In 1849, Japanese physicians imported the smallpox vaccine from Batavia through the Dutch trade factory in Nagasaki. Although Japanese specialists of Western medicine had learned of the vaccine’s existence as early as 1803 [Jannetta, The Vaccinators, p. 57-58], restrictions on foreign trade and the difficulty of transporting the vaccine over long distances in hot climates had prevented its importation for several decades. But once the vaccine reached Japan, a network of physicians trained in Western medicine quickly transmitted it all over the country. By the end of the Tokugawa period in 1868, vaccination clinics were operating in many towns and cities with governmental support. Vaccinations represented the first organized instance of preventative medicine in Japan [Umihara 2014, p. 209-10], and became an important steppingstone for the development of modern public health after the Meiji Restoration. 

This module describes the process of the vaccine's introduction to Japan as an intervention into existing notions of space and time. It argues that the cowpox virus was driven by an unyielding spatio-temporal logic, which determined not only the technical details of vaccinations, but also left its mark on social relations. The virus could not survive for long outside the human body. To stay viable, it had to be moved to another unvaccinated body every six or seven days, and physicians as well as government administrators had to develop new methods to mobilize patients and accommodate the relentless pace of vaccine transmission. 

The module highlights the role of networks and vehicles in mediating biological and social processes. The properties of the vaccine encouraged the formation and maintenance of social networks. Vaccinators needed to collaborate with colleagues near and far to acquire training, monitor transfers, keep records, and refresh their supply in case the vaccine went extinct. The introduction of the smallpox vaccine both depended on existing networks among physicians and encouraged the formation of new ones.

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 at 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 chains of vaccine transmission--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 much 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-bound sequence of the vaccination process. 

This module focuses on Echizen province, a region on the Sea of Japan whose territory was fragmented between many different overlords. Physicians from Echizen played a pioneering role in bringing smallpox vaccinations to Japan. The module invites the reader to explore a number of "vaccine stories" from this province that highlight the transformative power of vaccine transmission. Many of these stories involve some form of border-crossing--from town to village, from domain to domain, from commoner to outcaste, and from licensed to unlicensed handlers.