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

In the arresting oil painting reproduced on the cover of this book, a Japanese doctor inserts a needle into a young boy's arm under the watchful but approving eye of the boy's father, a powerful domainal lord. This event, which took place in 1849, represents a key moment in the dissemination of the cowpox vaccination in Japan. This was the moment when high-ranking political authorities in various parts of the country provided, for the first time, official support to the efforts by physicians to fight the smallpox disease through Jennerian vaccination. In Jannetta's book, this moment is the culmination of a narrative that traces the global diffusion of Jennerian vaccination from its origins in England at the end of the 18th century to its dissemination in Japan a half-century later.

After a discussion of the practice of variolation—the pre-Jennerian method of combating smallpox through a controlled exposure to the virus—the focus of Jannetta's narrative shifts to England, and to Jenner's efforts to develop the cowpox vaccine in the 1790s. Janetta provides a surprisingly in-depth treatment of this story, drawing extensively from Jenner's own written work. She then moves on to discuss the global diffusion of the vaccine—first to Europe, then to Europe's colonies. This diffusion took place rapidly, due both to professional networks through which information about the cowpox vaccination could spread and newly constituted national or colonial governments that implemented the practice within their borders.

Jannetta shows that while news of the Jennerian vaccination reached Japan quickly—in 1803, only five years after Jenner's findings were first published—the widespread implementation of the practice in Japan was more fitful. The news was first communicated by a Dutch factory employee in Nagasaki to a Japanese interpreter; a decade later, the same interpreter acquired a Russian tract on vaccination and, after several years, translated it. Additional momentum was created when the German doctor Siebold arrived in Nagasaki in 1828. Japanese physicians and intellectuals who had studied Dutch medicine flocked to Nagasaki to study with Siebold, producing a network of individuals who were convinced of the value of this new medical technology. Their efforts yielded fruit roughly two decades later, when political authorities began to lend their authority and administrative support.

Jannetta asks the question of why this new technology spread more slowly in Japan than it had in Europe and its colonies. Indeed, the analytical thrust of the book is in response to this question. There are two fairly obvious answers. First, Japan's political order did not take as its organizing principle the mobilization of the collective energies of its population—it was not, in ther words, a nation-state —and therefore was less motivated and equipped to carry out public health measures of this sort. Second, Japan's restrictive foreign policy during the Tokugawa era and its geographic remove from global trade routes curtailed the flow of information to Japan from the rest of the world.

Jannetta recognizes these two factors, but her main focus is on the structural impediments within Japanese society that, she argues, prevented a more rapid diffusion of the vaccine. In particular, she describes a Japanese society in which the flow of information was severely limited by both censorship and a cultural tendency to transmit specialized knowledge through vertical master-pupil lineages. She places this picture in contrast to European society, in which universities, medical societies, professional journals, and other conduits allowed for a relatively free flow of information about the vaccine. She argues, in turn, that the introduction of Jennerian vaccination to Japan provided the impetus for the formation of the kinds of social mechanisms—in particular, lateral, quasi-professional connections forged through the common pursuit of specialized knowledge—necessary for the widespread dissemination of the vaccine. These mechanisms, she argues, played a fundamental role in Japan's modern transformation. Vaccination was, in other words, a transformative technology for Japan...