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Bodies and Structures 2.0: Deep-Mapping Modern East Asian History

The New Clinic

The domain-run clinic opened on 10/25 of 1851 (lunar calendar) in Shimo-Edomachi in a former administrative building of the domain. With a size of over a hundred tatami mats, the new clinic was much larger than its predecessor and employed a greater number of physicians. To be sure, most actual vaccinations were still being performed by town doctors from the vaccinators' association and domain physicians appeared primarily in supervisory roles. The status difference between domain and town doctors continued to impede collaboration, and many domain physicians did not yet see the benefits of receiving training in the new technique. But Kasahara now began to train domain doctors as well upon orders from the administration. Interest in the procedure slowly expanded.

The new clinic opened right in time for the vaccination boom of the winter of 1852/53. In the fall of 1852, smallpox spread among Fukui's town residents and turned the castle town into a site of involuntary experimentation. Because vaccinated children appeared safe from infection, townspeople and villagers near the castle town scrambled to take their children to the clinic. Kasahara reported long lines in front of the clinic gate. Between 100 and 200 people seem to have lined up on each vaccination day, and on 1/23, 1853, the clinic had to turn 130 children away after vaccinating 230 [Yanagisawa; Ban].

Compare this event with a similar vaccination boom in Ōno domain in 1850/51. Or stay on this pathway to continue exploring space and time inside Fukui's clinic.

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Managing Space and Time Inside the Clinic
A floor plan of the new clinic in Shimo-Edomachi was discovered among the materials of a domain doctor of Hikone domain. When read in combination with a manual on vaccination procedures (Koshi no mae shū jotōkan tetsuzukisho) from the same archive, this plan reveals that the rooms in the clinic were laid out to support the sequence of treatments [Umihara 2014, p. 197-206]. The vaccinators also kept meticulous records on every child to convey information to other teams of vaccinators who worked in different rooms of the clinic or on different days. Anxious to avoid mistakes that could damage the vaccine’s fragile reputation, they inscribed the biological rhythm of the vaccine both into their books and into the floor plan of their clinic. (Hover over the image to explore the floor plan.)
Incoming children were all registered upon arrival and divided into three groups: those to be vaccinated; those vaccinated seven days ago who could serve as "pox bases"; and those vaccinated ten or more days ago, who reappeared for examination and if necessary revaccination. Every child was first sent to the collective waiting room (the so-called sō-damari), but was then classified by group and sent along a different sequence of rooms. The first group, for example, received a yellow sash and went to the upper examination room marked by a yellow flag, and from there on back to the waiting room to wait for vaccination. The second group received a red sash and was sent to the middle room before going back to the waiting room. Guards were posted on the doors of the waiting rooms to keep the children and their caregivers in place.

The third group went to the lower examination room. After vaccination, parents received a paper ticket indicating the date of their child's follow-up visit, as well as an instruction sheet for aftercare at home [Umihara, Yanagisawa].

Even after the smallpox epidemic of 1852/53, which had boosted the popularity of vaccinations, the mobilization of children for vaccinations required a certain degree of persuasion and coercion. Upon Kasahara Ryōsaku's urging, the town governor of Fukui ordered each town section to keep twelve unvaccinated children at hand for times of storm, fire, mid-summer and mid-winter as well as year’s end to help vaccinators “connect” the vaccine while public interest was low. Physicians regularly surveyed the clinic's records to identify children who had failed to show up for their second appointment. At the clinic, guards prevented anyone without an exit pass from leaving the building to make sure that children designated as "pox bases" would not go home before accomplishing their purpose [Umihara, Ban].
Also note how the status distinction between town and domain physicians manifested itself in the floor plan of the clinic.
Village Relay and Its Problems
In 1855, Kasahara Ryōsaku made a first attempt to take the vaccine to the countryside [Ban 1986, 163-192]. As explained at the previous station on this pathway, he did not do so to prevent extinction. On the contrary, he regarded rural vaccinations as too risky for “connecting” the vaccine and supported them only after the operation in the castle town had stabilized thanks to the founding of the domain-run hospital, increased training of domain doctors, and a boost in popularity after the smallpox epidemic of 1852/53. These developments had for the first time created a basis for vaccinating people with the sole purpose of saving lives, rather than warding off the threat of extinction.
In the countryside, there was considerable demand for vaccinations, but as Kasahara noted, most villagers who came to the clinic lived within 2 or 3 ri (between 8 and 12 kilometers) of the castle town. Even within that radius, poorer villagers could not easily afford to travel to the castle town two times in a row. In a proposal submitted to a high-ranking domain official in 1853—and while the area was in the throes of a smallpox epidemic—Kasahara argued that expeditions to the countryside would help shorten lines at the clinic and prevent avoidable deaths from smallpox.

Yet, village vaccinations posed a serious logistical challenge. Because there were no trained vaccinators in the countryside and population density was low, it was difficult to “connect” the vaccine over time. Both vaccinators and "pox base" children had to be brought in from town at exactly the right moment. To minimize the problem of distance, Kasahara devised the so-called “village relay” (muratsugi) method, which looked convenient on paper, but in practice relied heavily on governmental planning and pressure. Village relay was also quite expensive because of the amount of traveling involved, and Kasahara proposed defraying some of the cost by asking parents for donations. One problem with donations was that the vaccinators needed to guard against the perception of profit-making and thus had to keep donations strictly voluntary. A second, related, problem was that the government could not apply too much coercion to a program largely funded by volunteers. Village vaccinations thus highlighted the need for more overall governmental involvement in preventative healthcare.
Discussions and planning for rural vaccinations continued through 1854, and for 1855 the domain leadership finally approved an experimental tour to a number of coastal villages. During the preparations, Kasahara coordinated closely with the district governor in the district office (gun’yakusho), as well as with the censor (metsuke) who had been put in charge of the domain-run vaccination clinic. Kasahara and the district governor, Okada Kihachirō, were deeply committed to making the rural tour a success and cutting cost as much as possible to set a precedent for similar tours in the future.

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