Yukichi Fukuzawa’s Outbreak Communication 2: Going beyond the “Protect Everyone” Rhetoric
Meiji-era reformer and educator Yukichi Fukuzawa was also a strong advocate of research into infectious diseases. In the second half of this article, Kaoru Iokibe examines Fukuzawa’s ties to pioneering bacteriologist Shibasaburo Kitasato and points to lessons we can draw in effective communication.
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Yukichi Fukuzawa on my mind, I have been thinking about the importance, and the difficulty, of good communication in these pandemic times. How Fukuzawa handled communication in his times makes me acutely aware that communication skills alone are not enough, for Fukuzawa also contributed importantly to medical progress itself.
Shibasaburo Kitasato (1853–1931), who was later nominated for the Nobel Prize in medicine in 1905 (the first year it was awarded), completed his studies at the University of Tokyo’s Faculty of Medicine in 1883 and accepted a researcher position at the Ministry of Home Affairs Sanitary Bureau’s Tokyo Research Station. At the recommendation of Sensai Nagayo, his superior there, he was sent to study in Germany, where he worked under Robert Koch. While in Germany, Kitasato not only achieved a world-first by growing the tetanus bacillus in a pure culture but also opened the field of serotherapy by discovering toxicity-neutralizing antibodies.
Kitasato was determined to establish an institution for the study of infectious diseases after his return to Japan in May 1892, but this was by no means easy. Happily, Nagayo introduced him to Fukuzawa, who extended his full support. Soon afterward, the Institute for Infectious Diseases was established as a private institute adjacent to Onarimon in Shiba-ku (now Minato-ku), Tokyo, in December. Fukuzawa provided both the land and the building, and the industrialist Ichizaemon Morimura (1839–1919) provided the equipment and other supplies in response to entreaties from Fukuzawa. Quickly outgrowing its initial six rooms, it drew up plans to move to Atago (also Shiba-ku).
This plan, however, ended up providing a case study in the importance of good communication. When the move was announced, area residents fearful of an outbreak of tuberculosis mounted a campaign to block the institute’s establishment in their neighborhood.
Although there are indications he preferred this not be a public confrontation, Fukuzawa quickly stepped up in defense of Kitasato and the institute. At first, he sought to find a solution through discussion, compromise, and cooperation with and among the veto-holders. Yet with the Tokyo Imperial University planning to establish its own infectious disease research institute, and with the Ministry of Education pledging to back the university initiative, this effort to quietly resolve the issue was quickly stymied. Nagayo’s support turned lukewarm, frustrating some of Kitasato’s supporters.
Among the many suggestions Fukuzawa threw out for blunting the opposition to hosting the institute was to delete any mention of infectious disease from its name. Fukuzawa also took to the Jiji Shimpo editorial pages in defense of Kitasato’s research institute, but the message was muddled and the results were mixed as he tried to cover all bases—unabashedly calling the nay-sayers ignorant nobodies while saying he understood why emotion-driven people would be worried and concluding with the assertion that scientific research must be expanded.
After claiming that prominent local people understood the need for the new research station and that the nay-sayers were a decided minority, he went on to say this minority could not be ignored. Somehow, they had to be brought around without being allowed to get their way, since yielding to them could well be seen as giving a green light to people who oppose infectious disease research and prevention efforts.
Deciding that the real problem was that the current research facility was too small and unable to care for the horses needed to produce tetanus antibodies and the sheep needed for diphtheria research, Fukuzawa proposed a compromise: relocate the attached hospital, which was drawing the fiercest opposition, and expand and improve the research facility.
Admonitions and Assistance
Kitasato, for his part, acted decisively, announcing both his resignation as institute director and his reclusion from the research on July 16, 1893. Then, the next day, he sent a petition to Nagayo, who was the deputy director of the Japan Association of Hygiene, detailing his position. The full text of this petition was subsequently run on August 11–12 as an editorial (“Densenbyo Kenkyujo no shimatsu” [The Fate of the Infectious Diseases Research Institute]) in Fukuzawa’s Jiji Shimpo. Kitasato admitted that as cutting-edge research advances and yields surprising new results, some people might be moved to voice their objections. This, he said in mock self-deprecation, was beyond the control of an unlearned and unexceptional researcher such as himself.
Science will come to a standstill unless things get better, Kitasato went on; contemplation so deep as to defy explanation is imperative if learning is to be advanced; science is ultimately an arduous course of trial and error, and even the slightest disturbance—just the sound of a single leaf striking the window—is an impediment to the necessary concentration.
The scientific mind demands intense concentration, not only in implementation but even more so when it is theoretical science, with bacteriology especially epitomizing this need since it deals with such minute things. This is more profound than I can write, more essential than I can say. . . . The researcher is engaged constantly in thought and in experiments—quite often without anything to show for such efforts. He can easily go for an entire day without eating or a night without sleeping, so intense is his concentration. No distraction can be allowed at such times, not even the tap of a leaf against the windowpane.
This is all the more reason for him to have stayed out of the affairs of ordinary men, as the public squabble over the research facility’s establishment was the very essence of such mundane affairs, entangling him in the overlapping webs of miscellaneous distractions, be they attendance at meetings, explanations to all of the assorted local power brokers, associates, and friends, or the constant press of deadlines and appointments. His research had to be fitted in among all of these other chores, and this was proving far too arduous. It was very difficult to switch his mind back to science once he became entangled in worldly affairs. He likened this to an alcoholic beverage that takes only a moment to drink but whose intoxication lingers much longer.
Once my thoughts have turned to the mundane, even if only fleetingly, it is inordinately difficult to free myself of its grasp and return to research. As such, this is somewhat akin to the drinker in that the actual drinking does not take long but the effects linger on, and it is ofttimes hours before the reverie ends. As such, it might be said that I have spent many a day recently intoxicated with the mundane.
The petition concluded by saying he wishes to be free of the daily routine to pursue his research interests, even if he has to leave the institute behind. The latter half of the editorial consisted of Fukuzawa’s explication and editorial advocacy on behalf of Kitasato’s plea.
Fukuzawa also posed the petition’s implicit question to the leaders of Shiba, asking if they, too, were not responsible for allowing the opposition campaign to escalate. Did they really do all they could to explain the institute’s importance to local residents? After all, the government provided a subsidy, so things should have been expedited with all due diligence, but did they truly do their part? In closing, Fukuzawa said that the issue will soon be taken up in the Diet and that he would be watching that carefully.
An academic myself, I could not be more pleased that Kitasato had written so eloquently of our plight, and I am sure all of us have had our research stalled by the press of other business. Many find it most difficult to switch off mundane concerns and get back into scholar mode. Even for those who find this relatively easy, I cannot but wonder if they really slip back in a state of full concentration. As such, Kitasato spoke for all researchers tormented by their involvement in affairs of the world.
A footnote in Fukuzawa Yukichi zenshu (Collected works of Yukichi Fukuzawa), vol. 14, p. 113, records that this petition resonated with the public and that opposition to the institute subsequently died down. Yet I wonder if this was simply a matter of acceptance among local residents. Rather, there may well have been an element of intimidation at the thought of a world-famous scholar such as Kitasato saying he was severing all ties with the institute. That might not have given the opposition leaders pause, but I suspect the local authorities, the government, and the Japan Association of Hygiene were moved to take this matter more seriously.
It was Fukuzawa, in fact, who authored Kitasato’s petition and got it published. In the end, a compromise plan proposed by Fukuzawa was adopted, or rather, it might better be said that Fukuzawa went ahead and made this happen. The Tsukushigaoka Yojoen TB hospital opened in September on a site that Fukuzawa had purchased and leased to it. He was able to overcome local opposition to such a facility by admonishing influential figures and making advanced medical treatment more widely accessible.
Given the efficacy of the Yojoen’s ministrations, Fukuzawa subsequently purchased and leased it additional land so that a serology center could be opened on July 2, 1896, giving a major impetus to the tuberculin testing and vaccination program. The Yojoen’s financial status stabilized that same year. The research institute and other facilities later formed the core of what is now the National Institute of Infectious Diseases.
Major Beneficiary and Major Benefactor
That said, there were those around Kitasato who were reluctant to see the facilities expand so much so quickly because the time Kitasato spent treating patients and managing the institute was time cannibalized from his research. Fukuzawa was, of course, aware of this trade-off, and he sought to alleviate the administrative burden on Kitasato by placing one of his students, Shigeaki Tabata (1869–1945), in the Yojoen as Kitasato’s secretary. Going back and forth between Kitasato and Fukuzawa, Tabata contributed significantly to the Yojoen’s development. Fukuzawa not only supported the Yojoen financially but secured in Tabata a major voice in its management.
In an exemplary expression of his commitment to progress and learning, Fukuzawa continued to support the institute even when he himself was having cash flow problems. At the same time, it must also be recognized that, when the Yojoen was flourishing, it was an important source of steady income for Fukuzawa. Fukuzawa continued to buy land and lease it to the Yojoen whenever it expanded, this arrangement ensuring him rental income on a recurring basis. He also built a retreat for himself in the nearby Hiroo area where he held study meetings, social gatherings, and more, often commanding Tabata and other Yojoen personnel to take part. Fukuzawa was actively involved in the affairs of the Yojoen as supporter, co-manager, and beneficiary.
Among his side perks, Fukuzawa received milk regularly from the Yojoen, which had a small herd of cows, but an October 1896 delivery was of unacceptable quality. Fukuzawa lost no time telling Tabata about it. For an institution specializing in bacteriology and claiming to uphold strict sanitary standards, this, he felt, was a betrayal of his trust. There was nothing particularly wrong with the milk itself, but the bottle had a hair-like something on the mouth which, Fukuzawa claimed, anyone would find highly disconcerting and was proof positive that the Yojoen was falling down on the job. He closed his complaint by stating that he was keeping the bottle, milk included, as a topic of future discussion.
Tabata and Kitasato himself appeared the very next day to apologize and were treated to a three-hour dressing down. Can he really have spent three hours haranguing them about poor milk? Tabata’s diary, which devotes considerable space to this incident, notes that Fukuzawa was also angry about other matters and demanded that the Yojoen cut off the \100 monthly stipend it was providing to Sensai Nagayo.
Fukuzawa understood that Nagayo was unable to advocate more vociferously for the Yojoen because of his ties to government and his efforts to make Western medicine an integral part of Japanese health policy. Fukuzawa, though, felt that Nagayo could have done more and was indignant that Nagayo expressed no remorse for remaining a Yojoen beneficiary while doing little to promote its fortunes. A year and a half after the milk bottle incident, Nagayo celebrated his sixtieth birthday on March 28, 1898, as mentioned in part 1. Fukuzawa had been felled by a cerebral hemorrhage two days earlier, but Tabata’s diary records that he had already made up his mind not to attend the congratulatory festivities.
What Would Fukuzawa Do?
It is widely agreed that communication is much more constrained today than it was in Fukuzawa’s day. From today’s perspective, much of what Fukuzawa said and did in support of Kitasato might be classified as sock-puppetry (as when he wrote Kitasato’s petition), intimidation (the threats contained in the petition’s closing lines), self-serving (purchasing land and leasing it to the Yojoen), and power harassment (commanding people to attend parties and the long harangue over a bottle of milk). All the more effort is needed now to ensure smooth communication by reconciling one’s own interests with those of others and reaching a broadly acceptable compromise.
Fukuzawa preached that it behooves all those who value their own life and feel for the misfortune of others to adhere to measures based on Western medicine to prevent the spread of infectious disease. Even though it may be inconvenient and troublesome, he said, precautions are still essential in everyone’s best interests. Yet people remained skeptical in the light of the authoritarian nature of the public health authorities at the time, and Fukuzawa was reduced to constantly lamenting how very uncooperative people were.
Today, the public is being far more cooperative in the face of the COVID-19 pandemic. Yet I wonder if people are fully convinced that the measures being implemented are in everyone’s best interests. Even though the novel coronavirus threatens to incite intergenerational strife in that working-age and younger people are at the end of the vaccination line even though their need to go to work and socialize increases their exposure risk while the older people who can generally afford to stay reclusive at home are priority vaccinated, the effort to stem the disease’s spread still seems to rely on rhetoric—namely, please do your part to protect everyone—that has not evolved much since Fukuzawa’s time.
Were Fukuzawa with us today, I suspect his rhetoric would be more cutting, perhaps dragging young people’s grievances out into the open in one of his columns. Along with scathing ridicule of young people out carousing at night, he would also ruthlessly satirize the older generations, maybe parodying one reminiscent of Nagayo, and conclude with a level-headed proposal to deal with the situation. In addition to offering relief payments to compensate for forced business closures, he may be interested in the idea of creating a special COVID account.
An essay that Shigeki Morinobu and others published on the Tokyo Foundation for Policy Research website (Japanese only) this January proposes establishing a special account for COVID-related expenditures. This is intended to avoid the risk that special relief measures bundled into the government’s general account might become a permanent fixture and, by making revenue sources explicit, to avoid simply passing the repayment burden on to future generations.
This proposal also calls for reform of the social security system. While I lack the specialized expertise to comment on the proposal’s merits, the fact that it seeks to reduce the burden on future generations by reducing outlays for older people means it will need the older cohorts’ understanding and cooperation.
The kind of communication we need today is to promote preventive medicine among young and working-age people and to press older people to cooperate with efforts to prevent our fiscal system from collapsing. Far from being a distraction, speculating on what Fukuzawa would say and do if he were alive today. It can give us deeper insights into the composure, but not complacency, needed for effective communication.
Read part 1 of this series, “Yukichi Fukuzawa’s Outbreak Communication 1: A Lesson in Conviction and Flexibility”
 See Fukuzawa Yukichi shokanshu (Collected Letters of Yukichi Fukuzawa), volume 7, edited by Keio University and published by Iwanami Shoten in 2002, p. 1757.
 See “Hasegawa Tai to Keio Gijuku: Fukuzawa Yukichi to no setten o chushin ni” (On Tai Hasegawa and Keio University: Relations with Yukichi Fukuzawa) by Toshiro Shimura and Takeyuki Tokura in the Japanese Society for the History of Medicine’s Nihon Ishigaku Zasshi, Vol. 59, No. 4, 2013.
 Fukuzawa Yukichi shokanshu, pp. 1758–59.
 See “Densenbyo Kenkyujo ni tsuite” (On the Infectious Disease Research Institute) in Jiji Shimpo, July 5–7, 1893.
 Fukuzawa Yukichi shokanshu, op. cit.
 Fukuda Mahito, Kitasato Shibasaburo, Minerva Shobo, 2008, pp. 149–150.
 Shojiro Shoda, “Tabata Shigeaki nikki kara mita Fukuzawa to Kitasato” (Fukuzawa and Kitasato as Seen in Shigeaki Tabata’s diary) in Fukuzawa Yukichi nenkan (Yukichi Fukuzawa Chronology), vol. 8, 1981.
 Shoda, ibid, and Takayuki Mori, “Kitasato Shibasaburo o sasaeta Fukuzawa Yukichi” (Yukichi Fukuzawa’s Support for Shibasaburo Kitasato), in Kindai Nihon Kenkyu, Keio University Fukuzawa Memorial Center for Modern Japanese Studies, vol. 34, 2018, p. 39–60.
 Shoda, ibid.
 Shoda, ibid.
 “Korera no yojin” (Precautions against Cholera), Jiji Shimpo, September 5, 1885.
 See my “Norigata seijika Suga Yoshihide no genkai to ikashikata: Abe yori mo Kishi motoshusho ni niteiru Suga” (The Strengths and Weaknesses of Yoshihide Suga: A Bureaucratic Politician More Reminiscent of Kishi than Abe) in the March 2021 issue of Ronza.)