and cultural significance. Modern society's compul
sion for the new has made it compulsively forgetful. It looks at the
AIDS epidemic as something unprecedented when, in fact, many of
the same patterns emerged in the course of modern Japan's epidemic of
tuberculosis. Indeed, similar patterns can be found in numerous mod
ern epidemics for which the case of tuberculosis in Japan can help pro
vide a model for understanding.
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PREFACE
I could not, of course, have attempted to write this book without
substantial and sustained assistance from a variety of sources. Of the
many individuals and institutions who helped me, I would first like
to express my gratitude to Albert M. Craig and Barbara Gutmann
Rosenkrantz. Not only did they provide me with crucial, critical in
sights after reading innumerable drafts of this work, but they have
remained unfailing sources of support and inspiration over the years.
Among those in Japan to whom I owe a special thanks are the late
Kagoyama Takashi and Yamamoto Shun'ichi, both of whom took a
special interest in this project and provided me with many sources.
Yamazaki Hiroaki sponsored me at The Institute of Social Science at
Tokyo University, where he and Nishida Yoshiaki, Oishi Kaichiro,
Okudaira Yasuhiro, Shibagaki Kazuo, and Tohara Shiro generously
gave advice and support. In particular, I would like to thank Oishi Kai
chiro and Nishida Yoshiaki for allowing me to join the Goka Village
Research Group and for enabling me to see a silk filature firsthand.
My appreciation extends to all the members of this Research Group
but to Hayashi Yuichi and Oshima Eiko in particular for providing
me with numerous sources. I would like to thank Sonoda Kyoichi and
Marui Eiji at Tokyo University, and at the Japan AntiTuberculosis
Association, Iwasaki Tatsuro. Other scholars in Japan to whom Ire
main indebted include Amino Fusako, Amino Yoshihiko, Haga Shoji,
Kobanawa Heiroku, Naito Jiro, Obayashi Hideharu, Ono Yoshiro,
Ota Yiizo, Sawa Nagayo, Sonoda Hidehiro, Suzuki Takao, Takahashi
Kimiaki, and Yamaguchi Keiji. Seki Kenji, Seki Taeko, Takeuchi
Kazue, and Takeuchi Shiro opened their homes to me and presented
me with more kindnesses than I can begin to enumerate, but all of
which helped facilitate this book.
Michael Reich of the Harvard University School of Public Health
contributed extensive comments. I am especially grateful for his
efforts. Also at Harvard, Harold Bolitho, Haruko Iwasaki, Arthur
Kleinman, Henry Rosovsky, and Ezra Vogel offered valuable com
ments on drafts of this work. In addition, an anonymous reader for the
Council on East Asian Studies at Harvard contributed numerous in
sightful observations that forced me to reconsider both the structure
and contents of this book. For assistance and insights that took many
forms, I thank ltasaka Gen and Tarnai Kensuke. The patience of the edi
tors at the Council on East Asian Studies at Harvard, especially Sibyl
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PREFACE
Johnston, Lee Ann Best, and Katherine Keenum, was exceeded only by
their helpfulness. And a word of special thanks goes to John Solt of
Amherst College, whose poetic assistance took many forms, including
help with the translations of the verses I have incorporated in this work.
My colleagues at Wesleyan University, including Lydia Goehr, David
Titus, Ellen Widmer, Ann Wightman, and the late Carol Ohmann,
read all or parts of the manuscript and provided valuable comments.
E B. Smith, at Australian National University, introduced me to sev
eral valuable sources. Julia Perkins gave me considerable help with
proofreading and indexing.
The problems and mistakes that remain are my own-despite the
inspired efforts of others.
Numerous libraries and institutions made materials available for
this dissertation. At Tokyo University these included The Institute of
Social Science Library, the Medical School Library, the Meiji Shinbun
Zasshi Bunko, the Shinbun Kenkyujo, the Department of Economics
Library, and the Hong6 Central Library. I am also indebted to the
National Diet Library of Japan, the National Archives of Japan, the
Keio University Medical School Library, the Kyoto University Med
ical School Library, the Takeda Pharmaceutical Company Archives,
the Japan Anti.:fuberculosis Association, the Ministry of Finance, and
the Ministry of Welfare. I remain especially indebted to the Harvard
Yenching Library for its continued support. The Countway Library
at Harvard Medical School and Olin Library at Wesleyan University
provided access to many valuable materials, and the City of Togura in
Nagano Prefecture, Japan, gave me access to its collection of rare
municipal documents.
The Japan Foundation, the Fulbright-Hays Doctoral Dissertation
Abroad Program, the National Graduate Fellowship Program, Har
vard University, the Edwin 0. Reischauer Institute of Japanese Stud
ies at Harvard University, Wesleyan University, the Center for the
Humanities at Wesleyan University, and the International Research
Center for Japanese Studies in Kyoto all provided financial assistance,
and to them I am grateful.
Kobayashi Rie gave me years of patience and kind support. Only to
my parents do I owe a greater personal debt. To them, and to the mem
ory of Kagoyama Takeshi and Obayashi Hideharu, this work is
dedicated.
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