A spatial perspective shows the introduction of smallpox vaccinations to Japan in a new light.  

But professional connections among medical specialists were not sufficient to keep the vaccine alive. Vaccinators also had to mobilize unvaccinated children on a regular basis and ensure their appearance at the right place and exactly the right time. Such mobilization required a degree of governmental coercion, but government authority was fragmented in Tokugawa Japan. While the shogunate governed some lands directly and the most powerful lords held entire provinces as fiefs, other regions were divided into incoherent patches of land governed by many different lords. The spatial complexity of Tokugawa rule mattered because government officials and physicians, though united in their desire to build a public health infrastructure, did not always agree on when and where the vaccine should be moved and by whom. Both physicians and officials formed networks among themselves, and both had to navigate the feudal relationships and informal channels that connected lords and subjects of adjacent domains to one another.

In addition to networks, vaccines needed vehicles to move across distance and perpetuate themselves over time. The most reliable vehicles at the time were the bodies of young, unvaccinated children. As vaccinators transferred vaccines from arm to arm, they joined children's bodies together into ephemeral networks that vanished almost as soon as they had accomplished their purpose. Because of the social complexities of this method, some physicians also experimented with glass dishes and other forms of containers to transport vaccines in the form of scabs or lymph, but deemed none of them safe enough to supersede the need for human carriers. A third type of vehicle were the written records kept by physicians about specific vaccinations to monitor progress over time and collect data about coverage.

Vaccinators also built fixed, permanent structures in form of vaccination clinics. The need for built spaces once again rested on the vaccine's spatio-temporal characteristics. Because the mobilization of recipients required effort and precision and the risk of vaccine extinction was high, physicians preferred to gather children at central, easily recognizable buildings in castle towns that could draw visitors all year round. The spatial layout and record-keeping procedures in these clinics were designed to facilitate the time-sensitive sequence of the vaccination process. 
 

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.

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.