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From Batavia to Nagasaki
The first to import smallpox vaccine to Nagasaki was Dutch physician Jan Cock Blomhoff. Stationed at Nagasaki's trade factory for several years and ambitious to bring the vaccine to Japan, he received several shipments of fresh vaccine and equipment he had requested from the colonial authorities in Batavia between 1820 and 1823. But he failed to immunize any children, most likely because the vaccine had lost its efficacy on sea. Subsequent attempts to ship fresh lymph from Batavia equally failed.
In the 1840s, Japanese specialists of Dutch medicine intensified their efforts of importation. They were aware of the vulnerability of the fresh vaccine and asked the Dutch to deliver cowpox scabs instead. By that time, Japanese specialists already had significant experience with Chinese-style variolation, which involved pulverizing dried smallpox scabs and blowing the powder up a child's nostril. While such exposure to the smallpox virus was more dangerous than vaccination with the cowpox virus, physicians observed that scabs were easier to store and transport than fresh lymph. In China, where vaccination had been practiced since 1805, physicians had made similar observations for cowpox and transmitted their insights through writings circulating among their Japanese peers. While the Dutch seem to have been hesitant to move away from the transport of fresh lymph, they eventually fulfilled the Japanese request for scabs. After several failed attempts, a ship from Batavia arrived in the summer of 1849 with both lymph and scabs on board. The shipment was received by Narabayashi Sōken, a physician serving the lord of Saga domain, as well as the Dutch factory physician Otto Mohnike. The two men used both materials to vaccinate local children, but only the vaccine from the scab produced a reaction. Narabayashi's son Kensaburō thus became the first Japanese child to be successfully vaccinated with the cowpox virus, and became a source for further arm-to-arm transmissions [Jannetta, 78-87, 129-133]. Scabs thus proved to be a relatively reliable means of storage and long-distance transmission.
Vaccinations in the Dutch East Indies
Why did Japanese physicians obtain the vaccine through Batavia? In Java, smallpox vaccinations had been taking place since 1804. In that year, the Dutch governor-general put a group of children on board a ship to Mauritius to import the vaccine through arm-to-arm transmission. During the British occupation of Java between 1811 and 1816, Thomas Raffles established a thorough vaccination program on the island that partly relied on training local religious leaders and mandating regular reporting of vaccination drives to the colonial administration. The Dutch colonizers maintained that program after retaking control from the British in 1816. Their vaccination efforts encountered many problems such as resistance from parents and local elites, a lack of training among vaccinators, and logistical difficulties when trying to penetrate the outer islands. Yet, Batavia was the most accessible source of supply for Japanese physicians, thanks to Japan's officially sanctioned trade link with the Dutch as well as active support from Dutch factory doctors in Nagasaki [Neelakantan, 2010].
