In Japan, as late as the mid-nineteenth century, smallpox claimed the lives of an estimated twenty percent of all children born—most of them before the age of five. When the apathetic Tokugawa shogunate failed to respond, Japanese physicians, learned in Western medicine and medical technology, became the primary disseminators of Jennerian vaccination—a new medical technology to prevent smallpox. Tracing its origins from rural England, Jannetta investigates the transmission of Jennerian vaccination to and throughout pre-Meiji Japan. Relying on Dutch, Japanese, Russian, and English sources, the book treats Japanese physicians as leading agents of social and institutional change, showing how they used traditional strategies involving scholarship, marriage, and adoption to forge new local, national, and international networks in the first half of the nineteenth century. The Vaccinators details the appalling cost of Japan's almost 300-year isolation and examines in depth a nation on the cusp of political and social upheaval.
In Japan, as late as the mid-nineteenth century, smallpox claimed the lives of an estimated twenty percent of all children born—most of them before the age of five. When the apathetic Tokugawa shogunate failed to respond, Japanese physicians, learned in Western medicine and medical technology, became the primary disseminators of Jennerian vaccination—a new medical technology to prevent smallpox. Tracing its origins from rural England, Jannetta investigates the transmission of Jennerian vaccination to and throughout pre-Meiji Japan. Relying on Dutch, Japanese, Russian, and English sources, the book treats Japanese physicians as leading agents of social and institutional change, showing how they used traditional strategies involving scholarship, marriage, and adoption to forge new local, national, and international networks in the first half of the nineteenth century. The Vaccinators details the appalling cost of Japan's almost 300-year isolation and examines in depth a nation on the cusp of political and social upheaval.
The Vaccinators: Smallpox, Medical Knowledge, and the 'Opening' of Japan
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The Vaccinators: Smallpox, Medical Knowledge, and the 'Opening' of Japan
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Overview
In Japan, as late as the mid-nineteenth century, smallpox claimed the lives of an estimated twenty percent of all children born—most of them before the age of five. When the apathetic Tokugawa shogunate failed to respond, Japanese physicians, learned in Western medicine and medical technology, became the primary disseminators of Jennerian vaccination—a new medical technology to prevent smallpox. Tracing its origins from rural England, Jannetta investigates the transmission of Jennerian vaccination to and throughout pre-Meiji Japan. Relying on Dutch, Japanese, Russian, and English sources, the book treats Japanese physicians as leading agents of social and institutional change, showing how they used traditional strategies involving scholarship, marriage, and adoption to forge new local, national, and international networks in the first half of the nineteenth century. The Vaccinators details the appalling cost of Japan's almost 300-year isolation and examines in depth a nation on the cusp of political and social upheaval.
Product Details
| ISBN-13: | 9780804779494 |
|---|---|
| Publisher: | Stanford University Press |
| Publication date: | 05/23/2007 |
| Sold by: | Barnes & Noble |
| Format: | eBook |
| Pages: | 264 |
| File size: | 8 MB |
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Read an Excerpt
The Vaccinators
SMALLPOX, MEDICAL KNOWLEDGE, AND THE 'OPENING' OF JAPANBy Ann Jannetta
STANFORD UNIVERSITY PRESS
Copyright © 2007 Board of Trustees of the Leland Stanford Junior UniversityAll right reserved.
ISBN: 978-0-8047-5489-7
Chapter One
Confronting Smallpox
At the beginning of the nineteenth century, smallpox was a force to be reckoned with—a universal disease and the world's most reliable killer. The virus that causes smallpox, Variola major, was a tireless migrant that moved continuously from place to place in search of susceptible human hosts to infect. Because a human host provided only a temporary residence for V. major, the death or recovery of its host meant that the virus had to move on in search of a new one. Hence, the smallpox virus thrived in cities and other places where the number of human hosts was large or where a high birth rate produced new hosts to accommodate the peripatetic virus. In such places, smallpox became an endemic disease that circulated continuously from one susceptible human host to another. World population growth and increases in the number and size of cities eventually created environments in which the smallpox virus could sustain itself indefinitely.
In ancient times, the migrations of the variola virus were contained within separate spheres of contact that connected the great civilizations of the Old World. Human migrations of all sorts—interregional trade, wars, and expansion across frontiers—facilitated the spread of the smallpox virus to populations where smallpox was unknown and where every living person was a susceptible host. A dramatic transmission of the variola virus occurred with the discovery of the Western Hemisphere by Europeans. The human migrations that followed allowed V. major to make a transoceanic leap to the New World, where it found large new populations to infect, and these areas experienced massive depopulation from smallpox. In societies that experienced regular exposure to smallpox, the case-fatality rate was about 25 percent; however, in societies that encountered smallpox infrequently, the rate was much higher. When a high proportion of the population was stricken within a short period of time, few healthy individuals remained to care for large numbers of desperately ill people, and the death rate rose as a result.
In early modern times, as long-distance trade expanded to connect virtually all regions of the world, the smallpox virus was able to establish a global migratory sphere. V. major traveled by land and by sea, a frequent companion of its human host. By the eighteenth century, smallpox had become a universal disease that afflicted societies everywhere. Survivors of smallpox acquired lifetime immunity to the disease; hence, in densely settled populations where smallpox was endemic, it soon became a disease of children. Virtually all living adults were smallpox survivors, many of whom bore the hideous, disfiguring scars that were the telltale mark of the disease. High smallpox mortality rates could check population growth in places where the disease was endemic, but because most adults were immune, smallpox only rarely challenged political and social stability in those places.
By contrast, communities with small, scattered populations that had few contacts with the world's population centers could avoid exposure to smallpox for long periods. However, when the variola virus did strike and a large proportion of the population was infected, the political, social, and demographic effects could be devastating. In addition to virgin populations experiencing smallpox for the first time, nomadic communities and pastoral peoples who moved from place to place on the fringes of settled, agrarian societies were especially vulnerable. They too suffered unusually high mortality rates from smallpox when they came in contact with their more settled neighbors.
As the migratory sphere of V. major expanded and the incidence of smallpox cases increased, smallpox apparently became a more virulent disease. Certainly, seventeenth-century European observers believed that smallpox was a more serious disease than it had been in earlier times. Given the absence of case-fatality statistics, it is not possible to confirm this observation, but the annual bills of mortality for London, which began to be published in 1629, indicate that smallpox was already a major cause of death and increasingly caused a larger proportion of all deaths. This trend was observed in the eighteenth century as well. Genevieve Miller has referred to smallpox as "a formidable new scourge" that was "taking the place of old enemies like the plague...." It was common wisdom not to count one's children until they had survived smallpox.
What could be done? Apart from invoking divine protection, the time-honored methods of combatting smallpox were flight and isolation. But however effective these methods might be in the short run, where smallpox was endemic, they only postponed the inevitable. With the knowledge that exposure to smallpox was virtually certain, that no effective treatment existed, and that death or disfigurement were likely outcomes, two options presented themselves: to wait for smallpox to strike and hope for the best, or to deliberately expose one's children to smallpox under the most favorable circumstances possible. Interest in the latter option led to experimentation with a variety of techniques known as variolation. Before either the term or the concept of immunization had been formulated, variolation techniques were granting lifelong immunity to smallpox.
VARIOLATION
The purpose of variolation was to bring children safely through the ordeal of smallpox. The most primitive practice was simply to expose an uninfected person to a person with a mild case of smallpox; or, alternatively, to wrap a person in blankets or garments that recently had been worn by someone with a mild case. Casual exposure to smallpox could be accomplished without medical assistance, and in many parts of the world where smallpox was endemic, deliberate exposure was a rite of passage orchestrated by parents whose children had not yet had the disease. This practice was not without risk. Exposure to someone with even a relatively mild case was a dangerous gamble; a benign outcome was by no means insured. Taking such a risk would have been unthinkable had not the likelihood of contracting an even more virulent case of smallpox by natural means been so great.
What initially had been a simple folk remedy eventually developed into a highly sophisticated medical technique. Because of the danger involved, variolation was used most often when smallpox was epidemic and known to be circulating nearby. The imminent threat of exposure forced an immediate choice between naturally acquired smallpox and carefully induced smallpox. While deliberate exposure to mild cases of smallpox was being practiced in many communities throughout the world, more sophisticated variolation techniques were being developed in China and Turkey—two large population centers where smallpox was an endemic disease. Knowledge of these Chinese and Turkish techniques spread slowly, first by word of mouth or demonstration and later through texts disseminated and translated into different languages.
Chinese-Style Variolation
Evidence of the practice of variolation can be clearly identified in China by the sixteenth century. Initially a technique used by lay or folk practitioners, variolation subsequently was adopted by adherents of the Chinese Fever School of South China. Despite the fact that medical ideas associated with the Fever School were frowned upon by proponents of the more orthodox medical theories of North China, physicians in the South promoted variolation with considerable success. Variolation became a medical specialty, and physicians developed specific techniques, which they guarded jealously. Some physicians used smallpox lymph, the liquid substance contained in the smallpox vesicle, as the infecting agent; others used dried smallpox scabs that had been ground into a powder. In both cases, they recognized that it was essential to preserve the vitality of the variola virus, because if the virus died, immunization against smallpox would fail.
Chinese variolation simulated the way smallpox was acquired naturally, by breathing airborne droplets of the virus through the nasal passages and into the lungs. The variolator would collect the virus from a person infected with smallpox when the infective capacity of the virus was considered ideal, around the eighth day in the course of the disease. The virus would then be weakened, or attenuated, by storing it in a cool, dark place for several days or even several months. The Chinese learned that smallpox lymph lost its vitality quickly in hot weather, whereas when the virus was collected and stored as scabs, the virus remained viable for much longer periods. In the seventeenth and eighteenth centuries the "dry" or "nasal insufflation" method of variolation came to be widely used in China. Smallpox scabs were ground into a powder and blown through a tube inserted into a child's nostril—the right nostril if the child was a boy and the left nostril if a girl.
A compelling advantage of variolation over naturally acquired smallpox was that the variola virus could be administered to a healthy person who then would be isolated from other individuals. This assured that the person variolated would not inadvertently spread smallpox to others. Eighteenth-century Chinese physicians produced highly sophisticated variolation techniques; an extensive medical literature recommending specific ways to collect, attenuate, and store the variola virus; and instructions on how to perform the procedure. Eventually a consensus developed that fewer children died from variolation than from naturally acquired smallpox.
In the second half of the seventeenth century, under the patronage of China's Manchu rulers, Chinese-style variolation spread to North China. The Manchu people, like other inhabitants of the Northeast Asian steppe, encountered smallpox only rarely in their homeland, which meant that adults were as susceptible as children to the disease. When the Manchus invaded China in 1644, they already knew about the threat of smallpox, because pre-conquest Manchu missions to China had witnessed the loss to smallpox of many of their members. The Manchu rulers of the Qing Dynasty (1644–1911) devised a biopolitical strategy during their conquest of China, and afterward, to counteract this vulnerability by choosing their leaders and troops from among Manchu tribesmen who had already had smallpox. Despite this cautious approach, the first Qing Emperor, Shunzhi (1638–1661, r. 1644–1661) died of smallpox at age twenty-three. His successor, the Kangxi Emperor (1654–1722, r. 1662– 1722), was chosen over an older brother, because Kangxi had survived smallpox and was known to be immune. Manchu vulnerability, especially in the early part of the dynasty, meant that under the Qing, smallpox prevention became state policy, and variolation was officially recognized as the most effective way to immunize Manchu government officials and members of the military.
How far the practice of variolation spread beyond the Qing territories is less clear. Published literature on variolation was available to those who could read Chinese, which would have included Korean physicians whose medical tradition was derived from the Chinese. Korean diplomatic missions came regularly to China, and if variolation were an accepted medical tradition at the Qing court, it seems likely that Korean physicians would have learned about it and used it as well.
Japan, on the other hand, avoided contact with China in the seventeenth century, but during the last half-century of Ming rule (1368–1644), many Chinese physicians fled from South China to Japan to escape political turmoil. They brought their knowledge of Chinese-style variolation with them; and they became permanent residents, settled into the Chinese merchant community in Nagasaki, and often took Japanese names. Prominent among these medical immigrants were physicians affiliated with the Chinese Fever School who had practiced variolation before coming to Japan. Early seventeenth-century Japanese sources are silent on the subject of variolation; however, it seems unlikely that the Chinese physicians who took up residence in Nagasaki would have abandoned such a useful practice.
Initially, at least, Chinese immigrant-physicians formed an influential medical community in Nagasaki, and the ideas of the Chinese Fever School formed the basis for the Japanese Kôseiha School, which dominated Japanese medical thinking during the early Edo period. Dai Manquang, an expert Chinese variolator, had published ten volumes devoted to the pathology and variolation of smallpox before he emigrated from China to Japan in 1653. The Tokugawa government sent physicians from Edo to Nagasaki to study under Dai, and to create a new medical specialty devoted to the study and treatment of smallpox. This interest in variolation on the part of the Edo government seems to have lapsed, because there is little evidence of the dissemination of knowledge about Chinese-style variolation to other parts of Japan. To deliberately infect a child with smallpox required a firm belief that induced smallpox was a better option than naturally acquired smallpox. Possibly no prominent school of medical thought in Japan became a strong advocate of this view. The folk custom of deliberately exposing children to mild cases of smallpox was used in Japan, but, as will be discussed below, not until the late eighteenth century did information about Chinese-style variolation begin to attract the attention of practicing Japanese physicians.
Marta E. Hanson has observed that Chinese medical knowledge was transmitted westward to Russia and other European countries during the seventeenth century by means of Jesuit translations of Chinese medical texts. It is not clear how far this information spread; however, in the early eighteenth century, the Royal Society of London received information about Chinese-style variolation from an English employee of the East India Company who had witnessed the procedure in China. In a letter dated January 5, 1700, Joseph Lister described the Chinese insufflation method as a technique that involved "opening the pustules of one who has the Small Pox ripe upon them and drying up the Matter with a little Cotton, which they preserve in a close box, & afterwards put it up the nostrils of those they would infect." He thought that this technique might only be practicable "in these parts," but the advantage, he pointed out, was that a child could be prepared for the illness at the most appropriate age and season. Even so, despite the earlier arrival of information about Chinese-style variolation, it was the Turkish method that gained prominence in Britain and Western Europe.
Turkish-Style Variolation
The variolation technique that developed around the eastern Mediterranean, in the cosmopolitan centers of Greece and Turkey, had the same purpose as Chinese variolation: to induce a mild case of smallpox and insure future immunity. Unlike the Chinese inhalation method, which introduced the infection to internal organs through the respiratory system, Turkish-style variolation was a surgical technique introduced through the skin of the recipient. The variolator inserted live variola virus—ideally fresh lymph taken directly from a smallpox vesicle—into one or more scratches or incisions made in the skin. The Turkish variolation technique was called inoculation.
The Royal Society of London was an important forum for considering new medical and scientific knowledge. Its members collected information and presented papers on a wide range of subjects that physicians and scientists from around the world sent to members of the Society. Early in the eighteenth century, the Royal Society received reports from two Italian physicians about a practice of "transplanting" smallpox that was used in Constantinople. Constantinople was an international entrepôt where Greek, Italian, Dutch, French, and English diplomats and businessmen resided for extended periods of time. Two Italian physicians, Emanuele Timoni and Jacob Pylarini, both of whom had medical degrees from the University of Padua, had personally observed inoculation in Constantinople. The papers they submitted to the Royal Society described what they referred to as "Turkish inoculation." Timoni's paper was published in the Society's journal, Philosophical Transactions, in 1714; Pylarini's paper, which already had been published in Venice in late 1715, was reprinted in the Philosophical Transactions the following spring.
Meanwhile, Britons who were living in Constantinople were having their own children inoculated (variolated). The secretary to the British ambassador had his two sons inoculated before returning to London in 1716. And in March 1717, Lady Mary Wortley Montagu, the wife of the subsequent British ambassador, convinced Charles Maitland, the Scottish surgeon who was serving at the British embassy in Constantinople, to inoculate her young son, Edward Montague. She clearly was pleased with the result, because she wrote to a friend in England to say that when she returned to London she intended to introduce the "useful invention" of "ingrafting of the smallpox into fashion in England."
Lady Mary got her chance to do just that when she returned to London in 1721. An unusually severe smallpox epidemic struck the city that year, and she asked Charles Maitland to inoculate her young daughter. Maitland complied with great reluctance, and only after Lady Mary agreed to have other physicians present to serve as witnesses. The practice of requiring witnesses to be present when new, potentially life-threatening medical technologies were being tried and the outcome was uncertain was not uncommon. Witnesses could attest to the professionalism of the physician and the willingness of the parents to have their child undergo the procedure; they could also help disseminate news of good or bad outcomes by recounting later what they had observed.
(Continues...)
Excerpted from The Vaccinators by Ann Jannetta Copyright © 2007 by Board of Trustees of the Leland Stanford Junior University. Excerpted by permission of STANFORD UNIVERSITY PRESS. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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