Disease and Discrimination - A Case of Hansen Disease in Japan and Taiwan
Tsutomu SATO, PhO, Fujita Health Uniνersity， Japan
Introduction
Hansen"s disease(HD), obsolete named Leprosy, is a disease that has been discriminated severely all over the world. HD is a chronic inlectious disease caused by the bacteria Mycobacterium leprae, but it had been misunderstood as a hereditary disease or highly inlectious disease to be leared and terrilied lor a long time. The social stigma connected with the advanced lorm 01 HD lingers in many countries and regions. Effective treatments lor HD were lound out in the 1930s with the introduction 01 dapsone and its derivatives. Although the forced quarantine or segregation 01 patients is unnecessa巾，some HD colonies or sanatoria still remain around the world. There are some sanatoria in Japan and Taiwan, too
Japan and Taiwan in terms of HD
Political and social institutions on HD in Japan and Taiwan might be compared with the periods under Japanese rule. The first Japanese-Sino War broke out between Qing Dynasty China and Japan in 1894 after disputing over the sovereignty of Korea. China deleated and ceded the islands 01 Taiwan to Japan in the Treaty of Shimonoseki in 1895. The periods dictated by Japan were classified into three. The first, "early years' of Japanese administration on Taiwan relers to the period between the Japanese lorces landing in 1895 and the Tapani Incident 01 1915. The Meiji government 01 Japan appointed Kodama Gentaro as the lourth Governor-General and Goto Shimpei as the Chiel 01 Home Affairs. They established the carrot and stick approach towards governance lor several years. This approach held that the natives could not be completely assimilated. Thus, Taiwan would not be governed the same way as Japan, but would be governed under a new set 01 laws
The second period 01 Japanese rule is between the e 門 d01 the 1915 Tapani Incident and the 1937 Marco Polo Bridge Incident. This second approach to ruling Taiwan held that Taiwanese were similar enough to the Japanese, and thus was using the same laws in the Home Islands. In 1919, Den Kenjiro was appointed to be the first civilian Governor-General 01 Taiwan. He used a policy 01“Doka", which meant assimilation. Taiwan would be viewed as an extension 01 the Home Islands, and the Taiwanese would be educated as Japanese subjects. In this period, Japanese regulations on HD brought into Taiwan. Governor-General Kamiyama
Mitusnoshin who was nominated by the Japanese Diet in 1926, had planned to construct leprosy sanatoria for three years and then opened Losheng Sanatorium, originally named Rakusei Sanatorium for Lepe巾，in 1930. Compulsory segregation in this sanatorium had been executed to control leprosy until 1962. After that, the admission to this sanatorium was by patients' willin 伊 essand drug therapy by pills allowed outpatient treatment. With a force of sanitary police and medical office悶， investigation, quarantine, and imprisonment of leprosy patients were conducted in the term from 1934 till the end of colonial government of Japan
The third and final period of Japanese rule in Taiwan began with the eruption of the Second Japanese-Sino War in 1937 and ended with the World War 11 in 1945. With the rise of militarism of Japan in the middle of 1930s, the Governor-General was again held by military officer, and Japan wanted to transport and utilize materials from Taiwan for the war. For this aim, it would be essential that the cooperation of the Taiwanese, and then they had to be fully assimilated as members of Japan. Social movements by them were prohibited and the Colonial Government put in serious efforts to the “Kominka movement" that aimed at Japanizing Taiwanese society. The Colonial Government began to strongly encourage locals to speak the Japanese language, wear Japanese clothing, live in Japanese-style houses, and convert to Shintoism
Japanese rule in Taiwan ended after Japan defeated World War 11 and signed the Instrument of Surrender 1945. Republic of China(ROC) troops representing the Allied Command accepted the surrender of Japanese military forces. After the Chinese Civil War, the Kuomintang(KMT), led by Ching Kai-shek, escaped from China and the ROC government fled from Nanjing t口 Taihoku. Some 2 million refugees, including of KMT pa 叫y membe悶，soldiers and the intellectual elites, fled from China and arrived in Taiwan. Political and Cultural differences between the Taiwanese Chinese and the mainland Chinese caused the social instabiliti 郎， leading to the 228 Incident and the reign of White Terror. When the social were instable, patients and handicapped persons were discriminated with bias and prejudices
Japanese regulations on HD, that were established in 1907, 1931,1953 and 1996, had effects on Taiwanese leprosy patients while these periods. In Japan, a law on preventing leprosy(preLPL) was established in 1907. Five leprosy sanatoria administrated by an association of prefectures were constructed. These sanatoria were accommodations for aids to relieve the wandering patients. Wealthy patients could leave and go back their home. If this law had been introduced into Taiwan in the “early years' of Japanese ru悟，compulsory segregation
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mighl nol have been execuled. Bul direclors of sanatoria were in fact given a righl of disciplinary arrest which could punish the patients wilhout Ihe court who violated rules of sanaloria. Humane trealmenls of patients had decreased as Japanese militarism had extended
Firsl national sanalorium named Nagashima-Asiseien localed in Okayama was conslrucled in 1930. The firsl director was Kensuke Milsuda who was a key person pursuing forward slralegies of compulsory segregation of all palienls at home, disciplinary arresl and no marriage wilhoul sterilization in sanator陷，leprosy cleansing movemenls in each prefeclures and so on. First leprosy prevention law(LPL 1) was established in 1931 slrongly urged by Mitsuda. The Heallh and Welfare Minislry drove legally the leprosy cleansing movements, which was called "Muraiken Undo". In Taiwan, LPL 1 was issued by an Imperil edicl in 1934. In Ihe second period of Colony was laken the approach of assimilation thal used the same law in Ihe Home Islands. The severity of investigation, quaranline, and imprisonment was equally in Japan and Taiwan
After Japan defealed in 1945, despite patients' vigorous resistance which demanded to repeal LPL 1, second leprosy prevenlion law(LPL2) was established in 1953 in much the same as in 1931. The leprosy cleansing movements drove by Government was conducted as well as before the war. Some Ihousands palienls were compulsory segregaled and their human rights were tram pled on until 1996 repealing LPL2
There was no effective treatment for leprosy until the development of dapson in 1940"s The 7們 International Conference of Leprosy in Tokyo in 1958 made a recommendalion 10 abolish com pulsory segregatio 門， to Ireal outpalient Iherapy and 10 repeal the law. Mullidrug Iherapy (MDT) combining all Ihree drugs, dapson, rifampicin, and clofazimine, was recommended by a WHO Expert Committee in1981. A tide of many counlries of Ihe world excepl Japan followed the recommendation of the conference and WHO
Japanese Government repealed Ihe law in 1996 bul did not admit its commitment to systemalic slale discriminalion. The governmenl was sued by some former leprosy palienls, and then the Kumamolo dislrict court in soulhern Japan ordered Ihe governmenl 10 pay 127 former leprosy patienls for failing 10 change a policy of segregating Ihem after 1960s. Japanese Prime Minisler Koizumi decided not 10 appeal againsl a cou 內 ruling Ihal il musl pay compensalion 10 former palienls, and formally apologized 10 them
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Through the turbulent after the war, Taiwan took the outpatient therapy and the admission to sanatorium by patients' willingness as well as the world standard. But discriminatory sentiments planted in periods of Japanese colonial rule do not wither away Taipei Rapid Transit System planned to build a depot on the site where the Losheng sanatorium is. The government built a new hospital building , Huei Long Hospital, nearby for setting the patients and the demolition 01 the original houses was proposed. But a preservation movement has been fight for several years by patients and students. The proposed destruction of this sanatorium might be drove by discriminatory sentiments that someone sill have
Dissolution of discriminations
Causes of discriminations are the mistakes in the cause of leprosy that it was not sin but
bacteri昌， not inheritance but contagion， 鬥 ot strong contagious but weak. Leprosy prevention laws had .isolated patients in sanatoria compulso巾. agitated and made citizens fear. Citizens had been indifferent to patients. After curable by drugs. they have no chance to correct their prejudices. Those who have correct knowledge do not discriminate former patients. It may be difficult that those who had prejudices once change their mind. But 1 hope the students have correct knowledge and do not have pr的 udices. So education can dissolve the discriminations on leprosy
Correspondence Tsutomu SATO, PhD Fujita Health University
Address : 1-98 Dengakugakubo，Kutsukake-ch 口.Toyoake.Aichi.4 70-1192.Japan Phone : 0562-93-2000
Websile: http://www.fujita-hu.ac.jp/
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