A History of Leprosy and Japan


Toshima Tomiyo Who Stayed with Her Leper Husband, Tomozō, Tsukioka Yoshitoshi, The Postal News, no. 566, 1875. Image via Wikimedia Commons (cc)

by Julia Yongue

Kingdom of the Sick: A History of Leprosy and Japan,
by Susan L. Burns,
Honolulu: University of Hawai’i Press, 2019. 344 pp.

Though surely unintentional on the part of the author, the timing of the book’s publication, the first English-language monograph on Japan’s history of leprosy, could not have been better. In April 2019, just a few months after it appeared in print, Abe Shinzō became the first Japanese prime minister to make a direct apology to leprosy patients and their family members. Moreover, he assured them that the government would not appeal the Kumamoto District Court decision to award compensation, and pledged its commitment to take responsibility for the long years of discrimination and prejudice they had endured.[1] While this highly publicized apology must have provided the central government with a sense of closure to its own history of leprosy, Susan Burns reopens the debate in her book by casting new light on the state’s role in shaping the policy history of the disease.

The stigmatization and exclusion of leprosy sufferers can be traced back to the premodern period, when the cause of the disease was initially thought to be a form of karmic retribution. However, the hardships and discrimination, which affected not only their lives but also those of their family and relatives, only fully surfaced into public view in the 1990s, when their history became the focal point of major political debate. Public interest in leprosy gathered momentum as the state’s policies came under scrutiny through a wide variety of outlets including new books (some seven hundred published, according to Burns, since 2000), journals, films, television programs, museums, etc. Since the 1990s, this interest has tended to gravitate toward the government’s quarantine policy, “one of the longest sustained programs of medical quarantine in modern history” (p. 1). In these debates on disease policy, which have continued to rage into the 2000s, mention is often made of the forced sterilizations and abortions of sanitarium residents, the loss of their basic rights as citizens, and the confinement of some of the more outspoken residents in sanitarium prisons.

Burns does not debate the fact that all of these practices occurred nor that they were unquestionably problematic from an ethical perspective. However, rather than simply condemning these acts as so many have done since the 1990s, including Burns herself in an older work, she instead adopts a more nuanced approach in her history of leprosy in Japan, one that situates quarantine policies and practices in their ever-changing historical context. The evolution in her own perception of these policies results from long years of interviewing those with or associated with leprosy as well as extensive use of primary sources. Through her meticulous reading of sanitarium residents’ accounts of the 1920s, she discovers that not all of them were uniformly opposed to the practice of forced sterilization, one of critics’ most contentious issues. In some cases, residents willfully complied, due to their own fears of spreading the disease to their offspring. As she notes, however, the stories of such residents, who grappled with these difficult decisions, have often been omitted from works on the lives and writings of leprosy patients in the 1990s. By including these untold accounts in her latest work, Burns is thus able to challenge the well-established narratives of the 1990s and 2000s, referred to in recent scholarship as the “denunciatory history” of leprosy (p. 4).[2]

Burns emphasizes the need to understand how leprosy policy formed within an evolving historical context. She does this convincingly by tracing the history of leprosy in Japan from the premodern period (chapters 1 and 2), when the disease first appeared in historical texts starting in the first millennium CE, through the 1870s to 1910s (chapters 3 to 5) and 1920s to 1960s (chapters 6 to 8) periods. Her inclusion of the early period is essential to understanding the debates surrounding the introduction of the first leprosy laws. By taking this truly long-term approach, Burns is able to consider various policy influences, which emanated from both inside and outside Japan.

Perhaps one of the most interesting sections of the book is the 1870s to 1910s period. This was the time when the Japanese government began to ponder whether to model its leprosy policy on those of advanced Western nations where confinement in sanitaria was the norm or to adapt indigenous practices, some dating from the premodern period, to the new circumstances it faced. In the same section, Burns introduces many influential figures in Japan’s history of leprosy. One is Gotō Masafumi (1857-1908), an entrepreneurial Kampo medicine doctor who developed his own remedy, a self-proclaimed cure for leprosy. According to Burns, Gotō in particular “played an important role in establishing Japan’s reputations as a center of cutting-edge leprosy treatments” (p. 102). Thanks to Gotō, the nation would be perceived as advanced in terms of its leprosy treatments, one that attracted both Western medical experts and sufferers alike to learn or benefit from his treatments. Another key figure is Mitsuda Kensuke (1875-1964), a proponent of forced confinement and a key player in defining Japan’s quarantine policy. While Gotō’s role in the history of leprosy tends to be overlooked, Mitsuda’s came to the fore in the heated debates of the 1990s. These portraits and others give the reader an idea of the competing voices in Japan’s leprosy policy, its multidimensionality, and its complexity.

The book provides insights to a wide range of scholars. While of obvious appeal to historians of Japanese medicine or medical policy, Burns’s work is also of use to those interested in the early development of Japanese hospitals and sanitaria, which eventually stretched nationwide from Aomori to Okinawa prefectures. Her book is a valuable tool for drawing connections between disease and religion as well as disease and business. Her analysis of “leprosy in the medical marketplace” includes fascinating descriptions of various treatments, including the use of patent medicines, invented in many cases by doctor-entrepreneurs. Thanks to her meticulous work, which took “many years” to complete, the reader will certainly gain a deep understanding of the complexity of Japan’s history of leprosy as well as how it fits into a broader, global narrative.

Piece originally published at H-Net Reviews under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.


[1]. “Abe offers ‘deep, deep apology’ to relatives of leprosy patients,” The Asahi Shimbun, July 24, 2019,

[2]. One scholar that Burns mentions who has examined Japan’s ‘denunciatory history’ is Hirokawa Waka, in Kindai Nihon no Hansenbyō mondai to chiiki shakai (Osaka: Osaka Daigaku Shuppankai, 2011).