Kingdom of the Sick: A History of Leprosy and Japan by Susan L. Burns, and: Uncertainty, Anxiety, Frugality: Dealing with Leprosy in the Dutch East Indies, 1816–1942 by Leo van Bergen (review)

Leprosy (J. rai 癩) is one of the oldest and most studied human diseases in the humanities and social sciences. Its extraordinary complexity in both medical and cultural terms has sustained academic interest for decades. The question of whether leprosy is hereditary or contagious, as well as the visible suffering and terrifying physical symptoms that patients experience, makes the disease an obvious metaphor of morality and pollution. Systematic stigmatization of sufferers, who were almost universally segregated in the past, explains leprosy’s central place in the history of religious redemption and biopolitical governance. Scholars of colonial studies often find debates about leprosy’s nature most pertinent when articulating questions on the body, class, gender, and race, especially in relation to the formation of modern public-health regimes. They find modern actors in the long history of leprosy quarantine—Western biomedical experts, social reformers, bureaucrats, Christian missionaries, and patients themselves—central in the process of state building in an entangled global context. Finally, the fate of the cured or “freed” patients is often cited in post-colonial debates on human rights, heritage, and citizenship. The two recent publications under review highlight many of these issues and bear witness to the unique place of leprosy in modern Asian political culture. Kingdom of the Sick is about Japan as an up-and-coming modern nation-state, and Uncertainty, Anxiety, Frugality is about the East Indies, a multicultural place colonized by the Dutch. Focusing on the changing perceptions of leprosy and its management, these two books reveal important aspects of the evolving political culture in two very different regimes during a special historical period in colonial Asia.

The two books, though covering roughly the same period (mainly from the seventeenth to the first half of the twentieth century), are very different in approach and content. Using mostly Japanese sources, Burns depicts in great detail the ways in which Japanese doctors and bureaucrats handled leprosy, as well as how patients reacted to various institutional designs as Japan strived to join the league of modern nations. In contrast, Van Bergen uses Dutch sources to trace the actions of colonial doctors, military personnel, bureaucrats, missionaries, and secular organizations involved in leprosy control, examining how their changing understanding of the disease shaped the institutionalization of patients in Dutch Moluccas, Java, and Sumatra. Due to the nature of the sources used by the author, Uncertainty, Anxiety, Frugality does not include indigenous perception of leprosy or the attitudes of native doctors and patients toward policies imposed by the Dutch colonizers.

Susan Burns’s Kingdom of the Sick, based on years of in-depth archival research and extensive site visits from 1999 to 2016, is an important contribution to both the history of leprosy and the history of modern Japan. Burns adds layers of nuance to the familiar and often overly simplistic narrative, which she calls the denunciatory narrative (pp. 17, 257), that assumes patients as passive victims of draconian control measures. Burns does so by first highlighting two unique Japanese historical experiences: the long history, since at least the thirteenth century, of patients’ shared living in communities and a vibrant medical marketplace of indigenous remedies and institutions during the early Meiji period. Such experiences were crucial in the construction of patients’ subjectivity at a time when Japan was developing into a modern, colonizing state while still bearing the frustrating image as a “kingdom of the sick,” as Burns’s title indicates. Japan’s distinctively ambivalent self-perception as both a modern, civilized nation and at the same time as one of the “leprous countries” (p...