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The new discipline thus became central to imperial medicine and was a driving force of Japanese expansion into the Asian continent. Korea, by contrast, receives little attention in Iijima's work and is discussed only in relation to a handful of Japanese experts. The burden of malaria on the civilian population is ignored.
While it provides a valuable overview of key developments in research, it does not make a detailed assessment of the colonial government's anti-malaria measures or of the relationship between malaria and colonialism. This article aims to fill this gap by evaluating the impact of Japanese rule on the malaria situation in Korea, from the time of the initial settlements in to the end of colonial rule in Although it is generally assumed that urbanisation tends to diminish malaria, it will be shown that the relationship between its incidence and urban development was extremely complex, sometimes tending to increase cases and sometimes to reduce them.
As in rural areas, malaria was exquisitely sensitive to the nature of economic activity, as well as to the movement of migrant labourers. This article tracks these fluctuations in relation to colonial development regimes and considers the response of local and imperial governments.
It ends by examining the legacy of the Japanese war regime in Korea, which influenced the malaria situation for many years after the nation's independence. Malaria was a very common disease among Koreans, whether ordinary civilians or members of the royal family.
In the summer of , for example, Prince Yang-Nyeong was affected by a disease which was almost certainly malaria and the renowned monarch King Sejong sent his court physician to tend his son. Allen, first director of Jejung Hospital which was the first Westernized hospital in Korea built by the Korean government in , was one of those who regularly used quinine to treat malaria patients.
The extent of the malaria problem in Korea is also shown by the writings of Japanese doctors from the time of the opening of Korean ports. For example, Dr Koike, who was an army medical doctor and the director of a state hospital serving from to in the Japanese settlement in Busan, Saisei Iin, explained that after diseases of the digestive system, malaria was the second largest cause of admissions among Korean patients.
After Korea's ports were opened by Japan, in , many Japanese people flocked there to make money. As the first treaty port in Korea, the south-eastern port of Busan became, to all intents and purposes, an imperial city even before Japan became a colonial power in a formal sense. Other settlements soon followed. The port of Incheon, which is close to Seoul, was opened in There, foreign influence was not confined only to the Japanese, for Incheon was a gateway for goods and people moving between Korea, Japan and China.
In , China also forced Korea to make a trade treaty, with the object of containing Japanese influence and securing its dominant position in the peninsula. With the same object in mind, China permitted the Korean government to make commercial treaties with the USA and, the year after, with Britain. However, it is important to consider the malaria problem in context, as the comparative effort to control the various diseases in Korea is instructive. Japanese settlers and soldiers suffered a variety of infectious diseases, such as cholera, dysentery and typhoid, largely due to the lack of an adequate water supply in their settlements.
These diseases were also common in Japan and may even have been brought to Korea. Most Koreans, by contrast, were infected with amoebic dysentery. In , these four Prefectures accounted for In , for example, out of a total of 2, Japanese settlers of Busan, people were infected with malaria. By the following year, cholera disappeared but a malaria epidemic occurred, being particularly severe in Busan. In , for example, of the 2, patients treated at the public hospital in the Japanese settlement, were admitted with malaria.
In , soldiers of the garrison in Seoul were suffering from dysentery, pleurisy and malaria, amongst other diseases. Westerners living in Korea experienced similar problems. A British medical practitioner explained that just after the treaty was signed between Korea and Britain, half a dozen cases of intermittent fever had occurred among the British servants and workers in Seoul and Incheon. Other types of fever were also apparently very common in Incheon and residents often suffered from a variety of ailments simultaneously.
Consul General in Seoul sent a letter to the British envoy in Peking, requesting two months' leave of absence that autumn as he was suffering from fever and extreme debility, complicated by beriberi. He explained that some Western doctors in Seoul moved from Korean houses which were located in the lower part of this city to European style houses on the hillside. This had enabled them to escape from the danger of malaria. Avison—a missionary doctor who built the subsequently famous Severance Hospital in —also mentioned the problem of malaria in Korea.
He came to Korea in July and became the director of Jejung hospital. Before the mosquito vector theory of malaria was known, he recommended Westerners to build houses on hillsides and to have their bedrooms upstairs because he thought malaria was caused by bad air emanating from marshland. After the s, the cases of malaria decreased in some areas, especially where the Japanese settlements were located. The commander of the Japanese garrison in Busan reported that while malaria was formerly one of the most severe endemics in the area, it had all but disappeared.
No specific regulations against the disease had been devised but general sanitary reforms in Japanese settlements during the pre-colonial period probably contributed to it. In the Japanese settlement in Busan, in June , a sanitary conference was held, sponsored by the consular office, to discuss the enactment of rules for the prevention of epidemics and the public health of the settlement, in view of a cholera epidemic the previous year.
As a result, the Rules for the Prevention of Cholera were produced in These provided for the cleaning of the shores, lavatories and dwellings, as well as the removal of ill-smelling things. From the start of the Russo-Japanese war, Japanese imperialism began to spread further into the Asian continent. Preparing for the war, Japan acquired the right from the Korean government to construct a railway between Busan and Seoul the so-called Gyeongbu Cheoldoseon.
In the midst of war, the railway was opened to traffic in January and, in the same year, the Kanpu Ferry which plied between Busan and Shimonoseki, began to operate, making Busan the bridgehead for Japanese expansion into Asia. In view of its rising importance, the Japanese resolved to transform Busan into a modern port city and the sanitary implications of this had to be recognised if it was to function effectively.
This mirrors developments in Japan's first colony, Taiwan, particularly in Taipei, where a remarkable reduction in malaria took place after urban sanitary reforms were carried out, including sewerage systems and improvements to housing. The reduction of malaria in some cities controlled by the Japanese followed much the same pattern as in Western colonies in Southeast Asia. In Dutch Java, British Malaya and French Indochina, malaria became rare in cities but remained prevalent in rural areas.
After Korea's ports were opened by Japan, in , many Japanese people flocked there to make money. Both Simon Peter and James the Just spoke against requiring circumcision in Gentile converts and the Council ruled that circumcision was not necessary. The operation should be performed by a surgeon without administering an anesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. Thus, men who display this signal of sexual obedience may gain social benefits if married men are selected to offer social trust and investment preferentially to peers who are less threatening to their paternity. A history of the world's most controversial surgery. Reviewed book manuscripts for leading publishers. Most Koreans, by contrast, were infected with amoebic dysentery.
A Japanese naval doctor explained that the reason was that Western authorities carried out urban sanitary reforms for their people who lived in the cities. In all these respects, rural areas lagged behind. For this reason, the anti-malarial campaign established a new institution, the rural health station, in the countryside.
In some cases, urban development caused overpopulation and unsanitary conditions, which led to cases of malaria increasing. In rapidly expanding cities such as the great Indian port of Bombay, malaria cases tended to fluctuate, depending on the vigour with which anti-malaria measures were enforced. As a result, the Korean government was deprived of its right to conduct diplomacy independently of Japan.
Finally, in August , Japan annexed Korea forcibly. Even before the annexation, since , the state hospital and Western style medical school, which both were built in , came under Japanese control, which frustrated some recent initiatives taken by the Korean government to reform medical care and public health. Afterwards, the sanitation department was incorporated into the police system in order to manage the sanitary administration of Seoul and surrounding areas.
Following the annexation, the Government-General centralized the sanitary police system in Korea and, in the following year, the sanitary police were given control over all aspects of administration, except the management of the state and charitable hospitals which were directed by the Japanese military doctors. However, the high morbidity of Japanese settlers continued well into the colonial period. In , for example, 1, Japanese settlers were affected by dysentery, whereas only Korean dysentery patients were recorded.
In , there were 4, patients with infectious diseases in the main cities of Korea; among them 2, were Japanese, although the number of Korean patients was probably underestimated. Like Western imperial powers, the Japanese regarded the eradication or, at least, control of infectious diseases as a duty incumbent on any civilised nation or empire. Since the Meiji Restoration, Japan had whole heartedly embraced Western medicine, especially the laboratory-oriented medicine of imperial Germany. In particular, Japan aimed to sanitize the capital Seoul and reform the hygienic habits of its residents and presented these efforts as part of its civilising mission.
The Koreans themselves had little part in the programme and little was done to improve their general health during the colonial period. Unknown publisher, , Most adult Japanese who came to Korea were exposed to endemic malaria for the first time, by contrast with most Koreans, who would have encountered malaria as a child. Like other persons raised in highly malarious areas, Koreans exhibited a degree of clinical resistance to malaria.
It is well known that parasitemia prevalence rates are highest in childhood and early adolescence and decrease thereafter. The differential incidence of malaria among Japanese and Korean populations can be seen from a study undertaken by the director of the Kangreung Provincial Hospital.
Kangreung is located in Kangwon Province, in which malaria was severe. The director recorded that there were 8, Korean and Japanese residents and collected the number of Japanese and Korean patients who were treated for malaria at the hospital. The number of Koreans suffering from malaria was therefore likely to be underestimated. Nevertheless, the number of Korean patients visiting the hospital was large enough to show some interesting differences in the incidence of malaria among Koreans and Japanese, particularly the ages of the patients.
He pointed out that Japanese and 2, Korean patients were treated for malaria at the hospital from to , the vast majority of the latter being below the age of In contrast tp Koreans, the majority of Japanese malaria patients continued to be middle-aged. The susceptibility of this age group was problematic because it included key colonial personnel, including soldiers. In the Japanese garrisons in Korea, malaria was one of the chief nuisances and military doctors began to turn their attention to malaria as a specific problem rather than leaving it to be tackled by the sanitary police.
From to , the annual average number of malaria patients in Japanese garrisons was just above Of the total of 1, malaria patients during this period, were from the Hamheung Infantry, South Hamgyeong Province in the nineteenth division the recurrence rate was 26 per cent. During the same period, the annual average number of malaria patients in the twentieth division was just above , and the total number of patients was , the largest number being from Daejeon, South Chungcheong Province where the recurrence rate was 16 per cent.
From to , the average morbidity of malaria among soldiers of divisions in Japan was around 4 per thousand, whereas from to the average morbidity among Japanese soldiers in Korea was 55 per thousand, decreasing to 36 per thousand in However, only a few of them were cured completely; the rest ignored their symptoms or relied on the natural healing process. In addition, many Koreans slept outside during summer without mosquito nets.
The colonial government's inactivity in relation to malaria, according to some army officers, stood in marked contrast to its energetic measures against distoma pulmona a parasitic infection caused by a species of lung fluke and leprosy, which posed little or no danger to military effectiveness.
From to , the Government-General earmarked a sum of money for research on endemic diseases. During the first two years, these funds supported research on distoma pulmona as well as propaganda activities to let people know about the disease. Laws were also enacted to prevent the consumption of raw crabs, which was the main way in which the disease spread. The supply of information and the regulation forbidding the eating of raw crabmeat resulted in a decrease of pulmonary distoma.
Leprosy was privileged for different reasons. In , the Government-General built a national leper sanatorium on Sorok island to demonstrate the colonial government's philanthropic activities to other countries. From the s, the Japanese royal family began to take an interest in this work, encouraged by the Japanese government which was keen to establish the royal family as the pivot of totalitarian rule. The family's philanthropic work was portrayed as an expression of its divine and merciful nature. The colonial government collected contributions not only from civil servants but also citizens in its drive to enlarge the national sanatorium.
This policy led to the deportation of lepers from other regions to the sanatorium; not only wandering lepers, but also some settled persons suffering from the disease. Morbidity and mortality from the two diseases mentioned above was far less than that from malaria. In , distoma pulmonary patients amounted to 5, Japanese , Koreans 5,, foreigners 4 and the number of deaths was 1, Japanese 19, Koreans , foreigners 1.
As far as leprosy was concerned, the number of patients was 2, Japanese 20, Koreans 2, and of deaths, Japanese 1, Koreans Due to the anti-distoma pulmonary measures, in cases of this disease decreased to 3, Japanese 86, Koreans 3,, foreigners 1 and deaths decreased to Japanese 4, Koreans Even though it was difficult to determine the number of cases and deaths from malaria among Koreans, the number of recorded patients increased rapidly to , Japanese 8,, Koreans ,, foreigners but deaths decreased to 2, Japanese 26, Koreans 2, Generally the extensive prevalence of malaria fever in Chosen is attributable to unsatisfactory prophylactic measures, especially insufficient use of mosquito-nets and the old habit of sleeping out of doors in summer.
In this respect, however the persistent efforts of the health authorities to promote better-living conditions on the one hand, and the administration of quinine as remedy on the other, have brought about in recent years a remarkable diminution of patients. As he pointed out, the supply of quinine and knowledge of mosquito transmission had reduced mortality from malaria.
This increase in malaria cases seemed to be linked to the Government-General's economic policies: From to , government-controlled salt farms were constructed in Kyeonggi Province and South Pyeongan Province to compete with cheap Chinese salt and acquire revenue from sales. In , the staff and families of a branch office of the monopoly bureau located near the salt farm constructed in South Pyeongan Province were also suffering from malaria and typhoid fever.
In addition, sewage and drainage systems were incomplete. Thus people who lived around the construction often suffered from flooding. As a result, in , the monopoly bureau of the Government-General promised to build drainage ditches in this area. To improve the supply of rice to Japan, the Government-General began at the same time to increase rice production, the so-called Sanmi Jeungsan Gyehoek.
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In , due to the inflated price of rice, riots occurred all over Japan. In response, Japan put into operation plans to secure national self-sufficiency in foodstuffs and the Government-General of Korea supported it. The substance of the plan was the building of irrigation systems, reservoirs and land reclamation.
In , the Irrigation and Drainage and the Reclamation Divisions were founded by the government and in December of the same year the government enacted the Chosen Irrigation Association Law to prompt construction of irrigation systems. The irrigation rate proportion of agricultural land irrigated increased from Also, Korean agriculture depended increasingly on the rice-field farm system.
The main breeding areas for Anopheles in Korea were paddy fields, ditches, puddles, and even sewage and water plants. During the late nineteenth and early twentieth century, the cultivation of rice and sugar farms, which depended on the introduction of new year-round irrigation technology, led to many severe epidemics of malaria.
Another contributing factor to the rise of malaria in Korea during the s was the influx of Chinese migrant labourers, particularly from the Shandong peninsula which was one of the most malarious areas of China.
On the other hand, the number of foreigners from other countries was only 1, They were engaged in reclamation works, civil engineering, farm work, transportation and so on. There was also an influx of Korean and Japanese labourers into the port of Busan during the s. Because of the decline of agriculture, the development of industries, construction works for the harbour and so on, Busan experienced a wave of immigration and this led to housing problems and the enlargement of slum areas in the city.
Poor water supply and sewerage worsened the sanitary environment. The slum areas and Korean villages were untouched by sanitary reform and remained vulnerable to infection. As mentioned above, Kobayashi and other Japanese doctors stressed that malaria was to be found all over the country, whether in rice fields or mountainous areas. In other countries, too, malaria tended to thrive among poor farmers who were displaced from the land or who retained a small plot of land but lacked the resources to improve it. Such populations often lived in inadequate shelters and subsisted on nutritionally poor diets.
The reason for this obviously risky behaviour was that their houses were small and could be occupied only for sleeping. In Ceylon, for example, infection with malaria affected the delivery of food and water, often leading to infection with other diseases. This accords with J. Just after the annexation, Takeuchi, an army medical officer, reported on the general sanitary condition of Korean society. He drew attention to the problem of malaria among Japanese civilians and Koreans as well as Japanese soldiers; however his main focus remained on malaria in Japanese garrisons.
In , patients were treated for malaria but in the figure increased to Thus, in , this division began to take active anti-malaria measures, such as spraying oil into ditches and puddles, using mosquito repellents and nets. It also supplied quinine to soldiers as a prophylactic. These measures—which were carried out at the behest of the army and implemented by its personnel—appear to have produced a slight decline in the number of patients. In , the number of patients was and it decreased to in Unlike Japanese military officers, the Government-General did not begin to support research into malaria until the summer of In each colonial settlement, there tended to be a different hierarchy of disease problems.
In view of this, the colonial government's sanitary policies continued to concentrate on infectious diseases. A few Japanese medical officers and Korean doctors did do research on malaria but the central government did not distribute free or reduced price quinine to civilians, although a few local governments provided it for civilians, on their own initiative, when a severe epidemic of malaria occurred. In July , in South Pyeongan Province, which was still severely affected by malaria, the local government distributed quinine free of charge to the inhabitants. The board of health of this provincial office surveyed the carriers of plasmodium and there were about 15, people, normally under the age of twenty, who had the parasite.
This office provided enough quinine for 7, people, but the amount was insufficient. Reviewing the trend of hospital admissions and deaths from malaria, in , when malaria research began, the number of patients and deaths actually increased from , to , and from 2, to 2, But from , except for , the patients and deaths from malaria decreased overall with a few exceptions.
The numbers of patients with and deaths from malaria were counted until to be convenient for duties of the Police Affairs Division. In , most parts of Korea, particularly in the south Kyeongsang, Chungcheong and Jeolla Provinces were damaged by severe flooding and frost.
Heavy rainfall and flooding badly affected the harvest. For example, during the summer of , victims of flooding in Kyeongsang Province were attacked by malaria and dysentery and a relief squad was dispatched to the damaged areas. And 50, patients and deaths, all Koreans, were recorded in the areas of North Korea which experienced a bad harvest. As a result, mortality in these areas was higher than other provinces.
In the following year, the malaria epidemic abated and the number of patients and deaths decreased steadily. In , most of the provinces showed a fall in malaria patients and deaths, except South Chungcheong Province. One of the reasons why the disease decreased seems to be the drier weather. At this time, many areas were suffering from drought throughout the year. Overall, the number of patients fell from 14, to 9, and deaths decreased from to In general, there is a positive correlation between urbanisation and the decline of mortality and morbidity from malaria, chiefly because it tends to reduce opportunities for Anopheles to breed.
One reason for this increase in urban malaria may have been the fluidity of the population in these cities, a large proportion of which was made up of labourers. During the s, the Government-General planned to absorb surplus labour from rural areas by employing men in the defence industries under the quasi state of war since the Japanese invasion of Manchuria. As a result, they became fire-field farmers or casual labourers; many remained jobless for much of the time and most lived in insanitary conditions.
In , incidences of malaria were rising there, unlike in other provinces, while typhoid fever and dysentery were also severe. Among the labourers in Seoul, there were two carriers of the P. Discovered in , these labourers had been to Osaka and other places in order to find work. They also had a history of several diseases such as measles and typhoid fever.
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