The era from 1050 to 1260 marks a time of declining importance of disease in Japan. There were 50 epidemics over 210 years, an average of one outbreak every 4.2 years, compared to one epidemic every 2.9 years in the 700s and one every 3.8 years in the poorly documented 900s (cf. Hattori 1955, 1964; Fujikawa 1969). The killers of the former age retreated into endemicity. As always, the record is most complete for smallpox. Epidemics broke out in 1072, 1085, 1093-4, 1113, 1126, 1143, 1161, 1175, 1177, 1188, 1192, 1206-7,1225,1235, and 1243 (cf. Hattori 1955,1964; Fujikawa 1969). Although some plagues of smallpox appear to have been severe, especially those in 1072 and 1175, the disease showed clear signs of becoming an affliction of childhood. A letter of 1085 records a mother's concern for her infant who had contracted smallpox (Hattori 1975). In the late twelfth century, Minamoto no Yoriie, the eldest son of the great warrior leader Yoritomo, had smallpox as a boy. His sick ness seems to suggest the growing significance of the disease in eastern Japan, away from the greatest centers of population. The record of the 1243 epidemic of smallpox specifically states that the disease afflicted young children, which led McNeill (1976) to assert that the ailment was endemic by that date.

In the case of measles, epidemics struck in 1077, 1093-4, 1113, 1127, 1163, 1206, 1224, 1227, and 1256 (Fujikawa 1969). In the plague of 1077, young children were afflicted, although the record also reveals that many adults died. That the 1224 affliction seems to have attacked mainly young children, however, suggests to McNeill (1976) that, like smallpox, measles was probably endemic by that time. On the other hand, Jannetta (1987) has found evidence that the disease was still a foreign-borne plague as late as the nineteenth century. Analysis of additional records between 1200 and 1600 is still required to determine the precise status of measles in Japanese history, but it is important to note that at least Jannetta agrees with McNeill that the disease was not a major factor in the region's demographic history by 1200.

Influenza, a disease for which no permanent immunity is conferred, took a devastating toll in the era 1050-1260. According to the records, epidemics occurred in 1150, 1228, 1233, 1244, and 1248. The outbreak in 1150 was extremely severe, carrying off many elderly persons. The epidemic of 1244 was also harsh, afflicting all those aged 10 and above. An important reason for the grave plagues of influenza was undoubtedly the weather, which turned much colder and damper after 1150 (Kito 1983).

Dysentery also continued to attack the populace. There is evidence of a dysentery outbreak in the year 1077, and prominent individuals contracted the malady in 1144,1240, and 1243 (Fujikawa 1969). As during the age of plagues, the malady usually accompanied other diseases; the 1077 affliction of dysentery coincided with a measles epidemic.

In addition to diseases from the previous era, the period 1050-1260 also witnessed the first accounts of a new ailment. Fujikawa (1969) argues that in 1180 the Japanese first became aware of the existence of a smallpox-like affliction that may have been chickenpox. Eventually, doctors in Japan came to call the disease "water pox" (suito or henamo), and chronicled an epidemic in 1200. It is unlikely that the disease had a great demographic impact, and may well have existed in Japan long before the Japanese medical establishment became aware of it.

A disease that gained new prominence in the era from 1050 to 1260 was leprosy (raibyd). Although this affliction appears in records as early as the eighth century, Hansen's disease seems to have become a serious social problem in the thirteenth century. The colder climate probably caused people to huddle together, thereby facilitating the transmission of the malady as in western Europe. Healthy commoners spurned lepers and treated them as outcasts. The Buddhist monk Ninsho became renowned for his treatment of lepers in a sanatorium at Kuwagatani. The Portuguese missionary Luis de Almeida would gain a similar reputation for his work in the 1500s (Hattori 1964,1971).

Medical texts and other sources list other ailments as well; they include cirrhosis of the liver (daifuku suichó), bronchitis, dropsy, idiopathic cholera, hepatitis, worms, malaria, furunculosis (óryó shi), diabetes, and tuberculosis (denshi byd). The Hanazono Emperor and Fujiwara no Kanezane were afflicted with beriberi (kakke), whereas the poet Fujiwara Teika suffered from repeated bouts with bronchial asthma (Hattori 1964).

Because the effects of disease in the age 1050-1260 were limited, especially during the period 1050-1150, decreasing mortality from both old and new afflictions possibly spurred some population growth. Demographic expansion was particularly evident in the Kantó region (modern Tokyo and vicinity), as the warriors cleared lands for cultivation. The land clearance of this epoch was the basis for the estate (shoen) system adopted in the late eleventh century. The extent of population growth, however, remains undetermined.

Yet, no matter how much the impact of pestilence on Japanese society decreased during the years 1050-1150, there is little doubt that disease combined with unusually harsh weather in the following century to restrict population growth. Temperatures turned much colder and the amount of moisture increased dramatically, especially in eastern Japan where there was the greatest potential for growth. In three years - 1182, 1230, and 1259 - the inclement weather induced widespread famine and accompanying sicknesses. The Great Famine of 1230 was said to have killed one-third of the population. In all three cases, epidemics assisted famine as Grim Reapers of the peasantry. Thus, despite the growing en-demicity of many formerly severe diseases, the poor performance of the agricultural sector greatly restricted Japan's potential for population growth.

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