Kingdom of the Sick: A History of Leprosy and Japan by Susan L. Burns (review)

Hansen's disease (leprosy) is one of the earliest recorded infectious diseases in Japan and many other parts of the world, and in that sense it is a universal affliction confronted by societies everywhere. At the same time, however, its historical trajectory has varied widely by region. In Europe, Hansen's disease disappeared for centuries after the devastation of the Black Death, only to reemerge in the nineteenth century on the continent's periphery and in its overseas colonies. On the Japanese archipelago, by contrast, leprosy remained a constant feature of life following its first recorded occurrence, although the frequency of outbreaks varied somewhat depending on the era. This difference has led European historians to treat Hansen's disease as a part of nineteenth-century colonial and imperial medical history, whereas their counterparts in Japan have focused primarily on the disease's domestic history and transhistorical continuity.

Kingdom of the Sick is the first English-language monograph on the history of Hansen's disease in Japan. Adopting a longue durée approach, Susan Burns explores the trajectory of the disease from the classical period to the present in three chronologically arranged sections, with the first section (chapters 1 and 2) focusing on the premodern years, the second (chapters 3 to 5) on the 1870s to the 1910s, and the third (chapters 6 to 8) on the 1920s to the 1960s. Her primary concern, though, is with the modern era. As I explain in my 2011 book,¹ the Japanese-language historiography of Hansen's disease changed dramatically in the 1990s as many scholars began to strongly denounce the government's segregation policy. Burns argues that the restoration of former patients' social standing following victory in a 2001 lawsuit against the Japanese government elevated this narrative of "denunciation" to the status of historical "fact," leading discrimination against patients to be viewed as a product of government policy and the government as the actor primarily responsible for eliminating that discrimination. Criticizing this narrative, Burns seeks to provide an alternative understanding of the history of the disease in Japan by relying not on the oft-used concepts of "biopolitics" and "total institution," but on that of "biological citizenship" as first articulated by Nicholas Rose. This focus on biological citizenship enables Burns to analyze the biosocial community that developed among patients. As she notes, such communities arise among groups of people subject to a shared form of victimization or stigmatization, for example those affected by the Chernobyl nuclear disaster in the Ukraine; whereas biopolitics emphasizes the discipline imposed on patient bodies from above, biological citizenship highlights the solidarity and communal bonds that support victims' movements from below.

Burns's argument in chapters 1 and 2 is based primarily on research conducted in the 1970s and 1980s by Kuroda Toshio and Amino Yoshihiko on hinin (outcast) status in the medieval period, along with Niunoya Tetsuichi's work on premodern conceptions of kegare (pollution), Yokoi Kiyoshi's study of the Buddhist stigma attached to leprosy patients, and Suzuki (Yokota) Noriko's groundbreaking 1990s investigations into the early modern history of leprosy. Burns examines the formation and development of status groups among leprosy patients and asserts that popular conceptions of leprosy changed dramatically in the early modern period as the disease came to be viewed as a product not of "bad karma" but of "bad blood." According to Burns, that shift caused lepers to be excluded from their communities of origin, contributing directly to the formation of self-regulating leper groups. I suspect, however, that the need to remain logically consistent leads Burns to overemphasize the significance of these status groups; as Suzuki has demonstrated, most early modern leprosy patients did not belong to them and actually continued living at home.²

The next three chapters of the book discuss the decades leading up to the enactment of the Law Concerning Leprosy, Japan's first piece of legislation addressing Hansen's...