Japan has one of the highest rates of hepatitis C virus infection in the industrialized world. This endemic and the challenges it poses for the future of Japan’s healthcare system stem, ironically, from the formation of a modernist settlement beginning in the late 19^th century. Modern techno-scientific solutions to political problems inadvertently provided millions of opportunities for hepatitis C to spread in rural communities, among leprosy communities, the traumatized postwar community and into the national blood supply.

Late on the morning of March 24, 1964, Edwin Reischauer, President Kennedy’s ambassador to Japan, stepped through the front door of the U.S. Chancery building in Tokyo and headed towards a waiting Cadillac that would take him to a meeting with Kim Jong-pil, a South Korean politician and founder of the South Korean Central Intelligence Agency. Suddenly, a young Japanese man wearing a raincoat and thick-lensed spectacles darted up and stabbed Reischauer in the right thigh with a 6-inch kitchen knife. The wound was deep and bled profusely: Reischauer’s femoral artery had been severed. Embassy officer, John Ferchak, used his necktie to make a tourniquet, probably saving the ambassador’s life. Four aides quickly bundled Reischauer into the limousine and the car took off for the nearby Toranomon Hospital. There, Japanese surgeons worked for four hours to repair the damage to Reischauer’s leg. In the course of the surgery, he received several blood transfusions.

The next day, Reischauer released a statement to the press in which he said in part: “I was born and grew up in Japan, and now that I have received Japanese blood, I finally feel I have become half Japanese.”¹ But the transfusions had not only made Reischauer half Japanese, they had also infected him with the hepatitis C virus (HCV). He had been given what the Japanese were calling “yellow blood.” Three weeks later, recovering at Tripler Hospital in Honolulu, he displayed all the symptoms of acute hepatitis. In retrospect, this was almost certainly the acute phase of HCV infection, but since the hepatitis C virus was still far beyond the limits of scientific knowledge and the incubation period for hepatitis was not supposed to be so long, U.S. Army doctors diagnosed mononucleosis. Twenty-six years later, becoming half Japanese caught up with the founding father of postwar Japanese studies: after many years of debilitating illness caused by chronic HCV infection, Reischauer died of HCV-related cirrhosis and hepatocellular liver cancer. In the end, becoming more Japanese killed him.

In 1964, HCV infection via direct blood-to-blood contact with contaminated blood was happening wherever medicine could afford transfusion technology and wherever blood products and hypodermic syringes were in use as therapies or therapy delivery systems. Although the hepatitis C virus probably originated in West Africa in the late 15^th century, its global sweep and pandemic status in the world today are both intimately linked with progression of the modernist settlement: the dualistic epistemological structure of modernity in which science and technology are divided from and purified of culture and politics. In the late 19^th and early 2th centuries, this Platonic, post-Enlightenment settlement produced public health programs in North America and in Europe that were then exported into colonized territories as pure science without reference to their engagement with the political practice of imperial hegemony. If the results of unwitting introduction of European infectious diseases into 17^th, 18^th and early 19^th century America and Australia were genocidal for indigenous populations and cultures, the depoliticized delivery of public health vaccination, fertility management and disease eradication programs in colonized or subaltern communities between 1918 and 1989 was a modernist vehicle for both demographic and disease outcomes that would not become apparent until decades later.

Perhaps this latter consequence of a modernist settlement is nowhere more apparent than in the political epidemiology of hepatitis C virus in Japan, where the political problem posed by the possibility of domination by the Euro-American powers between 1854 and 1945 was countered by resort to intense techno-scientific solutions increasingly set apart from social and cultural matters as time went by. Amongst these solutions were a nationwide public health project, a pharmaceutical research and marketing project and adoption of medical technologies for delivery of public health services and pharmaceutical products. From these solutions came Japan’s 21^st century hepatitis C endemic. Among wealthy industrialized states, Japan has one of the highest rates of chronic hepatitis C virus infection: about 2.3 percent of the population bear the virus whereas in the United States, HCV infects about 1.8 percent; in nations such as Germany and Australia, 1 percent or less live with chronic hepatitis C infection. Japanese are four times more likely than Americans to develop liver cancer,² and more than three quarters of all cases of primary liver cancer in Japan are caused by chronic hepatitis C virus infection.³Since liver cancer is very difficult to treat, the great majority of people diagnosed do not survive without liver transplantation. Hepatitis C infection also produces a host of other disabling syndromes and conditions: cirrhosis; acute fatigue; lymphoma; depression; cognitive deficit; blood and skin disorders. The economic, personal and social burdens of chronic hepatitis C virus infection are thus very heavy.

Working back from the current endemic, we can track a political epidemiology of HCV infection in Japan that comes directly from the local modernist settlement. In the period from the arrival of Perry at Edo to the surrender in 1945, Japan’s modernizers were remarkable for all the qualities noted in modernists by the historian of science, Bruno Latour: daring; research; innovation; tinkering; youthful excess; increasing scale of action; acceleration; multiplication of modernizers; creation of stabilized objects independent of society.⁴ And yet there were sometimes catastrophic consequences from modernist techno-scientific solutions to the problem of how to keep Japan out of the clutches of the West and elevate it to the status of modern world power. One of the most admirable of these modernists was Sensai Nagayo, but his solutions also led to the spread of hepatitis C virus in Japan. In 1871, Sensai was an eminent physician practicing in Nagasaki, but he was called to Tokyo and asked to join the Iwakura Mission, a group of scientists, and policymakers charged with scouring the world for technologies, practices and ideas that might be brought back to Japan and used to construct a modernist settlement.