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

In an earlier, groundbreaking study, Epidemics and Mortality in Early Modern Japan (Princeton, NJ: Princeton University Press, 1987), Professor Ann Jannetta referred to smallpox as "the most terrible minister of death." In her new study, Professor Jannetta traces Edward Jenner's discovery of cowpox vaccination in rural England in 1798 to the primary role Japanese ranpō (Dutch, or Western methods) physicians played in institutionalizing medical knowledge by tirelessly promoting Jennerian vaccination to prevent smallpox. The primary thesis of The Vaccinators is that these ranpō physicians privately established social and professional networks in support of Jennerian vaccination in the first half of the nineteenth century and eventually became a catalyst for Japan's rapid modernization during the second half of the century. This is a deftly written and argued work on an important public health topic of nineteenth-century Japan, combined with a transnational examination of diffusing medical knowledge of one of the world's major epidemic diseases.

The first two chapters of The Vaccinators are overviews of smallpox in history, including the practice of variolation—exposing children to a mild case of smallpox—and a reasonably thorough account of Edward Jenner's discovery and experiments with cowpox vaccine in Gloucestershire. Exposing a child to cowpox through inoculation was less dangerous than exposure to a mild form of smallpox, and had the same effect of immunization from smallpox. Because smallpox epidemics normally resulted in 10–20% mortality rates, Jenner's safer vaccination method had a "revolutionary and global impact" on disease, mortality, and demographics. Jannetta skillfully delineates how Jenner's cowpox vaccination method quickly became diffused and practiced throughout much of Europe; British, French, Dutch, and Belgian physicians cooperated with one another despite the Napoleonic Wars. France, Spain, England, and the Dutch also transmitted this medical knowledge and cowpox lymph to their overseas colonies, usually by sending young children recently vaccinated as carriers aboard ships taking supplies to the colonies.

Despite the efforts of a few Dutch officials in Batavia, Indonesia, and at the small trading enclave at Nagasaki, Japan, and despite the translation of a Russian paper on cowpox vaccination into the Japanese language by a young Japanese translator, geopolitical problems between the British and the Dutch in Asia and internal obstacles set up by the Tokugawa government prevented this revolutionary knowledge from becoming widely known in Japan for decades. Philipp Franz von Siebold, a German physician working for the Dutch post at Nagasaki, trained a number of Japanese physicians in Western medical practices, including cowpox vaccination. Unfortunately, a scandal involving his procurement of maps, prohibited by Tokugawa law, led to the arrest, jailing, and even execution of some of the Japanese ranpō physicians he trained. This not only delayed acceptance of cowpox vaccination by the Tokugawa authorities, it also drove many ranpō physicians underground, especially those with connections to Von Siebold. Yet Jannetta argues that the "Siebold Incident" effectively led to multigenerational networks of ranpō physicians who transmitted Western medical knowledge, including cowpox vaccination, to Japanese physicians and scientists who institutionalized Western medical practices eventually accepted by the Tokugawa government. To support this argument, Chapter 5, "Constructing a Network: The Ranpō Physicians," includes biographies of eight physicians connected to Von Siebold, who promoted cowpox vaccination and later became public health policymakers during the late Tokugawa Era or early Meiji Era.

In 1849, Nabeshima Naomasa, daimyō (lord) of Saga domain, the head of one of the highest-ranking families in Japan, a strong supporter of Western knowledge, had his oldest son and heir, Junichiro, vaccinated with cowpox lymph. This was a strong political and medical statement in support of Western medicine in a country that regarded Westerners as barbarians. The dustcover of The Vaccinators includes a beautiful painting of the "first vaccination" scene at Saga Castle. Within months of the Nabeshima vaccination, instructions for physicians, pamphlets, and popular woodblock prints promoting gyūtō shutō (cowpox inoculation) appeared all over Japan...