Smallpox and the Epidemiological Heritage of Modern Japan: Towards a Total History

This article examines one of the long-term structural forces that contributed to the making of public health in Modern Japan. My overall argument is that the history of public health should be conceived as a total history, encompassing not just political, administrative, and scientific factors but also natural, social, and economic factors. Elsewhere I have discussed two of these factors in some detail, both of which were long-term structural forces resulting from the interactions of different realms: 1) the effect of the topography and the pattern of the use of land; and 2) the effect of the market as a medium for people’s behaviour seeking the prevention of the disease. Here I will argue that the Japanese long-term experience of diseases provided another structural force that shaped public health in Japan. The long-term cumulative factor can be called the ‘epidemiological heritage’ of Japan. Although the phrase ‘epidemiological heritage’ is my own coinage, the concept has been articulated and developed most clearly by Peter Baldwin in his Contagion and the State in Europe 1830–1930 (1990). Baldwin has shown that mediaeval and early modern experience of plague provided the basis from which nineteenth-century public health in Europe was developed. Repeated visitations of plague prompted European states to establish public-health measures, first in Italian cities and then in states in northern Europe. The anti-plague measures consisted mainly of spatial limits imposed on the movement of people and goods: quarantine, cordon sanitaire, confinement of patients in lazarettos, and disinfection of goods and letters at borders. These spatial measures entered the vocabulary of public health in the late mediaeval and early modern periods and remained there even after plague disappeared from Europe in the eighteenth century. When cholera hit Europe in the 1820s, European states resuscitated their anti-plague measures to combat cholera: ‘most regimes dusted off their files on bubonic plague and put what were by now fairly traditional policing measures into operation: military