- Foreword by author: this research series centers around the history of U.S.–Japan medical exchange and collaboration in the twentieth century. It explores how key agencies, in both the medical and diplomatic worlds, pursued cooperative efforts to develop public health throughout shifting domestic and global political landscapes. Continuing from “When Medicine Met Diplomacy Part I, II, and III,” this article follows the Rockefeller Foundation’s 1924 survey of Japan and traces how its initial momentum gave way — across years of factional rivalry, bureaucratic hesitation, and bilateral strain — to the suspension of the “Tokyo project” by 1927.
From May 12 to June 25, 1924, Victor G. Heiser, John B. Grant, and Frederick F. Russell moved through Japan’s public health landscape — laboratories, medical schools, training facilities, sanitary offices — with the brisk thoroughness of a survey commission on a tight schedule. Their findings, weighed alongside conversations with the Ministry of Home Affairs, soon translated into a concrete proposal: a three-year, three-million-yen plan (roughly 1,500,000 USD) for the buildings and equipment of a new institute of public health, with annual disbursements of one million yen. In November 1924, the International Health Board gave its tentative approval (Rockefeller Foundation, August 1931).[1]
On paper, the Tokyo project appeared to be in motion. Beneath the official momentum, however, opposition was already taking shape inside Japan’s medical world. Even while the Foundation officers were still in Tokyo, Nagayo Mataro (長与又郎), the head of the government Institute for Infectious Diseases and a participant in Japan’s first medical commission to the United States in 1923, wrote to register his concern. The “training of health officers has been carried on,” he observed, at his own institute under government control; a new institution, therefore, would inevitably “cover [overlap] with” existing work and become “surely a cause of future trouble” (Nagayo, June 1924).[2] Okano Keijirō’s anxieties at the cabinet table the year before, it turned out, had not been an isolated reaction but the first surfacing of a deeper structural unease.
The irony was that, only months later, Nagayo emerged as the proposed director of the very institute he had questioned. In early January 1925, news of his selection began circulating among Japanese medical professionals, and the appointment quickly became a flashpoint. Some officials within the Ministry of Home Affairs objected on practical grounds: Nagayo’s existing duties at the Institute for Infectious Diseases left no room for full-time leadership of a new school (Heiser, January 1925).[3] In a private conversation with Victor G. Heiser, the parasitologist and Diet member Miyajima Mikinosuke (宮島幹之助) raised three further concerns: Nagayo’s nephritis, his original hostility to the project, and his ties to a party that might soon be out of office (Heiser, January 1925).[4] The lines of dispute were not merely personal: Nagayo stood for the Imperial University and the government infectious-disease establishment; Miyajima for the Kitasato Institute and Keiō circle. After consulting Noguchi, the Foundation officers chose to wait until the Japanese side resolved the matter on its own (Heiser, January 1925).[5]
By the spring of 1925, hesitation had also taken root within the Rockefeller side. At an April meeting with Ambassador Matsudaira, Heiser signaled his doubts about Nagayo’s candidacy. Days later, Frederick F. Russell wrote to Yamada Junjirō to articulate what the Foundation considered the qualifications of an ideal director:
the director should be a man of recognized ability whose name will give prestige and character to the school; he should have the chief responsibility for selecting the faculty, organizing the curriculum, making the plans for a suitable building, and drawing up the budget for the future maintenance of the school. In our experience, the realization of a good school of public health demands a full-time active director in good health, who is technically qualified, has administrative ability of high order, who inspires initiative and loyalty in his subordinates, and in addition has assured government and public support (Russell, April 1925).[6]
From China, however, came a different reading. Roger S. Greene, the Foundation’s medical administrator in Peking, reported that according to Dr. Rudolf Teusler, “a substantial majority of Japanese medical men, perhaps all outside the Kitasato group, consider Dr. Nagayo the best man to head the institute, both on account of his scientific ability, and on account of his broad culture.” To resolve the full-time question, Greene proposed appointing a younger assistant director acceptable to Nagayo himself (Greene, May 1925).[7]
The internal divergence only deepened the Foundation’s caution. By June 1925, Heiser had grown “increasingly dubious about possibilities of working out satisfactory solution” and warned of the “great danger” of becoming entangled “in both national and medical politics.” George E. Vincent went further still, raising the possibility of postponing the entire project indefinitely, or abandoning it altogether, unless the Japanese, without external pressure, produced a plan in which they themselves had real confidence. “Any mere temporary getting together for the sake of getting our money,” he wrote, “would be most unfortunate” (Vincent, June 1925).[8]
When Heiser returned to Tokyo in October 1925, the silence was telling: officials would not talk about the institute on their own initiative, and even Yamada, whose 1924 letter had once articulated the proposal’s moral urgency, refrained from discussing its progress. Heiser’s report back to New York identified the obstacles with sober clarity: a deteriorating economy, a Ministry of Finance unwilling to authorize new undertakings, an election predicted for February 1926, a ruling party of “socialistic tendencies” wary of being identified with American capital, the Kitasato bloc poised to block legislation in the Diet, and the lingering resentment, only partly subsided, over the 1924 exclusion bill (Heiser, October 1925).[9]
Faced with this thicket, the Foundation chose not to press. Attention shifted instead toward fellowships, targeted support for a younger generation of Japanese physicians who could study public health in the United States and return to government posts. Selection criteria, articulated in mid-1926, emphasized candidates “well above the average — those who give promise of becoming leaders,” already tried out in the health field, young, in sound health, and with assured government employment upon their return (Heiser, July 1926).[10]What had begun as an ambition to plant an institution gave way, for the moment, to a slower investment in people. In April 1927, the Foundation’s officers had formally decided to abandon the Tokyo institute (Rockefeller Foudation, April 1927).[11] Three years of careful negotiation closed without a building, without a charter, without a director.
And yet the abandonment proved less final than it appeared. Within another three years, the project would stir again — reshaped by new circumstances, new actors, and a domestic landscape transformed by the late 1920s. The story is to be continued.
Reference
[1]Scientific Directors Minutes, approximately August 1931, Folder 6, Box 1, Series 609 Japan, projects, SG 1.1, Rockefeller Foundation Records, Rockefeller Archive Center.
[2]Letter from Mataro Nagayo, received about June 14, 1924, Folder 353, Box 56, Series 2 Special reports, Sub-series 609 Japan, International Health Board Division Records, Rockefeller Foundation Records, Rockefeller Archive Center.
[3]Letter from Hideyo Noguchi to Victor G. Heiser, January 3, 1925, Folder 8, Box 1, Series 609 Japan, projects, SG 1.1, Rockefeller Foundation Records, Rockefeller Archive Center.
[4]Victor G. Heiser, Memorandum of interview with Doctors Miyajima and Kusama re School of Hygiene and Public Health for Tokyo, January 5, 1925, Folder 8, Box 1, Series 609 Japan, projects, SG 1.1, Rockefeller Foundation Records, Rockefeller Archive Center.
[5]Letter from Victor G. Heiser to Hideyo Noguchi, January 9, 1925, Folder 8, Box 1, Series 609 Japan, projects, SG 1.1, Rockefeller Foundation Records, Rockefeller Archive Center.
[6]Letter from Frederick F. Russell to Junjirō Yamada, April 20, 1925, Folder 8, Box 1, Series 609 Japan, projects, SG 1.1, Rockefeller Foundation Records, Rockefeller Archive Center. See also Victor G. Heiser, Memorandum re Interview with Ambassador Matsudaira, April 16, 1925, same folder.
[7]Letter from Roger S. Greene to Frederick F. Russell, May 28, 1925, Folder 8, Box 1, Series 609 Japan, projects, SG 1.1, Rockefeller Foundation Records, Rockefeller Archive Center.
[8]George E. Vincent’s diary, June 17, 1925, Folder 8, Box 1, Series 609 Japan, projects, SG 1.1, Rockefeller Foundation Records, Rockefeller Archive Center.
[9]Letter from Victor G. Heiser to General Director of International Health Board, October 21, 1925, Folder 8, Box 1, Series 609 Japan, projects, SG 1.1, Rockefeller Foundation Records, Rockefeller Archive Center.
[10] Letter from Victor G. Heiser to John B. Grant, July 2, 1926, Folder 8, Box 1, Series 609 Japan, projects, SG 1.1, Rockefeller Foundation Records, Rockefeller Archive Center.
[11] “The Proposed Public Health Institute in Tokyo,” April 6, 1927, Folder 8, Box 1, Series 609 Japan, projects, SG 1.1, Rockefeller Foundation Records, Rockefeller Archive Center.
