A Medicated Empire

The Pharmaceutical Industry and Modern Japan

Timothy M. Yang

• Publisher: Cornell University Press
• Year: 2021
• Print ISBN: 9781501756245
• eBook ISBN: 9781501756252
• Topic: History
• Subtopic: Economic History
• Index: History

Winner of the 2022 Hagley Prize in Business History

In A Medicated Empire, Timothy M. Yang explores the history of Japan's pharmaceutical industry in the early twentieth century through a close account of Hoshi Pharmaceuticals, one of East Asia's most influential drug companies from the late 1910s through the early 1950s. Focusing on Hoshi's connections to Japan's emerging nation-state and empire as well as the ways in which it embraced an ideology of modern medicine as a humanitarian endeavor, Yang shows how the industry promoted a hygienic middle-class culture that was part of Japan's national development and imperial expansion.

Yang demonstrates that the company's fortunes had less to do with scientific breakthroughs and medical innovations than with Japan's web of social, political, and economic relations. He lays bare Hoshi's business strategies and its connections with politicians and bureaucrats, and he describes how public health authorities dismissed many of its products as placebos at best and poisons at worst. Combining global histories of business, medicine, and imperialism, A Medicated Empire illuminates how the development of the pharmaceutical industry simultaneously supported and subverted regimes of public health at home and abroad.

Part I

THE DRUG INDUSTRY, ENTREPRENEURSHIP, AND THE STATE

1

A STRATEGIC INDUSTRY

From the beginning of the modern Japanese state—and, for that matter, well before—government officials viewed pharmaceuticals as a strategic industry. In their efforts to nurture healthy, disciplined, and modern subjects, protected from the darkness of disease, they concurrently promoted a domestic pharmaceutical industry to help control their subjects’ purchase and consumption of medicine. They viewed medicines as necessities for Japan’s modernizing imperatives both at home and in its growing empire abroad.

Yet officials did not value all medicines equally. Soon after the fall of the Tokugawa shogunate, they attempted to modernize Japan’s medicinal market. They looked to Western nations as the pinnacle of medical and pharmaceutical science, and their official prioritization of Western medical knowledge and administration planted the roots for Japan’s modern pharmaceutical industry. Supported by cultural critics, intellectuals, and entrepreneurs—many of whom were connected to the incipient state themselves—they began promulgating laws and regulations that promoted Western medicines at the expense of indigenous ones. They cast Chinese and traditional herbal medicines as unscientific and superstitious; they considered opium a danger to health and morality; and they deemed indigenous patent medicines as placebos at best and poisons at worst. But the modern medicines that they championed had problems as well—particularly their susceptibility to counterfeit and adulteration. Above all, officials worried about the how medicines’ profitmaking potential so often superseded their humanitarian benefit. They portrayed the consumer as victim to the wiles and guiles of disreputable merchants, and they responded by implementing a number of regulations that culminated in the development of a national medicine regulatory system.

In their endeavors to control the medicinal market, government leaders worked together with—and, indeed, greatly depended on—the efforts of existing drug merchants and manufacturers, some of whom had previously been purveyors of the very medicines that the government sought to eradicate. Whereas some firms rallied against state regulations, which they perceived as threats to their livelihoods, others recognized the new medicine regulations as opportunities and adapted to become some of the leading pharmaceutical firms of the time. The government went so far as to create a state-sponsored pharmaceutical company, as it had done for major strategic industries such as shipbuilding, banking, and iron and steel.

This chapter examines how Japan’s domestic pharmaceutical industry developed as a response to efforts by state planners to control the purchase and consumption of medicine. It does so by providing the broader background and context of the medicinal market in the early Meiji period. The fundamental questions that Japan’s leaders grappled with at this time not only endured but continued to structure the fledgling pharmaceutical industry well into the twentieth century. How freely should medicines circulate in the marketplace? Should medicines be treated like other consumer commodities or were they too important (or too dangerous) for free market consumption?

Although Hoshi Pharmaceuticals was one of the firms that benefited most from this state sponsorship, its case was not unique for the medicine industry or, for that matter, seemingly any other industry in Japan. The development of pharmaceuticals as a strategic industry reflected the Meiji era’s top-down social engineering and cultural tastemaking to civilize and enlighten subjects toward the creation of a strong nation-state. State planners targeted indigenous medicines for eradication, deeming them unscientific, immoral, and steeped in superstition (and, therefore, in desperate need of regulation). The transformation of a medicinal marketplace—from one that primarily sold medicines derived from native and Asian traditions to one dominated by medicines based on Western biomedical practices—was gradual, uneven, and fraught with conflict. Like the broader program for industrial modernization, the top-down attempts to encourage Western medicines and inculcate medicinal practices were anything but smooth. Despite government efforts, indigenous medicines continued to flourish. The Meiji era was a time of flux and experimentation, when even the primary proponents of modern medicines remained unsure how they themselves could become modern, too. One of the underlying themes of this chapter—and, indeed, this book—is how the term “modern medicine” had different meanings for different people.

Medicines and the State

The development of the pharmaceutical industry in Japan began with the late-nineteenth-century institutionalization of biomedicine based on Western examples. In an era marked by an obsession with developing Japan into a modern, industrial nation-state and a concomitant hunger for goods and practices originating in Europe and the United States, Japanese leaders deemed the strength and fitness of the populace vital to the strength and fitness of Japan as a nation and empire. They institutionalized Western medicine and fostered its customs and practices across society to help shape, both literally and metaphorically, the body politic.1 Although the state’s role in molding healthy minds and hygienical bodies was far from unified—and, for that matter, far from uniquely Japanese—the speed with which Japan developed its medical and public health infrastructure was singular for its time.2

Hygienists such as Nagayo Sensai, statesmen such as Gotō Shinpei, military doctors such as Mori Rintarō (1862–1922), and bacteriologists such as Kitasato Shibasaburō laid the foundations for Japan’s modern system of state-licensed medicine and public health, based, in large part, on German models underpinned by advances in laboratory-based science and technology.3 State medical authorities established medical schools, quarantine stations, mass immunization programs, and “sanitary police” (eisei keisatsu) to eradicate infectious diseases such as cholera and typhus and sexually transmitted afflictions like syphilis and gonorrhea.4 Some established asylums for the mentally ill; others fostered campaigns to inculcate healthy everyday life practices like handwashing or even adopting hygienic Western-style hairstyles and clothes.5 The goal was to mobilize a populace ready to work in industrial factories and to fight in a newly constructed conscript army.6

To support this strengthening of the national body through the discipline of corporeal bodies, the government collected statistical data on Japanese citizens, including average height, weight, chest dimension, and life expectancy, as well as disabilities, contagious diseases, and infant mortality.7 As Michel Foucault famously wrote, “Knowledge is not for understanding; it is for cutting.”8 Recorded data and accumulated knowledge about subject bodies helped create a disciplinary modern regime of medicine and public health that proved essential for Japan’s top-down program of modernization based on the catch phrases “civilization and enlightenment” (bunmei kaika) and “rich nation, strong army” (fukoku kyōhei). Japan’s medical modernizers cast a panoptic gaze on its populace, mobilizing them to productively labor for the good of the nation, fight for the glory of the empire, and protect their bodies from disease.

Medical reformers based this program of a strong, invasive state as protector of public health and well-being on the German Staatsmedizin of Otto von Bismarck’s Germany. Although German models and ideas dominated official state medical discourse and practice through the early twentieth century, they were far from the only ideas circulating during the Meiji era. Despite its top-down nature and disciplinary intent, the institutionalization of state medicine involved fraught, wide-ranging processes that proved far from systematic. Meiji-era medical leaders did not work from a blank slate, but from within a milieu of cultural practices, disciplinary institutions, and intellectual currents forged during the waning years of the Tokugawa regime.9

Indeed, the category of Western medicine itself was up for debate. For example, for much of the Edo period (1603–1868), Western medicine was simply “Dutch medicine” (Ranpō, or literally, the “Dutch Way”); this only changed after Commodore Matthew Perry and his sōcalled Black Ships arrived in Edo Bay in 1853 and sparked a socio-political and epistemological crisis that opened the floodgates to Western imperialism, which ultimately toppled the shogunate. Dutch medicine entered Japan during the Edo period through merchant-explorers who mediated Japan’s contact with the Western world. Although the Tokugawa regime limited contact with Western nations, it allowed Dutch merchants to periodically trade directly with shogunal officials through Dejima, a roughly two-acre manmade depot off the coast of Nagasaki. The scientists and physicians who accompanied the merchants became the wellsprings of medicine and medical knowledge. Perhaps the most famous example was Pompe van Meerdervoort (1829–1908), who trained Nagayo Sensai.10

The eventual dominance of German medical doctors in the Meiji-era medical regime—rather than Dutch doctors or, for that matter, British, French, or American, all of whom sought to impart their teachings on Japanese shores—was, like the broader revolutionary Meiji regime itself, both a political compromise between competing factions and a pragmatic, practical choice.11 At the highest levels, government leaders established a centralized, hierarchical administrative structure based on German examples. The Medical Affairs Bureau (Imukyoku) was established in March 1873. In 1875, it was renamed the Sanitary Bureau (Eiseikyoku) and placed under the auspices of the Home Ministry. From this bureau’s Central Sanitary Board (Chūō eiseikai), officials monitored, regulated, and legislated nearly all aspects of medicine and public health, from supervising schools and hospitals to directing mass vaccinations.12 Yet Dutch medical doctors remained important, likely because of the legacy of Dutch medicine from the Edo period. Two of the key figures in establishing medicinal regulations, for example, were the Dutch military physician Anton Johannes Cornelis Geerts (1843–1883) and the Dutch chemist Johann Frederick Eijkman (1851–1915), both of whom the fledgling Meiji government hired as “foreign experts” (oyatoi gaijin).13

The administration of public health at the local level also relied on native institutions and practices for household surveillance and self-rule. These dated back to the Edo period, when the Tokugawa regime sought to curb and prevent infectious diseases such as cholera, smallpox, measles, and dysentery. In 1887, the Central Sanitary Board ordered the nationwide formation of the “sanitary cooperatives” (eisei kumiai), which comprised neighborhood leaders responsible for supervising and enforcing public health measures, the most important of which, according to William Johnston, “was to ensure that nobody within the cooperative concealed the identity of anyone who had an acute infectious disease.”14 Officials based these cooperatives on the “five-person groups” (gonin gumi) and customs of ostracizing villagers (mura hachibu) responsible for keeping peace and order during the Edo period.15 In Japan’s overseas empire, the administration of public health similarly relied on preexisting disciplinary edifices. For example, the government-general of Taiwan (as well colonial regimes in other places with large populations of Han Chinese) carried out public health policy by means of the indigenous hokō (baojia) system of social organization through neighborhood control.16 From this perspective, seemingly modern practices like quarantine did not seem very modern at all.

The Variegated Medicinal Market

Within an environment that privileged Western medicine, indigenous and non-Western forms of healing increasingly faced suspicion and hostility. The imposition of Western medicine by state medical elites involved the inculcation of scientific epistemologies and a concomitant attack on indigenous and non-Western forms of healing. Two key figures behind these efforts were the German military doctors Leopold Müller (1822–1893) and Theodor Hoffmann (1837–1894)—whom the Japanese government invited during 1871–1874 to educate a generation of physicians to become the leaders of a modern medical regime. Müller and Hoffmann targeted, above all, the Chinese medical tradition (kanpō in Japanese, which literally means “method of the Chinese Han Dynasty”). They blamed this tradition for the problems that they faced in educating Japan’s first class of Western-trained medical doctors, who, according to Hoffmann, had “blind faith in authority” and lacked the capacity for “independent observation or [forming] their own medical opinions.”17 The formal delegitimation of Chinese medicine began in 1876 with a government regulation that required all physicians to study Western medicine, followed by an 1883 directive that derecognized Chinese medical practitioners under the new medical system.18 Looking back on his time in Japan, Müller considered “th...

Table of contents

• List of Tables and Figures
• Acknowledgments
• Note to the Reader
• Introduction
• Part I THE DRUG INDUSTRY, ENTREPRENEURSHIP, AND THE STATE
• Part II MARKETING MEDICINES AND MEDICINAL INFRASTRUCTURES
• Part III THE OPIUM EMPIRE
• Part IV SCIENCE, SELF-SUFFICIENCY, AND WARTIME MOBILIZATION
• Epilogue
• Notes
• Bibliography
• Index