Our knowledge about diseases in the prehistoric era of Japan is extremely limited because not much paleopathological research has been done thus far. For the little information we have about the occurrence of diseases during the early historic period we have to rely on a small number of literary sources. One general assumption, however, may be made from the geographic situation of the Japanese islands: Prior to more extensive contact with the Asian continent, Japan may have been free from regular epidemics of certain contagious diseases such as smallpox and plague.
The most important sources on the early history of Japan are the Kojiki (The Ancient Chronicle), completed in A.D. 712, and the Nihonshoki (The Chronicles of Japan), completed in A.D. 720. Both these chronicles include references to diseases that af fected individuals, as well as to epidemics. The Kojiki informs us that there "raged many plagues" at the time of Emperor Sujin, who was supposed to be the first Emperor and to have reigned around the end of the third century A.D. The Nihonshoki confirms that "plagues spread out everywhere in Japan." These epidemics may have been caused by climatic irregularities at that period; one passage in this source states: "Because the winter and the summer exchanged their places and the cold and heat occurred in irregular order, the plagues spread and the people suffered." Considering the influence of these climatic changes on the crops, one may speculate that these epidemics were famine-related dysenteries. A passage in the Nihonshoki describes the symptoms of a princess at the court who had fallen ill, by stating that she "lost her hair and became very thin" - symptoms suggestive of high fever and dehydration that might accompany such forms of dysentery. On the other hand, it would appear unlikely that famine would have reached the immediate environment of the emperor. Hence, with so little information a diagnosis can hardly be made with any degree of probability.
Undoubtedly, poor sanitation and a lack of hygiene must have been responsible for epidemics of dysentery; these were recorded as ribyd or kakuran. The epidemic recorded for the year 861 was identified as sekiri, possibly meaning bacillary dysentery. From the first mention of this illness onward, it appears to have reappeared frequently. One of the representations on the Yamai-no-Soshi (Scrolls of Disease) made during the twelfth century, at the end of the Heian Era, carries a caption stating that a woman "has a sharp pain in the bowels, vomits water, has diarrhea and stumbles around to create a strange spectacle"; these symptoms suggest bacillary dysentery.
Diaries written by members of the gentry of the same period refer to the occurrence of malaria. The Anopheles mosquito, the host of various types of Plasmodia, seems to have been present in Japan at all times. Malaria was called either okori or warawa-yami, the latter meaning high fever and chills. Another name, also found in the scrolls, was gyaku-shitsu: According to this source, illness was characterized by fever and chills that recurred throughout an individual's life.
Tuberculosis, especially pulmonary tuberculosis, may also have been present in ancient Japan. Possible references to pulmonary tuberculosis are contained in certain passages in the Genji-Monogatari and in the Makura-no-Soshi, the two greatest liter ary works of ancient Japan. In these passages, persons are said to "suffer from the chest." The Ishinpo, a collection of excerpts from Chinese medical books, compiled by the Japanese scholar Tamba Yasuyori in 984, records a disease called denshi-byo. The symptoms of this illness were similar to those of tuberculosis.
The Ishinpo also lists nine helminthic parasites, among which the tapeworm, roundworm, and pinworm can be identified; in ancient Japan all three were called suhaku. With the understanding that the Japanese compiler of this book selected subjects from Chinese medical literature that were applicable to the situation in Japan at the end of the first millennium, it seems safe to assume the existence of a wide array of parasitosis there as well. Another text of the period describes a woman suffering from suhaku, who was pale and had dropsical swellings. A physician drew from her body a white worm, 12 to 14 meters in length.
Although there are some indications of the existence of lice in ancient Japan, there is no proof for the occurrence of exanthematous typhus. Nor is there any source prior to the nineteenth century suggesting an outbreak of the bubonic plague, a disease that raged in China for decades around the turn of the eighth to the ninth century.
Beriberi, a disease caused by thiamine deficiency and often associated with cultures that relied on rice as staple food, was endemic in Japan. It was called, alternatively, kakke, kakubyo, or ashinoke, the latter meaning "illness of the legs." The oldest record of beriberi in Japan refers to the son of the Emperor Shomu, who died of this disease in A.D. 744, at the age of 17 years. The Ishinpo, compiled one and a half centuries later, contains a detailed description of the symptoms, such as pain, paralysis of the legs, anasarca, and palpitations.
In A.D. 733, Yamanoueno Okura, the famous poet of the Manyoshu (the oldest existing anthology of poetry), died at the age of 74. According to his poem he had suffered from a disease for 10 years that caused him considerable discomfort: "The hands and feet do not move, every joint aches, the body is like a heavy stone and walking is difficult." Hattori Toshiro (1945) has concluded that this disease was rheumatoid arthritis. Others believe that arthritis deformans is a more likely possibility. Both conditions must have tormented ancient Japanese, whereas neuralgia of the hands and feet must have been quite common because of agricultural labor.
The oldest Japanese statutory law, the Yoro-ryo, enacted in 718, classified diseases of laborers and military men into three grades, ranging from severe to relatively mild. Among the most severe of diseases was leprosy. In this text it is described as follows: "The intestines are eaten by worms, the eyebrows fall down, the nose is out of shape, the voice changes, the body bends over, and it is contagious." Leprosy was called rai or rei or else tenkei-byo, which means literally "disease of heavenly punishment." Although lepers were regarded as untouchables and had to be strictly separated from the healthy population, a Buddhist legend has it that Empress Komyo (701-60), while cleaning pus from a leper's body, discovered that the man was Buddha.
As in all premodern societies, skin diseases, particularly inflammatory afflictions, were known among the Japanese. The Ishinpo includes chapters on afflictions that can be identified as scabies, pustular and other forms of suppurative dermatitis, carbuncles, scrofula, felon, and erysipelas. Some sources indicate that gonorrhea and soft chancre occurred in ancient Japan, under the names rin-shitsu, bendoku, and genkan. However, these terms appear in medical books only from the fifteenth century onward. Similarly, syphilis is encountered for the first time during this period. Japanese pirates apparently brought the bacterium into the islands from European ports in China.
Among the diseases of the nervous system, we have an illustration of cerebral apoplexy in the Yami-no-Soshi. Not unfrequently, diaries and literary works describe instances of mental disorders that can be identified as schizophrenia, or other neurological conditions such as epilepsy.
A well-documented and typical case of diabetes mellitus may be found in the medical history of Fujiwara no Michinaga, a very powerful nobleman of the Heian Era. In 1016, at the age of 62 years, he began suffering from thirst, weakness, and emaciation. His disease was diagnosed as insui-byo. As the illness advanced, he suffered from carbuncles, developed cataracts, and finally died from a myocardial infarction. As a matter of fact, this disease was hereditary in this branch of the Fujiwara family: Michinaga's elder brother, his uncle, and his nephew all died of diabetes at fairly young ages.
The relative isolation of Japan long protected it from the great epidemics, such as smallpox, plague, and influenza, which raged in other areas of Asia. This isolation was, however, as William McNeill (1976) has pointed out, a "mixed blessing." As Buddhism flourished, and contacts with Korea and China increased, diseases that were endemic in these countries began to strike the dense and immu nologically defenseless population of the Japanese archipelago. Smallpox, most probably originating from India, reached China in the wake of Indian Buddhist missionaries via the Silk Road. It was first described by a Daoist, Ge Hong, in his Zhou-hou bei-ji fang. The first record of a smallpox epidemic in China appeared in the Jianwu Era (around A.D. 495), when it was called hu-dou, "barbarian pox." It spread to Korea, and eventually reached Japan with the first Buddhist missionaries, arriving there in 552. In the same year a series of epidemics started ravaging the country and continued periodically until 582. There is no proof as to whether the disease was smallpox in every instance; measles or influenza could have been similarly devastating. Since the relationship between the opening of the country and the arrival of these diseases was apparently understood, there is little wonder that opinions about the question of whether Buddhism should or should not be introduced to Japan divided society and the influential feudal families.
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