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  • Kingdom of the Sick: A History of Leprosy and Japan by Susan L. Burns
  • Alexander R. Bay (bio)
Kingdom of the Sick: A History of Leprosy and Japan. By Susan L. Burns. University of Hawai'i Press, Honolulu, 2019. viii, 334 pages. $68.00.

Susan Burns has written a much-needed, English-language, book-length, critical study of the history of Hansen's Disease in Japan. The general public may be familiar with the general story. The Japanese state passed a Leprosy Prevention Law in 1907 to house the infected in leprosaria, which it amended in 1953 to force sufferers into lifetime confinement despite an effective treatment, Promin, being available from 1948. Former sufferers sued the state in the 1990s for maintaining a system of incarceration that violated human rights. They won. The Diet revoked the law in 1996. The critical literature on the history of Hansen's Disease, until recently, has focused on how the state used its power to subjugate and oppress those with the disease. In the wake of the court cases decided in favor of former patients, this narrative has become an unassailable fact. Medical historian Dr. Hirokawa Waka calls this genre of literature "denunciatory history."

Kingdom of the Sick takes aim at the "denunciatory" Japanese historiography and a narrative in which leprosy sufferers were unilateral victims of modernity and the Japanese nation-state and, instead, explores the agency of those with Hansen's Disease both in and outside the walls of the leprosaria. While many scholars suspect that patient literature—short stories, novellas, and poetry—cannot reveal the subjectivity of its authors since it was produced in an institution of control, Burns uses patient literature to highlight their "perspective." She reveals that even decisions to undergo sterilization, for those who wanted to marry within the sanitaria, were often choices made by patients weighing a number of different issues and responsibilities. Kingdom of the Sick argues that even under lifetime confinement, patients had a modicum of agency.

Chapter 1 examines how premodern Buddhist sanctuaries or villages dedicated to housing leprosy sufferers, or those afflicted with raibyō, were built upon religious and Confucian notions of morality, karmic retribution, and purity within the social order. Rai was understood in ancient Japan as a karmic disease. It marked the afflicted as unclean (kegare) and required [End Page 201] the sufferer to renounce family and become a beggar. In late antiquity, the imperial line began stressing its role as protector of the realm via purity rituals that "safeguarded the capital and its residents." This "pollution ideology" reordered spatial relations and forced the polluted, including those with rai, into marginalized spaces designed to buffer society from the afflicted (pp. 23–24). Rai sufferers often found themselves living with other outcasts and relegated to jobs removing things deemed unclean from temple or shrine precincts. The role of the rai sufferer in what Burns calls "the economy of salvation" (p. 28) was to be an object that aristocrats could perform pious acts for to increase their own karmic merit.

Chapter 2 focuses on how medical notions of rai in the Edo period changed from something karmic to something that ran in family blood lines. While Kingdom of the Sick skims over the medieval period, Burns does note that the Ton'isho by Kajiwara Shōzen, completed between 1302 and 1304, discussed rai as not a karmic disease but one that could be treated with particular drug formulas. Burns argues that this "suggests a new and intriguing willingness to interrogate the theory of karmic retribution and to deconstruct the disease category of rai. … [However, the work's] limited circulation, like that of all texts in this era, meant that its impact was probably muted. That situation changed dramatically after 1600" (p. 50). Here, Kajiwara's later text, Man'anpō, and Andrew Goble's scholarship in Confluences of Medicine in Medieval Japan (University of Hawai'i Press, 2011) concerning the contribution of Kajiwara's writings on rai as a nonkarmic disease that could be treated are passed over. Nevertheless, Burns shows that during the Edo period, instead of a cohesive set of ideas surrounding rai, a number of competing ideas about the hereditary...