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

"The Vaccinators is a book about connections," writes Ann Jannetta in the preface to this important work (p. xv). By tracing the personal and intellectual networks that lay behind the tortuous introduction of Jennerian (cowpox) vaccine to nineteenth-century Japan, she takes her readers on a journey from England, where Edward Jenner conducted his groundbreaking experiments in the 1790s, to Tokugawa Japan. There, vaccine was imported successfully in 1849, 50 years later than almost everywhere else in the world. Jannetta explores the barriers that kept vaccine out of Japan and, more important, the effects that the lack of access to this technology had on the local medical community. The Vaccinators is thus an adroit mix of local, national, and transnational history that will appeal to a wide audience.

Smallpox is the first disease in history to have been eliminated through human intervention. The story of Edward Jenner and his experiments that proved cowpox virus could protect against smallpox is well known, and this book is a contribution to an already large literature. The place of Japan within the vaccination enterprise, however, has, until now, not received the attention in English that it demands. Japanese historians of medicine have long been aware of the importance of cowpox vaccination in winning Japanese acceptance for Western medicine prior to the Meiji era. Jannetta draws on these arguments and expands them into an important thesis of her own: the doctors involved in vaccination created a new social and intellectual elite that played an important role as an agent of change, not only in the late Tokugawa period, but also on into the early Meiji era. Until recently, English-language works on the Dutch Studies movement in Japan had tended to downplay its long-term significance, arguing that the Japanese adoption of Western knowledge was too haphazard to form a workable foundation for scientific knowledge.¹ The example of cowpox vaccination in the late Tokugawa period, however, provides a powerful counterexample, and Jannetta's book is a welcome complement to other recent work in this area.²

Jannetta begins with a chapter devoted to the global problem of smallpox disease prior to the introduction of vaccination. By the eighteenth century, smallpox had reached almost every corner of the globe. In places where the disease was endemic (which were increasing along with world population), all living adults were smallpox survivors and it was common not to give children names or to count them as family members until they had safely lived through the disease (pp. 8–10). Facing a fatality rate of around 25 per cent, many parents decided to expose their children to smallpox in a controlled manner in the hope they would contract only a mild case. This was known as variolation, and Jannetta skillfully negotiates a wide range of secondary literature as she explains the methods of variolation used prior to Jenner's development of cowpox vaccine. Sophisticated methods of variolation were developed in Turkey (and spread to Europe) and a different method in China. Both methods were known in Japan by the end of the eighteenth century, but curiously they did not become popular practice. The reason, Jannetta argues, was that the government was disinterested, and Japan was yet to establish a coherent network of physicians, let alone a medical society, that could effectively mobilize this knowledge.

Chapter 2, entitled "Jenner's Cowpox Vaccine," is a brief history of Jenner's development of vaccine and its diffusion around the globe. This is a beautifully written chapter that demonstrates Jannetta's command of world disease history. She succinctly describes not only the importance of Jenner's work but why interpersonal connections were so important in trying to ship the vaccine from one place to another. As Jannetta explains, the geographical spread of cowpox was limited, and the virus was not always easy to obtain even in areas where it did exist. Moreover, it was fragile and quickly lost its...