chapter  4
17 Pages

Buddhism contra cholera: how the Meiji state recruited religion against epidemic disease

ByWILLIAM D. JOHNSTON

Imagine a disease of uncertain origin that strikes one in eight or ten persons in a community. It is unlike anything people have known. The main symptoms are malaise, headache, and vomiting, followed by violent diarrhea. Six to ten liters of fluid can be purged from the body in a very short time resulting in sunken eyes, leathery, bluish skin, lethargy, disorientation, and death. Between six and eight out of ten patients die, many within a day or less of their initial symptoms, some within hours. Nobody knows what to do. Many Japanese people experienced something like this when such a disease

first appeared in 1822. The disease was given many names, one being mikka korori, the three-day collapse. It described a common unfolding: three days of illness followed by death. Soon people called it simply korori, a name that also echoed what Dutch physicians had called it: cholera. The disease started in the southern parts of Japan and traveled north but never reached Edo, after which it disappeared. It struck again in 1858, this time reaching Edo with disastrous consequences. The estimates of dead varied widely. A Bakufu document published in 1862 estimated the total number of deaths at over 28,421.1

The epidemic had profound consequences on families, businesses, government, and the social order. It left the city and most of the country enervated during the two years before it disappeared. Well before this time, the Tokugawa Bakufu realized the political and social

importance of marshaling its resources in the face of epidemic disease. One result was the establishment of the Igakusho (literally “medical school”) for studying Western medicine. Its faculty was instrumental in creating widespread vaccination programs against smallpox.2 Faced with the enormous 1858 cholera epidemic, the Bakufu turned to Western medical understandings of the disease but lacked any kind of public health infrastructure with which it could enact control measures beyond issuing advice and recommending medicines to villages under its direct control.3 Anticipating that the disease could return, the Bakufu developed further control strategies. In 1862, it published a manual edited by Matsumoto Ryo-jun for cholera control based on European sources.4 It recommended dietary and behavioral measures similar to those found in

contemporary health maintenance texts that individuals could implement, as well as quarantine measures for both diseased individuals and infected ships’ crews. Through such efforts the Bakufu developed a groundwork of ideas, personnel, and policies that laid the groundwork for the Meiji government’s later measures. Still, without a definitive explanation for the cholera’s cause, the government

was hard pressed to develop specific, effective control measures. Japanese scholars, like those in Europe, could not settle on an explanation. During the 1858 epidemic, Ogata Ko-an, a preeminent Japanese practitioner of European medicine, noted that the disease had originated in Arabia, spread to China, America, and England, andwas carried in the atmosphere.5 Thirteen years later (1871), Ishiguro Tadanori authored a book on cholera based on the current ideas of Max von Pettenkofer and Ernst Delbrück. Although an Italian anatomist, Filippo Pacini, had discovered the cholera bacillus in 1854, the idea that bacteria caused the disease did not gain serious attention until Koch’s rediscovery of it in 1883. Moreover, germ theory was not universally recognized until considerably later. Pettenkofer, in particular, opposed Koch’s theory. He and Delbrück both claimed that cholera toxin was present in feces but in some cases could be carried in the atmosphere.6 Ishiguro also noted that cholera toxin was spread through feces and that German scientists recommended sulfurous acid as a disinfectant.7 The idea that acidic solutions could disinfect the cholera toxin entered Japanese medical discourse just three years after the Tokugawa regime collapsed; it quickly became one of the pillars of cholera control. For a while, Japan was lucky. Between 1863 and 1877 cholera was either

absent or caused only minor, local outbreaks. In 1877 it reappeared but caused a relatively small number of deaths (just over 8,000 nationally). Troops returning from the Satsuma Rebellion contributed to its spread.8