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

Excerpt from the "Vaccine Travel Record," 1857 (1) - translation

A Separate Clinic in Ōno [1857]

[Source: Hakushinki, pp. 238-239; translated by Maren Ehlers]

On the 15th day of the fifth intercalary month, Hayashi Unkei came and said that he wanted to notify me that they were opening a separate clinic in Ota village in the distant fief of Nishikata, and were letting Koyama Yōju conduct vaccinations there.

On this occasion, he brought 100 hiki of gold for sweets and five bags of tobacco. After we had exchanged formalities, he said: “When you informed us the other year that there was someone in Ota village performing vaccinations, we replied that that there had certainly been a rumor about it, but nobody was conducting vaccinations any more at that time. We said that we did not know of any such person, though we would continue to investigate. After that, we once again heard of a person conducting vaccinations, and when each of us inquired, we learned that this time, the domain representative [rusuban] of that area had given orders to a person named Koyama Yōju and initiated vaccinations, not knowing that we had earlier sworn an oath at the domain office [of Fukui]. We thus made him stop his vaccinations through the domain representative, who was himself ordered out of office afterwards. We have gravely misbehaved in this matter and earnestly ask for your indulgence.” Thus he urgently explained himself.

I responded that this was a matter of the past and nothing could be done about it. From now on they should exercise control so the rules would be properly followed.

[The physician from Ōno] requested: “Because Koyama has again expressed a desire to openly perform vaccinations at this time, we carefully instructed him in Ōno on the assessment of pocks and other things. On the 7th day of this month, we transmitted the vaccine to him. Two days ago, on the 13th, we also went to his place and imposed on him rules about all kinds of things on the basis of an inspection. On a related note, we will also take Koyama here so that you can face him in person and kindly give him a new transmission of the vaccine whenever he runs out of it in the future.”

In the past, Koyama, the man in question, had secretly taken vaccines from Naitō Teian [Dōitsu’s father] of Itō village in Sabae domain and begun to vaccinate. He also received vaccines from the vaccinators’ society of Fuchū. Furthermore, the Fuchū people once came here to ask me whether they should transmit the vaccine to this man in case he requested a transmission. I told them at the time that I had been told he was neither from Fuchū nor did he represent a separate clinic on Ōno’s side, and that therefore they should please hand the matter over to me if he came and made a request in the future.

I responded [to the physician from Ōno] that if a request came from Ota village for a vaccine transmission, it could not be addressed without Ōno’s domain leadership [goyōnin] sending a correspondence to the leading officials at the domain office in Fukui. Also, if we were talking about a re-transmission to Ōno, I would gladly provide it to them, but that they had been helping us out greatly in Ōno for quite a while. They had not let the vaccine go extinct even once, which everyone agreed was not a negligible achievement. I would consider it a pity if they had to request a retransmission due to extinction on this occasion. However, if they would just issue a notice without further ado that they would open a separate clinic in Ota, I would inform the other chapters of the association about it. I said I recommended this course of action because if I did so, the nearby clinics would probably transmit the vaccine to Ota no matter where they were located. I would be happy to meet with Koyama Yōju and allow him to become my disciple, but if things were done the way I suggested, this would no longer be necessary and I would not need to meet with him. [The Ōno physician] responded that if this were the case, they would choose to confer the status of a separate clinic as explained, and would make him strictly observe the oath in the future. Then he went home.

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1857: Reconciling Network and Territory
In 1857 the Nishikata exclave finally received a vaccination clinic, with Koyama Yōju in charge. Until then, local parents who wanted to have their children vaccinated most likely turned to clinics of other nearby territories such as Sabae, or to country doctors like Koyama and Naitō Dōitsu who were offering illegal vaccinations. The events leading up to the establishment of the Nishikata clinic provide some insight into the relationship between domain rule and the vaccinators’ regional network, as well as on the role of country doctors in vaccinating areas far away from the clinics.
In 1857, Ōno's domain physician Hayashi Unkei visited Kasahara Ryōsaku in Fukui and informed him of the following incident. Some time ago, he and his Ōno colleagues had learned that Koyama Yōju was once again performing vaccinations in Ota village. This time, however, Koyama was acting with official backing. The domain representative (rusuban, probably the rural intendant) had ordered him to vaccinate the local people, “not knowing that we [the vaccinators] had earlier sworn an oath at the domain office [of Fukui].” Hayashi apologized to Kasahara for this oversight, but reassured him that he and his colleagues had already put a stop to Koyama’s activities by contacting the domain representative in question. He also pointed out that the domain representative had since been removed from his post, though it is unclear whether this removal had anything to do with the vaccinations.
This incident shows that Ōno’s domain government, despite its collaboration with the vaccinators, was not fully aware of the doctors' professional network and agreements. The domain representative in Nishikata simply seems to have done what made sense from the government’s point of view: ask a physician of reasonable ability to vaccinate domain subjects within his region to achieve population growth and prosperity in line with the domain's mercantilist agenda. The vaccinators, as we have seen, had different priorities in mind: building public trust in the treatment and preventing greedier competitors from hijacking the technique. Ultimately, however, the two sides were able to resolve their disagreement because they shared the goal of full coverage and because they relied on each other: the physicians on the coercive power of the government and the officials on the physicians’ contacts and expertise.
Officials from the brand-new intendant’s office in Ota might have been forgiven for assuming that Nishikata would fall outside the control of the castle-town-based occupational associations with privileges in the rest of the domain. After all, Nishikata was not part of the territory of Ōno’s beggar boss association, for example, and its village watchmen acted independently from the beggar bosses in the castle town. Nishikata’s sake brewers, too, did not belong to the sake brewers’ guild in Ōno's castle town [Ehlers, Give and Take; Ota chōshi].
The vaccinators’ society, however, had separate chapters for each domain, and that meant that exclaves such as Nishikata had to be overseen from the castle town. With Koyama’s operation now terminated, the problem remained of how to achieve coverage in Nishikata. The vaccinators eventually solved this problem by integrating Koyama, this time on their own terms.
A Separate Clinic for Nishikata
In 1857, Koyama Yōju finally received a legitimate transmission. He had been working toward this goal at least since his vaccine theft of 1853. As Kasahara Ryōsaku noted in his journal in 1857, Koyama had also received vaccines from Fuchū’s society at one point, and vaccinators from Fuchū (a town close to Nishikata) once asked Kasahara whether they were allowed to share vaccines with Koyama. At that time, Kasahara still rejected this transfer between neighbors, arguing that Koyama was neither from Fuchū nor represented a “separate clinic” within Ōno domain. In other words, he deemed the transfer incompatible with the institutional framework he hoped to build for vaccinations in Echizen province. It seems that Kasahara was eager to have each vaccinators’ society overlap with a domain territory, and if the vaccine went extinct, he wanted domain governments to send a formal request for retransmission to their counterpart in Fukui. Perhaps Kasahara believed that with such a high hurdle for retransmission, physicians would try harder to preserve the vaccine. He might have seen this principle endangered by Koyama’s request.

In 1857, Kasahara and his colleagues in Ōno came up with a workaround to authorize Koyama’s operation without damaging their institutional framework. They probably felt pressured to act after Koyama and Naitō had stepped in to fill the gap and domain officials had tried to appoint an unintegrated vaccinator for Nishikata. First, Ōno’s physicians invited Koyama and “carefully instructed him in Ōno on the assessment of pocks and other things.” They transmitted the vaccine to him, then “went to his place and imposed on him rules about all kinds of things on the basis of an inspection.” This initiation turned Koyama into a legitimate vaccinator who could be trusted to act in a responsible manner.

Second, Koyama's operation received the status of a “separate clinic” (bekkan) of Ōno domain. As Kasahara explained to his Ōno colleagues, this status would allow Koyama to receive retransmissions from Sabae and Fuchū in case he lost his chain of supply. He cautioned that if Koyama requested a retransmission without such status, he could not receive one “without Ōno’s domain leadership sending a correspondence to the leading officials at the domain office in Fukui.” This was an outcome Kasahara was hoping to avoid because he felt it would taint the achievement of Ōno’s vaccinators, who “had not let the vaccine go extinct even once.” Clearly, Kasahara was hoping to maintain domain-authorized retransmission as a lever to discipline and motivate vaccinators within each domain. At the same time, he acknowledged that clinics in rural exclaves like Nishikata might require retransmissions from neighboring territories to remain feasible. When Ōno’s vaccinators notified Kasahara that they intended to follow his recommendation and open a “separate clinic” in Nishikata, Kasahara sent a letter to the chapters in Fuchū and Sabae to inform them of that fact.
In this manner, the perpetuation of vaccinations in Echizen province depended on the authority of domain rule, yet was impeded by its fragmentation. It took the abolition of domain rule in 1871 to bring the territorial geography in line with the vaccinators’ need for stronger and more centralized governmental control. But even centralization did not result in full coverage right away. In the second half of the 1880s, the vaccination rate in Fukui prefecture finally crossed the eighty-percent mark [Yanagisawa, 2018, p. 59]. This timeline shows that local structures of control and coordination remained crucial for the implementation of vaccinations, just as they had been under the Tokugawa regime.

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Excerpt from the "Vaccine Travel Record," 1857 (1)