Taking courage from the Dutch

Globalisation is not as new as we sometimes like to think. Within a mere five years of the publication in 1798 of Jenner’s tract about vaccination, Dr Francisco Xavier de Balmis set sail to the Spanish colony of New Spain (Mexico) with a view to introducing vaccination there. Having done so successfully, he sailed on to the Philippines, Macau and Canton with the same aim in view. Vaccination arrived about the same time in Java by way of Mauritius. No modern consumer product has spread more rapidly.

Vaccination, however, was late in reaching Japan. This was not because there was no need for it: on the contrary, it has been estimated that about a fifth of Japanese children died of smallpox before the age of five. The reason for the late arrival of vaccination was the two-and-a-half-century- old isolation of Japan under the rule of the Tokugawa shoguns.

Japan’s only contact with the rest of the world during that time was through the few Dutch merchants who were allowed to reside there and wait for Dutch ships, never very numerous, to arrive, bringing trade goods. But Western ideas, including those about medicine, filtered into Japan by means of translated Dutch books. News of vaccination reached Japan comparatively early, but the procedure was not performed until 1849, only four years before the arrival of the American commodore Matthew Perry.

The Dutch had tried to introduce vaccination to the Japanese, but the cow-pox material that they sent, in the form of dried lymph from cow-pox vesicles, did not survive the journey from Batavia in Java. Eventually, the Japanese asked for the dried crusts of cow-pox lesions, and this worked.

By this time, a considerable cadre of Japanese doctors who, for some reason not entirely clear, had decided that Western medicine was superior to the Chinese medicine that was traditional in Japan, and had trained in its methods despite official disapproval and discouragement, were ready to spread vaccination throughout Japan, and did so within only a few months.