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The Modern Epidemic: A History of Tuberculosis in Japan
By William Johnston
Harvard University Press, 1995, 432 pages.

Tuberculosis is a very serious disease. In human history it has killed millions and will continue to kill many more. In the industrialized world it is considered a very serious disease of the past. That is, if you haven’t forgotten about it completely. Tuberculosis hasn’t gone away in any country, though. We’ve merely been able to deal with it better in the industrialized world. But combined with HIV, tuberculosis is still proving to be the merciless killer it was a hundred years ago. In Africa, according to this just released WHO press release, “[in Africa] TB incidence rates have tripled since 1990 in countries with high HIV prevalence and are still rising across the continent at a rate of 3-4% annually.”

The Modern Epidemic is the story of Japan’s history with tuberculosis. The book is divided into three sections, each of which explores a different aspect of tuberculosis in Japan. The first section is “The Disease and The Epidemic.” This section tells us what tuberculosis is and how it is transmitted. We learn that tuberculosis was endemic to Japan, and was even mentioned in The Tale of Genji and The Pillow Book of Sei Shonagon. However, it became a much more serious problem after the Meiji Restoration when Japan was rapidly industrializing.

Tuberculosis becomes a major problem when people live in poverty, when they live in crowded conditions, when they have a lack of animal protein in their diets, and when they engage in work where a large amount of particulate matter can enter the lungs. In particular, it was the silk and cotton industries and the army that would become a major mechanism for spreading tuberculosis around the Japan. A causal relationship was established between the textile industry and tuberculosis early, but the power of the industry kept down reforms that would have improved the condition of workers. Textile workers, who were predominately women, would toil twelve hours a day in hot, dusty factories. When their shift was over they would eat a meager meal with little protein and sleep in crowded communal rooms. In these conditions tuberculosis became rampant. Sick workers would be sent home, often dying on their way to the train station. It would become harder for factories to recruit workers, so they would go to outlying prefectures for recruiting. Gradually sick workers would come back home, and a company would no longer be able to recruit workers, making them go even further into the country to recruit workers. In this way, the textile industry spread tuberculosis throughout Japan. The army did much the same thing when it sent tubercular enlistees home to recuperate. These factors led tuberculosis to become the number one infectious disease in Japan through to the 1950s.

The second section of the book talks about the social dimensions of tuberculosis. The disease meant much more than just getting sick. It was seen as incurable, hereditary, and disfiguring. It caused you to waste away and cough up blood. Due to Japanese ideals of purity these last features of the disease were particularly repelling. Since it was both perceived as incurable and hereditary, it was also seen as a karmic disease. It could put a blemish on your entire family bloodline. Getting tuberculosis could mean not being able to get married or being ostracized from family or village. In the extreme this led to a mass murder in Kaio, Okayama prefecture, brought about by Toi Mutsuo on May 21st, 1938. He killed thirty people, injured three more, and then committed suicide because he freely admitted his tuberculosis to a village that could not accept it. Tuberculosis also led to an entire genre of literature in Japan. Many famous Japanese authors would suffer through tuberculosis, write about stories about dealing with the disease itself, or mention tuberculosis off-hand as part of the fabric of the life of that era.

The third section was the section details how the Japanese government dealt with, or in many cases did absolutely nothing to deal with, the problem of tuberculosis. A number of issues come up in this section. A major one is that the Japanese government felt that it was every individual’s responsibility to take care of their health so that they may serve the Emperor. Contrast this to other countries such as American and the UK where a healthy life was seen as a right that everyone enjoyed. Tuberculosis was also a slow disease and it didn’t strike to immediately upset the social order, unlike other diseases such as cholera. Therefore, Japan was very slow to try to manage the problem of tuberculosis and when it did implement laws to prevent the spread of the disease they were poorly enforced. This continued up until the start of war with China when the supply of healthy bodies in the country had a direct impact on national wartime goals. The real decline in tuberculosis mortality wouldn’t start until after Japan lost the war and drugs that could treat tuberculosis were introduced.

I found The Modern Epidemic to be a fascinating book. It is a great reminder about how short our collective memories really are. The parallels between tuberculosis and HIV are also quite interesting. Both, in their time, have been considered the greatest epidemic ever to face us. Both confounded modern science for years, HIV continues to now, and tuberculosis is now spawning into drug resistant breeds. And now tuberculosis attacks those with HIV to become an even more deadly killer than before. Now is a good time to again become familiar with the history of tuberculosis.

This entry was posted on Thursday, March 24th, 2005 at 10:22 pm and is filed under Japan, Books. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.