American Evangelists and Tuberculosis in Modern Japan by Elisheva A. Perelman (review)

The activities of Protestant missionaries in late nineteenth- and early twentieth-century Japan have attracted a good deal of scholarly interest over the years, particularly in relation to topics such as gender, education, and social activism. In contrast, the medical aspects of their work are relatively unstudied, especially when compared with the substantial literature on medical missions in China and Korea. Elisheva A. Perelman’s work is thus a welcome contribution to the historical research on Christian missionaries. It is not, however, a conventional study of missionary-founded hospitals and sanitaria; rather, Perelman’s primary interest is in understanding why the Japanese state failed to tackle tuberculosis head-on in the late nineteenth and twentieth centuries, even as the number of those infected grew, and instead was content to relegate their care to foreign Protestant missionaries among other private entities.

This is an interesting question, if to some degree a myopic one. In this period the Japanese government consistently declined to fund institutions to care for sufferers of chronic diseases including not only tuberculosis but also mental illness and leprosy. Leprosy, in particular, makes for an interesting comparison with tuberculosis since the founding of the first public leprosaria in 1909 came about only through a combination of foreign and domestic pressure, and both Catholic and Protestant missionaries were involved in leprosy relief. That said, the government’s inaction in relation to tuberculosis is interesting on its own terms given the significant number of cases, which far outpaced that of leprosy sufferers. Moreover, as Perelman rightly notes, the decision by missionaries to involve themselves in the care of tuberculosis patients requires explication. Unlike leprosy, which was rife with biblical significance and was the object of an international Protestant effort spurred by the work of the Mission for Lepers, tuberculosis was by no means an obvious choice, especially considering the scale of the problem.

American Evangelists and Tuberculosis in Modern Japan invokes the term “moral entrepreneurship” to explain the competitive relationship that emerged both between the Japanese state and evangelical groups and among different missionary enterprises. Adopting the term from sociologist Howard S. Baker via the work of Jack E. Nelson on the Salvation Army in Japan, she uses it to describe the efforts of the different entities she examines to “maintain the appearance of the moral high ground” in relation to the others (p. 2). Perelman argues that amid the contesting claims of moral rectitude, tuberculosis patients were reduced to “pawns” and “currency”: robbed of their agency, they were viewed as passive victims and potential converts by the missionaries and as a threat to the nation by the state (p. 3).

Perelman’s argument unfolds gradually over a series of short topical chapters. The first three chapters are contextual in nature. Chapter 1 examines the so-called factory girls, the young girls and women who labored in Japan’s textile mills and became infected with tuberculosis in significant numbers due to the poor conditions within which they worked and lived. Perelman notes that in spite of the important role they played in the industrialization of Japan, female factory workers soon came to be stigmatized for spreading tuberculosis (as well as syphilis) to their villages, where, it was claimed, they infected the young men who were valued as the future soldiers, farmers, and industrial workers of the nation. Chapter 2 focuses on tuberculosis itself, exploring how germ theory and the new understanding of the disease as infectious contributed to the stigmatization of its victims. Chapter 3 is centered on the well-known bacteriologist Kitasato Shibasaburō, who devoted considerable time to tuberculosis research. A divisive figure who antagonized many in government and in medicine, Kitasato championed tuberculin, Robert Koch’s failed cure for tuberculosis, and neglected to take the lead in advocating for preventive measures.

It is not until chapters 4 and 5 that Perelman turns to her main theme of the relationship between the government and Protestant evangelists. In...