The Vaccinators: Smallpox, Medical Knowledge, and the 'Opening' of Japan (review)

At first glance, the title of the book might sound a little bit astonishing. What, the reader might ask, does the history of a disease and its treatment have to do with the opening of Japan? But it is well chosen, because it raises curiosity and the reader will soon discover that it carries the central argument of the book: Physicians who adopted Dutch medical learning (Rangaku) and tried hard to introduce variolation and vaccination against smallpox into Japan—the ranpö physicians—at least after 1820 contributed decisively to intellectual, social, and political changes in the country. To use Jannetta's own words, Japan's ranpö physicians—the vaccinators—were "important agents of change" (p. 182). Faced with the extreme isolation of the Tokugawa government from the concerns of its society and the restrictively monopolized foreign policy resulting from the Tokugawa rulers' raison d'état, these physicians had to build up and expand their own networks to reach their goal—to bring cow vaccine to Japan and to convince both high and lower echelons of Japanese society not only of the advantages of vaccination against smallpox but often also of Western medical science in general.

The reader is taken not only into different world regions and countries such as England, the Netherlands, Russia, China, and of course Japan, but also into different disciplines (history of medicine, social and political history). After briefly being informed about the migrant history of Variola major, the virus that causes smallpox, and of variolation in the eastern Mediterranean world and in China (pp. 8–24), the second chapter takes him to England. Pages 25–52 narrate the story and background of Edward Jenner's "discovery" that inoculation with cowpox lymph (that is, vaccination) would prevent smallpox. The next chapter (pp. 53–77) introduces the scenario at Nagasaki where the Dutch, besides the Chinese, were the only foreign merchants permitted to conduct a strictly regulated trade, and the first attempts of physicians to introduce cow vaccine and Western medical knowledge to Japan. In this context, especially the writings of a young Japanese interpreter for Dutch, Baba Sajürö, were of particular significance for spreading the knowledge about vaccination in Japan. These first attempts and efforts were the beginning of the construction of a close network, for which the Dutch connection (chapter 4, pp. 78–101) was particularly important as the foreign link. In 1824, Philipp Franz von Siebold (1796–1866) established a small medical school and clinic in the outskirts of Nagasaki called Narutaki, and students interested in learning about Western-style medicine came from all over Japan.

Jannetta introduces Japanese physicians and physician families who would make Jennerian vaccination their cause célèbre and who decisively contributed to the transition from Chinese-style to Western-style medicine in the early nineteenth century. Because of their prominent role in the introduction of Jennerian vaccination to Japan, the contribution of some of these physicians is treated in detail in chapter 5 (pp. 102–131). Jannetta draws a lively picture of the various social and intellectual "strategies" the doctors used to strengthen their networks. Adoptions and marriages between families of doctors, for example, were frequent, and the reader may be surprised how often name changes occurred, sometimes repeatedly. By the mid nineteenth century the work of the vaccinators had become at least so successful that, confronted with a death rate of approximately 20 percent of all born children from smallpox, the first great political lords were convinced by the efficacy of Jennerian vaccination: In 1849 Nabeshima Naomasa (1814–1871) decided to vaccinate his eldest son (p. 136), an act with political significance that provided the vaccinators with valuable support. In 1858 a first clinic for the purpose of vaccination, the Otamagaike Vaccination Clinic, was opened in Edo. When with the opening of Japan in the 1850s the Japanese—so far protected by a kind of cordon sanitaire—were ad hoc confronted with other hitherto unknown diseases and...