3

Health

Preventing, Diagnosing, and
Treating Venereal Disease

BIOMEDICAL INTERVENTIONS: PUBLIC HEALTH
REFORMS AND VD CONTACT TRACING

From the very beginning of the occupation period, the occupation regime considered communicable diseases a serious medical problem for the health of occupation personnel. Venereal disease (VD) in particular received major attention, since the occupiers believed, in accord with orientalist stereotypes, that it was especially widespread in Japan and in the Asia Pacific region as a whole. As early as January 1945, Commander Walter H. Schwartz of the U.S. Navy’s Bureau of Medicine Surgery, who was in charge of the Section of Venereal Disease Control, argued that despite the general downward trend of the venereal disease rate among U.S. soldiers and sailors as compared to the First World War and the period that immediately followed it, the military should be cautious. According to Schwartz, “Beneath that tobogganing curve are concealed a complexity of developments and circumstances.” Schwartz codified this supposed complexity regionally and racially, and envisioned that, “as we move more deeply into the Asiatic theater, we are likewise moving into areas of very high VD prevalence.”1 Similar views surfaced in an annual report from February 6, 1946, in which V. J. Erkenbeck of the Eighth Army’s Office of the Surgeon, stationed in Japan, stated concerning the activities of its Medical Department:

The health of the troops for the period of time covered by this report was excellent. [. . .] The most important causes for hospitalization due to disease were infectious hepatitis, malaria, schistosomiasis, scrub typhus, amebic dysentery and tropical dermatoses. Venereal diseases did not present an unusual problem until the arrival of Eighth US Army troops in Japan.2

While Erkenbeck admitted that there had been ten cases of diphtheria, all other diseases were either “no longer a problem” or only occurred in isolated cases among the Japanese civilian population. However:

After the arrival in Japan, the incidence of venereal disease among troops increased materially. [. . .] Prostitution in Japan is widespread and is controlled by the police, licensed prostitutes being confined to prostitute quarters. Periodic examinations and treatment of infected prostitutes during the war years was lax and specific drugs were very scarce. [. . .] Initial examinations conducted in the months of September and October 1945 revealed approximately 50% of them infected with syphilis and probably 75% of them infected with gonorrhea. In order to combat the venereal disease rate among prostitutes, the civilian authorities were ordered to report all cases of venereal diseases and to enforce weekly examinations of prostitutes. [. . .] Control measures in military installations as of the end of the year included an intensified educational program, posters, films, entertainment and recreational program. Among colored troops these were less effective than among white troops and very high rates were occurring among colored units stationed in the larger cities.³

The occupiers’ medical departments repeatedly portrayed venereal disease to the occupation administration as one of the most serious medical issues. They viewed venereal disease as a result of widespread prostitution, which they singled out as its predominant source. The deficiency of Japan’s police and public health system, according to Erkenbeck’s and others’ reports, even contributed significantly to its uncontrolled increase. They proposed educational campaigns as well as the introduction of thorough medical surveillance as solutions to win the “combat” against venereal disease. Their language was often riddled with racist resentments against nonwhite servicemen who supposedly failed to accommodate to such efforts.

As Erkenbeck’s annual medical report from 1946 indicates, there was a compromisingly high rate of venereal infections among the occupation troops in occupied Japan. The most common venereal diseases were gonorrhea and syphilis. In some units of the U.S. occupation army stationed in Japan, venereal disease rates went up to 50 percent during the early stages of the occupation period. The British Commonwealth Occupation Forces (BCOF) stationed in the Chūgoku region in southwestern Japan apparently faced quite similar rates, with a total of 5,823 venereally infected BCOF servicemen in September 1946—in some Australian units, the infection rate even exceeded 50 percent.4 A study on venereal disease by the U.S. Navy in Sasebo from May 1951, which estimated that the venereal disease rate “remained greater than 400 per 1000 per annum,” shows that such a high ratio was not uncommon during the whole course of the occupation period.⁵ Among the Japanese civilian population, venereal disease rates were also numbered among the highest of any communicable disease. A report from September 10, 1949, for instance, documents an overall number of 20,204 cases of communicable diseases in Japan, including diphtheria, typhus, malaria, scarlet fever, epidemic meningitis, measles, tuberculosis, and venereal disease. Like most reports on communicable diseases, tuberculosis headed this particular list with 11,474 reported cases, closely followed by venereal disease. In total, the report lists 8,287 cases of venereal disease, including 3,835 cases of syphilis, 3,994 cases of gonorrhea, and 458 cases of chancroid.⁶ Thus, venereal disease constituted 41 percent of all reported cases of communicable disease in this particular medical survey, a ratio not uncommon throughout the occupation period for both Japanese civilians as well as occupation personnel, while the dark figures were presumably much higher.

Considering the vast number of venereal disease cases among the military personnel as well as the civilian population, it is not surprising that VD received special attention from the occupier’s medical and hygiene departments. They urged the occupation regime to enforce medical regulatory measures to counter the spread of venereal disease. Among the ranks of the occupation forces, these measures may have been seen as intruding into the most intimate spheres of servicemen’s body and behavior: their genitals and sexual activity. Yet venereally diseased servicemen signified more than just sick soldiers unfit for duty. At stake was the reputation of the occupation project and its personnel.⁷ VD-infected servicemen could undermine the occupation’s ideals and stability, particularly because VD questioned the occupiers’ health, discipline, and prowess—traits that are closely entwined with the servicemen’s individual masculinity and the masculine character of the occupation regime. Numerous medical regulatory measures also addressed the civilian population, and the occupiers’ medical departments were particularly keen in monitoring all sexual encounters between occupiers and occupied. Their medical gaze thus also attempted to penetrate into the occupieds’ intimacy and monitor their sexual behavior.

This chapter analyzes the efforts and strategies of the occupiers’ medical and public health departments to cope with the issue of venereal disease, and discusses the interrelationships between American and Japanese agents who tried to sanitize sex by intervening at the biomedical level. The main focus will be on SCAP’s Public Health and Welfare Section (PHW), but the chapter also includes a look at the practices and concepts of the BCOF. The U.S. and British Commonwealth occupiers were hardly a homogenous ruling elite, of course, and each had their own histories of controlling venereal disease and regulating prostitution and their servicemen’s sexuality. Nevertheless, in occupied Japan they were all equally concerned about venereal disease and the medical condition of their personnel, and they implemented quite similar mechanisms of control.8 Where source material allows, I will highlight the interaction and ambivalent cooperation between occupiers and occupied by looking at exactly how the occupiers approached Japanese health authorities and specialists, how they communicated medical knowledge and practices to Japanese physicians and public health officials, and how they, at the same time, appropriated and remodeled certain aspects of Japan’s health system. The actions and reactions of the occupied are difficult to determine, not least because they could often only articulate themselves within the communicative boundaries established by the occupiers. Communication within those boundaries was possible, for example, through the occupation regime’s channels of communication (where translation of Japanese bureaucratic memoranda into English was compulsory), in minutes of meetings and conferences compiled by the occupiers, or at the numerous lectures, training programs, and inspections where American and Japanese physicians and hygiene specialists met, talked, and shared experiences. Such dialogues usually took place only in English or though translators and were, on the whole, subject to a grid of asymmetric power relations that made them quite similar to encounters in previous colonial settings. It goes without saying that such encounters were open for misunderstanding, ignorance, transgression, and mimicry, but they remain an invaluable tool for assessing the variety and complexity of the history of medical regulation during the occupation period. The aims of this chapter are to analyze the biomedical discourse on sexuality, prostitution, and venereal disease, and to explain the significance of venereal disease regulation for the occupation period overall.

Agents of Biomedical Control

Military surgeons at all echelons of the occupation army as well as members of the Public Health and Welfare Section (PHW) eagerly endeavored to prevent, control, and limit venereal infections by applying medical concepts and public health strategies. SCAP designated the PHW as the staff section responsible for building and securing basic sanitation and welfare programs, and protecting the health of the occupation personnel as well as the Japanese civilian populace. Although the PHW was rather small in number with only 150 members at its peak, the section assembled highly trained physicians, public health administrators, and specialists in vaccination, quarantine, nutrition, and nursing. The PHW employed American military and civilian personnel as well as several Japanese specialists, who mostly worked as translators. Brigadier General Crawford F. Sams, a graduate of Washington University’s School of Medicine in St. Louis and the Command and General Staff School at Fort Leavenworth, Kansas, headed the PHW. The peripatetic international life he had led during his career in the U.S. military was not uncommon for members of the PHW. Sams himself had extensive experience in foreign medical and health services as an assistant surgeon in the Panama Canal Division during the late 1930s and as the U.S. military’s chief surgeon in the Middle East and North Africa during World War II. He had also directed the U.S. military government’s public health policies in occupied Korea and during the early Korean War.9

The PHW and the occupation army’s surgeons often cooperated in the medical regulation of venereal disease and shared similar methods and aims when it came to dealing with prostitution in occupied Japan. At a conference on October 21, 1945, for instance, James H. Gordon, chief of the PHW’s Venereal Disease Control Section, and Brig. General Rice, surgeon of the Eighth Army, agreed that controlling prostitution by means of regular examinations of prostitutes, venereal disease clinics, and the distribution of modern drugs among Japanese health authorities would offer a “minimum standard of technical and administrative procedure [which] is highly desirable.”¹⁰ Such propositions show that the medical departments of the army and the PHW both followed a social hygienist approach, which did not attempt to repress prostitution, but favored public health interventions with scientific tools of preventive medicine, diagnosis, treatment, and surveillance to control the spread of venereal disease.¹¹ PHW administrators and military surgeons were often familiar with both U.S. domestic as well as overseas military hygiene practices and imported medical knowledge from the United States and various other regions of the world to Japan. They were keen on implementing their familiar methods of venereal disease control, such as maintaining prophylactic facilities, applying and distributing drugs such as mercurous chloride and penicillin, or early efforts to keep venereally infected patients under surveillance.12

After arriving in Japan, however, American physicians and hygienists encountered Japanese hygiene specialists and their knowledge, methods, and institutions of public health in venereal disease control. The contact with a new terrain and its at times unfamiliar set of hygienic practices and channels of communication in the public health system generated ambivalent reactions among the American medical and hygiene specialists. On the one hand, the PHW and other medical departments in the occupation army repeatedly emphasized America’s supposedly more modern and scientific approach to prophylaxis, diagnosis, treatment, and surveillance of venereal diseases, in contrast to Japan’s antiquated public health system. As markers of the occupier’s medical superiority, they referred to the development of modern drugs such as penicillin, but also diagnosis techniques and especially the acquisition of supposedly objective data through medical surveys. On the other hand, new developments in military medical practice sometimes involved appropriating facets of Japan’s supposedly inferior public health system. In one such case, for example, public health communication channels were modified to implement an extensive venereal disease reporting system called VD contact tracing. In doing so, the PHW had to rely on public health institutions and surveillance practices prevalent in Japan, such as the regular mandatory health inspections of sex workers that were carried out by Japanese physicians at venereal disease clinics near red-light districts, or Japan’s public health administration. One reason might have been the lack of resources and the occupiers’ need to rely on Japanese institutions and their personnel. Nevertheless, an ambivalent simultaneity of rejection and incorporation between American and Japanese venereology specialists, physicians, and health administrators often characterized the occupier’s medical interventions against venereal disease in Japan. In the course of the occupation period, the PHW planned to remodel—or, as the PHW staff preferred to call it, to reform—Japan’s medical venereal disease control, which was historically embedded in imperial Japan’s licensed prostitution system. This reform, however, was not a unilateral export of American medical knowledge to Japan. The PHW’s intervention did transform postwar Japan’s public health system, but the process of engaging with the biomedical circumstances faced in Japan, and the interaction with Japanese public health officials, also shaped and refined the PHW’s concepts and strategies for controlling venereal disease. Medical venereal disease control as fostered by the occupiers therefore followed quite similar mechanisms of what has often been described as colonial modernity in medical public health reforms.13 With regard to the vast web of U.S. military installations throughout the Asia Pacific region under the Far East Command following the end of World War II, it is even rather likely that the U.S. military further disseminated the knowledge it gained from its Japanese experience of venereal disease control throughout the whole region.

Ambivalences and tensions in the medical regulation of venereal disease also existed within the administration of the occupation regime. The PHW followed and propagated modern medicine and scientific, objective truth that would not buckle under moral or political sentiments. This, according to its members, was the core of its self-identity. Accordingly, Crawford Sams repeatedly pleaded for dealing with venereal disease as they would any other kind of communicable disease, regardless of its political and moral implications. Venereal disease and its allegedly single source—uncontrolled prostitution—should rather be “attacked” with “education, prophylaxis, case-finding, isolation and effective treatment of infections,” which Sams considered “the basic weapons of venereal disease control.”¹⁴ This thoroughly medical, seemingly objective perspective, of course, proved to be over-optimistic, and Sams himself acknowledged—at least retrospectively in his posthumously published memoirs—that venereal disease control was a “controversial issue” involving “a moral [. . .] as well as a medical” component.¹⁵ Despite the PHW’s persisting self-conception that it was guided by modern scientific reason in the hygienic control of prostitution, venereal disease, and sexuality, it was unable to avoid controversies and conflicts with other branches of the occupation regime. On the matter of licensed prostitution, for instance, as has been shown in chapter 2, the occupier’s provost marshal and military police (MP) tried to repress prostitution with police raids and off-limits bans. This was largely a response to political pressure from the military command, the U.S. State Department, and the American public, which was scandalized by the consistently high rates of venereal disease among servicemen and the supposedly lax control of prostitution in the Far East Command. Sams blamed the provost marshal and military police for treating prostitutes as criminals and advocated seeing them as patients, who, according to Sams, “must be located and managed in the same manner as contacts of any other infectious disease in order to prevent the spread of these diseases.”¹⁶ Accordingly, the PHW eagerly tried to convince the supreme commander of the inefficiency and even counterproductivity of police raids. The provost marshal and the MP treated prostitution and venereal infections as crimes, without locating and thoroughly treating infected patients, which would eventually be the only way to limit the spread of venereal disease.

Quite similar tensions existed between the PHW and the military’s Chaplains’ Association, whose members criticized the very existence of prostitution and the military command’s tolerance of the vast array of sexual opportunities in occupied Japan, and—as will be explicated in chapter 4—taught the servicemen high moral standards and developed character guidance programs to combat extramarital sex, promiscuity, prostitution, and venereal disease. For the PHW, however, Japan’s licensed prostitution system, with its regular health inspections of prostitutes and contact tracing, was a necessity, as it offered the minimum degree of medical control required to limit the spread of venereal disease. Its members thus regularly criticized the political decisions made by the military command, the ineffectiveness of police raids in red-light districts, and the chaplains’ moral judgments. They furthermore claimed jurisdiction for public health management in general and venereal disease control in particular.

Despite the PHW’s insistence on modern scientific reason and objectivity, however, its medical regulatory practices were, as Mire Koikari has rightly put it, “never outside the problematic operations of power.”¹⁷ The PHW was definitely influenced by political, cultural, and moral propositions surfacing in the introduction of modern medical and hygienic knowledge to the Japanese public as well as in the control of venereal disease.¹⁸ For example, it is remarkable how Crawford Sams and other members of the PHW cried out for a normalization of venereal disease as just another common communicable disease, while the PHW’s actual engagement in venereal disease control nonetheless reproduced venereal disease’s difference. Through the constant representation of venereal disease in extra passages, columns, and charts within medical reports, surveys, and memoranda, the PHW created a discursive formation of venereal disease in the occupier’s health regime that perpetually marked venereal disease’s slight extravagance and distinctiveness relative to other diseases.¹⁹

The following sections discuss in detail some of the major medical regulatory techniques of diagnosis, treatment, surveillance, public health education, and prophylaxis the PHW and other medical departments of the occupation army implemented, practiced, and developed. Two major medical regulatory practices will be addressed in particular: the medical report system called VD contact tracing and the medical institution of prophylactic facilities. The contact tracing system and the infrastructure of prophylactic facilities were both important medical regulatory practices for sanitizing the occupiers’ as well as occupieds’ sexuality. They constituted biopolitical efforts by the occupiers to measure, classify, and categorize the Japanese population as well as the occupation personnel for a neocolonial topography. At least on a discursive level, this functioned to legitimate the occupier’s rule, produced and affirmed alleged cultural and racial differences, and made Japan and its people more transparent and tangible for the occupation administration. Furthermore, an analysis of prophylactic facilities allows us to track some of the servicemen’s everyday sanitary practices against venereal disease. It helps to reconstruct how American sailors and soldiers themselves interpreted the occupation regime’s attempts to medically control venereal disease, prostitution, and sexuality, and allows glimpses of servicemen’s intimate relationships to their own bodies.

Medical Measures: Inventory and Appraisal of
Japan’s Venereal Disease Control

As early as the first few weeks of the occupation in September 1945, PHW officers convoked frequent conferences and meetings with delegates of Japan’s public health system, mostly bureaucrats of Japan’s public health administration. Additionally, the PHW also interviewed several civil venereologists and urologists like Toyama Ikuzo, Takahashi Akira, Ichikawa Tokuji, and a certain Dr. Miyata, all members of the Japanese Association for the Prevention of Venereal Disease (Nihon seibyō yobō kyōkai) and mostly scholars affiliated with Tokyo Imperial University. The PHW often praised their expertise, as they had gained proficiency in venereal disease control during their education in Europe or the United States.20 Nevertheless, most of Japan’s venereal disease specialists had formerly worked directly or indirectly for some sort of state agency under the umbrella of the Home Ministry (naimushō) in Japan’s public health system. In immediate postwar Japan, the PHW attempted to co-opt Japanese physicians, hygienists, and bureaucrats to help the PHW collect data and inventory existing institutions, equipment, and methods of venereal disease control.

Venereal disease control in postsurrender Japan was closely intertwined with imperial Japan’s licensed prostitution system, which allowed only registered prostitutes, who received weekly medical examinations in special venereal disease clinics, to work in licensed brothels in designated areas. Since the late nineteenth century, venereal disease control and the licensed prostitution system had been part of a larger public hygiene policy. Because imperial Japan’s authorities considered venereal disease a potential threat to the social order, they had treated venereal disease control predominantly as a police matter, and they integrated public health sections into the prefectural police departments under the jurisdiction of the Home Ministry.21 During the war years, police control of prostitution and venereal disease tightened even further, and local police units thoroughly prosecuted unlicensed prostitutes and also attempted to repress licensed prostitutes and entertainers. At a conference on October 20, 1945, Takenori Hyakutoku and Otake Bungo, chief and subchief of the Peace Section of Tokyo’s Metropolitan Police Department, affirmed to James H. Gordon, chief of PHW’s VD Control Section, that sole responsibility for the control of licensed prostitution and venereal disease lay with Japan’s police force.²² It thus has to be kept in mind that in imperial Japan, the police had potentially monitored all medical examinations and other public health interventions to control venereal disease.

Further revelations of how licensed prostitution and venereal disease control worked in Japan at the end of the war come from a meeting on October 3, 1945, involving Yosano Hikano, chief of the Preventive Medicine Section of the Tokyo Preventive Health Department, and Fukui Katsu, superintendent of the Yoshiwara City Hospital’s venereal disease section. At the meeting, both informed James H. Gordon and his PHW colleagues in detail about public health venereal disease control in Japan’s licensed prostitution system and shared with them their experiences in Yoshiwara, prewar Japan’s largest red-light district, located in northern Tokyo. According to the meeting’s minutes, Yosano and Fukui pointed out that “clandestine prostitution” was prohibited by law, and that the license system’s venereal disease control had only encompassed three classes of licensed women who all worked at “fixed houses.” Those in the first group, so-called “public prostitutes,” were “subject to periodic examination and compulsory treatment.” The second group consisted of “private prostitutes” (Yosano and Fukui do not explain the difference between these two groups of prostitutes), who were “subject to weekly examination,” though hospitalization and treatment were voluntary. Brothel owners, often organized in associations, usually provided the medical care or covered the expenses. The third group consisted of geishas, and Yosano and Fukui strongly emphasized that they should not be considered prostitutes but rather highly educated entertainers, who were thus not obliged by law to undergo venereal disease examination. Obviously proud of their work, Yosano and Fukui reported that 3,000 prostitutes and 120 geishas had once been regularly examined and treated in the modern, three-story-high Yoshiwara Hospital. Currently, however, there were “about 50 prostitutes in the Yoshiwara area operating in 3 shabby houses,” of which “13 [prostitutes] are known to be infected and are now in the Yoshiwara Hospital.” Certainly with some remorse, they stressed that the capacity of Yoshiwara Hospital had to be reduced to 100 patients, who, as the meeting’s minutes taker figuratively described, “are crowded together in the native style of floor mats.” Furthermore, “examination and treatment rooms are dirty and disorderly,” and “drug shelves are bare except for dust.”23

Japanese laws recognized gonorrhea (rimbyō), syphilis (baidoku), and chancroid (nansei gekan) as venereal disease, of which gonorrhea and syphilis were widespread. According to Fukui Katsu and his experiences at Yoshiwara Hospital, 50 percent of all prostitutes in Yoshiwara had a history of syphilis, and he further stressed “that about 40% of women coming into prostitution areas from the provinces have Syphilis”—numbers that were not uncommon in other brothel areas throughout Japan. Thorough examinations of venereal disease, however, were apparently rather rare, usually conducted by physicians in health centers such as Yoshiwara Hospital, located in the proximity of brothel districts or in segregated rooms inside the brothel itself. Physicians diagnosed syphilis by visual gynecological inspection only, and gonorrhea, as Fukui asserted, was “diagnosed by smear stained usually with methylene blue due to lack of Gram’s stain.”²⁴ Treatment of venereal disease was apparently equally deficient, mostly because modern drugs such as penicillin or mapharsen, which American physicians had developed and tested (in an often discriminatory manner) during the 1930s and 1940s, were not yet available in early occupied Japan.²⁵ As Yosano and Fukui reported to Gordon, in imperial Japan, physicians usually treated syphilis with an intravenous “injection of an arsphenamine, an injection of bismuth and an intravenous injection of mercury oxyceprate, given concurrently for about 10 weeks.” Treatment of gonorrhea consisted “of a sulfonamide (sulfanilamide, sulfa pyridine or sulfathiazole) in three gram doses orally and three grams of ‘Neo Polean’ (4 amino benzol sulfon acetamid) intravenously each day until cure.” Additionally, Japanese doctors also used gonococous vaccines if the Japanese National Institute of Infectious Diseases could provide them, and treated chancroid “with sulfonamides and ducrey vaccine.” Upon Yosano and Fukui’s report, James Gordon concluded that “the present organization and functioning of the program of venereal disease control is wholly inadequate to prevent the spread of venereal disease in the civilian population and the occupation forces,” and surmised that the “most pressing needs are for modern drugs and competent personnel of all types.”26

Another important aspect of the license system in imperial Japan was the requirement that prostitutes possess a health certificate issued by special venereal disease clinics or health centers to certify negative testing for venereal disease. Although physicians usually conducted the medical examination, police officers could also be present at the inspections, which, as Fukuda Mahito has described, “often promoted an atmosphere of fear, making the many of those being inspected uncooperative”²⁷—a rather euphemistic interpretation of the invasive, discriminatory, and often forced health examinations that embodied the gender-biased double standard and exploitative nature of imperial Japan’s licensed prostitution system. The health certificates (kenkō shōmeisho) stated the prostitute’s name, her (the overwhelming majority of sex workers were female) membership in a brothel association, the brothel where she worked, and the services she provided. The certificate furthermore listed the dates and results of all health examinations.²⁸ As a remnant of the former license system, local Japanese health officials continued to distribute such health certificates after the end of the war, much to the displeasure of the occupiers. Apparently, some sex workers began to use health certificates in their attempts to demonstrate their “cleanliness” to customers, but also to the police during raids, in order to dodge compulsory examinations. This accelerated a debate on the issuance of such health certificates and their trustworthiness among members of the PHW and occupation medical and military police departments, which went on until the 1950s. The PHW’s central point of critique was that the certificates often only camouflaged their bearers’ state of health. They criticized Japanese standards of examination and diagnosis, which fell short of those of the occupiers, especially since long-term disease surveillance was not part of the Japanese venereal disease examination requirements. Another reason was, as some occupiers remarked, that sex workers, pimps, and brothel owners often forged counterfeit certificates or bribed physicians, health administrators, or police officers to issue whitewashed documents. The occupiers therefore assumed such certificates should not be trusted, and they based their assumption on the prejudice that Japanese physicians, health administrators, and police officers were either lacking in professional skills and equipment, highly corruptible, or both.29

Members of the PHW gave similar assessments of the venereal disease clinics and health centers near brothel areas. Under Japan’s Health Center Law passed in 1937, Japanese communities maintained health centers (hokenjo) in most neighborhoods to cover health care all over the country. These were the medical institutions where most people experienced Japan’s health system in their everyday lives. A major part of the health center’s responsibilities was diagnosis and treatment of venereal disease.³⁰ From October 1945 until the summer of 1950, delegates of the PHW traveled to almost all of Japan’s prefectures and major cities on “staff visits” to inspect health centers and brothel areas. James H. Gordon, Oscar M. Elkins, consultant of the PHW’s Venereal Disease Control Division, and the Japanese American Isamu Nieda, PHW’s assistant venereal disease officer, usually undertook these tours—sometimes accompanied by Japanese representatives of the newly established Ministry of Health and Welfare (kyōseishō). All of them filed reports that included a detailed inventory of the health center’s capacity, staff, laboratory equipment, and drug supply. As the initial reports from 1945 to 1947 indicate, the PHW inspectors were largely dissatisfied with the health centers’ conditions. They supported their allegations of inadequacy with detailed descriptions, mainly by highlighting the lack of trained staff and laboratory equipment. A general criticism was that the health centers’ venereal disease control focused only on prostitutes, rather than on the general public.³¹

Quite often the PHW inspectors used subtle, but nevertheless significant expressions to articulate their dissatisfaction. One recurring marker in the PHW’s travel reports is quotation marks, which James H. Gordon and his colleagues used frequently to ironically underscore the inadequacies of the inspected facilities. Upon a visit to Yokohama in November 1946, a year after the end of the war, Gordon observed two prostitution quarters and nearby health centers. In his report, he stated: “‘Health examinations’ by Japanese physicians are said to be performed 9 times a week: daily by a private physician employed by the Association; twice weekly by an ‘official doctor’. The ‘examination room’ and ‘hospital’ in this area were visited. They consisted of three rooms, entirely bare except for a quilt and an irrigating stand in the ‘examination room’.”³² Gordon used “health examination,” “official doctor,” “examination room,” and “hospital” to express what Jacques Derrida called a nonrepresentational aspect that nevertheless signifies through the production of its difference. Gordon’s quotation marks are essential; according to Derrida, quotation marks are signs of citation, (often ironic) distantiation and transformation, in which the common usage and meaning of the term they surround is still visible, but somewhat displaced from its common meaning. It thus receives a new signification by creating a new context for the term and its application.33 Gordon created a difference between the “examination” conducted by Japanese physicians and the examination procedures favored by the PHW. Hence, the PHW ironically displaced Japanese efforts to examine and monitor infected prostitutes as substandard medical practice in contrast to the supposedly more advanced and accurate medical techniques the occupiers applied.

The PHW had a high degree of confidence in their visits, and its members were convinced that their advice would genuinely improve the level of local venereal disease control. This confidence—or rather arrogance—was not directed only toward the Japanese health administrators and physicians; it was also an inherent feature of criticism of the military command and local military government teams along with their staff and efforts to reform occupied Japan. Oscar M. Elkins, for instance, remarked in his staff visit report to Nagoya in January 10, 1947, that the Aichi prefecture’s director of sanitation, Dr. K. Oshima, only “carries out directives in the sense that it will please Military Government rather than understanding that he is making a start on what is to be a permanently improved public health program.” Furthermore, Oshima did not realize “his responsibility to the Japanese people or any concept of doing public health for the people’s benefit.” Elkins also described Oshima’s appointed prefectural venereal disease control officer, Dr. Takabe, as having “no concept of the necessity for establishing venereal disease control facilities for the people,” for he “was not an active clinician and . . . could not possibly have sufficient time for venereal disease work even if he were properly trained.” The regional military government team’s health officer, Captain W. Wiley, however, appeared to Elkins “as a very capable physician,” who had “an excellent idea of what we [the PHW] are trying to do in venereal disease control.” Elkins concluded, however, that the ignorance of Japanese administrators was not the only major problem. Equally problematic was the allegedly “anomalous” position of the military government teams, who were led by “tactical units who really have no interest in civil affairs.” Elkins, who “believed that as a result of [his] visit the Military Government Health Officer was aided in establishing venereal disease control facilities for the people in Nagoya Prefecture,” was of the opinion that public health work should be generally subordinated to the PHW and not to the military command.34 Thus, the subtly ironic remarks on the health centers’ condition, the criticism of the command structure of the occupation army, and the overt confidence in the PHW’s public health work are good examples of the PHW’s self-conception as a seemingly benevolent, more advanced, modern, and scientific group of occupiers. They are also good examples of the occupiers’ arrogance in occupied Japan.³⁵

Members of the PHW were not always subtle in expressing their arrogant and to a certain extent colonialist attitudes. They were also perpetually blunt in their evaluation of Japan’s public health system. Even though they considered liaising with Japanese specialists necessary, and at times even appreciated the work and expertise of young, foreign-trained Japanese specialists in particular, PHW officers nevertheless tirelessly pointed out what they saw as a general deficiency of the Japanese health system. When it came to the medical control of venereal disease, they believed Japan’s health system was only capable of efficiently controlling licensed prostitution, but totally ineffective in treating “clandestine” street prostitution.³⁶ Despite the fact that the PHW had to rely on the personnel and infrastructure of Japan’s health system—especially due to the understaffed situation of the PHW—most of its members were convinced, as the head of the PHW Crawford Sams put it, that the “very limited public health program of venereal disease control in Japan centers around the licensing, examination, isolation and treatment of public [read: licensed] prostitutes,” and was “completely inadequate to prevent serious hazard to the occupation forces and the civilian population itself.”³⁷ They responded with suspicion or even open distrust to the endeavors of Japanese health administrators, such as the regular health inspections and surveys of brothels, sex workers, venereal disease clinics, and the distribution of drugs, and regularly crosschecked reports filed by Japanese officials. PHW personnel sometimes reached conclusions that were at variance with those of their Japanese colleagues and hastily assumed that their own results—supposedly based on a more modern, more scientific truth—were correct. Characteristic is a small handwritten note in the margin of a report by Oscar M. Elkins commenting on the results of a certain Captain Richmond, who had concluded that the rates of gonorrhea in three of Tokyo’s red-light districts were much higher than a Japanese report had stated: “This is more like the true state of affairs. O.M.E.”³⁸

In general, PHW officers portrayed the Japanese health system as backward and inadequate. They reported “tragic work” done by Japanese physicians in diagnosis and treatment, and complained about the poor standards of all medical and sanitary institutions. In a summary report from March 28, 1947, Oscar M. Elkins collected statements made by PHW members and other U.S. military physicians all over Japan to address the contemporary situation of venereal disease control in Japan:

The chief difficulty seems to be in the training of the physicians and the reluctance of the public health department to get new measures started. [. . .]

The prefectural sanitary section is completely ignorant as to the exact figures on the sources of infection; but it has been estimated by one of the more alert private physicians that about 80% of the cases in men originate from prostitutes. [. . .]

They administer the drugs until the patient becomes symptom free only. [. . .]

There is no such thing as complete treatment. [. . .]

Clinical standards are poor. Treatment methods are totally inadequate. [. . .]

Generally, Syphilitics are all inadequately treated due to poor teaching prevalent in Japanese medical schools since the Tokugawa era. [. . .]

The clinical standards followed by the best clinics [. . .] are based upon the SCAP “Outline of Technical Standards and Procedures in the Diagnose and Treatment of Venereal Diseases” dated 27 November 1945. This is the theory. The practice varies from almost complete adherence to the principles outlined to a Mid-Victorian quackery which is a complete anachronism in the middle of the 20th century. [. . .]

It all boils down to the fact that V.D. Control, as we know it in the States, is practically non-existent in [Japan]. There is practically no case finding or contact tracing. [. . .]

An intensive orientation campaign aimed primarily at the medical profession to consider VD as a problem common to the entire population is my suggestion. Subsequently this campaign should filter down to the lay public liberally diluted with the local idiom.39

The statements basically describe Japan’s public health and hygienic practices and institutions as anachronistic and backward, always in contrast to the supposedly more advanced and hence more modern, rational, and scientific U.S. American (which is also to say, Western) health system. Such representations of the Japanese health system echo in most reports on Japan’s medicine, hygiene, and sanitary facilities, but with a particular emphasis on the control of venereal disease. A recurring narrative element in the PHW’s statements is Japanese physicians’ alleged ignorance of new diagnostic and treatment methods. The PHW’s perception and representation of Japan’s public health thus bears a remarkable resemblance to older medical and public health narratives in colonial settings, where colonialists had also expended much energy attempting to affirm their superior position through science, medicine, and hygiene as vehicles of modernity, authority, and masculinity.40 In the attempt to attest to their advancement and progressiveness, the occupiers stressed medical inventions such as the development of penicillin, but also new methods of diagnosis and medical surveillance. The occupiers regarded especially the acquaintance with numbers, as signifiers of supposedly objectified scientific knowledge—the “true state of affairs,” as Oscar M. Elkins was quoted above—as a clear indication of their superiority to the Japanese occupied. This conviction was central to the occupiers’ reform efforts in Japan’s public health system. It was translated into public health control through contact tracing and the case-finding of communicable diseases, techniques of biomedical control that the PHW first introduced in occupied Japan and eagerly applied in the control of venereal disease.

Cartographies of Venereal Disease: VD Contact Tracing
and Public Health Reform

The occupation regime had considerable trouble dealing with the Japanese system of licensed prostitution and venereal disease control. Members of the PHW agreed that monitoring sex workers by means of mandatory weekly health examinations would help to cope with the situation of widespread venereal disease.⁴¹ On the one hand they agreed to maintain licensed prostitution, at least temporarily, to enable strict venereal disease control for Japanese civilians as well as occupation personnel. Although the PHW considered the methods and practices of Japan’s public health system to be deficient overall for lack of modern drugs, it did believe that a mininum of venereal disease control could be achieved by introducing certain medical techniques, such as dark-field microscopy for syphilis diagnosis, and by educating Japanese physicians and nurses. On the other hand, however, a rigorous policing of prostitution contradicted the overall democratic project in occupied Japan, especially after the much-celebrated abolition of licensed prostitution in 1946. As members of the PHW had predicted, however, the abolition of the license system resulted in a spatial dispersion of prostitution, mostly in the form of “clandestine” street prostitution. The PHW called for a public health education program and effective methods of prophylaxis, diagnosis, and treatment against the uncontrolled spread of venereal disease, but was simultaneously wary of appearing overly authoritarian or disrespectful of individual rights. The PHW showed ambivalence in its engagement with venereal disease policies and put much effort into reforming Japan’s public health system, which its members perceived as their contribution to modernizing and democratizing occupied Japan. The occupiers’ benevolent desire to remodel Japan’s health system thus appears to be yet another reverberation of a colonial discourse. PHW officers often bluntly described public health reform as an imperative necessity and civilizing “uplift” integral to the occupiers’ zeal for democratization.42

The occupiers’ quasi-colonialist interpretation, appropriation, and reform of Japan’s public health system are clearly manifest in the PHW’s implementation of the social hygienist concept of contact tracing. Contact tracing—in this case VD contact tracing—is a method of public health regulation that requires the vast acquisition, storage and evaluation of data of venereal disease patients. It is a collaborative network of physicians, public health administrators, and law enforcement agencies, in which the personal information of venereal disease patients, such as social background and contacts, living environment, habits, and physical characteristics are shared so they can be used to supplement physicians’ diagnoses and health agencies’ interventions. On the basis of such information, public health authorities and law enforcement agencies were able to identify and detect particular patients as well as their contacts, who might have infected the patient or been infected by the patient. In theory, contact tracing spins a net of surveillance and control around the whole population and around a certain group of people in particular, whom the involved agencies consider to be contagious or in danger of infection. They in turn become easy targets for public health interventions such as forced medical examinations, treatment, and educational campaigns. Contact tracing was thus driven by a biopolitical agenda of population management, which sought to “economize the social” on the basis of statistical calculability.⁴³

During World War II, the U.S. military widely used contact tracing, but only domestically. Proponents of contact tracing, such as Commander T. J. Carter of the U.S. Navy, declared it a “new pattern in venereal disease control,” because it was adapted to the new, supposedly general trend of decentralization in commercial sex and the resulting decentralization of the spread of venereal disease. Carter, who was in charge of the preventive medicine division in the U.S. Navy’s Bureau of Medicine and Surgery, stated in an article in the Journal of Social Hygiene in 1943 that there was a “trend from ‘commercialized house’ prostitution to a sexual pattern of a more informal, clandestine, and possibly less mercenary character.” An “essentially ‘authorative’ approach” to repressing prostitution by police force alone would, according to Carter, not help to control “pick-ups,” as he referred to the new form of sex work emerging for military personnel in the 1940s. Repression would instead “result in the ‘scattering’ of prostitution and indiscriminate exposure” of venereal disease, if “the entire local area does not get at the problem by coordinated police, health, and social action.” Thus, contact tracing involved the collaboration of various agencies, but also the general public, who, Carter believed, were in need of more education in sexuality and public health as bulwarks of venereal disease prevention.44 Military health officers, however, did not always think of the general public as contributing to the success of contact tracing, regarding them instead as vulnerable targets for military public health policies. In another article in the Journal of Social Hygiene, Colonel W. Lee Hart, chief of the Medical Branch of the U.S. Army’s Headquarters Eighth Service Command in Dallas, Texas, dwelled on this point. Hart unmistakably classified the civilian population as “a great reservoir of infection,” who were also responsible for spreading venereal infections within the military: “The usual spread of infection . . . is from civilian elements to the military rather than from the military to civilian.” According to Hart, the military’s most effective tactic “to stamp out these diseases in their personnel” would be the circulation of “Contact History Reports.” Following a positive venereal disease diagnosis of a serviceman, the diagnosing physician would document the patient’s “contacts during the period when he may have been exposed to the infection” and forward a report to the state health officers. Upon the basis of this information local authorities would then be able to locate, treat, and if necessary isolate the “infected individuals.” Without any second thoughts about the rights or privacy of the targeted civilians, Hart claimed that “Through the cooperative efforts of the civilian health authorities substantial reduction in the incidence of venereal diseases in military installations has already [been] accomplished.”⁴⁵

In occupied Japan, military surgeons of the occupation army and members of the PHW univocally praised contact tracing as the only method for effective control of communicative disease. As documented in numerous memos, charts, and statistics, they promoted contact tracing as the most scientific approach to venereal disease control and also regarded it as proof of the modernity of the U.S. health system.⁴⁶ Statistics, as a technique for the economization of the social, was definitely nothing new in the history of modern Japan, as Japanese government administrators had been using statistical knowledge since the late nineteenth century.47 Nevertheless, the occupiers insisted that their skills in obtaining, evaluating, and distributing statistical data were more advanced than those of the Japanese occupied. This modernistic self-conception was further highlighted by the PHW health officers’ argument that they were, contrary to their Japanese colleagues, much more interested in the health of the entire population than in the welfare of any individual patient—a stance articulated along similar lines by the British occupiers, who also stressed the importance of maintaining statistics on the population’s “trends of disease.”⁴⁸

The occupiers started to introduce the regulatory practice of VD contact tracing in Japan as early as October 1945, but it was quite some time before they succeeded in establishing it. Its introduction was accompanied by tensions and contradictions between the occupiers and the occupied as well as among different sections of the occupation regime. The greatest problem was the issue of jurisdiction and cooperation among the various agencies involved, such as the PHW, the provost marshal, and their respective sections in the local military government teams. Japanese public health authorities also reacted in disparate ways. Some local administrators eagerly and wholeheartedly supported the PHW’s public health reforms in venereal disease control while others simply ignored directives, regardless of whether the occupiers or Japanese ministries had issued them. Most, however, preferred to carry on with the regulations and procedures of imperial, presurrender Japan. In this arena it was rather difficult to introduce a consistent and cooperative venereal disease reporting system that included both the occupation army and the Japanese public health system. This might be one reason why contact tracing failed throughout the occupation period to achieve its desired results of effectively decreasing venereal disease rates—despite the praise continually heaped upon it by the hygienists of the occupation regime. However, contact tracing nevertheless was a significant intervention into Japanese society, and it did affect the occupation of Japan in various ways. Close analysis of contact tracing reveals—among other things—the PHW’s perception of Japan and the Japanese, its attempts to map and measure the occupied society, and last but not least, its efforts to sanitize the sexual encounters of servicemen and women of the occupied country.

The U.S. military had applied contact tracing quite early within the occupation army, from the beginning of the occupation. The Eighth Army released, under the authority of SCAP, a “Venereal Disease Contact Report Sheet” with remarkable regional specifics for the Far East Command, which stipulated mandatory reporting of all cases of venereal disease since January 1947. U.S. military surgeons and venereal disease officers were compelled to fill out forms indicating date and time of infection, along with the “patient’s” and “contact person’s” nationality and color and/or race. It is worth noting that the military’s form did not require the patient’s—the male soldier’s—name, but only asked for his unit and station number. Much more space on the form was dedicated to identifying the contact person, however. Surgeons and venereal disease officers had to document all personal details including name, nickname, address, occupation, place of work, height, weight, and eye and hair color—sometimes they even attached photographs. The report sheet’s section on procurement history furthermore required full particulars on the contact: whether the contact was a friend, “pick-up,” or prostitute, and whether the initial contact was made on one’s own effort, mediated through a pimp, in a brothel, in the unit, on the street, at a train station, or in a dance hall; and whether the sexual intercourse had occurred in the barracks, at home, in a hotel, brothel, bus, an alley, or a rice paddy. Finally, the serviceman had to indicate whether he had been sober or drunk, and whether he had applied any prophylaxis.49

Interestingly, the report sheet used in the occupation army did not ask for any details on the biological sex of the patient or the contact person. The report sheet’s logic rather presupposed a gendered distinction, namely that the patient was male and the contact female. There is a revealing supplementary note on the form asking the physician to inform “the patient [. . .] that the purpose of obtaining this information is to treat the girl and prevent her from infecting others.”⁵⁰ Such utterances follow a classic gender-biased discursive pattern, which describes exclusively women—mostly in their role as prostitutes—as the source of venereal disease and makes them alone responsible for its spread.⁵¹ Furthermore, the new report sheet shows how the occupation regime generated a specific medical knowledge that affirmed a normalization of sexual encounters while accepting and even expecting sexual intercourse between male servicemen and women of the occupied society. Although at the risk of overinterpretation, I want to interpret the logic by which the report sheet normalizes sex as a significant and signifying element of the occupiers’ expectation that women of the occupied society always be available as prostitutes, “pick-ups,” or girlfriends. Hence, the report sheet’s gendered differentiation implies or reproduces a certain feminization of the occupied society—a classic element of colonial topographies that Anne McClintock has famously called “porno-tropics”: VD contact tracing and its data collection tools and logics portrayed occupied Japan as a dangerous place that lacked hygiene but offered ubiquitous opportunities for instantly realizing sexual fantasies, raising the specter that self-control might be nearly impossible. The male occupier could discover and explore these hazardous yet desirable opportunities in order to prove and affirm his masculinity and superiority, which consequently required close administration through modern, scientific medical and hygienic techniques. Venereal infections, as signs of uncontrolled, “diseased” sexuality, had to be prevented to protect the masculinity of the occupiers.52

Such gendered differentiations obviously had certain racial dimensions, which segregated the occupiers from the occupied. However, they also translated into another set of racial boundaries, which was reproduced in the military contact tracing report sheets. The report sheet compelled military surgeons to register both patients and contacts according to racial categories and to categorize soldiers as either “white” and “colored” or “Negro,” an expression of the racist color line the U.S. military maintained de jure until desegregation in 1948, but practiced far longer.⁵³ This resulted in numerous statistics concerning venereal disease according to racialized categories, which surgeons, hygienists, and military commanders repeatedly cited as proof of the supposedly higher infection rates among African American servicemen, to whom they attributed an ethnocultural susceptibility to venereal infections on account of their alleged hypersexuality and lack of discipline.⁵⁴ In order to racially categorize the “contact,” the diagnosing surgeons developed a much more diverse taxonomy according to which the mostly Japanese women were categorized as “colored,” “yellow,” “brown,” “Mongol” or “Jap” for short.⁵⁵ Most of these labels stemmed from an older tradition of racist thinking prevalent in the United States and the U.S. military, which—when it came to Japan—intensified significantly during the Pacific War.⁵⁶ Although the occupation administration’s censorship prohibited the occupiers in occupied Japan from making overtly racist statements in public, for example in mass media coverage, racist sentiments and tensions were nevertheless omnipresent throughout the occupation period.⁵⁷ Racist epithets like “yellow” or “Jap” in the venereal disease contact report sheets are typical examples of the continuity of racist terminology among U.S. military personnel. This seeming diversity of racial categories, however, should not mislead one to assume any sort of creativity or cultural sensitivity among the military surgeons and PHW officers—it consistently adhered to the strict racist segregation of the occupiers and the hierarchization of the (mostly) white, male occupiers and the nonwhite, female occupied.

On behalf of the PHW, SCAP released a directive that also ordered Japanese health authorities to trace VD contacts and to report all cases of venereal disease to the occupation authorities. The PHW compiled special forms to be used by Japanese physicians and health administrators to report venereally infected civilians “by name, age, sex, and full address.”58 All prefectural public health departments had to hand in these reports monthly, including population numbers of the prefecture, numbers of clinics and physicians, and the gendered numbers of venereal infections. The PHW was predominantly interested in the source and development of infection. They directed Japanese public health authorities to document, first, whether a commercial or “clandestine” prostitute, a friend, or wife/husband had infected the patient. Second, they expected the health authorities to note why, when, and where the infection was diagnosed, and, third, whether the patient had received medical treatment and whether the patient was still registered and being monitored. The PHW believed, as Oscar M. Elkins remarked, that these reports would provide “for the first time a picture of the National Venereal Disease Control program.”⁵⁹

However, it was quite some time before the initial directive was promulgated as the Venereal Disease Prevention Law on July 15, 1948. The law stipulated:

Physicians, when they diagnose persons as infected by VD (referred to as patients hereafter), shall give instructions as provided for by Ministerial Ordinance as to the treatment and prevention measures of infection to the patients or to their protectors, and also, after inquiring their names and residence persons who are considered to have infected VD to the patients, and persons to whom the patients have committed conduct liable to infect VD and other matters prescribed by Ministerial Ordinance, shall report the necessary matters in written form within 24 hours to the prefectural governor through the director of a health center in charge of the districts where said patients reside.⁶⁰

Physicians and public health officials at local health centers were thus responsible for the law’s implementation by diagnosing, preventing, and reporting venereal disease. The Venereal Disease Prevention Law even made them “liable to a fine not exceeding 3,000 yen,” if they failed to give proper health instructions or failed to submit the report.⁶¹

The PHW’s idea of contact tracing was that its Venereal Disease Control Division would collect data about infected civilian Japanese patients and their contacts, and subsequently would delegate the task of locating and treating particular patients to local public health inspectors. To accomplish the assigned tasks, the PHW disseminated the concept of contact tracing to the elite public health administrators of Japan’s National Institute of Health (NIT), a public health facility subordinate to the Ministry of Health and Welfare. Under the close supervision of the PHW, Japanese public health elites educated representatives of all prefectural health administrators in PHW-approved Venereal Disease Short Training Courses in matters of diagnosis, treatment, and contact tracing of venereal disease.62 Furthermore, the PHW provided and circulated a Physicians’ Manual for Health Statistics, which informed Japanese diagnosing physicians and public health officers about when, how and to whom to report venereal disease and other communicable disease cases. As stated in the manual, the report’s “direct purpose is to take preventive measures,” and, second, “to obtain information concerning present public health conditions and make it the data on which all health administrative programs are established.”⁶³ The PHW thus put much effort into remodeling venereal disease control in Japan’s public health system in order to bypass police authority and put venereal disease control into the hands of civilian public health administrators.

Some local authorities, especially on the prefectural level, took the initiative to disseminate the PHW’s model within Japan’s public health bureaucracy. Official educational journals informed public health administrators and police departments of the new regulations that compelled physicians to report any venereal disease diagnosis to the prefectural public health board. In Ehime Prefecture, for instance, the prefectural government stressed the importance of public health (kōshū eisei) and characterized venereal disease as a severe danger to the “people’s healthy body and mind” (kokumin no kenkō na shijin).⁶⁴ The prefecture’s governor ordered physicians to report all cases of venereal disease to the civilian local health administrations, and this became compulsory in Ehime Prefecture beginning in September 1948. The report was supposed to include the patient’s name, date of birth, sex, address, place of work, the physician’s treatment methods, and drugs prescribed. Furthermore, the report had to indicate the date and place of infection and include detailed descriptions of persons who potentially could have infected the patient. All persons mentioned were to be listed with their full name, sex, address, place of work, and any other “issues necessary” (hitsuyō na jikō) for identification.⁶⁵

Other Japanese administrators and hygienists showed less enthusiasm for the PHW’s reforms. Most prefectural police departments were notoriously resistant to reform66 and persistently claimed jurisdiction for prostitution control while continuing to educate their personnel in venereal disease control.⁶⁷ And—as has been shown in the previous chapter—local police units still patrolled Japan’s red-light districts. But civilian public health specialists also reacted in various ways to the PHW’s reform of venereal disease control. Some adopted an arrogant attitude similar to that of the PHW’s staff. It was directed not against the foreign occupiers, however, but against the Japanese public and predominantly stressed issues of class. In February 1949, for instance, Adachi Kyōgorō, a social hygienist professor and medical doctor in Hokkaidō Prefecture, summarized his research on the relationship between crime and venereal disease in a journal published by the Otaru city police department’s section for general affairs. On the basis of dubious, probably biased statistical data, Adachi stated that most “criminals” (hanzaisha)—Adachi does not specify what sort of crime he has in mind—are mentally ill and that one-third of all criminals contract a venereal disease. Adachi claimed that there is a causal nexus between crime and venereal disease, which results from poverty, lack of education, and “mental deficiency” (seishin hakujaku).⁶⁸ On the basis of this hypothesis, Adachi further concludes in discriminatory fashion that both criminals and the venereally diseased, among whom he includes prostitutes, have degenerative, “inferior” (katō retsuaku) tendencies, which he alleges have a noxious effect on the general population. Given the supposed ignorance and lack of education of venereally infected people, Adachi had reservations about a collaborative, educational, and more democratic public health system for venereal disease control. The people in question, he argued—criminals and prostitutes—lacked the ability to understand it. He thus promoted indirectly the old Japanese system of police surveillance and control.⁶⁹ In other parts of Japan, local health administrators tended to simply ignore the PHW’s guidelines for venereal disease control and made hardly any effort to cooperate. Rather, they responded to inspections by the PHW and to requests by local military government teams with a demanding attitude and pressed the occupiers for more resources, such as laboratory equipment and modern drugs.⁷⁰

Implementing contact tracing as envisaged by the PHW was not only difficult due to the stubbornness of some Japanese administrators. The issue of jurisdiction among the occupiers likewise obstructed the institutionalization of contact tracing as an effective public health measure during the occupation period. The delayed introduction of contact tracing is itself an indication of such obstacles. It was several years before the military command announced the official procedure, division of responsibilities, and channels of communication for contact tracing within the occupation army. According to Eighth Army Circular (No. 33) from May 26, 1948, it was ordered:

The tracing of Japanese contacts will be an activity under the supervision of the area provost marshal, in close cooperation with the appropriate Japanese public health authorities. Japanese police will be used if actual arrest is necessary. Proper measures to insure examination and treatment of Japanese contacts will be a function of Japanese authorities. Japanese nationals located as a result of contact tracing will remain in custody of Japanese public health authorities until necessary examination and treatment have been completed. Military police assistance will be only that necessary to prevent interference by allied military personnel and to enable accompanying military personnel to enter off-limit areas when necessary. . . . Military government team commanders will insure that Japanese civil authorities take the proper action to examine and treat contacts who are Japanese nationals, reporting the results of such examination and treatment. Liaison will be maintained with the provost marshal to avoid duplication of effort and to insure accuracy of individual cases reported.71

This directive omitted the PHW and devolved contact tracing to the military police and its provost marshal. The Eighth Army’s directive allowed the PHW and public health officers of the military government teams to receive copies of contact report sheets, but did not entitle them to intervene. Overall, the directive countered or even reversed the PHW reform efforts to transfer responsibility for venereal disease from the police to civil public health agencies. Crawford F. Sams overtly criticized the military command’s decision in various reports to SCAP. In a memorandum to the chief of staff he emphasized “that contact tracing is a public health procedure to be carried out by public health personnel and that the introduction of the police in any form tends to reduce the effectiveness of contact tracing as a means of controlling venereal disease.” Sams argued that contact tracing under the jurisdiction of the provost marshal led to further criminalization of prostitution and venereal disease, because police utilized contact tracing solely “as a means of apprehending contacts for the purpose of criminal prosecution or punishment.” “Police intervention,” Sams insisted, “jeopardizes the success of the venereal disease control program initiated by PHW with considerable difficulty, by destroying the confidence of the Japanese people already established in this program over the past three years.”⁷²

In practice, contact tracing only had a moderate effect. Considering the constantly high rates of venereal disease throughout the occupation period, it is questionable whether the immense effort and resources the occupiers invested really paid off. In any case, when the police or public health administrators implemented contact tracing exclusively, the overall project hardly achieved anything. Raids, curfews, and other repressive methods by the police neither decreased venereal disease rates nor achieved a significant reduction of prostitution. Public health interventions equally failed, or at least failed to make good on the physicians’ and hygienists’ promises to radically reduce infection rates—often due to a lack of drugs, laboratory equipment, and trained personnel. On account of these factors, and because of jurisdictional struggles, the occupiers never fully established a regular system of contact tracing until the end of the occupation.

Only on rare occasions did contact tracing actually have noticeable effects, but only if all involved parties closely cooperated and personnel with local knowledge handled the tracing. In one well-documented example, a report by C. P. Calhoun, venereal disease control officer of the FEC’s Naval Forces, describes an inspection tour to the naval port town of Sasebo in Kyushu from May 21 to May 25, 1951. A certain R. Izeki, a laboratory technician at Sasebo’s health center, conducted the inquiries together with his assistant. They began their tracing tour by sorting out the report sheets by district and crosschecking the information on the various locations. Calhoun, who did not spare his praise of the “contact tracer,” stressed that Izeki “located five contacts named in the reports out of six tries. At one house, directions were offered to find two other girls that had been named as contacts.” In his opinion, Calhoun concluded, the tracing tour was “a remarkable feat of judgment and luck combined with a thorough knowledge of the city and its alleys and hills. The cooperation of this tracing was so far superior to the ordinary that it was outstanding.”73 In many less “outstanding” cases, however, contact tracing had only a limited success rate or simply led nowhere. In an internal U.S. Navy study from May 1951 titled “Venereal Disease Problem in Sasebo,” for instance, the report stated that “contact reports at present furnish inadequate information for successful contact finding through routine channels.” A first screening of the reports “has eliminated approximately 75% of contact reports as having insufficient data to begin investigation. Of the 25% forwarded to the Sasebo Public Health Center, 50% of these, or 12½% of the total contacts reported from Sasebo were located.” The study accused local health authorities of inadequacy and ineffectiveness, calling them “grossly inadequate in the ability to diagnose venereal disease, especially chancroid.” What was needed, the study’s author claimed, were “trained personnel, and more active interest” among the Japanese public health administrators. “Without energetic case finding, accurate laboratory work, adequate treatment and confinement until cured,” the report concluded, “contact reporting is relatively valueless in the area.”74

Although the desire to decrease the rate of venereal disease in occupied Japan went unfulfilled, the whole system of contact tracing and the copious collection of data it engendered nevertheless had significant effects beyond their designated purpose. They helped the occupiers to deeply penetrate and map the occupied territory, both within and beyond Japan’s borders. In a report to the chief of PHW’s Preventive Medicine Section, for example, Lt. Colonel Long of the Eighth Army’s medical section designated so-called Venereal Disease Contact Areas “as representing those in which the greatest venereal disease contact problems appear to be present.” The report listed most major Japanese cities, such as Sapporo, Sendai, Yokohama, Gifu, Osaka, Kobe, Kyoto, Nara, Nagoya, Fukuoka, Sasebo, and Kumamoto. For Tokyo, Long highlighted the “main railroad stations, Ueno, Shinjuku, Yurakucho, Shibuya and Shinagawa” as pivotal high-risk zones for venereal disease infection.⁷⁵

Such information on venereal disease, the location of its epidemic occurrence, and personal details about venereally infected people (civilian and military) circulated beyond the territory of occupied Japan, however. VD information flowed within a tight network of medical and public health departments that connected Japan with military bases in the United States and U.S. military commands in Guam, Ryukyu (Okinawa), and Korea. For instance, the Naval Government of Guam’s Department of Public Health filed various venereal disease contact report sheets with the PHW in Tokyo along with the request to investigate particular venereal disease cases. Most case files, however, only stated the place and date of exposure, sometimes the sex worker’s nickname, hair color, and age. Consequently, transnational or transregional contact tracing did not usually lead very far, and the PHW typically responded to such reports by saying that the data furnished “was insufficient to begin investigation,” or that the “contact could not be located.”⁷⁶ Nevertheless, the transnationally circulating contact report sheets could affect the mobility of the occupier’s personnel. In some cases, servicemen got venereally infected while on leave. Those stationed in Korea, for example, went on recreation holidays to Japan, especially during the Korean War. Because of such cases, medical officers and PHW health officials raised concerns about border-crossing servicemen transmitting venereal disease. The highest political and military command in Washington, DC, also shared this concern. According to a War Department directive from January 31, 1947, the U.S. military prohibited infected servicemen from leaving their unit and its respective territory as well as from entering the U.S. “Zone of Interior until 30 days have elapsed following completion of treatment.”77 The biomedical net of surveillance that was set up to control venereal disease indeed tied the Asia Pacific region together, and sexuality was inevitably entwined with mobility—or the lack thereof.

Notwithstanding the questionable success rate of contact tracing, the occupier’s strategies and the coordinates it imposed to collect data on venereal disease helped to accumulate data on the occupied territories. Contact tracing’s report system organized knowledge about occupational personnel as well as about the occupied society, and both became more tangible for the bureaucratic rule of the occupation regime. The massive accumulation of data on venereal disease among the Japanese population had thereby the subtle function of surveillance, domestication, and legitimation of the occupier’s rule. This is to say that although the report system was designed to monitor the health and security of the occupation troops, it nonetheless positioned the Japanese population directly in the gaze and range of American medical knowledge and practice. By remodeling and guiding Japanese physicians and health officials by means of health reforms and training courses, PHW health officers integrated Japan’s health system into the sphere of U.S. hegemony and thus brought it closer to the U.S. “zone of interior.” Simultaneously, the report system was an important governmental practice for legitimating the occupier’s rule. As a tool to regulate public health, it aimed at securing the physical prowess and masculinity of the occupation troops as well as their reputation. Healthy soldierly bodies were important symbols of the “free world,” and they were believed to represent the success of the occupation project and its ideals of democracy and anticommunism.⁷⁸ The report system could limit the occupiers’ mobility—for example, servicemen infected with a venereal disease were not allowed to travel back to the United States or to other U.S. occupied territories. Despite maintaining such limits, the report system more effectively functioned as a mechanism to divide the occupiers from the occupied, enabling the occupiers to claim superiority on the basis of a supposedly clear-cut boundary between occupiers and occupied, whom the report system differentiated according to gendered and racialized categories.⁷⁹

PREVENTIVE CARE: PROPHYLACTIC FACILITIES

In another important public health strategy implemented to limit the spread of venereal disease among the occupation personnel and to sanitize the servicemen’s sexuality, the occupier’s military medical departments set up prophylactic facilities. Prophylactic facilities and the provision of chemical prophylaxis had a long history in the U.S. military and had been in common use since the First World War in Europe, but also in units stationed within the United States.80 During the Second World War the U.S. military used prophylactic facilities in Hawai‘i as an integral part of the military’s informal regulation of prostitution and brothels.⁸¹ The military established and maintained prophylactic facilities to counter the high rate of venereal disease and the high number of incapacitated servicemen, and integrated into a broad social hygienic anti-VD education campaign with lectures, pamphlets, and posters, they proved a practical tool for the biomedical control of venereal disease. The U.S. military called these facilities prophylactic stations—in military jargon mostly abbreviated as pro stations. Initially erected in military units, during the postwar period prophylactic stations were also increasingly located in brothels and red-light districts. The BCOF referred to them as prophylactic ablution centres (P.A.C.) or, to indicate smaller facilities usually located within the unit area, as prophylactic ablution rooms (P.A.R.). Prophylactic facilities were an intimate place off-limits to nonmilitary personnel and usually equipped with sinks, toilets, and sanitary products, where servicemen could wash their bodies in private. Within the prophylactic facilities servicemen had access to contraceptives and chemical prophylaxis, such as sulfathiazole and mercurous chloride, to protect themselves against venereal infections. Pro stations were a space in the occupation health regime where discursive regulations (such as anti-VD propaganda and hygienic instructions) coincided with everyday personal hygiene practices—the concrete sanitation and protection of the male soldier’s body and his genitals.⁸²

The occupation forces had immediately instituted prophylactic facilities upon their arrival in occupied Japan. Since early September 1945, medical officers had been going ashore to inspect brothels in Tokyo and Kanagawa Prefecture and medically securing recreational facilities by establishing prophylactic stations. On September 30, 1945, Lieutenant Colonel James H. Gordon of the PHW noted in a memo that a Major Philip Weisbach, M.C., commanding officer of the 1st Medical Squadron of the 1st Cavalry, had “reported that he had surveyed the major prostitution areas of Tokyo shortly after the arrival of troops in the city and had set up four prophylactic stations” in Tokyo’s Senju and Mokojuna, in Yokohama, and near the barracks of the First Brigade.83 Maps drawn by the PHW indicate that ten further prophylactic stations had been established outside military facilities in the Kantō region by January 1946, at the train stations of Tokyo, Ueno, Shinbashi, Yokohama, and Sakuragicho. All facilities were built close to well-known red-light districts, like Noge in Yokohama and alongside the Keihin highway between Tokyo and Yokohama. Their exact locations were made known in VD lectures and also advertised on so-called pro kits—the BCOF called them E.T. packets (abbreviation for Emergency Treatment packet). These small portable packages containing tissues and antibacterial ointment and sometimes condoms were distributed to the troops.⁸⁴ Apparently, the occupation army’s soldiers and sailors had no difficulty finding their way to the pro stations. And it seems that they used them heavily, at least in the beginning of the occupation period, when licensed prostitution had not yet been abolished and servicemen did not yet have to expect any form of punishment for contracting venereal infections. U.S. Navy chaplain Lawrence L. Lacour witnessed the large-scale prophylactic procedures as he passed by the Yasuura House on his strolls in Yokosuka. In a letter later printed in the Journal of Social Hygiene, Lacour noted,

As men were admitted into the lobby [of a brothel], they would select a companion (113 on duty that day, according to one of the Japanese attendants), pay the 10 yen to the Japanese operator and then go with the girl to her room. We inspected several of these rooms and found them to be reasonably clean. When the men returned they were registered and administered prophylaxis by Navy corpsmen. Although approximately 20 men could be treated at a time, there was a line waiting.⁸⁵

The large numbers of servicemen who waited their turn for prophylactic treatment after patronizing a brothel as well as the effort and resources the occupation army eagerly invested in prophylactic facilities immediately after their arrival in Japan both indicate the popularity of pro stations within the occupiers’ health regime. They also underscore the apparent normality of their use in the prevention of venereal disease.

In the occupiers’ records, detailed information on the prophylactic facilities’ structure is scarce. One rare exception is a directive by the British Government’s War Office released in March 1947 to establish P.A.C.s in “areas in which promiscuous intercourse is most likely to occur”—among which areas the War Office identified occupied Japan. The War Office wanted the P.A.C.s to be equipped with “waiting space and lavatory accommodation,” and that “lightning should be on a generous scale and a full and adequate supply of hot water provided at all lavage points and elsewhere as necessary.” In order to “attract men into them rather than the reverse,” members of the War Office argued, “cleanliness and proper maintenance are matters of the first importance” for the prophylactic facility’s layout, equipment, and organization.86 Another document is a medical report filed on January 13, 1947, by the American first lieutenant group surgeon Julius Rutzky of the Medical Detachments in Kyoto to the U.S. Army’s surgeon general in Washington, DC. “Because of several favorable comments about the Prophylactic Station maintained by this unit,” Rutzky explained with a certain pride in his work, “photographs of it are submitted with the report.”⁸⁷ One of these unique photographs shows the facility’s entrance labeled with a big sign reading “Prophylactic Station,” while others show the station’s interior with an arrangement of sinks and toilets and a shelf with drugs and condoms (see figures 1–3). True to the War Office’s recommendation to display instructional signs and health propaganda material, the walls of the pro station portrayed in Rutzky’s photographs were covered with instructional notes, anti-VD posters, and pictures of venereal infections with information about their etiopathology.

On the level of discourse, the reports and photographs present the prophylactic facility as a space in the occupier’s health regime where servicemen were reminded of the correct hygienic procedures to prevent venereal diseases. Like previous social hygienic concepts of venereal disease control, manifested for example in Second World War pamphlets like Sex Hygiene and Venereal Disease, the prophylaxis propagated in the pro stations also required the servicemen’s cooperation.⁸⁸ As Rutzky himself highlights in his report, no medical officers were present at the station and the military ordered its servicemen to use the sanitary facilities discretely on their own.⁸⁹ This was a significant change from earlier prophylactic facilities maintained during the First World War, where a physician or a station attendant had supervised or even performed the prophylactic procedure.⁹⁰ Due to complaints by servicemen about the lack of privacy and probably also as an educational measure, the military started turning prophylactic facilities into more private, intimate places, which, however, required the servicemen’s self-care to prevent venereal disease. Thus, the military established the sanitary infrastructure, but also asked its servicemen to take their sexual health into their own hands.⁹¹

FIGURE 1. Entrance to a prophylactic station in Kyoto, 1947.
Image provided by the National Archives and Record
Administration in College Park, MD.

The British and U.S. militaries both emphasized that each serviceman was responsible for protecting himself against venereal disease. Nevertheless, both military organizations also provided particular hygiene regulations, knowledge, and tools that servicemen should follow and apply accordingly. Notice boards in each station instructed servicemen to wash their hands, urinate, and wash their genitals before treating them with antibacterial ointment. Lectures on venereal disease prevention explained these procedures at greater length and explained, for example, that it was essential that one “squeeze one half of the ointment into the penis” after urinating and washing, hold the ointment in the penis for five minutes, “rub rest of the ointment over exposed area, . . . wrap penis in toilet or tissue paper” and not urinate for four hours.92 Another, rather excessive example of how instructions could go into minute detail is the War Office’s recommendation to “pass water in short sharp gushes, holding the urine back by pinching the top of the penis and letting it go with a rush.”⁹³ Such attention to detail in the instructions and regulations is thus a constitutive element in identifying the prophylactic facilities as panoptic institutions that disciplined the servicemen’s bodies by subjecting them to the physically absent, yet symbolically omnipresent gaze of the military’s health regime. This powerful gaze furthermore aimed at the internalization of certain self-care techniques, which manifested in the array of instructional notes, pictures of VD infections, and anti-VD posters as well as in the architecture of the sanitary accommodations.⁹⁴

FIGURE 2. Inside a prophylactic station, 1947: sink, anti-VD poster “Tokyo Rose has Thorns,” and visuals of venereal infections. Image provided by the National Archives and Record Administration in College Park, MD.

FIGURE 3. Condoms, pro kits, and chemical prophylaxis in a prophylactic station, 1947. Image provided by the National Archives and Record Administration in College Park, MD.

The normalizing effect the prophylactic facility’s regulatory technique exerted on the soldierly body and its sexuality was twofold: first, it categorized the soldier’s body as either healthy or sick, and second, it aimed to control and sanitize the servicemen’s sex. Pictures of VD infections and anti-VD posters displayed in the pro stations warned of the hazards of uncontrolled sexual intercourse—a supposedly inevitable consequence of contact with prostitutes or “pick-ups”—and lent venereal disease a dangerous aura. However, the supposedly modern and scientific prophylaxis propagated in the stations simultaneously promised security and protection. This ambivalence is well illustrated by an anti-VD poster titled “Tokyo Rose has Thorns” that is also visible in Rutzky’s photographs. The poster shows a rose on the left side, next to the stylized face and neck of a woman in traditional Japanese headdress and kimono, apparently a Japanese prostitute or “geisha.”⁹⁵ The rose’s three thorns, on which “Syphilis 18%,” “Gonorrhea 61%,” and “Chancroid 42%” are written to indicate the danger of VD infection, are pointing toward her like arrows. The poster’s subtitle, “Don’t risk VD, if you do, take a PRO,” relativizes this danger and transforms it into a calculable risk that can be treated with the proper medical scientific methods. A sign on a shelf for condoms and pro kits further underscores the controllability of sexuality and venereal disease. It reads: “Individual Prokit. These can be used anywhere. Take a few along. Why take a chance?” These statements unmistakable reproduced the occupier’s male fantasy that sex would be available always and everywhere in occupied Japan, while simultaneously normalizing their sexual practices to the extent that they were safe and protected, which meant free of venereal disease. Apparently only actual venereal infections that separated the healthy and stable from the sick and weak soldierly bodies were critical—a supposed danger to military order and the occupation project in general.

To be sure, prophylactic stations were not only tied into the discursive net of the occupier’s health regime. They were also a place for the servicemen’s bodily routine of washing, treating, and protecting themselves against venereal infections. Rutzky’s report and photographs give an indication of the traces left by the occupiers’ everyday sanitary practices and intimate experiences. Of foremost significance is the way Rutzky’s photographs were created, circulated, and archived. The pictures were taken by (or on behalf of) a more or less unimportant group surgeon of an equally unimportant medical detachment in Kyoto. However, they were attached to an annual report to the office of the Army’s surgeon general, a lieutenant general and head of the Army Medical Department in Washington, DC. Today, the files are still stored in the adjutant general’s records, whose office was an important interface for intramilitary communication with the authority to classify certain memoranda as relevant to the military’s record keeping. In other words, the military command took those photographs seriously and circulated them within the occupier’s metropole; otherwise they would not have found their way to the place where they are archived today.96

Considering the content and details of these images, the archival circumstances are not insignificant. At a first glance, the photographs show a sanitary facility with sinks and toilets. It is a visualization of the occupier’s modern health regime in Japan that—as discussed above—aimed at the production of healthy soldierly bodies. On further observation, however, it is remarkable that the toilet one sees is not an imported U.S. American one, but a modified Japanese toilet—so to speak a “hybrid toilet.” The toilet bowl’s oblong form, with the hemispheric end facing the wall, supports this observation. Moreover, what makes this toilet so distinctive is the at least half-meter high pedestal beneath the toilet bowl, a “stitching” detail—or punctum, to speak with Roland Barthes—that disturbed contemporary observers and still puzzles today’s.⁹⁷ This pedestal, which never existed in this form in any genuine U.S. American or Japanese sanitary area, made it possible to stand up straight over the toilet and to wash one’s genitals, using toilet paper and water from the tap installed above. These photographs of a “hybrid toilet” (see figure 4) thus not only constitute a rupture in the frequent representation of the Japanese health system as backward, but also indicate some transnational entanglements in the sanitary practices that regulated venereal diseases during the occupation period. That is to say that the occupiers did not only import health-regulating medical knowledge and facilities unilaterally from the United States and impose them on occupied Japan; rather, the U.S. occupation administrators showed a certain “capriciousness” in their selective appropriation of culturally different hygienic artifacts, which they applied—despite their reluctance to accept Japan’s health methods—even within the most intimate space of sanitation, where the male occupier was supposed to clean his scrotum.98

FIGURE 4. Arrangement of “hybrid toilets,” sanitary products, instruction boards, and anti-VD poster in a pro station in Kyoto, 1947. Image provided by the National Archives and Record Administration in College Park, MD.

The remaining records hardly enable a reconstruction of how prophylaxis was actually practiced, and what the prophylactic facilities meant to the practitioners themselves remains largely obscured. First Lieutenant Edward J. Meyer, the executive officer of the 720th Military Police Battalion, for instance, took rigorous steps to “stamp out VD” within his command, saying that “all men going on pass are required to carry the mechanical and chemical ‘pro kits’ in their left breast pocket. Unfortunately,” he admitted, “there are a few stupid individuals who do not take precautions against this dread affliction. This type of man,” Meyer assured, “is being carefully observed and will be discharged for allowing misconduct to interfere with the performance of duty of the individual concerned.”⁹⁹ Other commanders complained in a similar way about servicemen’s lack of responsibility, in particular in not using their pro kits properly. One report mentions rumors that servicemen misused pro kits or sold them for high prices on the black market, where, as the report put it, “Japanese Nationals are very desirous of obtaining Pro Kits . . . to be used as a germicidal salve for the treatment of ‘athletes foot’ and other fungus disease of the skin.”¹⁰⁰ Such complaints obviously targeted the misuse of military property, but are nonetheless examples of the multiple ways sanitary facilities and items could be appropriated and repurposed.

Official records hardly ever speak directly of the everyday use of pro stations and pro kits for what the military actually designed them for—sanitizing the servicemen’s genitals to prevent a venereal infection after unprotected sexual intercourse. Official accounts only refer to them in the technical terms used on instruction boards and during sex education lectures. They do not narrate firsthand experiences of visits to prophylactic stations or how they were used, and only a few indirect descriptions in official documents contain traces of prophylactic practice. Quantified data in lists, charts, and graphs generally obscured the individual venereal disease patients among the occupation personnel, and personal accounts all seem to be told from distant, merely observing perspectives. This absence or silence of prophylaxis in action is somewhat surprising considering the vast efforts and resources invested in the maintenance of prophylactic facilities by the PHW and other social hygienists in the military’s medical departments interested in science, as well as the meticulously documented research on venereal disease and its diagnosis, treatment, and recovery. But, as Ann Stoler has reminded us, such gaps in the archival material are often quite meaningful in themselves. They can either indicate that certain issues were unimportant for contemporaries, or they can reflect historically specific discursive patterns and offer insight into the ways specific themes and topics were communicated without being directly addressed. Stoler has further suggested that, in addition to systematically silencing certain issues that were inexpressible in a certain discourse, such gaps can also be perceived as signifiers of a “common sense” shared by those who wrote, read and compiled administrative files. That means that although certain issues such as sexual intercourse and venereal disease infection and their treatment were sensitive, contemporaries nevertheless knew about them and might not have felt any need to record them officially. Or they recorded such issues in a particular way, not because it was forbidden to utter them, but because contemporaries considered them self-evident and thus not worthy of mention.101 The way the occupiers obscured individuals’ use of prophylactic stations by keeping personal experiences and details distant and obfuscated indicates that there was indeed such a “common sense” when it came to prophylactic stations and the handling of information—both official and personal—about concrete sanitary, antivenereal disease practices. This obscurity in the occupiers’ records about the pro stations’ everyday use, I argue, is thus an integral part of their very existence, function, and application.

In interviews and memoirs some veterans of the occupation of Japan report about prophylactic stations and their application. There are remarkable narrative strategies at work in these interviews, in which veterans talk about prophylactic facilities by creating personal distance from the object, for example by emphasizing that they had never visited prophylactic stations (or brothels) themselves and had only seen or heard of them. Accordingly, most veterans’ narratives only tell us that pro stations existed and that others frequently used them. Veterans nevertheless speak of the massive availability of allegedly diseased commercial sex and the widespread fear of venereal infections among servicemen, and thus justify and normalize the military’s maintenance of prophylactic facilities and distribution of prophylactic drugs.102 One revealing narrative is that of Melvin A. Ashkanzaki, formerly master sergeant of the 308th General Hospital, which includes remarks on prostitution and venereal disease treatment in occupied Japan. Throughout his interview, Ashkanzaki repeatedly emphasizes the vast “supply” of Japanese prostitutes and the strong demand for venereal disease prophylaxis among servicemen—excluding himself. As Ashkanzaki explicates: “Some of these guys were hungry. [. . .] A lot of guys were lined up. I would see them in lines, guys waiting in line in front of these whorehouses.”¹⁰³ However, he asserts that he had never visited a prostitute, because:

Frankly, I was afraid, because they [the prostitutes] had every kind of disease imaginable, I could say they had no care, they didn’t care, not like the Army would, they [the Army] would take good care of it. [. . .] So funny, these whorehouses, the guys were lined up to go in there. [. . .] Out of curiosity, I wanted to go in and just look around and see what it is, I wouldn’t go in for any business.¹⁰⁴

On the one hand, Ashkanzaki reproduces the omnipresent fear of venereal disease and attributes its source and spread to Japanese sex workers alone, while on the other hand he highlights his trust in the army’s sanitary institutions, which he sees as taking care of the servicemen’s health. Furthermore, he tells elsewhere how he had to supply a prophylactic station while on duty, but never came in physical contact with the patients—another reminder of how anonymously prophylactic facilities seem to have worked. He describes the painful prophylactic treatment of syphilis with mercurous chloride, in which a solution was injected directly into the urethra with a thick glass cannula—a procedure that was explained to servicemen in VD lectures and also visible on the instructional notes in Rutzky’s photographs.¹⁰⁵

Christopher W. Stupples, who was stationed at the British Commonwealth General Hospital in Kure, Western Japan during the Korean War and worked in the hospital’s venereology section, reports quite similar procedures in his memoirs, although he does not address prophylaxis in particular:

My job in the hospital (as Special Treatment Orderly Class 3 - though I had passed for Class 2) was the initial investigation of venereal disease. We were, as a result of the cease-fire [during the Korean War], the busiest section in the whole set up. When anyone was referred to the Ward their details were taken by the Clerk and then the patient passed to me for testing. This was mainly preparing smears and reading off the results under the microscope. My report then went to the Medical Officer who prescribed treatment accordingly. I was also heavily involved in giving treatment. With one and a quarter inch hypodermic needle I was in my element and I must have injected buckets of penicillin in my time.106

Due to his involvement in the treatment of venereal disease, Stupples was in direct contact with the patients. His mention of “a quarter inch hypodermic needle” points to the painful procedures described by Ashkanzaki. However, although Stupples came in close bodily contact with the patients, he does not give personal impressions of any particular patient. Rather, he distances himself from the issue at hand by assuming an ironic stance in his narrative.¹⁰⁷ The ironic remark about injecting “buckets of penicillin,” however, functions not only as a mechanism of distancing, but also affirms the widespread prevalence of venereal infections and the seeming normality of the occupation army’s massive use of prophylaxis and drugs in occupied Japan.

The obscurity surrounding prophylactic facilities, reproduced by contemporaries in the way they constantly distanced themselves from their actual usage, is a striking indication of the intimacy of medical venereal disease control and of the occupier’s emotional investment in it. Although the military designed prophylactic facilities according to a supposedly modern scientific rationale to protect and treat the servicemen’s genitals with social hygienic procedures and drugs, the facilities nevertheless constituted one of the most private and intimate spaces within the occupier’s health regime. Usually, surgeons and hygienists insisted that transparency and public involvement were necessary elements of any effective venereal disease control program. Such transparency and public involvement were evident, for example, in anti-VD sex education campaigns and venereal disease contact tracing. Prophylactic stations, however, were spaces hidden from the public, where servicemen were often alone without the physical presence of military commanders, administrators, or physicians. As cited above, Rutzky also said in his report that “no aid man has been on duty in the ‘Pro’ Station because an overwhelming majority of the men stated they would not use it if such were the situation.”¹⁰⁸ The insistence on privacy as well as the indescribability of concrete physical hygienic practices within the prophylactic stations signifies the discomfort, uncertainty, embarrassment, and even shame administrators and servicemen felt when confronted with VD prophylaxis and treatment. They seem to have been a thorn in the self-perception of the masculine soldier and the male-dominated occupation regime.

In his memoirs, Alton Chamberlin, second lieutenant of the 97th Infantry division, vividly illustrates the ambivalent relationship between the scientifically connoted controllability of venereal disease and sexual encounters, the fear of venereal infections, and the uncertainty and shame of direct, bodily exposure to venereal disease:

After each session with a Japanese girl I faithfully used a pro kit to protect myself from V.D. I think most of the other guys did too. So after we would get up the next morning we would have to unwrap the toilet paper from our genitals and wash off the protective ointment. After being in the Army for a while, pissing, shitting and showering next to naked men, I had lost all sense of embarrassment. So I would get some warm water in my steel helmet and wash my not-so-private genitals out near the open latrine area in plain sight of anyone interested. Sometimes there would be Japanese cleaning ladies in the area. They would look at me and giggle. It didn’t bother me. I let it all hang out.109

To begin with, Chamberlin explains how he adhered carefully to the army’s hygiene regulations by washing himself and applying chemical prophylaxis after each act of sexual intercourse. He narrates this procedure as a routine, apparently performed by everyone on a regular basis. This statement furthermore indicates that not only the prophylaxis against venereal diseases, but also the sexual encounter with women of occupied Japan was part of the servicemen’s everyday life, following—again—the logic according to which female sexuality was always available to them. The servicemen’s sexualized perception is similarly normalized by Chamberlin’s description of his bodily nakedness as if no one could have bewildered him, even when he was exposing his genitals. Moreover, he was apparently enjoying being watched and giggled at by Japanese “cleaning ladies” while he showed off his genitals, a performative act meant to confirm his masculinity by signaling that he had sex with multiple partners on a regular basis. However, a few pages later in his memoirs Chamberlin continues:

I awoke one morning and discovered a sore on the bottom side of the head of my penis. I was filled with fear. Had I used the pro kit properly the night I was drunk? I had sex several times since then. [. . .] I went on sick call. The examination medic confirmed my fears. “Looks like you’ve got V.D. all right,” he said. “Probably syphilis.”

On the train to a military hospital in Tokyo I was one sad lad. I resolved not to ever again be bad. [. . .] I vowed to myself to never again commit the sin of fornication with a geisha girl. [. . .]

At the hospital blood was taken and tests were done. Having American nurses tend to me was embarrassing. They knew why I was here. I thought they must think it was pretty low of an American soldier to have sex with a Jap whore. I could not look them in the eye, much less flirt with them. I might never be able to make love to a woman again, so dark were my thoughts.110

At the very moment he suspects a venereal infection and is subsequently diagnosed by a military surgeon (“Probably syphilis”), a significant dramaturgical shift occurs in Chamberlin’s narrative. Although I make no claim that Chamberlin’s narrative mode follows a conscious or programmatic intention, it is nevertheless conspicuous how Chamberlin’s homodiegetic narrative switches from the humorous, ironic, and often chauvinistic anecdotes we find throughout his memoirs to a tone of fear, bitterness, remorse, and shame.¹¹¹ In his uneasiness at the moment of uncertainty as to whether or not he is venereally infected, Chamberlin blames the allure and high availability of sex in occupied Japan—rather than his own promiscuity. The changes his way of labeling Japanese women undergoes is indicative: he first speaks of a “Japanese girl,” who is fun to have a session with, then of a “geisha girl,” who embodies the sin of fornication, and finally of a “Jap whore,” with whom he has diseased, infectious sex. In his gloomy, almost depressive state of mind—which, however, relapses into the joy of sexual adventures as soon as he is certain that he did not contract venereal disease—Chamberlin even considers becoming abstinent in the future. However, it is remarkable that Chamberlin’s fear of venereal disease was not related to, for example, symptoms of illness such as bodily pain. The confrontation with the authoritative gaze of white American physicians and nurses alone triggered his reasoning. Not pain, harm, or illness, but the potential loss of his reputation as a man and soldier caused feelings of embarrassment and shame, forcing Chamberlin to rethink his escapades.

• • •

Prophylactic facilities were a significant intimate institution that medically regulated servicemen’s bodies and sexual relations during the occupation of Japan. Military surgeons, public health administrators, nurses, and military commanders remained personally absent from the pro stations in order to guarantee a certain amount of privacy for the stations’ users. Usually, “no aid man” was on duty, and the occupied were not generally admitted to the facilities. Preventive care against venereal disease thus seemed to work in obscurity, hidden behind the walls of prophylactic facilities. The occupiers’ biomedical power within the pro stations was nevertheless omnipresent, manifested in sanitary equipment and products, and laid out in hygiene regulations and anti-VD propaganda that taught servicemen the proper use of contraceptives (condoms) and chemical prophylaxis against venereal infections. The military imposed regulations to effectively sanitize and protect the servicemen’s bodies, but it also demanded the servicemen’s cooperation and their responsibility to care for themselves.

The actual use of prophylactic facilities is rather difficult to reconstruct since there are hardly any available sources of information about the servicemen’s everyday experiences of anti-VD prophylaxis. Accounts such as Alton Chamberlin’s memoirs, but also the seeming impossibility of addressing venereal infections in a personal way in official records, as well as the reserved and distancing descriptions of prophylactic facilities’ usage in veterans’ narratives, nonetheless indicate that individual anti-VD prophylaxis evoked uncertainty and shame. The occupiers’ medical system of venereal disease control, which its agents believed to be modern and to guarantee a controllable sexual encounter on the basis of scientific medical knowledge, was thus simultaneously influenced by the not-so-rational emotions of embarrassment and shame. In contrast to the way the individual preventive care of servicemen was hidden away in prophylactic facilities, with the medical reporting system of VD contact tracing, the occupiers demanded total transparency from the occupied. This allowed the occupiers to intervene into intimate spheres of occupied society and to measure and map its population for governmental administration. Biomedical regulations, the compelled transparency of contact tracing, and the concealment of VD prevention in prophylactic facilities nevertheless sustained the prejudice that not the servicemen themselves, but the Japanese population—and in particular the body of the Japanese prostitute—were the source and reservoir of venereal disease. Analyzing the occupiers’ biomedical interventions uncovers their basic assumption that servicemen’s sexual adventures in occupied Japan could be sanitized. And it highlights the occupiers’ efforts to maintain control of the occupation through the regulation of sex, a reminder that their stance as rulers required them to take meticulous care in upholding their self-image as a powerful, masculine occupation force.