Vaccinators and local government officials had to accommodate the vaccine's constant need for bodies and unrelenting rhythm of transmission. They developed a schedule of sequential practices and produced new forms of written records. They built clinics and organized professional networks to improve trust and control. They also reshaped collaboration between governments and physicians to enforce procedures and facilitate access to children's bodies. On one hand, the vaccination process compelled vaccinators and government officials to work within existing social and political structures and rely on existing notions of territoriality. At the same time, it pushed them to experiment with new structures that were better suited to the space-time of the vaccine. 

A spatial perspective shows the introduction of smallpox vaccinations to Japan in a new light. By connecting three overlapping notions of space—political, occupational, and epidemiological—we can gain insight into the social dynamics and political conditions of perpetuating the vaccine. By exploring the tensions between these three notions, we can also identify structural challenges to widespread immunization, and follow negotiations between rulers, subjects, and physicians as they attempted to build an infrastructure for public health in Japan.

In the middle of the nineteenth century, the mechanics of the vaccination process were similar all over the world. What differed was the social context [compare, for example, to Agostoni, 2019 on Mexico], and even within Japan, the social and governmental structure was far from homogenous. The situation in Echizen province can be contrasted with that in Saga domain (Hizen province), which succeeded at setting up an infrastructure for vaccinating every child in the domain. In Echizen province, domain territories were scattered, including Fukui’s, and Dutch science was comparatively weak. In Saga, on the other hand, Dutch Learning had a strong following and also enjoyed the support of the domain administration. Besides, the domain’s territory was much more coherent than Fukui’s. Although Saga was internally fragmented into one main domain and three smaller branch domains, each governed by a different branch of Saga’s ruling family, this kind of fragmentation probably aided rather than impeded vaccinations. As Aoki Toshiyuki has argued, the samurai leaders of these subordinate territories both shared the lord of Saga’s interest in vaccinations, and were willing to place their subjects under the control of the medical office that was in charge of coordinating vaccinations in the main part of the domain [Aoki, 2018]. Vaccinations in Saga thus benefited from a relatively high degree of governmental centralization. Whereas town and village physicians took the lead in Fukui and built a professional network of vaccinators across domain borders, in Saga it was domain doctors who were in charge, and their sphere of influence overlapped with that of the domain. Comparisons such as these shed light not just on vaccinations and public health, but also—more generally—on what forms of rule were possible under different territorial configurations of space.

After the Meiji Restoration of 1868, Japan’s government and society underwent great changes. The new regime abolished domain rule and gradually dissolved self-governing associations among subjects. On one hand, these measures centralized governmental authority and produced a greater commitment to Western medicine and public health. On the other hand, they dismantled precisely the social and political structures that had so far supported vaccinations. How vaccinations developed under these circumstances is a subject for another occasion, but the growth of public health continued to be a slow, localized process, and the spatial layers of local society continued to matter. In Fukui prefecture, according to Yanagisawa Fumiko, the vaccination rate only crossed the eighty-percent mark in the second half of the 1880s [Yanagisawa, 2018, p. 59].

This module has highlighted only a handful out of the many paths taken by the vaccine, even within the confines of Echizen province. Sabae domain and the town of Fuchū, for example, had active communities of vaccinators who treated subjects from other territories. By adding these and other cases, we will understand even better how bodies and territories in this province channeled the flow of the vaccine and were shaped by the vaccinators’ actions in return.