Kyushu’s Samurai Vaccinators: The Fight Against Smallpox in Late Edo Japan

Kyushu’s Samurai Vaccinators: The Fight Against Smallpox in Late Edo Japan

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samurai vaccine
Faced with an epidemic, a forward-thinking group of doctors and samurai leaders launched a successful vaccination campaign in late Edo Japan.

A crucial part of the global response to the COVID-19 pandemic has been vaccination and boosters, and Japan is no exception. In fact, Japan has a long history of vaccination and variolation. Today, let’s explore the response to smallpox in the late Edo period. Understanding this past inoculation campaign against what was then an incurable and seemingly insurmountable epidemic can help us better understand our own situation amidst the COVID pandemic and inoculation efforts today.

Understanding Terms

Nabeshima Naomasa, daimyo of Saga and samurai supporter of vaccination.
Nabeshima Naomasa, daimyo of Saga domain in the 1840s. His support in the smallpox vaccination campaign was crucial. (source)

Before we begin a discussion of the late Edo program of inoculation against smallpox, we have to make a clear distinction in terms. Firstly, the program discussed in this article was an inoculation campaign, but it was not vaccination in the modern sense, which occurs via injection. Although syringes have existed since ancient Greek times, hypodermic needles were invented around 1844 and were not yet ubiquitous enough for use in this inoculation campaign in Japan.

Vaccination today is usually delivered via injection. It administers an attenuated form of the virus to help the immune system learn how to defend itself. This is different from variolation, a method of inoculation still in use in the Edo period. It involves inserting powdered smallpox scabs or fluid into superficial skin cuts. This would prompt a mild case of smallpox, but one from which the recipient would recover immunized. Variolation has a lengthy history of its own, but was supplanted by the growth in the availability of hypodermic needles, and is no longer used today.

Edward Jenner Coins a Phrase

What began a medical revolution that initiated the march to eradicating smallpox was the work of the 18th-century physician and scientist Edward Jenner. Jenner noted that milkmaids became immunized to smallpox after being infected by cowpox, and theorized that this immunization could be passed on by deliberately transmitting the infection between humans via a method fundamentally similar to variolation. As Stefan Riedel notes:

In May 1796, Edward Jenner found a young dairymaid, Sarah Nelms, who had fresh cowpox lesions on her hands and arms…On May 14, 1796, using matter from Nelms’ lesions, he inoculated an 8-year-old boy, James Phipps. Subsequently, the boy developed mild fever and discomfort in the axillae. Nine days after the procedure he felt cold and had lost his appetite, but on the next day he was much better. In July 1796, Jenner inoculated the boy again, this time with matter from a fresh smallpox lesion. No disease developed, and Jenner concluded that protection was complete.

And it’s from Jenner’s method of using cowpox (vaccinia in Latin) to inoculate against smallpox, that the word “vaccination” derives.

An Ancient Illness

Smallpox had a long history in Japan prior to the start of Jennerian vaccination.

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As historian Ann Jannetta observes, one of the world’s earliest accounts of a smallpox epidemic, dating to 585 CE, appears in the Chronicles of Japan (Nihongi 日本記). Over the centuries, smallpox turned endemic across all ages and all social classes. A particularly famous 16th-century case of smallpox was that of Date Masamune, daimyo of Sendai. He fell victim to the illness as a child, and while he survived, it cost him the use of his right eye. Contrary to popular belief and frequent depiction, however, he did not remove the eye; forensic analysis of his remains in the 20th century suggests he kept it but was simply blinded.

18th-century painting of Date Masamune by Tosa Mitsusada. His smallpox-blinded right eye is visible. (source)

Japanese physicians first learned of Chinese-style variolation in the 17th century. It had at least a century of history by that point, and though some visiting Chinese merchants demonstrated the technique in 18th century Nagasaki, and while Chinese texts on variolation did reach Japan, it did not enjoy broad acceptance and application. Later, Dutch physician AL Bernardus Keller introduced Turkish-style surgical variolation to Japan. He personally explained the method to Shogunate physician Katsuragawa Hoshu and Date retainer and physician Ōtsuki Gentaku. Katsuragawa and Ōtsuki both went on to write treatises on variolation. Despite this knowledge, even the Turkish style of variolation did not catch on, nor did it ever gain official acceptance.

Solving a Problem of Distance

Otto Gottlieb Mohnike, German doctor in Dutch service at Nagasaki. Instrumental In the vaccination effort. (source)

When attempted once before the summer of 1849, the cowpox vaccine couldn’t be shipped intact from Holland to Nagasaki. However, after this, Otto Gottlieb Mohnike, a German doctor in Dutch service at Nagasaki, radically changed the picture. He suggested that cowpox matter be brought up from Batavia– modern-day Jakarta, then a Dutch colony– significantly shortening the time en route. One wonders: did he have a receptive audience?

As with many of his predecessors and successors working for the Dutch trading post of Dejima, Mohnike worked closely with Japanese doctors and translators, both from the Shogunate as well as from the domains of northern Kyushu. There was growing interest in new methods of smallpox inoculation in the early 19th century, primarily spearheaded by physicians specialized in rangaku, or Dutch studies. These efforts were piecemeal, and still primarily done through variolation. In 1846, for example, one of those physicians, Ōtsuki Bankei, son and successor to Ōtsuki Gentaku, successfully inoculated the daughter of Date Yoshikuni, the then-ruling daimyo of Sendai. It took the petition of a physician named Itō Genboku (1801-1871) to catalyze the movement which got vaccination in Japan underway.

A Network of Doctors and an Inquiring Daimyo

While Itō was just one among the network of physicians interested in or agitating for importing cowpox matter and new, western writings on smallpox, he was in a particularly good position to do so.

Ito was a doctor in service to Saga, a major domain in northern Kyushu. Nabeshima Naomasa (1815-1871) was daimyo of Saga. He had a keen interest in foreign learning, and not only because his domain was immediately adjoining the Shogunate-controlled international port of Nagasaki. In 1808, Saga had coast guard duty when a Royal Navy ship, HMS Phaeton, barged into Nagasaki harbor in search of French warships. The Saga batteries did not stop it, and the Shogunate punished Saga for it. Subsequently, the memory of his domain’s powerlessness drove Naomasa’s father Narinao’s rearranging of Saga’s priorities, including investment in foreign learning. Naomasa continued this trend. When Itō asked for his assistance in petitioning the Dutch officials at Dejima to import cowpox matter, Naomasa readily obliged.

Itō Genboku, a leader in the vaccination campaign, later in life. (source)

Itō and fellow Saga doctor Narabayashi Sōken pressed for that importation against the backdrop of growing opposition to western-style medicine. In 1849, the Shogunate’s official medical institute banned western medicine and the importation of western medical texts. But this did not stop the growing efforts to import the vaccine, and on August 11, 1849, the vaccine arrived in Nagasaki aboard the Dutch ship Stad Dordrecht. The vaccination program began with Mohnike’s vaccination of three Japanese children at the home of Narabayashi Sōken on the 14th. With this modest beginning, a medical revolution was underway.

In early October, Nabeshima Naomasa followed through on his endorsement of the vaccination. At Saga Castle, under Narabayashi Sōken’s supervision, Naomasa oversaw the vaccination of his own children, beginning with his heir Jun’ichirō.

Getting the Word Out

This was only the beginning of modern Japanese medical science and involvement in vaccination and pandemic response. By the beginning of 1850– after just four short months– the vaccine had reached all of Japan, though it took longer for most of the population to be inoculated. The vaccine eventually continued beyond Japan proper, extending into Ainu lands then under colonization by the shogunate and the Matsumae domain. It reached Edo itself with Naomasa’s official procession to the city, arriving in November 1849, where he had his daughter Mitsuhime vaccinated. He did not seek Shogunate approval, and curiously, found that the Shogunate also did not stop him. Through the rangaku community of physicians in Edo and other major centers like Osaka and Kyoto, word about and supplies of the vaccine spread with growing speed.

Vaccination centers sprang up in many cities, and as Jannetta observes in her book The Vaccinators, “among [Western-style] physicians who used it, variolation was always regarded as inferior to vaccination. Thus, as soon as cowpox vaccine became available, vaccination immediately became the method of choice.”

In a fitting irony given the Shogunate’s opposition, Itō established a vaccination clinic in Edo at Otamagaike in 1858. The law forbidding these endeavors, however, remained on the books, unenforced, for the rest of the Shogunate’s existence.

In Lieu of Epilogue

The Jennerian cowpox vaccine would not be Nabeshima Naomasa’s only encounter with western medicine. Many years later, as a retired daimyo during the Boshin War, he was living in the Saga domain estate in Kyoto. Following an attack of dysentery, Naomasa’s personal physician administered a stunning amount of mercury as a treatment. Naomasa’s health worsened, and he sent for an American doctor from the American diplomatic legation in Osaka to treat his illness.

With Joseph Heco as interpreter, US Navy physician Dr. Samuel Pellman Boyer went up to Kyoto to treat Nabeshima Naomasa. He would be the first American to enter Kyoto. While Boyer did consult with Naomasa’s medical staff, his diary doesn’t make any mention of vaccination, though this isn’t surprising given the nature of Boyer’s assignment in Kyoto. I can’t help but wonder if Boyer would’ve been interested to know the story of what Naomasa had done earlier in life, had the subject come up.

Naomasa’s desire to protect his son’s health paid off, perhaps more than the man could’ve imagined. Protected against this deadly endemic disease that had plagued Japan since the 6th century, Junichirō survived. He took the adult name of Nabeshima Naohiro, succeeded his father as the daimyo of Saga shortly before the Boshin War. Naohiro lived a long, full life even after the abolition of the feudal domains, notably becoming a diplomat who served in various European states. He died in 1921 at the age of 74.

Nabeshima Naohiro as a Meiji-era peer and diplomat, during a long and healthy life made possible thanks to vaccination. (source)

A Lesson for Today

As of this writing, Japan and the world are in the grip of the COVID pandemic, and a vaccination campaign has been underway for a year. While there aren’t any more daimyo, there are lessons that can be learned from this vaccination campaign. By taking action to save lives despite high-level opposition, it wasn’t just that first wave of vaccinated people who benefited, but everyone else in Japan as vaccination spread and the population was increasingly spared from the ravages of smallpox that had left death and visible scars throughout the population for centuries.

Whatever the contemporary vaccine in question, we owe it to our progeny to avail ourselves of it if able, and do likewise.

Sources

  • John Z. Bowers. Western Medical Pioneers in Feudal Japan. (Baltimore: Johns Hopkins Press, 1970), pp. 217, 236.
  • Samuel Pellman Boyer. Naval Surgeon: Revolt in Japan, 1868-1869. James A. Barnes and Elinor Barnes, eds. (Bloomington: Indiana University Press, 1963), pp. 78-88.
  • Robert Craig. “A History of Syringes and Needles.” The University of Queensland Faculty of Medicine. Posted 20 December 2018. Accessed 6 January 2022.
  • Joseph Heco. The narrative of a Japanese: what he has seen and the people he has met in the course of the last forty years, Vol. 2. James Murdoch, ed. (Tokyo: Maruzen, 1895), pp. 118-129. Accessed 6 January 2022.
  • Ann Bowman Jannetta. The Vaccinators: Smallpox, Medical Knowledge, and the ‘Opening’ of Japan. (Stanford: Stanford University Press, 2007), pp. 19-24, 130-131, 144-146.
    ____. “Jennerian Vaccination and the Creation of a National Public Health Agenda in Japan, 1850–1900.” Bulletin of the History of Medicine 83, no. 1 (2009): 125-140. doi:10.1353/bhm.0.0185,p. 128.
  • Stefan Riedel. “Edward Jenner and the history of smallpox and vaccination.” Proceedings (Baylor University. Medical Center) vol. 18,1 (2005): 21-5. doi:10.1080/08998280.2005.11928028
  • Saga-han no Torikumi.” Saga City HP. Accessed 6 January 2022.
  • Timon Screech. “Admiral Sir Fleetwood Pellew (1789-1861) and the Phaeton Incident of 1808,” pp. 1-19 of Britain & Japan: Biographical Portraits, Vol. X. Hugh Cortazzi, ed. (Folkestone: Renaissance Books, 2016).
  • Noell Wilson. Defensive Positions: the Politics of Maritine Security in Tokugawa Japan. (Cambridge: Harvard University Press, 2015), pp. 113-121.
  • ____. “Tokugawa Defense Redux: Organizational Failure in the Phaeton Incident of 1808.” The Journal of Japanese Studies 36, no. 1 (2010): 1-32. doi:10.1353/jjs.0.0131.

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Nyri Bakkalian

Dr. Nyri A. Bakkalian is an author, recovering academic, raconteur, and Your Favorite History Lesbian. Her PhD thesis focused on the Boshin War in the Tohoku region. She is the author of "Grey Dawn: A Tale of Abolition and Union" (Balance of Seven Press, 2020). She hosts Friday Night History on anchor.fm/fridaynighthistory and the secret to her success is Arabic coffee. She misses Sendai daily.

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