A Healthy Defeat? The sudden decline of TB in occupied Japan

Between 1945 and 1955, Japan experienced many seminal changes, most of which have been amply studied and described. One development, which was very significant for Japanese people at the time and perhaps the most important in the long run, has however been mostly ignored by researchers; the immediate postwar years saw the sudden decline of tuberculosis, which had been the leading cause of death since at least the previous century, to the status of a minor disease.

In 1945 alone, over 200.000 Japanese died of this 'national' disease, a death toll comparable to that caused by the thermonuclear bombardments on Hiroshima and Nagasaki in the same year. Nor were things looking up; the country was impoverished, partly ravaged, and at pains to cope with the influx of millions of displaced people. Although the first antibiotic therapy against tuberculosis had been developed as early as 943 in the United States, new medication was not widely available in Japan until the mid 1950s. The Japanese medical establishment and the newly installed occupation government faced an unparallelled epidemic of a deadly disease in a nigh destroyed country without any new medical means.

Remarkably enough, they appear to have done an excellent job. Compared to the 1920s and '30s, TB mortality had halved by around 1950, and the disease had been almost eradicated among young people. Regrettably, nobody knew, or knows, how this remarkable feat was achieved, nor has much been done to find out. Not that it would be easy to explain the decline of TB in Japan; because so many changes occurred in Japan in this decade, it is particularly difficult to establish causality.

The changes in TB incidence and mortality in Japan were spread remarkably unevenly. Some areas progressed much quicker towards the new disease regime than others. It is not immediately evident, moreover, what determined the disease outcomes in each prefecture is not clear; underperformers include both rural (northern Tohoku, Ehime) and urban (Osaka, Hyogo) prefectures, and neither is there a clear relation between disease and income or profession.

This project aims to gather detailed historical information concerning the spread of the disease and differences between areas and explain the geographic variations.

Publications:

- A Healthy Defeat? Mapping the Postwar Decline of Tuberculosis in Japan, 1945-1955’ Editing in process for inclusion in: Virus. Beiträge zur Sozialgeschichte der Medizin.