Jennerian Vaccination and the Creation of a National Public Health Agenda in Japan, 1850–1900

Ann Jannetta

Bulletin of the History of Medicine, Volume 83, Number 1, Spring 2009, pp. 125-140 (Article)

Published by The Johns Hopkins University Press DOI: 10.1353/bhm.0.0185

For additional information about this article http://muse.jhu.edu/journals/bhm/summary/v083/83.1.jannetta.html

Access Provided by your local institution at 06/07/11 8:18AM GMT Jennerian Vaccination and the Creation of a National Public Health Agenda in Japan, 1850–1900

a n n j a n n e t t a

Summary: Vaccination played a leading role in transforming the social and political status of medicine in Japanese society in the second half of the nineteenth century. The process began well before the Meiji Restoration of 1868 created a centralized government under the Japanese emperor. At the beginning of the century, medicine was a private business. There was no oversight from an interested government, and there were no medical societies or journals in which to debate and formulate opinion about medical practice. Medical knowledge was transmitted privately through personal lineage structures whose members jealously guarded their medical techniques. For almost a half century before live vaccine could be imported, knowledge of vaccination was limited to a small group of Japa- nese physicians who could read Dutch. This special knowledge created a medical elite whose members managed the transmission of vaccination after the vaccine arrived, and dominated the new medical and public health bureaucracies created by the Meiji state. By the end of the century, a rigorous vaccination program was in place, smallpox mortality had fallen, and Japan’s Western-oriented physicians were in control of a national public health bureaucracy that could monitor the vaccination status of individuals in households throughout Japan. Keywords: Nagasaki, variolation, Jennerian vaccination, arm-to-arm method, Vaccination Proclamation, Nagayo Sensai, Eisei Kyoku, ranp¯o, rangaku, Otama- gaike, public health in Japan, Baba Sajur¯o, Jan Cock Blomhoff, Otto Mohnike, Levysshon, A. J. C. Geertz

In the summer of 1849, more than half a century after Edward Jenner published his famous Inquiry claiming that inoculation with cowpox virus would prevent smallpox, a select group of Japanese physicians welcomed

I wish to acknowledge the invaluable role of Professor Shizu Sakai, professor of medical history, Juntend¯o University, Tokyo, who convinced me of the importance of Jennerian vaccination in the development of modern medicine in Japan.

125 Bull. Hist. Med., 2009, 83 : 125–140 126 ann jannetta the arrival of live cowpox vaccine at Nagasaki.1 During the intervening half century, the technique known as Jennerian vaccination was introduced into virtually every country in the world. Japan was a notable excep- tion. Early in the seventeenth century, the ruling Tokugawa shogun had ordered Japan’s ports closed to all foreign ships, and for 250 years, the Japanese had maintained extremely limited contact with foreign nationals and foreign information. Officially only merchant companies from China and the Netherlands that had been granted a special charter to trade with Japan were permitted to enter the port of Nagasaki. In Nagasaki, Chinese and Dutch traders were confined to separate trading compounds so as to prevent contacts between foreigners and the Japanese. These restrictions meant that information about developments in the West reached Japan mainly through imported books or through conversa- tions between the resident Dutch merchants and the very limited number of Japanese officials and interpreters assigned to the Dutch Factory in Nagasaki. Remarkably, considering the circumstances, news of Jenner’s discovery reached the Dutch compound in Nagasaki in 1803, about the same time it reached other Asian countries.2 But it proved far more diffi- cult for the Japanese to acquire the vaccine—live cowpox virus—required to perform vaccination. The impediments were formidable. First, cowpox was not indigenous to Japan, which meant that live virus had to be imported. Second, the direction of the Pacific Ocean’s monsoon trade winds dictated that ships coming from the southwest could sail to Japan only in the summer months. Third, the cowpox virus was highly susceptible to heat and did

1. A social history of the introduction of vaccination to Japan can be found in Ann Jan- netta, The Vaccinators: Smallpox, Medical Knowledge, and the “Opening” of Japan (Stanford, Calif.: Stanford University Press, 2007). This article provides a short narrative covering events concerning vaccination that took place in Japan under the rule of the Tokugawa shogunate; it then turns to a discussion of the ways in which the vaccination policies promulgated by Japan’s Meiji government produced the foundation for a national public health agenda by the end of the nineteenth century. 2. The American ship Rebecca, a neutral ship chartered by the Dutch East Indies to carry the Japan trade in 1803, brought news of Jenner’s discovery to the Dutch Factory at Naga- saki. A young Dutch interpreter, Baba Saj¯ur¯o, learned about vaccination from Hendrik Doeff, the director of the Dutch Factory from 1803 to 1817. In 1820 Baba completed Tonka hiketsu [The Way to Avoid Smallpox], a translation of a Russian vaccination tract, published in 1805, that reached Japan in 1812. Baba Saj¯ur¯o’s translation remained unpublished during his lifetime, but it was copied and circulated privately until 1850, when it was edited and published by Toshimitsu Sen’an as Roshia gyut¯ ¯o zensho [Treatise on Russian Cowpox] (Edo, 1850). For additional information about Japanese translations of Western medical writings on vaccination, see Jannetta, The Vaccinators (n. 1), chap. 3. National Public Health Agenda in Japan, 1850–1900 127 not travel well in the summer months. In other instances, merchants had kept the virus alive on long transoceanic voyages by vaccinating children sequentially, using the arm-to-arm method, but under no circumstances were children permitted to enter Japan. Finally, in the early years of the nineteenth century, when the new technique of vaccination was making its way around the world, very few foreign ships came to Nagasaki, because Dutch trade in the Pacific had been seriously disrupted by the Napole- onic Wars. Vaccine had arrived in the Dutch East Indies, the Philippines, Macao, and China by 1804, brought on Dutch, Spanish, Portuguese, and British ships. But no ships brought vaccine to Japan during this period. When Dutch–Japanese trade resumed after the war, the Dutch began an earnest effort to introduce vaccination to Japan from Batavia ( Java).3 Dutch ships carried cowpox lymph and lancets to Japan every year between 1821 and 1826, and at least several times during the 1830s and 1840s, but the vaccine was always ineffective by the time it reached Naga- saki. The problem was the long, hot voyage between the Dutch East Indies and Nagasaki. However, Japanese physicians already were learning about vaccination by means of Western medical books. Foreign books were subject to censorship, but medical books—both Chinese- and Western-language books—had a special status and generally were welcomed. Medical knowledge was regarded as nonpolitical and potentially useful, and medical writings that described Jennerian vaccination and its successes elsewhere in the world began to reach Japan after 1810. These writings came from Russia, England, Germany, Holland, and China, all countries that were using vaccination to prevent smallpox; however, most of the information about Jennerian vaccination that reached Japan came from European books written in Dutch and brought by Dutch ships. Japanese physicians interested in Western medicine were known as ranp¯o (Dutch method) physicians. They had learned about Jennerian vaccination by reading and translating imported Dutch medical books. They had also read Chinese medical books about both variolation and vaccination and had become familiar with Chinese and Western ways of immunizing against smallpox. The practice of variolation—inoculation

3. Jan Cock Blomhoff, director of the Dutch Factory in Nagasaki between 1817 and 1823, initiated the effort to acquire vaccine from the Medical Service at Batavia in 1820. Vaccine lymph was sent in 1821, 1822, and 1823. In 1823, Blomhoff recruited two Japanese physicians to assist the factory doctor, Nicholas Tullingh, but this and all subsequent attempts at vaccination with imported lymph failed. National Archive in The Hague, Nederlandse Japan Factorij (hereafter NFJ), 1609–1860, Dutch Factory in Japan, 1609–1860, p. 695: outgoing letter from Jan Cock Blomhoff to Council at Batavia, no date, 1821. 128 ann jannetta using smallpox virus—was older and more highly developed in China than it was in the West, and the Chinese had learned through several centuries of experimentation that smallpox virus (Variola major) remained viable for longer periods when stored as scabs than when stored as lymph. This information would later help the Japan import live cowpox virus (Variolae vaccinae).4 At the beginning of the nineteenth century, the content of Western medical books was accessible to only a small number of individuals who could read Dutch; however, by 1820 the number of ranp¯o physicians studying and translating Dutch books had grown exponentially.5 The most influential among these physicians established private medical schools in Japan’s major cities and towns, where they supervised the translation of many important Western texts. These schools, called rangaku (Dutch learning) schools, became points of contact for a generation of physicians who advocated Western medical techniques.6 By the 1840s Western medicine was attracting not only a large number of physicians but the patronage of merchants and regional overlords as well. Smallpox was the single most important cause of death among Japanese children in the nineteenth century;7 consequently, it is not surprising that books about Jennerian vaccination attracted a great deal of interest. Writ- ings about vaccination by European physicians were copied and translated into Japanese by doctors who were interested in ways to prevent smallpox. Although few of these translations were published, they circulated as manuscripts and were shared with teachers, students, and colleagues. As a result, long before the vaccine virus arrived in Japan, Japanese physicians knew a great deal about vaccination: how to perform the technique, how to preserve the vaccine, and how to judge a successful vaccination. As they learned about the successes of vaccination elsewhere, they grew confident that vaccination would not only prevent the dreaded disease of smallpox but would demonstrate the superiority of Western medical techniques as well. Ranp¯o physicians and rangaku scholars regarded the arrival of live cowpox vaccine in the summer of 1849 as a major triumph. The circumstances

4. Soekawa Masao, Nihon t¯o by¯o shi josetsu [An Outline History of Smallpox in Japan] (Tokyo: Kindai shuppan, 1987), pp. 8–9. 5. See Sabur¯o Miyashita, “A Bibliography of the Dutch Medical Books Translated into Japanese,” Archives Internationales D’Histoire des Sciences, 1975, 25(96): 8–61. 6. See Richard Rubinger, Private Academies of Tokugawa Japan (Princeton, N.J.: Princeton University Press, 1982), chap. 4, 5. 7. Ann Bowman Jannetta, Epidemics and Mortality in Early Modern Japan (Princeton, N.J.: Princeton University Press, 1987), chap. 4. National Public Health Agenda in Japan, 1850–1900 129 were extraordinary. Cowpox lymph had been sent in 1848 but, as in ear- lier years, it was not effective when it arrived. The Japanese, familiar with the Chinese method of preserving smallpox and cowpox matter as scabs, made a special request. They asked the Dutch to send vaccine virus in the form of cowpox scabs the following year. In 1849 Batavia sent samples of the vaccine virus as both lymph and scabs. Three Japanese children were vaccinated, two with the lymph and one with a vaccine reconstituted from the scabs; but only the child vaccinated using the cowpox scabs produced a successful vaccination lesion.8 Japan’s newly imported supply of live cowpox vaccine was limited to the virus contained in the pocks on this one child’s arm.9 Despite the fact that the amount of live vaccine virus received in 1849 was extremely small, the national transmission of vaccine and vaccination in Japan was exceedingly rapid. The vulnerability of the virus was well known, and great efforts were made to keep the vaccine alive. The first order of business was to expand the supply of vaccine: Nagasaki city officials and physicians, in collaboration with the Dutch Factory physician, Otto Mohnike, arranged to bring children from domains throughout Kyushu to Nagasaki to be vaccinated. Having been vaccinated with the arm-to-arm method, vaccinated children were returned to their home districts to distribute vaccine virus to other children from the pocks on their arms. The arm-to-arm method was the key to increasing the supply of vaccine and to the successful transmission of vaccination in Japan. Beginning with the tiny supply of virus in Nagasaki, within six months vaccination was being performed in clinics throughout the entire length of the Japanese Islands.10 As Otto Mohnike wrote to the director of the Dutch Factory, Henrij Levysshon:

I am pleased to inform Your Honour [Levysshon] that at Nagasaki and in the other towns and districts of the island of Kyushu vaccination has taken root so well that we may hope that this wonderful invention will not only never be lost, but even that it will spread over the entire Japanese empire. At Naga- saki vaccine pocks already exist in their thirteenth generation—in nineteen children whom I have inoculated today—and the entire number of children inoculated by me from week to week since 14 August until now has reached

8. The child was Narabayashi Kenzabur¯o, the third son of Narabayashi S¯oken, a Nagasaki ranp¯o physician. Soekawa, Nihon t¯o by¯o shi (n. 4), p. 45. 9. For a detailed account of the rapid transmission of cowpox vaccine in Japan in 1849, see Jannetta, The Vaccinators (n. 1), chap. 6. 10. Tennent¯o no zero e no michi [The Road to the Eradication of Smallpox] (Tokyo: Nait¯o kinen kusuri hakubutsukan, 1983), p. 36. 130 ann jannetta

176. Apart from this, I have had Japanese physicians inoculate children in the areas outside Nagasaki.11 Ranp¯o physicians quickly mobilized personal connections to organize the distribution of vaccine beyond Kyushu.12 These connections included father–son, teacher–student, and lord–retainer relationships spanning the length and breadth of the Japanese Islands. Prominent regional lords participated actively in the distribution, hand-carrying vaccine from their domains to the capital and beyond. The shogun’s government in Edo remained entirely aloof from the process, but its absence of interest was no deterrent. By the end of the year, vaccination clinics had been opened in doctors’ offices throughout the entire length of the Japanese Islands.13 The circumstances of the late arrival of vaccine were important. Unlike the introduction of vaccination elsewhere in Asia, in Japan vaccination was not a foreign technology imposed by a colonial power. In the Dutch East Indies and the Philippines, vaccination was introduced and administered by Dutch and Spanish colonial governments, respectively; in China, it was promoted by the British. In Japan, however, vaccination was actively sought by Japanese physicians and their patrons. The Japanese could proceed with confidence, because the efficacy of vaccination had been proved elsewhere many years before. Nor was vaccination a technology imposed from above. In Japan, vaccination was promoted and introduced by physicians from peripheral domains far from Edo. Another decade would pass before the shogun’s government offered any support whatsoever. For almost two decades, vaccination remained under local control. Local physicians maintained vaccination clinics as part of their private practices; they reproduced vaccine lymph by means of arm-to-arm vaccination. Physician networks and local authorities also managed the distribution of vaccine from place to place. The logistical problems were enor- mous; possibly local knowledge and close local supervision of the scarce vaccine was an asset in the early years of vaccination. An announcement that vaccine had been received at a local doctor’s clinic would prompt a call for a certain number of children to report to a specified clinic at a specific time. The vaccinated children were required to return to the clinic several days later so that the doctor could determine the success of their vaccination lesions and take live virus from those lesions to vacci-

11. NFJ (n. 3), 1632/36, letter from Mohnike to Levyssohn, 11 November 1849. 12. Many people participated in the transmission of the vaccine virus. It was hand-carried to physicians in major cities and distributed from cities to nearby towns and villages. A chro- nology of the 1849 transmission is found in Jannetta, The Vaccinators (n. 1), pp. 146–47. 13. Tennent¯o no zero e no michi (n. 10), p. 36. National Public Health Agenda in Japan, 1850–1900 131 nate other children.14 Vaccination certificates were issued by local clinics, which recorded the successes and failures of vaccination, in part as a way of monitoring the effectiveness of the vaccine. By documenting successes and failures over time, it was possible to monitor a community’s immunity to smallpox, but success depended on the interest and diligence of local participants and would have varied from community to community.

From Private to Public Sponsorship of Vaccination Smallpox, however, was a national not a local problem, and it had no respect for jurisdictional boundaries. Personal networks and arm-to-arm transmission may have facilitated vaccine production and distribution in the early decades of vaccination, but neither personal networks nor local institutions had the capacity to build and sustain a comprehensive vaccination program over the long term. As long as vaccination depended on the recruitment of children, arm-to-arm transmission, and limited local resources, smallpox would continue to claim the lives of Japanese children. A transition from private to public sponsorship of vaccination began in the final years of Tokugawa governance with the creation of new institutions dedicated to immunizing children against smallpox. The first sign of serious interest in vaccination by the Tokugawa government followed an outbreak of epidemic smallpox in 1857 in the northern island of Ezo (Hokkaido). At the request of local officials in Ezo, the Tokugawa government recruited and sent two experienced vaccinators to the northern island, where they vaccinated several thousand children.15 The second sign was the opening of the first vaccination clinic in Edo the same year.16 A group of Edo physicians petitioned the shogun for permission to open a private clinic in 1857, and the Otamagaike Vaccination Clinic opened early the following year. The Otamagaike Vaccination Clinic was privately built, financed, staffed, and managed by the sponsoring physicians, but in 1860 the Toku- gawa government took over the clinic’s finances and the appointment of key personnel. From that time, the clinic and its successor institutions were managed and operated by the government. Rather quickly, these

14. Soekawa, Nihon t¯o by¯o shi (n. 4), pp. 60–61. 15. Brett L. Walker, “The Early Modern Japanese State and Ainu Vaccination: Redefining the Body Politic, 1799–1868,” Past Present, 1999, 163 : 121–60. This excellent article gives a detailed account of the Ezo vaccination campaign of 1857. 16. Fukase Yasuaki, “Otamagaike shut¯ojo kaisetsu o megutte” [A Consideration of the Otamagaike Vaccination Clinic], Part 2, Nihon ishigaku zasshi, 1980, 26 : 420–31. 132 ann jannetta successor institutions—the Seiy¯o Igakusho (Western Medical Institute) and the Igakusho (Medical Institute)—expanded their activities beyond vaccination services to take on the additional functions of a medical school, laboratory, and research institution. The ultimate institution produced through this progression was the Medical School of the Imperial University of Tokyo. After many centuries of military rule, the Tokugawa family relinquished its claim to rule Japan, and an oligarchy of regional leaders reinstated the Japanese emperor as head of state. The young Emperor Meiji moved from the ancient capital of Kyoto to the new capital in Tokyo (formerly Edo) to become the ruler of Japan. The oligarchs who had formed the new government in the Emperor’s name became the de facto rulers of the new nation. A significant number of these new leaders had been trained in Western-style medicine, and their modernization agenda included strong support for Western medicine. Interested in finding ways to combat disease, improve the health of the population, and build a strong nation, the new Meiji leaders were active supporters of Jennerian vaccination. As they began the task of building a national government from scratch, there were important reasons why the Meiji leaders saw disease control as a central concern of the central government. Following the forced opening of Japan’s ports to international contact in the late 1850s, morbidity and mortality rates rose sharply.17 In addition to endemic smallpox and other indigenous diseases, new diseases unleashed an upsurge of unusu- ally severe epidemics.18 Japan’s new leaders considered it their responsibility to develop policies to prevent or contain the diseases that caused these epidemics. An urgent need to bring what was a highly visible threat to the country’s well-being under control was obvious, and one of the new government’s first acts was the creation of a bureau within the Meiji government that would defend the public’s health. In 1874, the Meiji government created the Eisei Kyoku (Central Sani- tary Bureau) in Tokyo and appointed a physician from Kyushu’s Omura¯ domain, Nagayo Sensai, as its first director.19 This key appointment

17. Ann B. Jannetta and Samuel H. Preston, “Two Centuries of Mortality Change in Cen- tral Japan: The Evidence from a Temple Death Register,” Popul. Stud., 1991, 45 : 417–36. 18. Devastating epidemics of cholera and measles struck Japan soon after the ports opened to foreign traders in 1858, and these were followed by epidemic typhus and bubonic plague, which heretofore had been unknown in Japan: Jannetta, Epidemics and Mortality (n. 7), pp. 189–207. 19. Ann Jannetta, “Nagayo Sensai,” in Doctors, Nurses, and Medical Practitioners: A Bio- Bibliographical Source Book, ed. Lois N. Magner (Westport, Conn.: Greenwood Press, 1997), pp. 200–201. National Public Health Agenda in Japan, 1850–1900 133 ensured that support for vaccination would be given the highest official priority. Nagayo Sensai was a third-generation ranp¯o physician; his grand- father, Nagayo Shuntatsu, had been a smallpox doctor and an advocate of Jennerian vaccination long before cowpox vaccine was available in Japan. In 1849 Shuntatsu had personally transported cowpox lymph from Nagasaki to Omura,¯ and he had immediately opened a vaccination clinic there.20 His grandson, Sensai, had known about the merits of Jennerian vaccination from his earliest childhood.21 Nagayo Sensai was educated in Osaka at Japan’s most prestigious West- ern learning academy in the 1850s.22 In the 1860s he returned to Kyushu to study under the Dutch physicians hired by the Tokugawa government to establish a Western medical school and hospital in Nagasaki.23 With the change of government in 1868, Nagayo was appointed the first director of this new hospital, and vaccination was standard medical practice from its inception. In 1871 Nagayo was chosen to join the prestigious Iwakura Mission to the United States and Europe, where he was able to visit western medical schools and hospitals.24 In Germany he was introduced to the new ideas about public health that were being discussed, in particular, the importance of collecting health statistics as a way to monitor and control disease. On his return to Japan in 1872, Nagayo was appointed director of the Meiji government’s newly created Eisei Kyoku in Tokyo. Nagayo had returned from Europe with a firm commitment to con- structing a national public health system. One of his first official acts as director of the Eisei Kyoku was to issue a Vaccination Proclamation that made Jennerian vaccination the only legal way to protect against smallpox. Variolation (inoculation with smallpox virus) was declared illegal. Vaccinations were to be given free of charge and inspected for success, and successful vaccinations were to be certified with a red stamp on an official document. Vaccinees whose vaccinations were unsuccessful had to be revaccinated, and those whose vaccinations were successful were to be revaccinated every seven years. Vaccinating physicians had be certified by the government and were required to report vaccination statistics to

20. Soekawa, Nihon t¯o by¯o shi (n. 4), pp. 33–34. 21. Nagayo Sensai, Sh¯o k¯o shishi [An Autobiography], in Matsumoto Jun and Nagayo Sensai, ed. Teiz¯o Ogawa and Sakai Shizu (Tokyo: Heibonsha, 1980). 22. Jannetta, “Nagayo Sensai” (n. 19), p. 198. 23. Ibid., p. 199. 24. The Iwakura Mission was a Meiji government–sponsored tour of European countries and the United States, headed by Iwakura Tomomi (1825–83), a court noble who had sup- ported the Meiji Restoration. Its purpose was to learn about the operations of industries and governments in the West. 134 ann jannetta the government every six months. Perhaps most striking of all was the provision that all children were required, by law, to be vaccinated between seventy-five and one hundred days after birth.25 Nagayo’s visionary Vaccination Proclamation was a long-term commitment to free and universal vaccination, but the difficulties were formidable. First, there was still a severe shortage of viable cowpox vaccine; vaccinators still depended on arm-to-arm vaccination to supply fresh cowpox lymph. Second, the required certifications, documentation, and reporting requirements placed onerous new responsibilities on physicians. Hereto- fore, they had been accountable only to their patients and to local officials; now they were expected to report to a distant bureaucracy that was still being created. If successfully administered, the mandate articulated in the Vaccination Proclamation would link individuals and communities throughout Japan to the new central government in Tokyo. Initially, the Eisei Kyoku was situated in the Education Ministry, but it was soon moved to the Home Ministry, which was the most power- ful ministry in the Meiji government. The Eisei Kyoku comprised four departments: General Administration, Bureau of Statistics, Bureau of Vac- cination, and Bureau for Control of Medicines. With respect to Japan’s vaccination rate, Nagayo promptly set out to accomplish two major objec- tives: (1) to increase the quantity and quality of Japan’s vaccine supply to accommodate the vaccination mandates now required by law and (2) to create a data collection system to monitor how well vaccination policies were being carried out.

From Local to National Control of Vaccination: Vaccine Production If the Eisei Kyoku was to successfully enforce the provisions of the Vaccina- tion Proclamation, it was essential to establish a national system of vaccine production and distribution; that is, to move vaccine production from the arms of young children to government laboratories with the capacity to produce large quantities of vaccine directly from cows. Because of the rarity of cows in Japan, vaccine production was a special problem, but the idea of using cows to produce a vaccine was not new to the Japanese. As early as the 1830s, Japanese physicians had tried to produce a cowpox vaccine by inoculating a cow with the smallpox virus.26 Despite their lack

25. Yamazaki Tasuku, Nihon ekishi oyobi b¯oeki shi [The History of Epidemics and their Preven- tion in Japan] (Tokyo: Kokuseid¯o, 1931), p. 361. 26. Soekawa, Nihon t¯oby¯o shi (n. 4), pp. 33–34. National Public Health Agenda in Japan, 1850–1900 135 of success, experiments on cows continued until the vaccine was imported from abroad in 1849. A consideration of problems concerning the quality and quantity of Japan’s vaccine virus supply can be found in the very first report of the Eisei Kyoku Nenp¯o (Annual Report of the Central Sanitary Bureau),27 which covers the period from July 1875 through June 1879.28 Although arm-to-arm transmission with good vaccine virus from a known source was still regarded as the most reliable vaccination technique, the report duly notes that vaccine which had been passed through a long sequence of individuals using the arm-to-arm method became increasingly ineffective over time. The same was true for vaccine transported frequently from one jurisdiction to another. Moreover, the report notes that the quality of cowpox vaccine was adversely affected by seasonal variations in temperature. It was clear that, if smallpox was to be eradicated, vaccine must be produced on a considerably larger scale and with much greater quality control. This growing demand for vaccine prompted both private and public initiatives designed to produce cowpox vaccine from cows. Nagayo Sensai had personally observed the calf lymph production method practiced in The Hague in 1871.29 He purchased the necessary equipment, and by 1873 he had successfully reproduced the Dutch vaccine production method. In 1874 the Eisei Kyoku opened a Vaccine Distribution Center (Shut¯o Keisho) in Tokyo to meet the growing demand for a higher quality vaccine. This center operated a vaccine laboratory that housed female cows to propagate fresh cowpox vaccine. Initially, both foreign and domestic cows were used, but in June 1880 the laboratory stopped using domestic cows. The reason given was that domestic cows had thick, rough skin, whereas foreign cows had smooth skin that produced a consistently bet- ter quality vaccine.30 Using calves for vaccine production made it possible for the Vaccine Distribution Center to function as a national production, distribution, and vaccination center. The government’s goal was to immunize as many children as possible at the earliest possible age: it granted the center the authority to vaccinate healthy infants under one year of age and to sched- ule vaccinations for infants in different Tokyo wards. The center later set

27. Annual reports of the Eisei Kyoku covered calendar years from 1 July through 30 June beginning in July 1875. These reports have been reprinted as Meiji-ki, eisei kyoku nenp¯o, 1875–1900, 7 vols. (Tokyo: Harashob¯o, 1992). 28. Ibid., 1: 21–23. 29. Ibid., p. 83. 30. Soekawa, Nihon t¯oby¯o shi (n. 4), p. 185. 136 ann jannetta up branch offices in the city’s districts—Yotsuya, Shiba, and Hongo—to accommodate infants who lived an inconvenient distance from the main office. The center supplied vaccine to the Ministry of Education and the Ministry of the Army and responded to special requests for vaccine when smallpox cases broke out elsewhere in the country. It also sent vaccine to the Ryukyu Islands, which recently had been brought under Japanese administration. The increased production of vaccine using the calf inoculation method made it possible to greatly expand vaccine distribution and the delivery of vaccination services in Japan. Not long after the Japanese government developed the procedures to manufacture and store cowpox vaccine, the Tokyo Vaccine Distribution Center was approached by other countries seeking vaccine and information about vaccination. In 1880 an emissary from Korea visited the Tokyo Vaccine Distribution Center to learn how to perform vaccination and how to manufacture vaccine using the calf lymph production method.31 The following year, a request for vaccine from the Russian Embassy in Tokyo was met with a supply of newly implanted calf vaccine. In its 1881–82 annual report, the Vaccine Distribution Center reported what it called its “regular” and “irregular” distribution of vaccine: 14,015 vials for regular distribution to prefectures, 7,660 vials for irregular distribution to prefectures, and 4,740 vials to individual citizens for a production total of 26,415 vials. Vaccine production and distribution had more than doubled since 1874, when the first reports were issued.32 Fresh vaccine was being produced every month, and vaccinations in Tokyo were being offered every day of the week except Sundays and holidays.33 In 1882, the Vaccine Center received a gift of six “seedlings” from the United States, and they were tested on both calves and children without success. The Japanese concluded that the seedlings were too old and had lost their vitality, which suggests that the international transmission of the cowpox virus was still a problem. By then Japan’s Vaccine Center was producing and distributing vaccine nationally on a regular basis: in 1882–83 it reported a production total of more than 40,000 vials distributed to Japan’s prefectures, the Ministry of the Army, and the Ministry of Education, plus private sales to physicians and foreigners.34 The manufacture of vaccine from calf lymph did not mean that the arm-to-arm method of vaccination was abandoned. It continued to serve a

31. Ibid. 32. Meiji-ki, eisei kyoku nenp¯o (n. 27), vol. 2, 1 July 1880 (Meiji 13)–30 June 1881 (Meiji 14), Appendix 5, pp. 536–37. 33. Ibid., vol. 3, 1 July 1881 (Meiji 14)–30 June 1882 (Meiji 15), Appendix 4, p. 385. 34. Ibid., vol. 4, 1 July 1882 (Meiji 15)–30 June 1882 (Meiji 16), Appendix 4, p. 643. National Public Health Agenda in Japan, 1850–1900 137 useful purpose in villages and towns throughout Japan for the rest of the nineteenth century. Nor did the new public bureaucracy replace personal and private networks, which continued to play an important role in vaccine distribution. Private physicians and local institutions were the nodes of a loose network that continued to communicate information about the local whereabouts of viable vaccine. These local networks were a valuable human resource for the new public health bureaucracy, and they would continue to be an essential part of the national system as it expanded.

From Vaccination to the Creation of a Public Health Agenda When the Eisei Kyoku was created, vaccination had been practiced and documented locally for over twenty years; consequently, it was logical to begin the compilation of national health statistics by collecting local and regional data on vaccinations and smallpox cases. Vaccination statistics were the first public health statistics to be systematically collected by the Meiji government, with the Eisei Kyoku publishing its first tabulation of smallpox cases, deaths, and vaccinations for the period 1874 –79.35 The resulting report gave both positive and negative vaccination results, by prefecture, for first vaccinations and revaccinations. During the first twelve-month period covered in this report, more than one million per- sons, mostly children, were vaccinated. Vaccination statistics became more detailed over time, and data collection expanded to include many more jurisdictions. The reporting methods used to collect statistics on smallpox and vaccination would become the prototype for the collection of data on the incidence of other acute infectious diseases. In 1885 new public health regulations required all citizens to record the vaccination of family members in the koseki, an official household register newly required by the Meiji state. Physicians who issued vaccination certificates were now required to report to the government, each month, the names and addresses of the individuals to whom they had issued certificates. The local police were authorized to check the birth and vaccination certificates of all households in their jurisdictions, and a new smallpox case would prompt a visit from a police officer, who would determine whether there were other unvaccinated children in the family or neighborhood.36 Within a decade, vaccination policy had accomplished

35. Ibid., vol. 1, 1 July 1875 (Meiji 8)–30 June 1880 (Meiji 13), pp. 24a–24b. The first reports came from Japan’s three cities—Tokyo, Osaka, and Kyoto—later followed by data reported by prefecture to the Eisei Kyoku in Tokyo. 36. Yamazaki, Nihon ekishi (n. 25), p. 361. 138 ann jannetta a striking measure of social control: the Meiji government could now reach down to monitor individuals in Japan’s smallest social unit—the Japanese household. The national health system relied on the records kept by individual vaccinators and local clinics as well to learn when and where children were being vaccinated and whether vaccine in different parts of the country was proving effective, as well as information about numbers of vaccinations, revaccinations, and subsequent successes and failures. How successful was the Eisei Kyoku in nationalizing Japan’s vaccination policy? A. J. C. Geertz, a Dutch physician and pharmacist from Utrecht, considered Japan’s immunization policies to be both effective and advanced for their time. Geertz had worked with Nagayo Sensai in Nagasaki to help set up an academic curriculum for the Nagasaki Medical School, and he had then secured a prominent place in the Meiji government’s new public health bureaucracy in Tokyo. In a letter to The Japan Mail in June 1879, Geertz commented on the importance of extending central government control over Japan’s vaccination program:

a large number of physicians . . . each in his own immediate neighbourhood, contributed their share to the work [of vaccination], but this would never have produced such quick and excellent results, if the system had not been governed and controlled by an able hand. For, although . . . vaccination was in a limited degree practiced in the years before 1874, it was not until that time that there appeared regularity, system, order and control in the matter. To Dr. Nagayo Sensai, the chief of the Central Sanitary Office, under the Naimusho [Home Ministry], by far the largest share of praise is incontestably due.37 The success of the early Meiji government’s rigorous vaccination program is also apparent in Table 1, which shows the impressive decline of smallpox deaths after 1885. Japan’s last major epidemic in 1905 witnessed 10,704 cases and 3,388 deaths in Japan’s population of 48 million people, a significant decrease in the number of deaths in a major epidemic year. Vaccination played a leading role in creating a social and political envi- ronment in which a comprehensive public health agenda could emerge as a government priority. The process began well before Japan’s political leaders created a central government and restored the emperor as head of state in 1868. At the beginning of the nineteenth century, medicine

37. A. J. C. Geertz, “Vaccination in Japan,” Japan Weekly Mail, Yokohama, 12 June 1879. Geertz’s letter provides statistics showing the number of vaccinations and revaccinations performed in Japan during the period from 1 July 1875 to 31 December 1877. Geertz’s letter includes an English translation of the eight articles in the Eisei Kyoku’s Sanitary Code that pertain to vaccination regulation. National Public Health Agenda in Japan, 1850–1900 139

Table 1. Smallpox Cases and Deaths, by Year, 1885–1900

Year No. Cases No. Deaths

1885 12,618 3,299 1886 73,337 18,676 1887 39,779 9,967 1888 4,052 853 1889 1,324 328 1890 296 25 1891 3,608 721 1892 33,779 8,409 1893 41,898 11,852 1894 12,418 3,342 1895 1,287 268 1896 10,704 3,388 1897 41,946 12,276 1898 1,752 362 1899 1,215 245 1900 111 4

Data source: Yamazaki Tasuku, Nihon ekishi oyobi b¯oeki shi [The History of Epidemics and their Prevention in Japan] (Tokyo: Kokuseid¯o, 1931), p. 374.

had been a private business with little oversight from a disinterested government, and Japan’s advocacy for vaccination came from private physicians who learned about western medical techniques by studying foreign medical books. The half-century delay in acquiring live cowpox virus gave Japan’s ranp¯o physicians time to build a strong case for Jennerian vaccination on the basis of its successes and acceptance elsewhere in the world. Foreign knowledge had created a medical elite whose members managed the transmission of vaccination after the vaccine arrived and quickly dominated the new public health bureaucracy created by the Meiji state in the 1870s. Central government control of vaccine production and a national data collection system soon followed. By the end of the century, a rigorous vaccination program was in place, smallpox mortality had fallen, and Japan’s western-oriented physicians were in control of a national public health bureaucracy with the ability to monitor the vaccination status of individuals in households throughout Japan. These initiatives gave Japan’s national government the tools it needed to build a strong public health agenda and, in the twentieth century, to expand this agenda into its colonial empire in Asia. 140 ann jannetta

ann jannetta is Professor Emerita of Japanese history at the University of Pittsburgh. Her publications include Epidemics and Mortality in Early Modern Japan (Princeton, 1987), The Vaccinators: Smallpox, Medical Knowledge, and the “Opening” of Japan (Stanford, 2007), and articles on disease and demography in The Cambridge World History of Human Disease and Encyclopedia of Social His- tory. In her new research, she examines the role of the medical journal in creating national and international communities of medical practitioners in the nineteenth century. ,(十日> )ョ澪/11′,「 m闘ゅ」。■3・ヾ薬ハ計)。 o諄。,″ ゛ハ～N^,もヽプ0采耐03+ル燿ヽ "゛い卜o■ や譲同o、前悦綺o,卜 >卜 ′コ|,(H Hl> ) ゛卜団 q゛跳李‖o、 ′gャト、釉^りヽ0壼坤0撻剛競0 卜ヽ澪埒 ′ ゛～サ■、コ帯悦醐]w゛ oo● 藩回0「ヽ、■ 丼‖ ′"「前戯ゅ」o■ 日薄¶o“ ′ヽ山ハざ0諄訓ハo「ヽ ■]巌文 0「画≫製 ′場(「澄池か醸普,」 ′苺ヽ)o● “荊富ヽ囃珊も 10濤語0丼陣ふ■ザヽお辮“ゝ NキプOS・ ′ハc～即， "ざとも,■ ざ刈競 ′,( ||> )日外x。 (「薔壼‖ヽ 1導J ヽ菰 10れ黎翔o)コ ^熙 ,い ′辟■麟)。サ0卜 ●゛粛^゛と ′苺ヽ)汁。■o卜 ●>゛おヽ「●oき， ,喘誨 ′4oξ F～汁サψ'「「洵齢ゆJoFお 0)● サc′ ^,き iど潰範ヽ「ざ剛婦珈,■ )(● o>1)ョＥゃXハザも ′●ど,競河■3, ヽ'卜、プ ′ヽ戯>● 0● 肝´ 【前鵬澤ヽ疇み ■ざコ ′熙底慈 (ドドざ )11澪団 ′31E潤、↑雉=o津回「〓ッキョ躙剛癌」。゛●サ]IFル ●∝rヽ町ヽ ′ハc、。かoc,c際、■ oぼン w壽剛続,苺 W′ 「゛、市昴゛証蔵●3漆節 ′ゝ卜q>。と酸"ン 000Jヽ | ′.・‐ 」 '"゛サ Oll・■)識コ0」研ヽ、■ ′o片丼お津>| ′ 怯た 0口 >,4● さ゛,「割メヽ。 ,さ nt=▼ 間■o「 ●>ヽ０。″ザ■c兼「き ― ,譲 ‖●コ臨島 ′^0● "、 ′=0,,FでトトIH,E■ ヽ″シヨ。た0かヽ●ビや'軍学く「ヽ"面OJキ「き'部コ飾 oぃ ― 」 ′●ξ剛耐。「灘ぶ研習`ヽJ。ヽc前誨～ ■,FE副ヽ口0 17uF)11高“卜でo・供|セ1ヽコロやい ′^"翼氏頻壺D「0ヽロ ′ 「■縮JO"「 o翅 ‐ "平 ● 菱ヽ゛諄゛OM料 "飾酎 ′▼ ッ| ‐ 、、ヽ、゛諄゛0悽絣覇]洵 ′,"出邦゛ツコ|ドヽヽFs,"か゛、 ●縣場稟価;゛ンコ●3譲～「ゅtr濱J● 苺当雨“qヾ Nゆ ≫ 。い0^゛ ‖"力 ■口耐●もo′ キ「“汁議を熙当摯 ▼"珊 ′ さ市津>1● ざヽ。,ラヘヽ9■ ゛0節 ●帖ゴ摯ゝ(の「m麟きぷoき麺回場劇」・1諄絣範3'(B澪 ^0「ゴ資a ttN o酪ョ"=詰渕料oド゛・0ゝ・ ′ざ ,も (M・炸)汁H>lo諄゛ ′畔鉾か0課 ^c゛調F“ 弟″oも “ )コ゛。F>絣 ^■ ,尉。料 ●3ゃ、と゛゛サ ′F^ど滸範。漱0■ ,滲ン磁～藩前^コ洵丼 ′"妻 0ヨヽ「ヽc 。が,S,(‐ )「巌油誨"lw」 =卜 Jらゆ口)尋 S卜、キ■出撃J^即 Nゞ 0前商 ′怯゛N雨 0針針。卜●サヽいヽ■ 「捕 ′in(十日>|)日外埒卜、すⅢ“ャo「 m蘭ゅ」ハど樹範前罪」汁o四圏サ1,すOf.,半面ヽ ● 撃珂ヽオ ′rlび u"Oo■ o,o(ヽ。 Fが、nt喘母笥鑽0ど柵編丼半キヽ" |●●証醸。'もり凝αヽ■●おいにヽ眸 ′姜赳澪洵蘭0取可籠鸞S爺冊駐譲 ′o)o。 >,^c団濠りや01き゛サ米壼0研 m′ 0`■ .7r O(1.ぶ餃^F`ヽ 0「潟ヽ民OJか 0すザ。(‐)「ラヽ～サも蓋離o「前耐oJ c nlハもザにか,■ 。●に前前お蹄=10ゆ 0加 '。ザヽが,サ「ξЖ焔]舛薔ヨ属咄 | ■回,い 0>0● ・0寧燕0111タヌrl‐"0)コ ′0ハ画0い

にJ。さ,^r則も・`1′～"も国oF,メ o熙 lllr′キ雨‖、ヽ冊藩 ′,ゝンc富か ‐・s製 ● ¶ ,● 3露鷲携詫さo前齢。か゛ヽヽN゛ ′計、か0不 3辞 Os釉 ●,(口 ‐・澪炸)十日>| ●・り■So姜 0壺～塔場≧ⅧO絆 N゛ ",前第冽^を ," 。汁o)0,^む ,′ 「o^製～既 0口「穀臨番 w■ 」′a ′姜00さ゛調゛●^oF「寄雨」0も rr,怯洵蘭。(‐)ヽプ ″qメ″,rl c、コらヽ,"oさ癖満巌S薗卜ぃoサ |、サぉす鮮に″世きい"● 9沐剛雨ヽ3瀬斑 ′"商い0゛灘コ ′● 洵謗Ж ′)洸。゛■汁翌おヽ疇 ′ 市 "F〈 ,ぃざン咄卜●■■ ヽキ0～ ¨さ峠 ′、。か。゛maど ,≧ 興""今 ■キ前麟ァ '● ,コ藁、を、咄)卑前蔵"nl前 oヾ。ざ屁゛ ′ 縦雨oま .ル●R"「〈「m譴 J′ョ■)(中)「“ Ilt uィレ.ハ)前面nキ」 |トザハoぉ ■■サか、コo前蘭■ハ■ ■c出～ ′ 剛勘o疇 ′バさ丼゛声米■o羅かヽ"ドト箇 ′キゴ語0い ″Oα ●さすヤ図S■ 日。洸o卜 ●W■ 事0翅゛、、 ,mI前サく、キ、o、からヽヾ北ヽお沐ぉ市 >| 。 ,,゛サ)● (¨)前ヽ冽ハ、トヾ)■ 、ヽ錮)、、、スoキ ■■s釉 ■ 畔 ′ 。巌雪雨o語研、 03前ド ′^鉾 r、o沐、cm嗣 ¨゛ザ ′藁,ヽと、゛～蔵リマヽヽ。゛゛ぅF“ s,ol丼黎 )、ョ>| ′0燿ぉ津十さ^ '゛ ψ ザψ町 ′"0■ 。●メド画,("`ヽ ,中 7● 鱗0,■ ヽり菫≫サ》蕩■、、、ヽ ′■0● す粛■,コヽ前献o、ラン),ヽ 0米 oo″ ′0トラ^■ に気 0■ 軒ヽc溶染寓証。卜。ヽo卜。,^。ヽF蝠「 ‖ 8■ 」3回》o前溶棗 +′ 陣ヽ●》口0卜。いヽハ"駆総 OM副屁ブ、に、、むコび ′ ヽ膨怯 ‖澪ン ′)oも ,丼轡評oo卜 ●4～ ■)0 ′ハc、 S牟前日――iScF I 。″、゛ハ●"か、テ、´、N′ 「"も "も藁ら,、熾呂

中睡日螂

――rtr聯潜o「剛耐壁課oさ抑回場鮮」0こャぉ諄糾逓絆桝 ―― ・・サ「汁鳥梓冨E」んや碑ゝへЧ 続河怯謝H′ ^、サ0● ■前汁o゛ ,α O嶽 P・l^""、 ■ 叶サ議謝0本釉 ′>B針訃 ′神お0ヽトン |「洒洵蘭J′ (薔 ∞ 』。ヽ・,「 0た r.|。リン対=":"Hl卜半絣ヽユロ)中ヽ0>||′ キ米ゴ画。か'ハ、ヽ cttN卜に)「襲謀こ洵劇 ′汁前,Σ ～010爺 J′■(ヽ)「" いヽヽ●●ヽ莉 ′藁8丼ヽコ ′■。・"c機宮も′"■ )ヽ前麟ヽヽ剛」F゛ >剛 ′゛`ヽ「汁c″ ‐「c、就兼メ゛卜「wヨ ,「丼>剛飾Jらルロ3 anH‖ (″H>1)口澪lll′"Wいえ・ヽ阿0ど涸怯柵誰簸蒲汁プ^c▼ ンと繊■冷口 | ′び0ヽ ,「。ヽ"oらヽいか゛rl、峙,N蓋難４ .・゛ 0翅畔● 針「。 ,■ cコ1諮 ′キ圏蹄卜,へざ ■』 ■ ´ ゛゛ヘ 0前戯0■ ど糊湿 ′rl彗ヽ薄uo証ぃコ脳汁cttNG)0も〓 c澤塑a識「い "耐もVブ"『 "調石さ)゛ ■● ′,● sc.か。ヽ ,瀧函π卜ヽ 0"中申剛,斗 H』 ′らいヽ。'"'ハざ馘 ″ザ■さ0柵斑 ′■0゛～●～゛""輩ヽ■m′ ～,藁「書怯証,■ 椰漑さすも"3■ ■機蒲 ′いい●0評涸。りヽ・゛ｉ卜。)。み0ヽざ鮨も l lRI「■前」た0″ も,“ よ～鬱錦,。,レ0～ ′ヽぼ剛競■卜副 ′■み」サ Ⅲ巌輌ネがヽ巌o● ,ど "濠ヽ商0"も ′゛,ハ。キ～0 。汁q゛～慟 ‐ さ■群ヽ日;ぶ ‐督 ′,かレヽ傘前日●・7コ)^い～,WК I 0■ oF(● )「ンココ対,ミヨ罰゛ゴ》汁訥■」′ヾン゛■ 。(D″ ,゛ 0撥 ●載●ン訓ヨ爾a,゛計ン晨′>トコ)′ ^ 。さすンい絆ゝ冊mm同 ^IE戦 ′)ヽ OFもヽ剛艘 ′,*ヽ～サSヽ資理0゛則● ′V● ^,● ヽ怯C凛 ^ヨ蠣キ●狂ざ熊雨^辮 0前ヽ辮゛図ヽヨSO゛。か0ハ雪洵S WIE櫨譲゛。卜、りOr,捕護゛■Ⅲ"漆ヽ前～澪日Πヽ前》 ′^剤 ′姜飢凛添築0ヽ | 。か'ハ c回ヽハo「 (D「目ヽ米ヽ4当ヽ日0当 0ばヽココ誨 ¨ 書 =■ ′,●ll ttI～ヽ首目ヽ工珀橿朦會J′,お「前間にJO醸樹範。ル、汁゛■ 。ヽ0汁もヽS3■ ゛ヽMcヽ～叫前か0卜」′0針燿屁薗懸●ξヽ頭 ′ハo‖ ンに叫ゆ熙"o■ ′「かざ"゛卜`悦 0■ 121′^いヽ。卜,ハ ,゛ ,枷場叫翫OSン苗 ′■、ヽす叫面キ`,(ンロ> )|シ削 ′ザ摯戯諄0狐ヽお絆汁o^ ヽ口督百^ヽ ●"■ 0い ′■3鷺隷。ルさ゛「鴨鴻躊゛ザ゛ ""m戯剛ン .、も、ハヽ図督0=築ヽ |● ′F訓 ●口" 晨N諄 ‖0ヽ副゛さい ′姜■粘訓0'日外咄。汁～戯■,ヽ前市0"● 0■ 袢薔ヽ ■いコ枷 0日米 ′へ o東 N目 ^飾 0ド゛りヽ同国汁cヽい ′サヽかヽ ‐ 辮前■c沌 ^'対゛酬漱0‖ 弧部 ′■前戯0■ k。゛0^" 。|も0^゛副蓋 ″■■, ミ攣辞い0コ )汁 ●丼いヽ面ヽ辮前 ′■ル辞"僣 0■ nハも゛～、瘤"当 ●コ粒 ′碗0汁 o籠 r."い ^● ●ャ市諄満 ^ゆ ≫3 ′,剛I‐卜「村田+」′■ヽ「ヽ前嵐JO)ヽ 0●ll ′よヽ 3洵前 ′ハαヽ。ル●ヽ商゛リン0露滴熙雨前齢 ′場と。Ⅲ 。汁。゛`>>1聡誘0>|コン ′>日ざサ市■ヽよ～蕗壼0苺導 ′屁熙■ 「前薗0」 0● ど樹範

い。 ,F"=ザ観 >普゛ザ富ど剛撮 ′Fも′Dl●凛。(8)と,ハ。が,「 “ザが '「厠聟J゛ヽ^片～日間 ′^oか ■“業～ヨ爾 ,ど ■ ′^ ヽン,おど刈節 ′▼"苅灘澁戯囃当務 ′キ■,絲 oコ ″"■ `ヽヽ。ブヽヽか怯ョ国 ■計"さい,おど郷 ′悦計もヽ卜「ぃ 4絆鉢々斗,が ,ハ ■"ヽ～剛滸 ′「゛"a椰゛ 'が翌 ■計粛もいヽ鮮「洵商ゆJ′^ヽ場■か激^瑚屁さ前 ■ざЖ競。゛,ハ ■も叶III～,XLI S“ ^oF(o)「自蠣Nお樹J;評 Il,両葺 ′コoい。)oも , 〈cヽ廿ヨ■ .■コ聖 ′譴燿か癖)(る)コミ ,「 ″■■E● サ゛市 ′ハ。卜●ID尋びハざ>。か,おい■ 輸習コ >コゝ゛>卜 0■ ■",ハ o「ン=」 ′「ヽ゛^α 訛塾3苦 Ы釉 ^ 苅 Sヽ ′藤コ怯゛oF。 ■卜時以訃。・片じ商ヽゴ●S新 ′^ ″壼ヨヽ莉兼 ""蒋 II督“ヽコ ● 0"ヨ ´ 痴ド藤書 3冊奢ヽ市'第躍～>督 ′ハc"澪畔ヵ●Ыユ。ヽoも・プ「oザ ● Vは ^》コ ′ 0ヽ ′蒲証卜Jョ゛ioα o四苦 ′濁前丼肝 B訓 ^た゛ヽ‐ ゞ ′蒲 IE翻ンコ摯議■ ヽ莉 ′●o● o針証ュ遊灘:欝響こミ]!ぎ】澤r:11ょ蓋こ載:∫点見まξξ 「・ ]冒群量:辱ξギき鳳番厳t塁臀轟:量離響縣I曽尋無撃い0■ 凛粛～S針を>′ ,,コ繊.‐サ剤飾 ′,「「●礫」 ^ヽど 1 ′ o●痴聯ゥ ′び～ド愉m瓢晨、、。ドコ屁、 ′ゞゴミ=ふ」世F蝙 lII鷲志ll議1薫:檬丼Sき。前融 ′ユ■前ヽ絆苅鏃^● 臨尚鮎 ′藤と>剛競壽商0「ント」。ぃ)「゛0■ 薔痛選賀ョョ鸞奢 ′0製ヽョロo 。卜●●Ⅲ鶴樹≫ヽ‐"or、 ■ ¨ ′ ハⅧ首べ■ 、●トお癖0剛滸ント ′ゅ司響ヽ稀J。か,,御 ′●●湿o ll卜| メつかヽ最期ヽにヽ 0「爾ξ」,゛ふ0前 0とコ麟 ′ ヽcに " H,(汁 H> )ョ丹埒0「評Il黎≫日34澪洋面蜘。(, 市 Σ｀。 ‖爵謝 o彗ヽコ首 ′コ〉l oヽコり鵞璃 ,両ュザ^s,3● (ヽさ、ヽ隧母工●うかH,> o響、ど飩゛゛ ′ヽ。■0計ヽ「、前麟ゅ」〕かヽ9■ ″ヽ市■0ン |′●サ“漱剤a‖ F市儘鍵,c絆圏■ョ餞 ,ヽ ′冊剛夕■廟目●ΣOお ,汁 oシ～,ヽ ,「薔)」 0ヽ「さ》=》苺」o,(ヨロ>|)晨ヽコ ′■よ)●sl^"いヽさ資。か oOら 0当 )=お丼澪き ′■,ヽ oン刈■諄"v翅ヽo 1藻「ユド gヽ >=」市河o壽尚 ′「かヽ3響膊～書ヽヽさ"さ唇 :撃早:蘇昌掌鶯曇暮 11ぜ撃lき誕よ薔:鮮瀞響縣蕎響蒲0ヽ。″ 。能当rl澤ザ″゛サリ■「壽箇を■● 諄゛ ′ 菫。ンもたo卜 ●サoハ JO前尋雄co～ ′o 。・^ヽ゛～館ヽ幕き、 ′ >刈 oざ澪百瑚湖ハoお「柳剛」 0卜 ."ヽも"彬 ^ラ～ ^絣臀゛ o,日 ^「怯>刈 ′c゛一い。汁oV汁ざ゛包●詮誂 ′▼″,゛ ^H 應鮮雨 ‖ 前麟■ 百証驀,蘇 ≫ ′綺oぃ ^ぃ、。ザヽ■■議仙お0● … ヽ砕諄 ′ぉ゛o■ お0い。「。●coり論ヽnl● ′民ヽ,F卜 “oさ、よ"闘滸場>滸。゛o● 樹班が、■猫キヽコ^cN‖ olDlaがヽ洵● ′ 、ぉ醐^贅逮 |●料 ′■凛A期市諄訓ル ● も,,「当ざ営剛置o■ ξ剛競 ′員颯露 ′かヽ前浙「キ E^騨 ′咄゛割蓋中冷゛聖屁●訃斗0■ 藩粛,卜 | 。c鷹 ∝ ,E^ヽ ´中o諮 ■ 諄 >絣ン,サ撻詢ら詢滸 ′゛～コ^}おト咤

え「『〓サ,営翫::ら等鶴諄ぶ顧:]=黒畢罫∴ξや‖I盤 (c～ヾヨゞ。■コ聖石毬 ′ '( 〕 (いo諄 ‘ 籠さ )。 F`、叶卜,oむ 0^`ヽ c)可市奢Э ヽ鳥踏!題ζゝ :l澤＞脳籍(]ξlI[製鸞こξ 」ヽ・習彎l111営tヽRll踏だ,ll憮鶉 1:絆:罰鸞一 '1臨」監1罵[(∫£当F撚輩懲〔まド n臨浴′■ ° 亀謂 ■ゃミL=ド騨ξよミよhJ llま:よ懲書麟霊華:曇3]首ギ【鼻:l[よII」i鵞。さ,^ヾ >汁。゛市市謂母渕 #=慰]飢∬蹂理1‰:‖ 彙tttT;キ:脚‡ぶ話尋」、 1ミ」攣爵汁 0コら戴T二Л勇武『1で: 尋凛 ● 督 ,〈〉|> )H》対 ′昇迪 10ヽ響 ●ト ]ま‖曇こ営ユ:柵鼈寓繋11や憮製もけらヽ 0(H書両ュコ W薔薔 ′肇υ熙も)癖 ,汁 α O‐ ●o 「辮 α辮誨"「前耐ゅJ′ ^″ ●^゛ヨ罰卜。・Sin麟 ^縮ぱ[顎鷲:ビt』講壼奮I鱒脚跳禦島↓ 謝 ′,ざ ″ 。リユ o麟゛ ′cヽ ″ .汁、り葺漑 ^コ α^,゛た0す 0,ハ「。、既～軒●宮J 3訃鵬■ド～ ′)。゛諄「「 “゛ざ鮎まに(3)「ヽ颯碑たヽ■l

評卜海w雨 o当 _lも )」、ぉ津藤 ′=鼎讐「前嵐ゅ」o(1 「研,さ」S,メ刈から「●副」壼菫:鳥こ l[J′ 驚隋鋼 :I:焦 1澪 [「曇 E」怯ン可撻、o鍼壽o期疇謝 ′">糾汁。■、悌゛)「制。か, )メト F■ 一 J、 ,図、証戯 ′葬^(,w)くヽ , こ前麒o 1lII革 fm紺蠍猟誅漁 81:yざ。くヽ00,怯 oBo絣 “瓢 ■),,,ハも、■)゛型゛(1ヽo 訃謝 ′キ競褥03澪 "o「洵闘ゅJ、も"0藁 ●,日澪" 爵螢 ′IIョコンo贄 ,コ ′●期●汁ヽ業マ営:!『「営‖ や聟 ′rl c、。社,藻～戯、藩前●メ ■ けo>普、",9 。ブヽ゛ 0「鸞^0 ′ ～目『リコ滸齢″,■ rを薇●ン苺 ■■ ,tか o「「対■s朗゛■ 0さも,F■ ぼ絣 llヽコJ′¨中離,3,"sコ節 ′^(日、口叫)、 ¨ ど汗■0"も ′=謝 H。さ■滉熙～膨語0疇証叫鮮o、 ′i「 `1,がル、ぃ曇け～前戯 ′cヽと tギ鼻艦j曇曇11[:こ日,こ畢‡よ]ぎ :彎 :77: ズオ即)゛、、。″●らゆ ′⑩ 冑D■ Ⅲ,′ ← 5)″ 、ヽこキ ′(0わ |● 頸屁湿麒0^ど画^"畔、こ。す0゛゛料,障洸キヽ ′(Σ節)ヽ、 ▼、 ― 丼怯 oか、 ′(諄ヾ)ヽ、、 ′、ヽ , ′、咄 ■“ Sl i鴻 o>辮 Il ^“ 理 ′霞～キ゛卦H′ ^り゛"キ胡‖o ′ ｀ "い゛ 1燎W鼻ご」(書滞踏魚。ま:Iきぶ主1きま「≦[彎ざ黒。ざ゛ma● (3)「Ic▼ かc,■ ^畔「薔ゴド,I● ■゛斗● ′o丼コ o 獅〉|かo～ ′サoトル～出期、さ`Υ い・ |⊆ 。ザ"‐ 寄諄ンooJ′ a ll●_卜 , ｀ ′■ ヽ ‐|サ 0も齢ヽめに対帥「びF「ン 1>ョ =謝 HI..| 81tζl彎1まご1ギ|ま昌影撃FI暑響鷲慕苗需骨彗ヤ潤0>柵。,,o～り屁に日戯s,力:薔量 ′C汁ザ■樹ヽウ :I::TiF リ'撃尉 ′ド。ヨ鉾SX前 ■3サ゛鮮rlド、却〕→ヽ齢ど別苗翻怯‖手 ′ヽ(ドロ)ヾ、、、q"゛諄剛》ヨ「き刈Jヽトリ、■■燿 ′■おも"ε ゛。す、菜窯絆‖ 盛J場併いo■ 艘ド■「「ョ図 10撥剛〈「>1那 J^α ´ヽや凝目がヨ聾靡滉軒os・ ′●c、′ヽキ^ぃい゛ヽ ′ ゝ cす o ′^α～)●員0゛い叫卜かヽ漱窯サミ粁細 ′藁ル、oド円。卜,゛ぶ～゛「卜「"剛」～●～ ′ヾ″π「“。・,「洵望「さヽ ′ 粋J も,「 ′汁、ヽF館ぃo,車訓αttlo a"ι "● 、霞奇。> ヽ3断 ■・1針回π>刈 ′キが珀「゛ヽ悌●=J卜もsa爺ヨヽ絣0民 ""o策悩 ′,゛蔵 ′枷前。,ヽ～詢■漆0卜 ■● ・ ′ 0翫湖 ′0飾 o～ ′熙o‐ プ"。ヽ゛s・●●ヽ「羮83■ + 予 l10>普 ′悦た。卜,怯苺ヽ踊吝 ′,3》 o■ 汁ユ～》u′ 許 =辮 ■0ハ rl`ヽ ′゛ヽ0か畔らca.サ ,゛ ,o● "はサ" ヽc「 S、覇"滞 ^D霞もos・ = ゝン激。 ●00い～ヽ餃蒻誨いヽN)ド鮨■「"o● >c露譴～「ヽ増」をい H」 0童丼 ●は型0「洵冊」ヽ rlン普o岸市 ′^針ハ■ヽかヽヨ翌～ ′姜ド副。「獅桜 ,ンツ M」 )りぅとサ。い■|′ 卜'■ 1′ 響奇ヽこ事oメ剛 ′熙ヽ o「 ′いヽ朝さ冷」汁oも ′●サoヽ。ヽ0 ´ 。(")「",n.」も・ ―― ＼^ザヽき"トトンき＼、転＼ヽか,ハ ■も"耐～ Sヽハl‐5叶澪～ヽ0‖ N■ ザ゛y′ 0 サ鮮,帖へら＼ oいキヽ ^聖 fRI自累中＼、＼ 0証＼■‐～ぷJ 卜●澪゛》劇rl●サ"ヽ対面 ′0か。椰N駆議●ヽrl c澪● 。。・,F■ 0"cN粛 "ざ ,x澤゛ ● “ ^ヽ ― 燎 ■聟満=ヽ諄劇 ■t馘 ′ べ■ヽoヽ藤 ,E社 >― ョか0>剛財さ齋ココ場●ヽ ′畔けヽo口 0ヽ ■ も・゛滸響簗o苺 0い ′肇a椰業゛をコ ′゛悦″～"0ヽヽ蒲漏汁。,F「薄畔ヽ樹雨J「ヽ ′ヽヽct10NE■ Nを「ざ浣剛尚 ′ oヽ察a謝 oゴ議壽吝゛吝戯測図」S■ ""こ゛‖ド卍。,ヽさ椰■π“ヽ ′姜澪 ′丼>M。 (3)ヽ,ザ～卜卜 nlVた ,^,゛ ●o口膚苺ヽ事脚びヽ ]ⅢⅢⅢ 「壼瓢J oo゛ヽヽいも,「 o,ハ、「叫叫ヽ「獅冊J o‐ ′キ■ `"証 0前・Lと ,)OX,即苺0´ 樹 ′ざ゛皿かヽ米゛ ,怯゛ざヽ ′晨0^0コハc滸 |ヽは訓r.lc‐い。か"^)Fい。馨lこ『:言し :ミ 1:ι 書:難 1:ミ議魚:弾】評11習 ■もコヽ0が ,ハ g獅譴にC)「0ヽ習～ざ“^ヽ劇 ′,コ「料～浄滸)ヽ,ヽヽ u ヽ」導ヽ箇も,゛SIハ汁。313藤 0画ふ ■ コヽ‖ 嵐ヽ前Ж屁すり,平 2=;ヽ膠～朧S｀口ヽR o理 ms》 w、搬"4)0ヽ ′c斗ゅ曽蒲N(露議)ヾゝヾ ●「ヽ詢 ′S● ゛丼悌」●叫o■ (OO> )01驀口 ′悦嘔 | ｀卜ヽロ ^丼キ訓ト ′著゛ Ny訓ふ"● >普 o津市oプト +'コ ,.・OSN>か ^市 ,01らこ浙嶺 ′●■り粛0い「か 3=」ヽ僕場》剛 ′,■ 十憫mを ‖+節 >Э 雪蜂。,ヽ。(8)「o汁出 ■■,サヽがもり ●絆出ゝ料摯oコ】汁oψ ～ ′,“ 。c a■ キ、「r、^。。゛ざ、～ ′屁コ,前 ′民ざν"ヽ ,゛ ^ 。か0ハ゛サ0辟 a ι 0>q「 ^● ヽ剌氏 ′■。 ⅢαoNヽお首箭 ′゛c゛習゛

怯'ドヽヽユ‖oもlo、ぉ隷籠～●ド′^cヽ。が、撻冊獣考]言瞥撃協l[r[泄flli賢「まま『雪[鷲7:鸞話ζ]:f7灘古ζ」:こ1轟:円罵]繁11こ:;嘗辛} :f]『潮Iζ]ヽ」当量篭場嵩訓l懲ヽや蠣゛>サ,′■卜「詢齢oJ 普oべ糾範袢】′へ。ぉ詈類lξ慇戦71 。'か ^屁 ■,卍 sn狐 ●■ ンざ ′ 、o"^。縞書゛OLc゛颯oと , ^0゛さ丼母・尋● 蹂瀬汁0も “ ′「訓ヾ0「剪●聡」。ぃ,o 。■゛⊆" 絣^0>0゛も・珀■゛トリ ,「「前藤ゅJ、 0「浚4にコル

:|よ露馨:I蔀慰::盤話昌l洋 §曇らく:‡ ミ「F:1 ′怯と。ヽ。゛ゝ、ぃ0さ o誘料)L‖ ヵ詢ゞ●>洒 ′へα 鉾F「さ「 )」 ■繁」′霞^ど刈最o当瑚謝。)o卜 ●ヽ凛ゝ理・ I↓ ,卜 m商ヽも。ぉ澪燎sh・I疇、熙尋『 ′■o′ α^c

H求拇悦 ■ 倒半当 ′民～トン ′薔^o● o盪熙ラ莉3薄 = 。0● ● コ韓富S■ )。副～ゞ疇 oど w燿 ′キヽすヽい●■'●3と樹 0゛0さ。・ ,「 ■ 編 ′キ前離悦、 ′lw ド卍ザか、隣●=JF、剛「゛米、出、前,3,燿。)Sざ ■掛澤゛ザョo,叫ゴ海oⅢ ■餞 ′シリメ糾゛●ド′E ■を‐サ o膨 ,oたゅ簿。、ぃo藩 a苅ャ^゛、十■馴ヾ。「熙●ぜ置コ躙き0■ 祟料 H 」′ ● か,壼 ●、弩0「濶海」^cM～獅擦Э 粋 ′怯晟。(ヽ'汁r薔コ●,騎』柵。。,ヽ "oハ nVa藩ヽン普 ′ユ | ′,丼蒻。s、がヽr.K)。ヽ■製k′ ゛ 0諄質 ▼ __「 ,・|を )0■ oす "′ oぃ。軒Fl奢Jo齋 ≫ 普。・゛o● ― 。型和 ′藁00■ も,■ ●卜ヽ蕩コン,韓 "o当猥″ヽザ゛凛゛浄ハざ゛詢津 rl汁獣)「 qン 0ン、■ ■■ Ｏ期,颯日ヽ ′兼● ′“●■0景 “N゛ "a路滸 ′ル●,「勁半卜gψ ヽ ′"゛ "● ゛“Fヽド弾ヽ卜開0前洸 ′)ヽ Ч 。た0汁 c師。(■メ゛諄■OOOき M13(十日H― >B>|)コ十ヽ "茅ンヽ癖ラト0い ′,3● Fと、い●怯か許 ′ゆ0ヽ。)。ヽ黎0薔油戯靭きヽ ′i口》0>剛ル砒バα端 ^Sヨ “ 昴 ′r 葬り差キ「(ヽ゛″← 「諄洵コ)」 "寃 "ざ洵獣口>SNコ 8, り薔麹‖ヽ |ヽ>o「丼●鮎評゛サ気留'′ "。 "● (8)撻糾0驚ヽ ′薔剛滸 ′ハ,甘 πむ浙汁 nl斃 rlo h● 0凝ヽ「競。ざ評阿嵌薔《,m 榊),ヽ車馬檄■m滸 ′ハ。「図瑚 Эヽ薄コンヽ最》〓 ,cNttSヽキ爺喜 ′びハ、゛,「いけ00>,剛ハお石吝 o■ がヽ摯市場ざW節澄出戯酬当諄 ′)ヽもヽ卜。'ヽ )も馘酸N゛ (トザ■cN事 “声,嬌 *‐.毬10～。加,0"ヽヨ●■詢 ●蔭螢 ′,● ■0"n、ヵ尋汁 ●き蒲サ翫苛屁缶 0゛一ヽド ′ 難 ″ 。■直叫澪ヽ>剛 "卜えヽヽ ′^米 0゛粛^,び「゛サ“に」サ講lTWζttl鮒蝙号ltミ孟褥営。さ゛^野籠0臨吝 ′,製たヽ市議^oお皿゛節瓢0゛さい０乖ン+警 ′●ざH‐ヽオヽ ′Ⅲン樹。,絆ザ屁パ、“コ^斑》。efo″ 民ざ,「嶽口来 ′■Fい 0■ 訥巌「,3許剛吝0苫珊節～翻理0い ′叶, ^″‖゛澪ヽ市^書諄「樹鶴′■レ,「コ普。cヽ‖゛■ヽ。゛ヽ所翻理篤“ι〉,″ ゛箋滉。0ヽ N・r澪^c● c澪詢聴■き海 ′●にヽ0 ′民ヽ■゛'"MO前浙 ′,藍 "諦当ヽユ節節かヽXEE ,ヽさり前ヽ'Σ O嶽コ罰Ж中識。自0■ OMO加 a浚 ■藤 ●どトザヽOFいヽ「蓼駆ヽ臨前。か■ミヨ場0● ●ヽコ潰 ^お前界0ゴ許 ′^馘 ■=丼 ′^駆 NttN′ α耐当"゛粛■ ′0"ヽ証富蝶 |,日ユ概諄ヨヨ丼日蓋>ザ ^● ●節ヽ■回榊 ●・ta飩臨滸齊"｀期国 ′ヽ0針叫畔c↑ X● 前 ′民染津 , ′洵訃0さ。年,‐ ,叶汁「,′ ■,ヽ 0薔 ‖キr・。"酎 0 ,コ >"oO激融"ン >コ》H」。さシハ籠0>樹゛ヽN爵詮藤洵ドび"、 ‐ハ肺n′ ■サ0「。、oか Oc゛ IIH●NN ′^卜 ●ドヽび前“ ′『0・ttt a刺■謝s,苺語o令〈0ドゆ当》0ヽ ′c溶剪,'ヽ 0前撃■ザヽ働iヽ置。かo゛ " き )日 H′ ゝ,裁け悧■餅N゛ ;● 藤■c"ヽ藩ゝ。, ヽ蝋臓薔哺班 ′薔■,● ヽど車,゛ ^コ1町顧賜悦河油0ゴ許さ0爵 4● `"ザ辟|.・ハ甫嚇●'゛ i′ ぴ訃南0'聯拇。ヽ ‐ ′●サ■ 。トンF「 Jlヽ)J。日ヽ,0,ヽ 0● ●ド謝^g もり0屁 ●‐サ民ゆド0ン浙 ′αツα ′,0か。研)臨湖当3りヽo■ ,ヽ ′i^ど「Fさいヽハ罰コ‖ド場奇評ザツ" 市icttc,卿 H′ ハ。■汁o。゛■●ドヽヽ●油D■ ,ヽ ,rr)、社●ヽコ |(ヨ壼)た、¨ヽヽ汁。),4リンm● N ′Fかヽ前澤椰 1 ′,臨置。(ら,も・,「 ″,WⅢ ■ヽや ′● O● コ ′c゛今OS鋼～論a回コo壽泄 ′1壽 ′,Sヽざ携

'熙～機0ヽも,日F"も。叫もヽ聯》o>剛 oNコ (ふ崚)ヾヽ4ざ刈逓日 ′,o許ヽ踊滸へoc熙 ●ど樹競。“)「…… 。 ]ξズ鳥ょよ壁[サfI響燎薔lttll[澪:ミ11:盤彗 [黒紆輔鷺∫1臨適鱚 ι】I::1li]》11罫響こま量1≦[準〕やl(1量]斬具鶉徊鶉i麒鶉コ譲0日前゛,"a感柵途証 ,コ屁はど nr「浙輛^「、F′ o、 ::糖置:彗 ξξふζ 。い・゛法Ffヽ^ 0■ 0● 堺～李》,3藩鋪o),もャ′「m耐ゅJ′゛サ,

。,卜畔゛■cttN屁 B Iき:;)i』iヽilil澪:i卜::]!∫|11: 諄首磋かヽルЯ洵:量11[:ξlミ1継ギ‖よ昌ξ貫』冒ン二嚇:書量I:1年ぶこ慢鷲遣}lご∫暮轟∫F撃12]: ,X001 ′ 卜絆ぴ薫ξξ』薔[尋1∫」ξ『f∫ござ 1ヽ鵬ヾ0「刺市登」。■ぶ ′き、●.‐^^■ cr・趙織匙贅T 泄ル 10● 「ぃ瑚JO>凧母,汁か゛「o■ a=J′ '撥調0爵 1 ′=声 ″ 桜 ,■ 滉掛。り。コ許0ヽ滸o^ざ樹節 ′gサ「～)03)「 M載」屁市,料、訓～ざ、 ′びOm。 ,「「。。e)oざ゛l:IトおE」・ヽ悌 0コoハ～。0国ゃ。゛●・●舛0・,「りoと,ハ !:ilぽ槻儒l誂7][群き、ポ:ご背ξごI席デ: i訴 0菫巫 .軍^ザ)ヽ書 )o rlV^コ巌■ヨ理o炒剌o澪 `、翼 o^叫吋 ′ 怯ぶ0叫 ON湘許0ゞが鰯柵0籠 Yllまざ゛ ′ヽきコ●H'0■ ′●番Wi゛ 0′ ■●覺村0もた。汁ざ゛■罰場詢訥IE,■ 0 ∞ ′=黎図0'障。か゛■゛瀬。・'「サ'■ ,ハ 0汁。0)コ華臨 ′●■>剛汁o「ン=J。か'ハざ"訓携"“ )0゛ F 。「 ▼ 沐ヽ3懇れ,ン ′●驀‖ 「洵戯ゆ」0ど絣働丼華 ′■0か叫悦僻証咄゛～サ満●=嘉」ヽ>絣 ′●●Ⅲいヾ贅怯晰出、 "■ 珊Oα 卍鍛か00「いヽ。ヽ諄～滲同ON獨 ′■`ヽい 0,"0,諄 ,A● "熙怯>せ 0妍榊沐臨置「辟や0ヨ罰寓ュ ,ヽ 0>普 ´,ヽ 0メ断鶴P」T筆色鷺Ⅷ翫辣蝙 ∬∬]I 絣■きコS,,ヽン当ヽ割刈剤螂 ′■ント汁。゛卜ヽも・"0● 錮●Vヽ 0椰漑 ′^o i ― 。)0だ。S・「"証‖″,0さ斗柵3みヽ′藁●('>旧ヨロ> )コ,さ驚 ●熙理0掏疇ヽ"び ^ザ゛●ざΣ ′"「 0い ●前厳 ′●■南ず0」ず醸普ヽ。も′いヽ0)、 'へ●00「゛跳繭螢Э浄 | どい・ 0^。ザ″悦ルllt,籠り諄 ′■0。・'"ン。"゛慰■鶉颯0 ,3「満H」 S>刈 ′ハ、"3離酬0幅藤●α い ′怯ヽこ樹0》。・'F師薗い」 ′c澪～澪世゛ザハo語藤「ヽコ0 0ト・|゛o錫 ′●゛″S■ ヽ取南,3褥き0ど剛節 ′咄み。汁も ●た0″ ■コヽ日目0,「゛ン」市 1導 ′g翻 "付「ヽコ」す0り羊鴻NI蠣も,ザ"゛り゛調α駆寓い藻 .^C～藤四ヽ 0>辮 ^ン ●力■■Ⅲ■俯澪が。'ヽプ^も騨OW盛夕■駆・日兼同0ヽ ′ら^■ 珊Ⅷ露訓)。 00● ■瀾とヽす0い 0ヽ対～"ゞ。汁 `'諄ザハ o"計ヽ"′ '^が ■0“ ′昇洒 I 「前麟ゆJらど刈嶺 ′,Sが ,^ヽ゛サゆ'ヽも' ′"゛ ■ Ⅲ■ユX● 響yO>剛。●0・ら'ユ 0期日かかヽ '″ ●詢漱・汗ヽ「計'■ c語藤^"。 ,澪ユ「ン=J′ ゛り辟Cサ 0 0ヽ ′,暉た0コ ■抑刹0い絆'′ c)g。ヽ",鮎嶽議● 。卜も゛^「 > ゛,い “ ′嗜りか0す "ヽ製疇3)' ′ "● い0'■ 悦踊吝 E」 0ン別 0い ′‐0● g麟出■ヽ証0前置 ′,日台前ユ 3と 'ヽ O frぃ、c聟瀞壁奇許“゛γ昴。が'ハさ00第場奇冊語譲″cおけヽ「洵蘭OJ臓剛締0'日霜ヾ。汁'ベ絆00副飾副綱■″""許奎ハ o"● 詢吝 ′,不師訥0い ′ ヽ0ヽ》き■●ι“が,鮎コ菜^cに冊輩 ′熙 |●r^単 ^ 。さ伊らも"″ 。0もい0せ準″ も ■ ′,き ,駆料 0い "g戸「い悦■■'「 )「>=」 0“ ′o ヽ「昴満0汁 0瑚吝 ′屁ハざ回節翻。ヽC巌藤ハ"3田薄' サα 。'ヽ゛呼掛ヾ゛蘭熙■サヽ0華澪●勢黒0「ン=J ■輌悦ン剛0^ヽ ′■0● ■ξ藩,剛置0澪 0い。い0^0' 。(●)が'ハ ●餅爵副「″さ"お対怯「蔽可‖*ヽ」*孤コを "汁 o"しにお>|｀ ■ 颯螢 ′0辮ヽこ ′゛“「汁■0～「ゆ ′ハC"「さ→」0,>糾。譲AE "澪ヽも・,「「 J^。 ●● ′α^湮議゛■簾薄お丼針激》澪.壕、 N華」彎津

.〈汁。お籠薄ぶブ ▼督ヽど辮、コ譲o瑚吝 ′^,,怯 ),に Sをき磁0画 o゛ ′、 ^C〔、壺 ^o「昴0ヽ》0さ葉o,),メ M)゛ ,^rl゛ "卜串ヘ 'キヽいい。と。)ヽ )藁 s片゛ザ^枷社卜 ′、響aS 、おもヽ⊆o■ ■楓滴を*′ rrか図薔^gN澪 ■■=ザ "哺メ剛夕■難馘ヽヽ"～瑚湖 ′F‖ 博譲゛ぃ・o甘峠 ′cゝ汁キ ,ブ換+粛絆岨。 r・汁。麟y市゛ψoコ | ′●゛怯ン剛。汁。ヽおも,"oさ ●お 0副節》■鷹ヽ>ooH′ ゛ぃ～卜■鮎、ぃ片も・口「 oト ψ ′ 料ヽパヽキ商ゅ ′ 片,、 ON綸怯>漑・.冷汁ヽ悌 ′■■鴻い0● リサ声o>J′ ^(1ヽ。いまc■ 、口|,卜 _丼、悌■ 油戯辮ヨ摯 ′c)。。かoみヨ】■,ヽ。たoぃ oも ,)S に ^″ ヽN′ ゛卜:叶00,>激 ■さぃ。、0>⊆ rtN、聴ハ "さ。たo諄。,ハさい0菜お証ユハOF澪ヽかヽ卜書゛》 Cい 0">1コ丼 "も ′ ,前登加ゆ洵 lo● ゛憮ンき。゛さヽ0叫落絆"oさに o>滸・ ′ 壁爺 o、 ′●メヽ瀾卜,醐藩o ゛.‐0怯 0い oゴ誹臨吝 ′`馴節 ′キ●a■ b 15o畢畢高″=● さ■ゴ喜悦踊置。ド、り、■み■■●～姜澪4> 。ヽc● N場 >》 o日゛もo>》 0 o「受‖澪譴o>普 ′cり c oc)か o■ ヾ゛卜が、譲お^ ロヨン ′33洵訃 ′,■ コ節諄■oぃ。も・ブ")。熊 )ヽヽ ′,卜 “汁、゛。巌受oンと樹節0>普 ,ヽプ^～ "ヽ～ ^■ "“ ゛■せ、計煎0い 0゛ンい。と●脚^叶、^か 0, ‐"o● ヽ吝 ′ 避強ぃ諄晋、 ′o汁ざ■巌回～珀事o湖凝箭ハ。節～Hcヵ》oll′,nt'ヽ再饗 ′=ξ り、大o^さ。゛河越S「ン=J 筐 "洵 ^コヾ凝 ^ヽ計 ′場。″ 。叶ヽ馘卜,■ 概■=、゛運～い。・ ′ 汁 )訃 o■ 4,● ●ぃ。ヽo卜 ⊆滸誨～誨滸■尋 | ・片ヽ,い ´ ■ヽも叶黎N。りヽ0″ ,■ cざ 4■ 、前。・～ ′ヽ )畢ヨON″ ,サ誨■河0′ 3ド～,コ ol 。゛o^゛ “ ・り゛9S難゛鬱ヽ、ぃ"o～ ,Fqン ´■ザ゛aど剛キらい節 ′屁00゛、い議 ′怯ヽ。″●゛ゝ"謙ハも"3藤コ0ン。ザ"むヽぇ、、●■斗) 刈●ヽ ′叶N應 ^⊆ 騨～剛固)> omコキ「 ^N>.、証ヽ》,3が翌■昴蓋 ´こ市゛■馴詳「汁00キザド、 rlt油レ野飾 ′コ訃gサ o。 ″● OM● 彗、釉 ′41。片●I～馴0(ト r.員ふ ■嘔ヽヽコメお0羽ネ弧ハ。Illlaコやド則 ′ゥ断商 ,議 0ヽさ“o"》浙～癖,.“ o´ 層s撻 )「゛ "銚゛ NJ′ 0 >ザ ^● "゛聾^"o′ XH ′ ット。(゛計●"ぃ oブ "‖ 理o ヽキ訃m。゛s.●"いた0前額^計洒゛o》 ■卜 ′サン浙o 強Icコ S,P,議 o>せ |ざ ′,ヽ「“ⅢΣ河 ′,0}ル撻ゝゅ駆か >17‐ ゛、前c● ●ξコ゛り当ヽ荊 ′●コトコ 1′藁い畢誨 0「"XOメ営),"oコ事臨滸 ′9″ざ■「)||,おゅ+Ⅲ 序 00議 .・D・゛■ 0■ ド林丼針 (oo> )1 1澪団 ′屁"漱壽Jヽも"■ ,讐澪がヽ溶飩富 , '片漱吝ゝ>剛 .さもネが、=ψ 。も゛^もにンN輌訓Э EE鮨0ユ +粛口、卜,屁助貯゛ヾ ■ ンIE;臓洵ぉざ剛湿 ′●皿卜o,落 ,Pサ゛料場ン゛ t゛ SV^～圏癖市ざx"、ヾロキ絆コ ′澄■oぃ。ル● も・０ ^o藩～層剛ブ、゛s・ハコ動oど漸撮冊鮮o～ ′)、ぃコ 11」:[葺鳳JF平凌畢軍ζlこここ]習t響響:首薔怯】画 υ ヽ単躍 ′ハgヽ .か0「 “十石」ユ幾0藝 ,絆削、きヽハヽ ]量 I洋さ撃3慇ェ蘇]1廉瞥澤∫ξ]営醤]悩 !tl撃孟ゝ置 ′ヽ蕗喘臨コo「、、■ ,コ議 ′丼oか ,別～則聴●““ ξI[1:《 Э ■ 麟 lll√ ll躙摯lli誅島営嚇量洋ヽ。(つ汁社0″ 、 cШ 砧"口| 斜ヽ0メ激 ′゛⊆● 。卜。)ヽキ"“ 、o"oさ、「 oばこ絣〓 "たヽ■0ど「riりヵサ■～巌絣儘■り、o雌 Ⅱ 卜謝 ′■(事場悦メ剛 ′■。ブ●゛)ヽ ′cッ g。 )oも。・■ ヽ【一むれ当 | Ｍ 0澱蜀。●皿卜H3面ュ)。社総昇●浄き導L′ 汁゛ S熱単 ● ′ ヽ財華o(コ態oc,ど ,′ ^も ●゛■0日崚■c野市■■ ヽ一 0→ ヽ班NSξ 詢。,叶》●"● r.lc囀●謝ψ,「か 0″ 1石ヽ ,パラ ′ ● 麟ヨ葬沐¨)「"計 J′おq、か■■ξFrヽξ剛輪■ヽ」糖～選ヽ゛、》^ど将帯諄怯、、■●(,H袢 ‖)‖、雲lo、ウ前。'卜 ●●N皿ぉ舛汁,ハ ,ャヽ高葺み丼工ざヽいも″屁０ ′よ0が、円「N■ 薔同FRI鱚ゆど剛飾a皿冊悦、諸 ′●I 「自葺。さ"ヽ゛,油訃0コ郎)′^c,洵゛〈Fまコ0"ヽヾ■ (HH> )澪埒。汁cSヽ c目～>い o前 0「訥ネ当ヽo゛差 ■す )世謙,3猥回 ′熙鵬怯ゝヽ0》扇 ′姜鵡)● ““ "剤ヽ剛 ′ 汁ハい、前菌Ⅲ■nlll゛針澁0「 )コ》J「とo 「 'ヽ」Sべcr薔観鰐ヨ証N′ らヽ 1卜■ン●畔料o「回単o今 o、コ巌、ルHrl o ～。ヽ0「もお臓さo諄濶^～ o薄に案ど剛館■苺義 ′oも。ヽ0ヽプ^● ゛oヽ ■●釉普～コ訃0,ヽヽかヽ「観躙3き外、プヽc怯図軒oM詳。゛゛■ 「ゴヽ」肛習゛■沖,o>滸 ′■嗜請oど W競。かが富鉾“か。ヽ゛ 0「ヽ証 ●い、口らo● )回かoO時単 ξ浙節 ′ξも | コM料を沐興かo>蟄 ′キo゛ ●‐いヽ計摯)^「ヽ薄サロ ^ 。か。Sもび "^諄 >0>浙 "もゝ×o臨吝 ′民゛゛゛■卜。(3)0● ゛]ШFト ■薔副mo「翻コJ′熙^「「 o)● 、前麟DJ o十日外埒ラ^,t‐ ■●硼,ハ o～ 0罪桜0゛り響喘南OM詳キ0■ 彗。社●計,ヘ口0苺絣ヽ呼 ′ハo「訃き資ふ■IIかヽい撚ヽ藩熙`ョ o ■ルドヽN「ヽ醐コJ、嵐場滸Ш汁「部黎ハ、今sN,ヽ 0 ユ"Wヨ飾0辮音ヽ ′■,ヽ 0>絣。も・""ハゝヽい^ヤハン剛をが ‐ 苫漸耐。ザキ^へ ,● ■采幹ザrrヽ。)が ,ハ ● '訃 ′″鮮0設ヽo「、ヾ■、、ヽ」0い ′゛場ヽc)o "滸需■c● 詢藩3潤 ξO～ら 0)| ′ 漑難ゝξ卜゛■針喘。「 ′ヽ 0》蟄 ′■●ヽ ′、ザ丼"。ヽ r浄 o" ,ハ、ヽ証>RII藩お 0汁「ocN序『日o3料 ′く、、第)0世慶母詢画o■ 剛,

ヽ"～絣理 `～ y][滞:諄き聯:ξ鷲慧7]聡鶯熙暑当‖ミlJ。〔:ム; 露“ ′～蝦サ )″ 、サリ●壽前かo、 ■,゛ルも゛悦図河oコ許勁前、ぃ●母卸o● ど洒蟻o>普 ■も聡ぶilζttI品ヽ31燎l畢7ザ:I「]ま∫∬営撃臀∫ 0′▼丼ヽ卜。 ● ● さコ塾●3ュ l ′■獅瓢ヽきo河奇a殖 0～を加メヽ ● ‐ ′:fiY]爵Ⅷi絆l恙鱗 ● 卜繭「「HII商》J。,、■●■卜ざ、。■0卜、サ籠ザ■ ξ卓I[:き:き]ご:き!:言]Iきき:f]]ま::』。■,゛ 0,館卜■

:i:illil!j![il書[li11:]i:!骨l .((やヽ,■ 。壼●ハ■●澪澤0繭れ ′ゝ、。サ)ザ ■ ～姦。 `、N囃市)「 Ⅲ苺飩麒。,″ 0「 ‐サ`日キキII蕊墨言晋‖ζ:霙ヽも市9,「 .● ト● o・考 ::メよキ鼻滞[麟鮒1挙鸞 .サ嗜lH夕 >`,゛ ′屁、¨■,もぉo館 Or, 1緊[淋キi:妻軸緻詭選ミ‡ilttyI事ご::iき'i‡il:][J,|‖]: "が rl日 oョヽ鱗市 ′ 図とも、o■ 日麟。たもサ籠藁″ぃo 孟1獣ζ♀鷲晋臀:::IξI[Iデ響:‖壁l「;鮮品鮮ハザハザ津π総*`剤綿屁>冊。'Ⅲ ,ハ、す翔■,皿 ●～津出 ′丼撥斗い・ザr樹力ヽヽヽ0陛寓辮晋゛」′ざ゛゛` 。コと 0,勁吝 0>刈 ′c社 )。 ■0゛ざ゛～Nur“ 汁ザ■ 。おOr.|'べ,● 1卜謝ヽSL申瑯夕■●咄～゛″序ヽ0ヽ ′0 い 0"もヽ c'ヽり熙N(0弧瀬時薔0ン Ж ′晨 '00評詢置 ′,も 0も ,～望螢0ま議0,ン激。e)「痛■寓蓋融筍砕ヽ蕩 “ 、おふ■洒応ヾ"悦崚“0゛ ■■料 ′Sヽ市市ン l 。か0`0 〔 ,,も 0「部ド0>樹 0^」き'報コ飾"〕事0詢滸汁,ハ T『 ζllWi瀬阻 ξ7憮》凛響響戦 : ヽ゛市童湮 ′コ | ′姜00^ハ c卜軍"「ヽc積ブコも,ヽ。りυ゛お ′0^晰 ]卜謝。片π両ユ罰 0‖ (lH> )Hシ淑 ′ヽ●管; F 謗籠ハo汁 i● ●ヽ。かヽ市"0汁 'ハ o,ma畢市o卜 ■ 畔nl。‐o)●剛,^ヤ^0田N「゛+′,^'も凩ヽ鶴0 営 oラヽ気 ′F>剛汁 o)F辮 40前閥叶roヽ ′民トロ|「凛緊ド■,"甘薄凛S>樹0^」鷲"訓ヨ飾 ′かO nt護訃ハざご OF。が ")場。,丼がヽサ藁●゛り彬0"屁ざ■ 「誌樹JO'6ヽ前 ′ハ拌ヽコ許 0洵湖 ′,すた 0さ 0場 ,中 ,■ 譴 t V ll・゛トツ^ヽもヽコ部副鹸怯函n鎌 ′oャ "″ コ3`ヽ ′昇● IWザヽ ,C● 'ル、0「り薔 ′"゛賃 C● c錮椰 ● II い。●31● ～ 0い・'F諄 ●■'● コ滋前。・'ヽコヽ 1(00 ～珀許0剛口 ′■CF図詢0ヽ藩コン。'',ハ i卜ざヽい,、 31ゝヽ注と,0い 0工 )′ 場「剛嵐ゆJ汁 o「 ,4N加。,,゛や 0焼ゆど剛範0+日興咄 ′キ0'汁 "け rl cd壼 ■いいサ゛)'0た、ザハざ徹 ′rl。円a盪尋0いヽヽ ′ヽ>樹ン。)0ともヽ醸Jがヽサザ ′キ ,^c゛りN機灘"薄 Sn尚 ■、帰3「 o「 0■ 巌ネE」 ' ^もヽ蕩0口 >>浙 0盪喘嗜譲当撃 ′●ヽコ^0汁゛y.昇ハハcttrlゴ訂 ′ゞ餃摯潰ヽ書華>+騨 ′謝業 ′ξ^'社。('ヽ■■0● ざ゛g'C。゛SI`0ヾ "″ C誕書 `● 罰)′ 昴"0。゛トかo配ヽ以前0'工 0ヽゆ‖ ′^、3■国]0ヽ ●鵬0●藩0'■ ヽ野田^ザ廿「置トラ)0「い汁0霧市N奇罫0ヽ桃壽尚も ′=骰譲0綺柵)プ″0ら 00さ ●●同蒻携ド訓"同 0■ mざ 00。 ({)｀"■ ｀゛ヽヤ●剛や管mttЭ 剛前 ′■'図菰0 ′FS● "。 ,諄 "「帯青コ｀ヽJらヽ～ ′ハ●げF゛りヽヽ●"ざ “ ′ハC爵世゛'科 "0甦響ロント●●Hか。か0 ヾ") ′cサ ■ 。ザ"OS・ ■^00)。り'● 序震Jル、計(8)「挫 ^諄鶉国0い事0剛滸卜ヽ薄0コン>剛 0(コヤンW'゛ ● Ш3部薄汁き,調壽q割 ■'サ 8丼則 ′C語藤^C"潤卦゛圏瑚か報当'′ 'Sヽい0)コ滞も｀0おぶ節 ′～'■ よ導苫刈嶺ヽ 1ヽ ′ヽ"E≧ ^当ンS♪ 洋ゝ｀ ■き Hヽき瑚ヽ「r‐■諄'E」に0「 ´柵 H ヽ ′rA cヨ単ネ'翔 0当 "罪回も・プトJJOヽ (■ ′`婆燿

゛。 0・^S卜、ヽ樹 10滸詳0 さ0'哺 )尋台ヽ′ザF「ンM」 0ヽ ′「夕ヽF薔逃誨ヽ絣澪桝 ′゛ヽ「o・`ヽ゛^ヽヽ「口 ^ 戯ヽ」3,ヽ oン清「ど》 ′)ヽ。か。りヽキ●●゛o,N絆引)_●臨口o外辮,>刈 ,● ～(●9サ Ⅲザ,■゛31゛寄■鵬コ,3薔 “)′8● ,「螢黎 0ヽ自市凛ヽr、゛り、 ′さ゛。ヽ■■cOFIR・辟料0「ヽN も O譴》0姜ヽ辮。ヽも,ヽ ,「 “かざ"卦 x,藝著“ 凛 ШI 欝13コ|じさ」ζ黒撃ヾξ:蘇′1詈ぎツF鱗諧:3よヨをヽコ ′ざ防さ洵llr,3日壽姜>」「>囲 ′ヽお遊誰颯ヨ, ら゛″りい,「「 "富 ‐ 前m"J゛ゆ≫ サo′ ハザけお諄剛 .か0み響澪「ヽ前JO>刈卜.卜 0コ導。卜●罰`^0「国続 ′サ前戯ヽ。oa醍理N畔洸"0● どΣ 。)0゛サ辟■■ mo「醐コ」。も″卜"′ 藁ヽoOヽ c゛ヽ0,ヽ 0>冽 0ヽ "^～゛ヽ゛コウ ■ 員゛ ′ゝ叫か糧0「前麒ゆ」卜,0 。ヽ0',^c出 ,■ 博油闘コザ,o針 ■ m鷲ハ,゛ぉ。ど糊覇 ■日外¶ 脚訃o熟ヽo卜ヽ ′^囁ハさ●粧VS),皿 ,ヽ ′^>F r3 o"も 0ハ ⊆",卵製カ。(ゆ汁ヽ薔半^置 ′■,ヽ s>激。C)卜,剛 lRI S剛詢0彎評や慨 0>。 0す ‐ oヽヽ ●鶴=^ヽ oド剤節 ′ "お會"肝 ●゛> ′0"0● ゛今0゛「辮靭Jq汁汁,)「日ヽ」0サ ′^" 督 ′り洸。所o(、ty,Eへ。F● 童 ′,諄～(～r,ざ■産騰 Ж●0● ■甦y● 斗=F,か o● ヽ既ン柵‐"r・剛聞 ′卜" 瓢0>せ 0違餓 F表ヾF)「誨燿。。 0調」キ>樹。)。 o`聖。(8)かo゛ N前劇0ハ薔刈逹おお■■薔飛ョ図掏1宮 ′コ脳躍キ石3パ刈,さい ′●卜●゛ザ゛0ヽ「圏ヽ‖燎J′iバ ′ヽ卜●理0い ■か漑識舗。も,,卜ヽo卜 40「さ罰■口"」 ‐ ・ o,則 IX.ヽ 0汁 g00卜 u‐ドa「ヽ口o画毯J。とG猥ハ外ヽコ0ココ゛,滸豪 ′",べざ滅●席 ,■ )。 )● 畔～ンを・絆帥滋薄 ′らヽ |゛Sきに‖,祉 ′コ舟03熙せ ′0> ●W尚おら |コ避 ′,,片薔^"″ ンIc,Nにヽ桝口 * ′令撃 0価コ ′油舟0翡剌■ P 辮 ′百薄。(》、さ(81r》宙「加,シ「>"Jが ,ハ α呻薄πど画 ′■コ"熙 ●s～ >狂嗜副 J)■〕゛彗～卑ヽか■ドNン樹 ′Ⅲ珀‖櫨譲 ′ゞ。ヽこ騎図■■ドo加 p′ cm爵ゝ「節NM報剛前」お゛いと0● ●■鵡回ヽど剛続冊劇)■ 証 ′令〈日H>|〉澪tll 「卜。ヽ「や区華ゅ」′や普■●喘ン=′ 卜が"i゛ “"■ O｀削ヽ‖剛。さo^誦珊XS凛 |夕熙c● ■(3)]け盟卜、肛゛ 0たが「 OF9>。 V"書 o),゛ ■,■ Ⅲハ >)コ」 ●●ヽサン“=怯 >ヽか,ハ、置コヽど剛範計 ′枷日,〈>H> ) ψJl●0゛回 ′屁● ^「】」ヽど漸館。かOo員さし'WN 日澪珊。か,ハ。翌u獅訓,蒲昇渕ざ,ラ ″ ′■丼o、 llヨ料外歯 ′ハc"》蒻籠殖●さヽ0>蟄屁,ヽ ′〈。,お。ヽS″ ザ■o国蜘=「調゛」ヽ3壼 ¨"0さ ■ 卜「 ψ "ブ「・ ■ ント」■■脳ザヽ.●ハ ■q卜」,■●) 汽0゛汁Ⅲ■媚肝N鷹峠HO● 鶏諄剛節 ′悦ヽ。)ヽキヽい ′α騨～署4■ 蔭、コ薔 o澪 ,雄船ョは1 .os・■譴潜辮o■ 澄■ヽあコ>卜、 ′にかoさ～ ,"′ 、 ,Fざ迪 ,コ aコンJ～滸誨゛o■ ■。「a=哺 c,、丼澤 ′屁「前≫刈」 (‐) 燻0ントキ椰=。 o● 臓"柵コン叶井ンロ^″ ■にトコ～

ヽ。00み「`ヽい・ザ副弓薔量誉「こ肇こで曇歯「暑ユ尋単][尊厳II鵞【思£i ゛ザハ■ ヽOc円藩●サ疇 ′～r堺 ‖゛、ル藤獅^ぃ～ト "′ 〔>ヽヾ。〕ヽシc▼ Xα o■ 清ハ、りヽ。c、 ‖゛ヽ丹諄訓卜闘 ′、゛,コ ● 「 ■ 轡ゴ」oま絣範ャ)o法 c“ 、丼o 細・am゛ ^。り■「“レ訃「辟虔爵ヽョ澪 ′さ]、即o 簿 ′■0ヽ ,壽 oF,′ ,ヽ ● 。,ヽ ,■ ッ■た、゛習ヽき胸r10米0」ヽ満～E′ ,",cた 0ルョ藩^語 ´即■D = ヽ。)ヽ 08■ 「ゴ 0ざヽヽ卦」樹綺 rl,"oヽ藁、ヽ ■で O>トヨH■ サco汗 "華態0ヽ首ミ ′、cs藩卜華せo ■ ′゛)飾 ψ・プ～「=J汁 E● ヽ 0調諄剛婦o斗訓 ′ハα卜■ ヽ|ヽ′゛を0ゅ油o当ヽおコふ珈,コ叶。e,い ,ざコN ン。卜、た0ヽ c節莱■c「「ヽゝ｀｀ヾ 0ヽさ)J～ン0■ ¨ド ′V"S● ゛■ヽ卜N畔当尋曇lきざ[:4需l響:置:喜II』1),こ当量:驚パ cヽ。か゛～ンさ=凛日丼 ′●ヽヽ、ヾ」ヽ^00諄 "0い a ヽ ,い,単靭民辟ドユ‖+H"日0′■゛″g》゛ど ,゛ ,‖"o● o●コ0ヽ ′悦か,Sヽお柵節l[IttUよ鳥1ギ〔:膳増II:〕軍l∫き〕ま曇節>さ十日■拌。)、 ,ハ、丼● 。>、お、●諄o・"0咄も ′"0汁叶■ 詢浄ハc"ヽ =′ 、■‐コ▼瓢"ぶトンヽヽンヽ■● ド ′受ふ貿縣貰[tl凛]kよli跳彎1113こ考:星ギ識lS 「::薔も,ザ ll慕こ臀営古祥ミ[1:【寺tl帯書lま罰:帰。ト゛,^n.Vドハo灘～゛o柵釉゛ヽ。● ′oNc゛颯゛ヽいΠ゛)が洒。り0い・"oハ゛ ● 0外 ●,ザ Fヽコ0>「F ″"～ Σ■■ヽ澪■E● 卜■,o a■ ■薔ミンが、「、A ′サ0゛ ″,～ ■こ0(ヽけ0“ ● す 0「 ^■ 。ざい汁。諄をo ｀｀uヽ」Э^´ "゛゛^ザ "～即場撃日諄。かoら摯日外゛颯ハo● ´)卜も、Fざ oヽ s蒻諄耐刹,ど M衝 ′ i nl・ト譲ヽ卜α矮則|)膊コヽハ鮮●“ ′=0ヽもⅢ「■橘皿0藤抑。ン、識",「 =」場>冽 Ooに ,′ 十日外埒oヽ ●0ヽ。(3)● 。●0ハ ■0い ′os卜。o「製誨洵嵐0● ≫ ゛o湘 "サ "o熙がヽ o理 ■●● ●●コシ離コ音■コン゛ 0^Oc,′ ^かヽ型口)「協前簿JOR肝語辞ヽぶ0湾》

丼卜。(゛疇求罰ow》 ,丼 ■藤“鏑理Э澪洒差叫彙""′ ,藤 ′キ gヽ峠尋鵬 ′こo)。円ザ"`》証遺携ヨ開 o`)、 cH剋～「画ュむ冊篠欝r.・もヨ前ra諄ヾHざJ● コ苺 ′α櫂～ 0「市oヽ～ ― 四‖ 館闘翻コoざ糾鶴 ′lll(キH> )日外、鳥8掘1751嘗摺。た0卜 ●妨画"がハ。"声ざ、キ>糾 li誂甜tミミ、I湛:】0^ヽ ′ゝた。S′"ザ ●メ剛″α 「 ^絆 ,′ )什ン=」 0゛゛α ショ)『即゛"J』疇当卜、耐～、摯。前キトコ)ふ > ° 語o′ 、嶽Hsョ ′キ■コ● 。(3)o,ハ ●■刹ゝ"rヽ夕, rl,す量諾5t111体曇1雷1:∫ぶ34置,1鷲11:響 0“ ゛^剛気姜前蔵 ′^cN汁疇さら譴屁 :詳帯ン刈0どコ■,ヽ ci澪苺コメo副鰯 ′「゛コ ′'市卜 J声 "討らヽか、ン層ヽ醸劇 ^゛、ぉ、釉H oo)● ザôメ〉可^〈釉")、き洋置ご]鳥昌営ミ戚彗登:[壁懲ξI曇こせ[ぶ量号:『 ●3か゛ ″ :き革剛怯当、 ′,顔 ●oコ串o“ 、コ、「加凛絣調J :I][11尊][1:I:ililllll!i意～ ‐ ン樹ル ■■"′ cざ、卜南0りヽ壼o～霞訃s,q> ― ′舛0■ 。か、rJご S昌 0゛サ「EJ― aCき , 〉 | 建 1場oか ,゛～゛獣)「ヨ薔」ヽヽ団 ′ヽあ 0>普 o・t薄ぶ■ 黎^"、アЖ ′卜‐oき ,訓剤綿。)。ヽヽ・ト 0卜。ザヽo「 ,c,蓼、」= αHEE～ III首ヽも■ユ、コ | ′丼嶽H口掏諄ε゛母o舟 ■゛丼ヽ厳ゅ場゛、文ヽ、卜=″ ザ■ 。コ 0コ g書 =′ xか J′洵詐罰円ゃコ ′^『卜 .、さ゛～躊キ翡‖ o「 t謬日闘ゅ」。● 「澪商かo3嗜蔵■醸恥oトミ ′"ôも。"。 o゛ ●飯oさ ,荊場,～ ,"製゛無。衝E>"姦「=」 ′サ、 ′ざ"簿講^ココo=口 )》卜巌゛゛^商 0,α "oメ浙 ′o 。ヽ0)、 y 卜0゛。)。゛^sび 0担研ヵ師》卜が渕■「諄議。ゝ、 ●飩かヽゆ■ ● 前 Ж ,ヽルcuⅢ ■ 「EJ(^)● F,第 )。ル. 3誨粛 ′屁冊壺o」藝“副剤鍼 ′卜が"a,、。e)。 ,ハ ●ヽミ1ll111鶉鶴ご ● 悦ヽヨ戯呵^潟 ),証半 ′市み、■■c調 ●か0“ 熟慾ゞ欝:1鷺獣117 .ヽ0)。 o● も・帰o■ ,潰 a苅。7:賢‖」 ′リン剛ヽプ■c゛鵡ハc、難屁xか。か0怯嗜語4卜も、 ζ 罰晉員lTギζヽこ:iま『::き壼干‖鷲‖ 醸ミ静msン 0"′ 「瓢 ´丼,戯熙 ■o■ ,ハ oさド●ョo゛鮨‖ョ■Jo前固′ヽ"Fざ～。ヽ。こ^前卜 ′■゛″゛■卜齢òoも。ドプ^c期間^c● NEぇざゴョ)、前 ′゛騨蘊瞬Ｗく趙＝も蜆げヽ渉、き゛動撻証ヲヽ鶏ヽヽ議「輛憾書ヽ葺薔辟下撫 π鮨一ヾヽ獅轟蘊鐵ば磁ゝとぶヽ鮮゛彙ヽ Ч 「響珈蝸譴コヨ〓，市マき゛と ‘ ヽ卜」ヽ ´ 薔節;よf閻艤駆1懲盪I) 一 rl) 競鴛卜掏,コ『 J「誨,コ H』 ■ご書薔Fi↓ ζl蕉蓄‖『 1ぇ .彗コ〈=) 馘戴呻`蠍高ま鮒 ) T(11製薔蝋‡揚林諾輩I田漸蹴Ъ) 。 =塑 ′ レ母ョ飾再染躍普》屁、‖ 'ま ζ :贅選ζ覇書 :慕亀 ) ′諄"師疇 H絣、料軸痴ぷ厖 Wi],L) 綱llミ:』畔 ζ営11「こよ|』董:景8きま)]当「摯,“ )わ0ヴバOR乱亀詈:動,1#F」〕為露ξ 。壼ヽ・| :

簗 .コOョ「コ勲劇 u囀鶉』「前麟鷲よき副N≫Hさ弾摯濯儡曇〈;昂糠; ‖よh鴻」ヽ ) °°｀°目汁コ ‐●ω _ンむざ、潰卜きン● ま 1き薔 ‖ 晨書 ]:露 )ャ ‡ ぜミ GDコヽヽヽキ岸゛゛ F制出諄昨 :'SI薦菫 ,シ卜 cЧ ■ ::鉾"。盪:響業、化デ↑「Fッ時′ツ0ド颯晨=ド ¨ 悦鰍‖ 「 H鏃 .=、゛ざ゛oヵ澪。r, Ｅ ● ｋ」ヽ＞」ユ 'tζ ´ 」:欝ξl撃I黒]ゞ::11灘1具き意島lζ]ざ驚薔 ) や

ド|「誂撻辮ド"‖ド咄籠ョ(3)"),ン“騒] 鞣騨 i電謂革」悸鋼鵠警}]きさ]増こ) 。(狐|>日―o

口ヽ』罰綱 1葛o■ ),ド mキ |「書日新き』換、琉0青 (8)

。〈興ド | ′'|さン 1 ′洋》丼『鮨1ヽ清嗜前"‐H■ 』藩議 | 辛,両 ■ 理口Σ),|ドさ | 『世斗翔日絣述』前狂首喘〈8) ド ′゛ >旧 lw型 ≫‖耐』晰由に、ヽ。(国01日 ′‖ドン咄』 |』♀県逸 ) 4 コ| ′枷| | trimeH+ 8HE 奇お財、鮨日疇、》華"郎 n加丼「メ》可ョ■ンJ ′●>料″,日餡摯獣L'1年帯]薫iまき鳥 ′ 一 >ドド| ′ ０ MJO"r"ドx、 ¨ 、o■市,コ』中ぶ則ま韮1:)

ヽ瑚》橿ヽメヽ響w癖コ :::需 1摺轟ず}:き革員蠅 }) ■ ，４

「〓石な〓ヽ０」ユ半「露■詢,,sI』ヽ >椰圏 ′,昴 o》寧0ド o,瀾て、) ヽ・。汁●゛違～,コ ■3世一露 ′痒 "苺 "ヽき譲 .●oま諄″ 「■o゛ン百=^薔～■ ′ヾ゛`丼係■陣NⅧ 」F>澪 ′登″⊆「サ"■ 鮎0■ 鮮瞳湾■汁 lr・10,簡 * 口 ′■9ン、。か,ハ ,サツトヽⅢ薔0「 ● と ψ 」導」ヽすヽぃャ■割綸ブ,〈胸斗、)ゞゝヽoと w競丼 ′葬 l?I燕鶴黒乱lさ翡ご譴層 ● 墨凛 t〉 (翔OO ― 汁ド |『」猥奇さ標日3鋭ヽ』鐵■(8)"), >H>|「出ミン樹饉洋椰」「゛゛、,洒ゅJ薔ヨ炒ュ, (8) .回OII 1‖ィ書よ』認輔祠響穏靭 ― 認番』た) ド || .IIo 、 | ′菫熟輸華,鸞》摯汁ャ》回副渕洵 ri 。河ロヨ q"じ +N● X"圏回、丼♯ ■x■ )口》ヨ』蟻罰攣》画計,丼〈3) 、国 ′十ロンド | ′♪南ュャ》渕桝『日、昴,■ x,日回 .口)|ヨ』副ー‖B ′ ,o田意識書鼈 .書習]彗詈苦!ξ許ヨl彙‖ ド | ′ヽお笥華海ャ》ジ冷檬》口訃渕桝『+ 薔鎌L) ヽ嗜X,日回》丼‖ "X■ )コォ』綺前鷺》回計】丼〈8) .壼絣^■ サ00(ド )"′回、 1-1ド "石狐ヨ 1 0■ コ ′ハ^■,コ型 .Ioドド | ′嶽、コ『ト m「ド+、 ●xttB回 ,ォゝヽ一― 署 ■ヽ■)口》』瑯弩(3)序 (3) ヽ市ゆ‖0競加、゛,■ ■掛o薔 oキJョ Hュト (8) .刈Hl l ―ml ′ 十> ド | ′華鸞輸華"ャ

軋0「藩付J疇証回J′sM 鼻 0ブ滸¨ 「「、、、、■、」 ::1) ま13,1:意(11ご■、ttttttiΨ躊

oヾ―斗 JF「即、丼鑑丼』載ョ(ヽ)" 〈ふ)

.(0ザ^c″ 絆詢" 。 Medical History, 2011, 55: 313–318 Smallpox and the Epidemiological Heritage of Modern Japan: Towards a Total History

AKIHITO SUZUKI*

Keywords: Epidemiology; Public Health; Comparative History; Japan; Smallpox; Plague; Cholera

This article examines one of the long-term structural forces that contributed to the making of public health in Modern Japan. My overall argument is that the history of public health should be conceived as a total history, encompassing not just political, administrative, and scientific factors but also natural, social, and economic factors. Elsewhere I have discussed two of these factors in some detail, both of which were long-term structural forces resulting from the interactions of different realms: 1) the effect of the topo- graphy and the pattern of the use of land; and 2) the effect of the market as a medium for people’s behaviour seeking the prevention of the disease.1 Here I will argue that the Japanese long-term experience of diseases provided another structural force that shaped public health in Japan. The long-term cumulative factor can be called the ‘epidemiological heritage’ of Japan. Although the phrase ‘epidemiological heritage’ is my own coinage, the concept has been articulated and developed most clearly by Peter Baldwin in his Contagion and the State in Europe 1830–1930 (1990).2 Baldwin has shown that mediaeval and early modern experience of plague provided the basis from which nineteenth-century public health in Europe was developed. Repeated visitations of plague prompted European states to establish public-health measures, first in Italian cities and then in states in northern Europe. The anti-plague measures consisted mainly of spatial limits imposed on the movement of people and goods: quarantine, cordon sanitaire, confinement of patients in lazarettos, and disinfection of goods and letters at borders. These spatial measures entered the vocabulary of public health in the late mediaeval and early modern periods and remained there even after plague disappeared from Europe in the eighteenth century. When cholera hit Europe in the 1820s, European states resuscitated their anti-plague measures to combat cholera: ‘most regimes dusted off their files on bubonic plague and put what were by now fairly traditional policing measures into operation: military

Ó Akihito Suzuki, 2011. ‘Cholera, Consumer, and Citizenship: Modernization of Medicine in Japan’, in Hormoz Ebrahimnejad * Akihito Suzuki, Professor, Department of (ed.), The Development of Modern Medicine in Non- Economics, Keio University, 4-1-1 Hiyoshi, Western Countries: Historical Perspectives (London: Kohoku-ku, Yokohama-shi, Kanagawa 223-8521, Routledge, 2009), 184–203. Japan. Email: [email protected] 2 Peter Baldwin, Contagion and the State in Europe 1830–1930 (Cambridge: Cambridge 1 This paper does not discuss these two forces in University Press, 1999). detail. See Akihito Suzuki and Mika Suzuki,

313 Akihito Suzuki cordons sanitaires, quarantine, fumigation, disinfection, isolation.’3 This set of time-old anti-plague measures served as a prototype from which anti-cholera measures were developed in Europe in the nineteenth century to become the core of modern public health. Several centuries of visitations of plague thus provided Europe with the crucial part of the epidemiological heritage to develop its modern public health. Japan, on the other hand, had not experienced plague in the late mediaeval and early modern period. What formed, then, the epidemiological heritage of Japan? Which disease served as the prototypical epidemic disease when cholera struck the country in the nineteenth century? This paper argues that smallpox held the key and the epidemiological profile of the disease moulded and conditioned people’s response to epidemic diseases in general. Centuries of smallpox epidemics had formed the basis, from which had developed anti-cholera measures and other public health policies in modern Japan. One should thus examine the long-term context of these smallpox epidemics in Japan from the ancient and mediaeval periods through to the early modern period. The first recorded smallpox epidemic in Japan was in the eighth century. The smallpox that started in 735 ravaged the country and killed probably about one-third of the entire population. Almost certainly this was a virgin soil epidemic. Later, twenty-eight smallpox epidemics were recorded until 1206. Among these epidemics, there was a clear trend of progressive shortening of the interval between two epidemics: until the year 1000, smallpox visited Japan with the interval of twenty-four years on average, while between 1001 and 1206 the interval became thirteen years.4 (Table 1) By the Tokugawa Period or the early modern period in Japan, smallpox was firmly settled as an endemic disease.5 Statistics from a village show that the village experienced major outbreaks of smallpox about every ten years. (Figure 1) They also show that about ninety-five per cent of the deaths from smallpox were those who were under ten-years-of-age. (Table 2) This epidemiological profile of smallpox in early modern Japan had an important soci- etal consequence. Since victims were almost exclusively children, the management of smallpox became the business of each household. Medical advice-books for lay people published during the Edo Period often included how to protect one’s child from malignant smallpox. Likewise, suffering and recovering from smallpox became an important part of the ritual celebrating the growth of one’s child. The ritual was called sasayu, and became an important occasion to throw a family party, inviting friends and relatives.6 The management of the smallpox of one’s child was integrated into the management of the household during the Tokugawa Period.

3 Richard Evans, ‘Epidemics and Revolutions: Epidemics and Mortality in Early Modern Japan Cholera in Nineteenth-Century Europe’, in Terence (Princeton, NJ: Princeton University Press, 1987); Ranger and Paul Slack (eds), Epidemics and Ideas: Ann Jannetta, The Vaccinators: Smallpox, Medical Essays on the Historical Perception of Pestilence Knowledge, and the ‘Opening’ of Japan (Palo Alto, (Cambridge: Cambridge University Press, 1992), CA: Stanford University Press, 2007). See also, Ann 149–74: 163. Bowman Jannetta and Samuel Preston, ‘Two 4 Early epidemics of smallpox have been Centuries of Mortality Change in Central Japan: The explained in detail in William Wayne Farris, Evidence from a Temple Death Register’, Population Population, Disease, and Land in Early Japan, Studies, 45 (1991), 417–36. 645–900 (Cambridge, MA: Harvard University Press, 6 Jannetta, Epidemics and Mortality, ibid., 1985). 61–107. 5 Smallpox in early modern Japan has been closely examined in Ann Bowman Jannetta,

314 Smallpox and the Epidemiological Heritage of Modern Japan Table 1 Number of years between outbreaks of smallpox in Japan

735À1000 1001À1206 Outbreak no. Year Interval (years) Outbreak no. Year Interval (years)

1 735 À 13 1001 3 2 763 28 14 1020 19 3 790 27 15 1025 5 4 810 20 16 1036 11 5 853 43 17 1072 36 6 879 26 18 1077 5 7 915 36 19 1085 8 8 925 10 20 1093 8 9 947 22 21 1113 20 10 974 27 22 1126 13 11 993 19 23 1143 17 12 998 5 24 1161 18 25 1175 14 26 1177 2 27 1192 15 28 1206 14 Average interval 23.9 Average interval 13.0

Source: Fujikawa Yu, Nihon Shippei shi [History of Diseases in Japan] (Tokyo: Heibonsha, 1969).

Another profile of the epidemiology of smallpox from the seventeenth century was the spatial fragmentation of the diffusion. While in the ancient period an epidemic of smallpox covered the entire country in a single wave, during the Tokugawa Period the disease lost its nationwide coverage. Smallpox became spatially limited in its diffusion, ceasing to be an event for the state under shogunate or the domain rule by daimyos . Instead it became the affair of local villages. Diffusion maps from the eighteenth and nineteenth centuries show mosaic-like patterns of affected settlements and unaffected settlements in each outbreak.7 Under such a situation, there was little reason for the state or the domains to think that controlling smallpox was their business. The changing spatial profile of smallpox thus separated anti-smallpox measures from the worldviews of elites of the state and the domains and integrated them into those of common villagers. People in the village were left free to inscribe their belief onto anti-smallpox measures. Folkloric religions and local customs became backbones of the rituals for smallpox: people made offerings of food to the demons of the disease and danced to music to guide them out of the villages. The fragmentation of the diffusion of smallpox in the Tokugawa Period put the control of the disease out of the power of wide-area administration and

7 Suda Keizo, Hida no Tos o shi [History of Smallpox of Hida], (Gifu: Kyoiku Bunka Shuppan Kai, 1992), 32-4.

315 Akihito Suzuki

Figure 1: Deaths from smallpox in Hida, 1795–1852 Source: Suda Keizo, Hida no Tos o shi [History of Smallpox of Hida] (Gifu: Kyoiku Bunka Shuppan Kai, 1992).

Table 2 Mortality figures and causes divided up by under/over 10 years of age in Hida, 1795–1852

Deaths under 10 Deaths over 10 Percentage of under 10

Smallpox 735 38 95.1 Diarrhoea 217 41 84.1 Measles 29 6 82.9 ‘Wind’ disease 10 198 4.8 ‘Epidemics’ 0 19 0 ‘Temporal Disease’ 5 111 4.3 Subtotal 996 413 70.7 Unknown 967 337 74.2 Other causes 1770 2772 39 Total 3733 3562 51.2

Source: Suda Keizo, Hida no Tos o shi [History of Smallpox of Hida] (Gifu: Kyoiku Bunka Shuppan Kai, 1992).

316 Smallpox and the Epidemiological Heritage of Modern Japan enlightened rationality, and set it into the realm of the business of village, using magical and religious methods most familiar to them. The epidemiology of smallpox in early modern Japan thus prompted small-scale units of families and villages to take the responsibility of its control. This epidemiology was buttressed by Tokugawa ideologies: didactic emphasis on Confucian family values encouraged the family’s self-help, and the administrative system of the self-government of villages contributed to the making of family- and village-based ‘public’ health. The large-scale units of the state or the domains, who were actors representing rational, bureaucratic, and systematic values in early modern Japan, were largely absent from the smallpox control. It is a mistake, however, to regard this family- and village-based public health movement as representing something backward in the context of early modern Japan. On the contrary, this is the point I would like to emphasise: those who practised the management of smallpox in the household and the village believed this was a civilised way of dealing with the disease, if compared with other forms of managing smallpox practised in the peripheral and isolated parts of Japan, such as small islands and regions isolated by steep mountains.8 In these remote places, smallpox visited only rarely and retained its virgin soil characteristics. Contemporary observers clearly noticed the contrast between ‘central’ regions where smallpox was endemic and semi-endemic, and those ‘peripheral’ regions where smallpox behaved like virgin soil infections. When observing the visita- tion of the disease in peripheral places, people from central regions were not only stunned at the magnitude of the damage but also struck at the ways in which the residents of the remote regions behaved during the epidemic: unlike the residents in cities or ordinary villages, those in the peripheral regions fled the place or practised spatial quarantine. These behaviours caused emotions ranging from curious bewilderment to moral condemnation from observers from cities, towns and villages, where smallpox had become endemic or semi-endemic. What horrified them most was the discarding of the children and family members suffering from smallpox and fleeing the village, which represented an unthinkable barbarity by the standards of those who had already experienced endemic or semi-endemic smallpox. Note well that different epidemiological pro- files moulded different patterns of behaviour or even different moral standards. The endemicity of early modern smallpox in Japan thus held the key for the family- and village-based public health measures against the disease. Immunity of adults, the restriction of the victims to children, and the fragmentation of the diffusion allowed most of Japanese society to deal with the disease with the small-scale social units of the family and the villages. Where the outbreak retained the violence of virgin-soil epidemic, the smallpox was treated using a different set of strategies: isolation, quarantine, breaking up the family, and fleeing from the place. The epidemiological heritage of experiencing smallpox as an endemic or semi-endemic disease with shorter intervals

8 For smallpox epidemics in peripheral parts of the Ainu Flee to the Mountain’?], Shiso, 1017 (2008), Japan, see two excellent papers by Kozai Toyoko, 78–101; see also, Kawamura Jun’ichi, Bungaku ni ‘Isetsu no nakano Hachijojima’ [‘Hachijo Island in miru Tos o [Smallpox in Literature] (Kyoto: Medical Discourses’], Shiso, 1025 (2009), 46–71; Shibunkaku, 2006), 140–8, 180–2. idem, ‘Ainu ha naze ‘yamani nigeta’ ka’ [‘Why Did

317 Akihito Suzuki provided early modern Japanese society with the public health system centred around the family and the village, with the state and the domains largely absent. In this article, I have argued that the attitudes toward smallpox in early modern Japan were forged in the ecological balance between humans and microbes. The balance shifted historically, moving from infrequent but destructive visitations to frequent and manageable ones. It also differed geographically, with peripheral regions retaining the savagery of older epidemiological regimes of infrequent epidemics. Japanese ways of managing smallpox through household and villages fitted well to the epidemiological regime of smallpox that existed for the most part of early modern Japan. Perhaps most important in the making of the epidemiological heritage was the absence of plague. While plague prompted European states in the mediaeval and early modern period to assume strong power for its prevention, Japanese society had been, for the most part, allowed to leave its management of epidemics to families and villages. The early modern public-health model in Japan was thus deeply influenced by the ecology of diseases, par- ticularly endemic smallpox and the absence of plague. This is the ‘epidemiological heritage’ of nineteenth-century Japan faced with the new epidemics of cholera, the new states ambitious to Westernise the nation, and the new model of public health and medicine imported from the West. The establishment of modern public health in Japan, which has been told as a story of importing Western systems by the government, turned out to be a far more complex phenomenon involving many factors, and the most important of them being the epidemiological heritage forged through the long-term process of experiencing smallpox as a child’s disease.

318