Modern medicine has developed a number of technologies to observe, diagnose, and intervene in the human body. Medical technologies make bodies visible by number and form. Many historians have studied how such medical technologies as the stethoscope, pulse meter, cardiograph, and thermometer were invented and subsequently influenced societies. However, recent historians have turned their attention to the technology-in-practice to show a unidirectional history intertwined by devices, clinicians, and users. This paper aims to follow this line of study by focusing on a history of clinical thermometry in modern Britain and Japan. First, it surveys secondary works on medical technologies in history and explores how clinical thermometers were invented, improved, sold, and consumed in two distinct cultures in Britain and Japan. It argues that clinical thermometry was used for consumers’ own sakes, for example, performing a gender role and dreading influenza, and also framed by such external factors as war and pandemics.
To maintain control of their bodies, human beings gradually resorted to technological devices to understand their precise conditions. The precise understanding of the body is one of the important reasons for the development of medical technology, which this paper explores with a focus on a particular medical technology, namely, clinical thermometry.
The rise of medical technology has attracted a number of historians of medicine. One of the leading scholars is Stanley Joel Reiser, whose Medicine and the Reign of Technology has often been referenced by fellow historians (Reiser 1978). His major argument is that modern medicine has evolved its objective approach to human bodies and diseases instead of relying on subjective evidence taken from patients, and human bodies are examined either by laboratory workers or through mechanical and electronic devices (ix). In arguing so, Reiser has extended his perspective to a variety of medical technologies, not only manual and electronic devices but also computing technologies that have developed since the mid-twentieth century (Reiser 1993: 262–73). Such new clinical manners have often been regarded as objective, efficient, and standardized.
Reiser awoke in his fellow historians, especially of the next generation, the awareness of the great worth medical technology had (Blume 2000). In the last quarter of the twentieth century, historical studies of individual medical technology flooded the field of medical history, ranging from diagnostic technology based on laboratory technologies (Davis 1990) to therapeutic technology, especially the artificial radioisotope (Kraft 2006), stethoscope (Sterne 2001), electrotherapeutics (Rosner 1988), roentgenology (Herzig 2001; Pamboukian 2001), microscopy (La Berge 1999), spirometer (Lo 2009), sphygmograph (Wallis 2016), and kymograph (Borell 1987). These studies share a basic notion with Reiser that technology changed the medical landscape; in other words, they ushered in the advent of “technology-centered” medicine and society (May et al. 2006; Postman 1992).
However, historians of medicine and technology, particularly of the generation after Reiser, paid more attention to those who applied technological devices to their bodies. Stefan Timmermans and Marc Berg proposed another approach called “technology-in-practice” in their article “The Practice of Medical Technology” (Timmermans and Berg 2003). Considering the past historiographies of medical technology divided between technological determinism and social essentialism, they refer to Alan Prout’s study of the metered dose inhaler, Anselm Strauss’s ethnographic study of medical technology in hospitals, David Locker and Joseph Kaufert’s study of the iron lung, and the like, all of which show a “less unidirectional relationship” among medical technologies, clinicians, and users (98, 101–2). Such empirical studies suggest, Timmermans and Berg argued, an entangled history in which “the material and the social intertwine in complicated ways” (108). Some authors have followed this line of research (Melling 2010; Rabier 2013: 438).
In this line of historiography, this paper aims to explore a medical technology in use, situating it within the perspectives of social, economic, and cultural history, which shows that social relations, economic activities, and cultural norms entangled, or framed, the history. In particular, it pays attention to the user dimension, which is influenced significantly by a perspective of the social history of medicine for which Roy Porter promoted “history from below” since the 1980s.
In doing so, it focuses on a history of clinical thermometry because, despite its user-friendly character, its actual use has been largely uncharted in past historiography. Reiser contributed one chapter to the history of the clinical thermometer but did not explore its users (Reiser 1978). The manufacturing and marketing of clinical thermometers, too, have been rarely studied. For what, by whom, and how was the clinical thermometer used in daily scenes? This paper shows that it was not a mere medical device used in hospitals and clinics but a commodity sold by manufacturers, chemists, and druggists and, finally, used by laypeople at home and other nursing sites. By approaching these dimensions around the clinical thermometer, this paper also suggests that the thermometer crucially contributed to the modern culture of body and sensing. With this technology, nonmedical laypersons have understood their own physical trouble in daily settings through numerical measurement. The historical study of clinical thermometers leads us to a rich past of medical technology in use, in sales, and in nonmedical settings.
In addition, this paper tries to compare the English history of clinical thermometers to the Japanese experiences. Because it became small and relatively easy to craft in the latter part of the nineteenth century, this device soon became a popular item to be imported, exported, and even crafted in some developing countries at that time. One such country was Japan. Historians of both Japan’s medicine and technology have rarely studied this medical technology. The former has approached clinical thermometry only through a perspective of the history of several eminent firms of medical devices (Kawakami 1965), and the latter has hardly ever studied it, commemorating Japan’s development for industrialization in the Meiji era and becoming a high-tech country after the Second World War. Most historians of technological development in modern Japan limit their arguments to national policy formation and corporate developments in nonmedical industries (Morris-Suzuki 1994). With this perspective, they have paid much attention to the transplantation of technologies in heavy industries from the West but hardly to medical technologies (Fujiwara 2016). Even a four-volume series of the social history of science and technology published in 2006 did not include any articles on medical technology before the Second World War (Nakayama and Yoshioka 2006). Through an international comparison, this paper argues that both Japan and Britain developed clinical thermometry to some extent along similar social, economic, and cultural trajectories.
Clinical Thermometry in Development
In the mid-nineteenth century, doctors increasingly relied on medical devices to monitor structural defects and functional changes in bodies. Prior to the 1850s, doctors largely gave credit to their own art of medicine rather than a machine’s number. They had been taking and reading patient pulses since ancient times.
Throughout the eighteenth and early nineteenth centuries, however, doctors such as John Floyer, William Henderson, William Falconer, Julius Herisson, Stephen Hales, and Carl Ludwig gradually changed this medical landscape with the sphygmomanometer. A turning point was Etienne-Jules Marey’s sphygmograph, which enabled self-registering of pulse-taking (Reiser 1978: 101). Other medical technologies allied this trend: for instance, spirometers helped doctors recognize lung conditions and respiratory functions in disease (91–93).
Among these technologies, a device to detect body temperature, the clinical thermometer, became incredibly popular, and Reiser provided the basic story for this in his seminal book Medicine and the Reign of Technology. According to Reiser, the technology of thermometry had a long history in which Galileo de Galilei, Benedetto Castelli, Santorio Santorio, Robert Boyle, Gabriel Daniel Fahrenheit, Hermann Boerhaave, and Anton de Haen were involved with projects to detect a human’s body temperature (Reiser 1978: 110–13; Woodhead and Varrier-Jones 1916). However, it never obtained popularity because of the size and complicated directions for use, which were solved by later improvements. The actual machines were large and cumbersome—a disadvantage that the later thermometer (described in this paper) did a good deal to solve. At the end of the sixteenth century, Boerhaave mentioned that “external febrile heat is recognized by the thermometer,” and De Haen discovered a morning remission and evening exacerbation of human temperature in fevers, the rise of temperature during febrile rigors, and discrepancies between pulse and temperature, but their contemporaries generally neglected the significance of medical thermometry (Wunderlich 1871: 21–22). It was the same in the late eighteenth century; John Hunter found that local inflammation caused a rise in body temperature at the inflamed spot, and James Currie’s Medical Reports on the Effect of Water, Cold and Warm, as a Remedy in Fever and Other Diseases examined “the action of warm and cold baths, of digitalis, opium, alcohol, and restricted diet, by the alterations of temperature they produce” (24). Such concerns regarding body temperature continued to attract doctors’ attention but were not linked with medical diagnosis or popularized in the public.
Doctors in the earlier part of the nineteenth century, such as Gerard van Swieten, Gabriel Andral, Henri Roger, and George Zimmerman, contributed to earlier improvements (Reiser 1978: 114–15). A particularly important scholar was Henri Roger, who explored body temperatures in various diseases: intermittent fevers, typhoid fevers, smallpox, scarlatina, measles, rheumatism, dysentery, meningitis, bronchitis, pneumonia, tuberculosis, whooping cough, chorea, dropsies, rickets, paralysis, and so on. Rogers did not show a definite course of the temperature in any given disease, but his idea influenced the succeeding generation, especially Carl Wunderlich (Wunderlich 1871: 31–32).
A revolution began in the middle of the century. Influenced by F. W. F. von Barensprung and Ludwig Traube, who applied the results of thermometry to diagnosis, the German doctor Carl Wunderlich contributed significantly to clinical thermometry between the 1850s and 1860s (Wunderlich 1871: 37). From 1851, Wunderlich had the body temperatures of all patients in the hospital taken with a clinical thermometer, which amounted to approximately 25,000 patients. Initially, temperature was taken twice a day, but for the last ten years of his study, it was taken between four and six times per day in the case of fever (38). In the intensive study, he defined a normal temperature as 97.25° Fahrenheit in sleep and found specific curves of body temperature in each disease such as enteric fever, typhus, smallpox, measles, pneumonia, tuberculosis, meningitis, and other diseases whose major symptoms were fevers (Fig. 1).
In a preface attached to a translated book On the Temperature in Diseases: A Manual of Medical Thermometry, he raised seventeen reasons why medical thermometry is “indispensable,” all of which show his conviction (Wunderlich 1871: vi). It would help doctors, he argued, discover “the laws regulating the course of certain diseases,” “certify the diagnosis,” and “regulate the results of our therapeutical efforts” (vi).
In this technology, too, self-registering became a key to popularity. In the earlier part of the century, clinical thermometers were applied by doctors, but thereafter became a health check tool that each individual could apply for themselves. Contemporary doctors refused the idea of making medical tools available to laypeople, but with a growing industry around the clinical thermometer, they and society regarded its convenience as a merit. Another key to its popularity arose from the technique of graphic presentation. With this technique, not only doctors but also laypeople could understand normal and abnormal curves in a visual form. Neither words nor numbers were needed, but instead a curve was visually displayed, as Borell (1987) has argued, which is why many contemporaries and historians have regarded Wunderlich’s study as revolutionary.
Clinical Thermometry in Modern Britain
Medicine and Politics
At the same time as Wunderlich’s study, English doctors developed a theory and technology of clinical thermometry. In his Handbook of the Scientific and Practice of Medicine published in 1858, William Aitken contributed to clinical thermometry, which he regarded as a key to access “the nature of diseases” (Aitken 1858: vi). Aitken tried to identify courses of diseases with an index of human temperature, yet he had not made a chart for each disease at that time, simply producing a table to show a curve of the body temperature in typhoid fever (160). However, it was his great contribution that he and L. P. Casella, an Italian medical instrument maker, exhibited a clinical thermometer in the Great Exhibition in 1851 and that, with Aitken’s help, Casella invented a pocket thermometer around 1860 (Oxford Dictionary of National Biography).
In 1866, The Medical Times and Gazette featured clinical thermometry, setting the tenor of medical opinion about clinical thermometry. The anonymous author of “The Thermometer in Disease” introduced Wunderlich’s study on body temperature and diseases and emphasized the usefulness of the clinical thermometer in diagnosis (“The Thermometer in Disease” 1866: 177–78). According to this article, physicians used to diagnose pleurisy based on objective symptoms, such as respiration, percussion, and pulse, and patients’ subjective narratives of pain. At the early stage of disease, however, such signs were often obscure. Clinical thermometry changed this clinical encounter as doctors could gain other reliable information from the body temperature. With this technology, they could “at once decide the true nature of the disease in question” (“The Thermometer in Disease” 1866: 178). On this basis, this author recommended a thermometer made by Casella’s firm.
The Medical Times and Gazette published another supportive comment posted by several physicians (Water 1866: 416). Among them, Clifford Allbutt, a distinguished English physician, argued that “qualitative knowledge shall be quantitatively ascertained whenever possible” and recommended taking a thermometer more habitually and constantly in one’s pocket than a stethoscope (Allbutt 1867a: 182). His favorite thermometer was made not by Casella but by Harvey and Reynolds, a manufacturer that produced a new portable clinical thermometer jointly with him (Allbutt 1867b: 316).
The year of 1866 is often seen as a watershed in the history of the clinical thermometer. In a physician’s memoir, it was said that “thermometers began to make their appearance in English hospitals about 1866–67 and came into general use in 1868–70,” because its size became smaller and its measuring time shorter (McGuigan 1937: 153; “King’s College Hospital” 1865: 647–48). Later, indeed, English doctors increased references to taking body temperature. At the meeting of the British Medical Association (BMA) at Bournemouth in 1891, a St. Bartholomew’s physician, T. Lauder Brunton, reported that the clinical thermometer was “now to be found in every doctor’s waistcoat pocket” (Brunton 1891: 217). At the annual meeting of the BMA held at Portsmouth in 1899, a Queen’s physician, Richard Douglas Powell, accepted that the clinical thermometer had become “as important in bedside medicine today as the barometer and compass combined are in navigation” (Powell 1899: 321).
In the early twentieth century, a war brought a radical change to the history of clinical thermometry. In October of 1918, the Ministry of Munitions issued a Clinical Thermometer Order that all clinical thermometers be tested by the National Physical Laboratory (NPL), chiefly because of the increasing demands for this diagnostic instrument from before the war and partly because the NPL aimed to promote British clinical thermometers with a mark of standardization (“State and Research” 1918: 361). According to the annual report for the year of 1919, the NPL had examined twenty thousand to thirty thousand items per week in 1918 (“Work of the National Physical Laboratory” 1920: 308; Moseley 1978; Magnello 2000; Pyatt 1983). In 1920, the government submitted a Ministry of Health (Miscellaneous Provisions) Bill that stipulated that “no person shall sell, supply, or deliver any clinical thermometer unless it has been tested, approved, and marked in accordance with regulations made by the Minister [of Health]” (“Parliamentary Intelligence” 1920: 423). This bill failed to pass that year and was not enacted afterward. After all, the abovementioned Ministry of Munitions Order was kept as it was transferred to the Board of Trade in 1919.
The state action was probably influenced by the 1918–19 influenza pandemic, which caused more than two hundred thousand deaths by mid-1919 (Van Hartesveldt 1992: 91–92; Johnson 2003: 132). As past studies have already argued, few doctors unfolded ideas of pathology, therapeutics, and prevention, and the state authorities did not promote countermeasures. However, as will be shown in the following, a significant number of clinical thermometers were sold around 1918, promoted by wholesalers and druggists.
Economy and Consumption
Behind the popularization story were manufacturers. An article in the Lancet in 1856 showed thirty-nine makers of the clinical thermometer, which included several eminent makers, including L. P. Casella and Negretti and Zambra, both of which were located in Hatton Garden in London, London’s tool makers’ area (“Microscope and Philosophical Instrument Makers” 1856: 343). They had already begun production of medical thermometers in the earlier part of the century and, accordingly, competed with each other at the end of the century. To differentiate their item from others’, for example, Negretti and Zambras emphasized in a catalogue that it no longer contained bubbles of air and was “indestructible” (Negretti and Zambra’s Encylopedic Illustrated and Descriptive Reference Catalogue n.d.: 41). It also aimed at additional value by publishing a manual of clinical thermometry to provide basic knowledge of body temperature, application procedures, and proper intervals for recording. Counterparts similarly advertised their original and improved thermometers as sensitive, strong, clean, and small in advertisements and elaborated their original manuals (“Hick’s New Patent” 1890: 81).
Another pioneering manufacturer was L. P. Casella, originally established in London in 1767 by an Italian instrument maker named Casare Tagliabue and later taken over in 1837 by Louis Pascal Casella, an Italian immigrant from the same hometown as Tagliabue (D/B/CAS/66). His firm produced various kinds of meteorological instruments and purveyed them to the Admiralty and Government’s Ordnance, and a spinoff commodity was the clinical thermometer (D/B/CAS/7) (Fig. 2). They produced a smaller, portable, and self-registering clinical thermometer jointly with William Aitken, a doctor from the Army Medical School, and were said to be “the first to construct a registering clinical thermometer” (“Late Mr. L. P. Casella” 1897: 1226). According to a biography, before them, the clinical thermometer did not have a self-registering index, and its stem was ten inches long. Instead, they enabled self-registering and shortened it to six inches. L. Casella and Aitken made it more “easily and conveniently used” (D/B/CAS/49). This thermometer could register temperature at any part of the body and at any position taken by the patient. The time in taking temperature was also shortened to 2.5 minutes. The original price of this item was 9 shillings and 6 pence in 1868 (D/B/CAS/7). The practical procedure was the same as for others. Casella, too, prepared an instruction card, “How to Use Casella’s Clinical Thermometer” (D/B/CAS/49).
However, Casella’s clinical thermometer did not sell well in the latter part of the nineteenth century because of its custom-made production while other manufacturers promoted mass-production. Casella was a traditional tool maker; it employed only twenty-five laborers in the early twentieth century (D/B/CAS/54). Hence, it did not join the fierce market competition and use mass production (D/B/CAS/49). The clinical thermometer occupied a relatively small part of the sales as most orders were for meteorological instruments.
Despite the passive production of clinical thermometers, Casella is an important case because it left order books between 1874 and 1931, now held at the Hackney Archive in London, with which we can find how much and to whom they were sold (D/B/CAS/10–13). Regarding the former point, this document shows that Casella sold only 19 items of a total of 5,049 between 1884 and 1918 but suddenly increased production and sold 4,981 items between 1918 and 1922, certainly due to the outbreak of the Great War and influenza. This sales trend is supported by the number of advertisements appearing in the Chemist and Druggist.1
Those who bought Casella’s clinical thermometers were drug stores, chemists, and wholesalers, occupying 76.5 percent of the purchasers, 92.3 percent of total sales of the item, and 94.8 percent of the sales receipts. They include the following well-known medical traders: the British Drug House, Timothy White, T. Edward Lescher, Evans Sons Lescher and Webb Ltd., Burgoyne, Burbidges and Co., and Baird and Tatlock (D/B/CAS/10–13). Other customers were individual direct purchasers, though most of them are unidentified. They were medical practitioners, physicists, and farmers (D/B/CAS/10–13).
One of the identifiable purchasers of Casella’s clinical thermometer was Herbert Dennis, a headmaster of the Great Ayton Friends’ School at North Yorkshire, a Quaker secondary school. According to Casella’s order books, he bought a clinical thermometer on 25 March 1918 at the price of 1 shilling 3 pence, five on 5 January 1919 at 10 shillings, and a dozen on 6 March 1922 at 1 pound 6 shillings (D/B/CAS/10–13). It is fortunately possible to trace his school’s documents held at the North Yorkshire Record Office. However, it is difficult to find the direct reason why he bought them. For example, the school diary left in the archive does not give any precise information as to the purchase (ZFA, MS 4056). There are only several simple records in the petty cash book that show the purchases (ZFA, MS 4056).
There are several kinds of Great Ayton’s documents that indirectly suggest the background for Dennis’s purchase. Based on these, I propose the following three possible reasons. First, the sales to Dennis were certainly caused by the 1918–19 influenza pandemic. In 1918, an opening essay of the Beckside, Great Ayton’s school magazine, supposedly written by Dennis, described how this disease attacked a small Quaker school. The school was “visited by surely the most extraordinary epidemic that ever entered into the four walls of the school” and “was no respecter of persons and came upon us in no half-hearted way” (ZFA, MS 4056). The epidemic raged for weeks in a neighboring village and came to the school on 3 July, when the school was already on vacation. A week later, 54 had the disease, which soon reached 110, but there was no serious case. As a result, the opening new term was postponed until September.
In the influenza panic, clinical thermometers were used at the school. According to the report of the managerial board of the school, Dennis stated that “I shall never forget Mr. Baker violently protesting he was feeling as fit as anything with a temperature of over 102” (ZFA, MS 4056). With regard to this use of the medical device, he praised the school’s quality in preventive and nursing care, because the school could protect 52 candidates for the Oxford Local Examinations from the epidemic. This influenza story, however, is inconsistent with the fact that Dennis had already bought the first clinical thermometer in March 1918, before the outbreak in July, which would lead us to think of other reasons.
Second, clinical thermometry might be promoted as a part of school health. The Report of Inspection of the Friends’ School, Great Ayton, held on 26th, 27th, 28th November 1919 stated that, “during the pupils’ school life, physical measurements are regularly taken. The question of periodical medical inspection is under consideration” (ZFA, MS 4056). This was possibly because several contemporary manuals for school health recommended clinical thermometers to be used at schools. For example, Francis Warner’s The Study of Children and Their School Training described clinical thermometry in a chapter titled “Hygiene and Health Management during School-Life,” where he instructed teachers to take the temperature of students who were “flushed or ill,” and he concluded that “every school should be provided with a clinical thermometer” (Warner 1889: 230).
The second hypothesis may be reasonable because the headmaster, Dennis, was said to have a scientific mind. A draft paper of the reminiscent book called Centenary History devoted a chapter to Herbert Dennis, where it stated that he was “a man linked with the past of the school, familiar with its present ways and made by them responsible for its future. . . . Methodical efficiency marked his work; he kept careful and accurate records; statistics occupied an exalted place in his hierarchy; facts weighed heavily” (ZFA, MS 4056). Indeed, he somehow bought sixteen clinical thermometers in four years.
Another possible and better explanation was scientific education for ideal women. The abovementioned inspection report stated that the school provided for girl students a teaching of hygiene (ZFA, MS 4056). They were instructed on how to follow hygienic rules, but it was said that, regarding this subject, “no attempt is made to develop it on a sound scientific basis. It would be great advantage if the course of work could be complementary reorganised so as to include a graduate and logical series of experiments and practical observations” (ZFA, MS 4056).
To supplement this, we can remember the Victorian medical culture in which nursing for the sick was considered a woman’s role. As well as “to prepare or apply poultices, fomentations, hot bags and bottles, blisters, lotions, leeches, ice bags, evaporating lotions, and wet packs, and prepare for cupping,” taking body temperature was the nurse’s duty (“British Nurses’ Association” 1888: 774). Between the latter part of the nineteenth century and the early twentieth century, this norm was repeatedly expressed in various manuals for home nursing and public health (Billroth 1891: 184–88; Craven 1889: 94–95; Newsholme 1892: 304). Additionally, the practice of clinical thermometry was assigned not only to female nurses but to mothers and daughters in household manuals. It was thought they should know how to use a clinical thermometer, for it was considered a female vocation (Weathery 1880: 51–52; Thomson 1883: 600; Harrison 1909: 30–34). Let us look at an article of the women’s journal Quiver in 1898. Author Lina Orman Cooper stated that “one appliance should be in every Home Ruler’s domain—that is, a clinical thermometer. Every mother should know how to use the same” (Cooper 1898: 1009; Cooper 1901: 459–60; Primrose 1899: 365). She did not regard this instrument as a mere medical appliance but thought that “we save ourselves hours of anxiety by using this little instrument, and we often guard our Home Rulers from unnecessary physic and bed” (Cooper 1898: 1009). In The Girl’s Own Paper, an influential English magazine that aimed to propagandize ideal women, several authors similarly set out an idea that it was women’s task to take the body temperature of patients in their families. Some of them were doctors; others were female writers (Westland 1888a: 422; 1888b: 766; Medicus 1892: 677; Hope 1885: 26). The hygiene education for schoolgirls must be read in this context.
It should be also noted that Dennis was rather influenced by his wife. Dennis was married to a granddaughter of the first headmaster, George Dixon, which led them to the school in 1913 when his wife, Muriel Dixon, became mistress of the household. From the perspective of technology-in-use, particularly referencing English experiences, we observe a rather entangled scene of war, epidemic, school health, and gender.
Clinical Thermometry in Modern Japan
Medicine and Politics
In Japan, the history of clinical thermometry began with a gradual reception of Western medicine starting in the nineteenth century. The Westernization of Japanese medicine began in the 1860s. In 1871 Japanese government sent politicians, bureaucrats, and doctors to Western countries to learn how to transplant Western medicine to Japan and hitherto published the Isei, an order to institutionalize Western medicine in Japan. This order covered the national administrative system, educational institutions, national control of doctor’s qualifications and salaries, infectious diseases, midwives, and drugs. However, Japan’s dream for state medicine was incomplete because of the lack of resources. People depended largely on traditional medicines and doctors, and the hospitals were a limited choice for treatment. The modernization of Japanese medicine was still underway (Kawakami 1965: 86–113).
The history of clinical thermometers in modern Japan is best understood within the context of the medical market. After the Meiji Restoration, Western medicine developed not only in medical theory and clinical practice but also in medicinal drugs. The importation of the Western drugs soon exceeded Japanese ones in the late nineteenth century. Major medical wholesalers and firms challenged Western dominance by increasing their own drug production. It was the same in terms of medical devices. However, Japanese medical manufacturers could not have covered domestic demands at that time, which was clearly understood in such an urgent situation as the First World War. In wartime, Japan suffered from shortages of imported drugs and medical devices. This national crisis led the government, doctors, and medico-commercial bodies to an alliance to increase medical materials manufactured domestically, which became a new basis for Japan’s medical industries (Kawakami 1965: 291–97).
The clinical thermometer was known by doctors who studied Dutch medicine in the earlier part of the century. For example, Choei Takano, a famous doctor and intellectual acquainted with Dutch publications, invented a clinical thermometer based on Dutch medicine (Watanabe 1935: 508).2 It became popular gradually after the waves of Westernization caused by the Meiji Restoration. In 1883, a local inventor and entrepreneur, Kosuke Kashiwagi, crafted an original clinical mercury thermometer in Yamaguchi, which was the first domestic product (508). Kenji Tsuruta, an academic majoring in physics, also contributed to the improvement in the late Meiji era (508).
As production developed, medical and political concerns emerged about verifying clinical thermometers, and starting in 1893, voluntary examination started with Tokyo Kenbikyo-In (東京顕微鏡院, Tokyo Institute of Microscope). Michiho Ikeda, a doctor from the Department of Medicine at Keio University, mentioned in his paper in 1924 that, in 1893, Tokyo Kenbikyo-In examined ten thousand clinical thermometers, both international and domestic, and found that 2.77 percent of the items were working incorrectly (Ikeda 1924b: 604). In 1915, the Japanese government established Chuo Doryoko Kentei-Jo (中央度量衡鑑定所, National Metrology Institute; NMI) in 1915. It was often said that, before the establishment of this institution, the quality of domestic clinical thermometers was very low (Ikeda 1924a: 502). The new institution contributed gradually to the improvement in the quality of domestic products, but the Great War reinforced the idea that domestic medical products were low quality. The war stopped imports from Western countries, causing even lower-quality domestic products to occupy the market (Ikeda 1924b: 605). Ikeda argued that clinical doctors did not have enough knowledge about clinical thermometers, so it would be fatal for them to misdiagnose diseases using low-quality products, particularly in the early diagnosis of tuberculosis (615). Indeed, the NMI rejected about 28 percent of 2,507 clinical thermometers between 1917 and 1918 (605).
To address the quality issue, the Japanese government enacted a new parliamentary act in 1919 (Ikeda 1924a: 502). The new act introduced a system in which every manufacturer and retailer must be registered by the national authorities. It was not easy to become a registered manufacturer and retailer, because the act regulated various conditions in detail. For registration, manufacturers had to prepare enough capital, and retailers had to obtain a drug store license given by the state (Watanabe 1935: 508–9; “Keiki Gyosha” 1922: 2). In addition, it defined a standard quality for the clinical thermometer, both the appropriate materials and physical structures, which made small- and medium-sized factories give up production, and urged bigger firms to craft better products in Tokyo, Osaka, and Yamaguchi.
The 1919 act also strengthened the national inspection system in which mechanical engineers appointed by the government were sent to each factory for inspection and instructed on what materials were to be used and how products were to be processed (Watanabe 1935: 508–9), and clinical thermometers were sent to the NMI. For this system, the NMI established three offices in Tokyo, Osaka, and Fukuoka. The examination charged manufacturers 15 sen (銭) each, taking between four and five days to complete (514). To this end, clinical thermometers that had passed the examination were given a stamp. Those who used illegal clinical thermometers, temperature meters, and pressure gauges were to be sentenced to imprisonment of up to a year or fined 500 yen (“Kenin ga naito” 1925: 2).
Japan’s experience shows both that the war was crucial in the history of the clinical thermometer and that Japan was obsessed with the modernization of medicine and health. Britain introduced a system of compulsory examination at the same time but never resorted to total control over the whole industry, including retailers. In contrast, Japan pursued a state-controlled style of mechanical production to improve it.
Economy and Consumption
The market for clinical thermometers expanded significantly in the 1920s. As of 1924, Ikeda referred to about fifteen domestic firms and ten international makers that engaged in producing clinical thermometers. The former, for example, included Kashiwagi, Kanto, Jintan, Olympus, Ricoh, and Favor, and the latter included Zeal (England), Right (Germany), Pyramid (United States), Hicks (England), and Rectal (United States) (Ikeda 1924a: 504–5). Such major firms developed commercial strategies to sell clinical thermometers to the public. The historical database of Asahi Shimbun shows us many advertisements for this new health device. One of the domestic products that appeared in the newspaper was the Kashiwagi clinical thermometer, which was produced by the abovementioned pioneer in Yamaguchi (“Kikusui Taionkei” 1917: 6; “Tsumuta Taionkei” 1923: 7; “Zehi Taionkei” 1926: 5; “Kashiwagi Taionkei” 1935: 8).3 The advertisement stated that it was the best and most authentic domestic product and that it would send purchasers a brochure entitled “Common Sense of Clinical Thermometer” （体温計ノ常識）.
On the other hand, international products kept a privileged position in the market. There were local agents that imported and sold English, German, and American clinical thermometers. For example, a British clinical thermometer manufactured by Powell & Co. of London was sold by the merchant Noda Tokumatsu Firm in Tokyo (“Giba Taionkei” 1922: 7; “Right Doku” 1924: 6; “Totsu-gata Faber” 1924: 3).4 Its newspaper advertisement in 1925 stated that it was examined both by the Japanese and British governments, and the cost was 3 yen each (“Taionkei Adon” 1925: 3).
One of the eminent domestic clinical thermometers was Jintan’s thermometer, which began to be sold by a firm established by a group of elite doctors including Mitsuomi Sasagawa, Shibasaburo Kitasato, Eigoro Kanasugi, and Tatsukichi Irisawa in 1924 (“Jintan no Taionkei” 1924: 6; “Jintan no Taionkei” 1925: 8). The Jintan Thermometer has a rather unique story. The elite doctors thought it was necessary to promote domestic production of clinical thermometers after the Great War for the reasons mentioned above, namely, the suspension of imports and low quality of domestic products. It was almost a part of national policy, because elite doctors established a new firm through the Japan Imperial and Private-Sector Society for Promotion of Hygiene in 1886, which was a voluntary association in its official profile but was actually a state-affiliated institution for public health.
In 1921, this society established a new manufacturing firm, Akasen Clinical Thermometer Co., which was based on a small instrument factory in downtown Tokyo established by Eiji Takeuchi, whose name was given to the original name of the company “Takeuchi Terumo Manufacturing” (presently Terumo) (Terumo 1992: 5). In 1923, this new firm succeeded a department of measuring instruments from the Takachiho Instrument Factory (presently Olympus) and, around the end of the 1920s, sold clinical thermometers through four wholesale agents: Fujimoto Firm, Yamaguchi Medical Instruments, Matsuyoshi Medical Machines, and Fujimoto Medical Industry (270–71).5 This company supplied clinical thermometers to the Japanese and Bulgarian armies in the 1930s, also contributing to the war medicine in the Second World War.
Jintan and Morishita’s role in this project was to assist with the public relations of this company. Hiroshi Morishita has been well known in the history of modern medicine in Japan; his nouveau riche story represents a Japanese dream in the age of modernization. Born in a family of Shinto priests in Hiroshima, he began apprenticing for a tobacco merchant at the age of nine and six years later went to Osaka where he again started as an apprentice at a Western cloth shop. In so doing, he realized the importance of advertisement in the coming new modern economy (Morishita Jintan 1974: 18–31). In 1893, he established his apothecary firm, Morishita Nanyo-Do, in Osaka, whose first and best product was and has been Jintan, a cure-all medical tablet including various Eastern herbs. To sell this, Morishita employed original market strategies. Before Morishita, medicines and herbs were sold largely either by peddlers, independent apothecaries’ shops, or practitioners. Morishita started placing one-page advertisements in national newspapers as well as elaborating a national network of wholesale agents and drug retailers and achieved significant success (46).
His marketing strategy was applied readily to the clinical thermometer. In 1921, Morishita put a one-page advertisement in national newspapers to call for public entries for a prize contest to name and phrase copy about a new clinical thermometer that was going to be sold by Akasen (Fig. 3). Interestingly, the advertisement had already suggested several model names and phrases that implied doctors’ wishes: for example, “a key to everyone’s health,” “a consultant for health at home,” “indispensable for each to have one clinical thermometer and defenseless if no clinical thermometer is at home,” “civilized men have a clinical thermometer rather than a watch,” “it is worth being charged with bodily injury if parents neglect to take children’s temperature and let them get ill,” and “it has many advantages to prevent imports completely” (“Taionkei no meishou oyobi hyogo dai-kenshō boshū” 1922: 8).
In reply to the advertisement, 610,496 postcards were sent to Morishita, who finally decided on a new brand name, Jintan’s clinical thermometer, which was rather uninteresting because it was already suggested by Morishita in the above advertisement (Morishita Jintan 1974: 68). However, 1,624 applications proposed this simple name, and a housewife living in Shizuoka was presented the first prize of 1,000 yen (Morishita Jintan 1974: 68; “Jintan Honpo” 1922: 4). She sent the first postcard to suggest “Jintan’s clinical thermometer.” A prize for the sales phrase was given to “Jintan’s clinical thermometer makes invisible illness visible” (“Jintan Honpo” 1922: 4). With these commercial strategies, Jintan’s clinical thermometer successfully became popular in modern Japan.
Following Jintan’s success, in 1923, a local agent of the German-made Right thermometer also advertised a poem and haiku contest, whose prizes ranged from 10 to 100 yen (“Kenshō Boshū” 1922: 3). Among the winning entries, an entry in short prose tells of an ideal scene in which clinical thermometers were used in modern Japan:
As an anxious first day of marriage and pleasant second day has passed, on the third day of bashfulness, my mother-in-law was in bed with an illness. I sat up caring for her all the way, and I applied my thermometer (which I brought from my parent’s home) to her three times a day. My first communication with my parents was to tell that I have perfectly performed the duty as a new wife. (“Kenshō Right” 1923: 3)
The reason this entry won the prize is very clear; in modern Japan, women were expected to play a gender role in nursing at home and should know how to use this new health device, as in the abovementioned British story. Clinical thermometry was a new icon of modern gender.
Along with these, newspapers published a number of articles about clinical thermometers for public enlightenment, specifically showing how it was crafted, how to use the device, and how important it was to keep the machine working correctly (“Machi” 1934: 7; “Korekara” 1935: 5; “Takujo Kagaku” 1937: 4). The enlightenment project was to instruct not only in newspaper texts but also in public exhibitions. The Measurement Exhibition in 1921, planned by the Ochanomizu Education Museum, provided an opportunity for visitors to check their own clinical thermometers: the officers of the Ministry of Agriculture and Commerce examined clinical thermometers to affirm whether they worked correctly (“Yasube” 1921: 5). Similarly, the City of Osaka provided thirteen temporary examination offices between 1931 and 1936, where engineers checked clinical thermometers free of charge (Fujiwara 1937: 50).
The enlightenment projects and cultural supports around clinical thermometry trained users who checked their own health individually and periodically. For example, Takashi Hara, the prime minister between 1918 and 1921, wrote in a diary on 26 October 1918 that he felt cold and applied a clinical thermometer to himself. The result was 38.3° Celsius (Hara 2000: 31).6 The reason he did so was probably that he worried about influenza at that time. In addition to him, several famous writers, including Kafu Nagai, reported using clinical thermometers in entries of their diaries. On 11 November 1918, Nagai stated that he might have a cold because of the lack of fireplaces in Nihonbashi Club, a snobby social club in Tokyo, which he had visited that day. He then used a clinical thermometer, but it showed the normal temperature. However, he thought that it would be better to go to bed in case he caught influenza (Nagai 2001: 43). There is no further evidence to understand why he did not rely on the result taken from his clinical thermometer. Perhaps, he resorted to the clinical thermometer due to the fear of influenza, but did not actually trust the technology itself.
On the other hand, not all intellectuals counted on the medical device. A literary author, Ujaku Akita, often recorded the weather and his health conditions daily. While often referring to the air temperature in the morning (Akita 1965: 185, 188), he never resorted to a clinical thermometer in fever. He stated very simply, “I feel a touch of cold. My runny nose embarrasses me” (152) and “Cold. Severe fever! Painful. My body smarts hopelessly” (159).
It can be said, however, that modern Japanese society largely accepted this new and civilized health device. A historian of modern Japan, Ryuichi Narita, argued that, in modern Japan, internalization of health norms went in effect with factors of Japan’s strong wishes for civilization, Westernization, and nationalization (Narita 1995: 389). In Japan, clinical thermometry worked well with supporting factors of war, commerce, gender, and wishes to develop the country for Western civilization.
The international history of clinical thermometry, as this paper has shown, tells us how British and Japanese societies exploited this medical technology for their political, economic, and individual health needs. From social, economic, and cultural history viewpoints, instead, we can understand its history to be more multidimensional than past studies have shown. The clinical thermometers were not employed solely by medical professions, not practiced exclusively at hospitals and clinics, nor popularized immediately after technological invention and improvement, which is clearly a research outcome that this paper’s methodologies of “technology-in-practice” and “history from below” have achieved.
The British story of clinical thermometry tells us that, despite the significant technological improvement in the 1860s, clinical thermometry did not develop immediately. The popularization required commercial promotions elaborated by manufacturers and retailers, a sudden inflation of public fear against an epidemic in the First World War, developments in school health education, and a gender culture that assigned the task of clinical thermometry at home to women. This story becomes clear with the historical documents of a manufacturer, Casella, left in a small archive in London.
Japan followed a similar trajectory to the British one. In Japan, too, the First World War was crucial in the rise of the clinical thermometry, because the war forced the country to produce its own product. However, while Britain introduced a system of compulsory examination at the same time but never resorted to total control over the whole industry including retailers, Japan pursued a state-controlled style of mechanical production to improve it. The degree to which the state intervened in health industries was clearly different. In regard to commercial promotion, Japan shared almost the same course as Britain. The advertisements that appeared in a Japanese national newspaper popularized modern health norms, including clinical thermometry. In addition, they seem to play a significant role in forming a particular gender culture in which women should take temperature using a clinical thermometer. Both in Britain and in Japan, women were expected to play the gender role of nursing at home and to know how to use this new health device. Clinical thermometry was a new icon of modern gender. Another difference from Britain is that Japan promoted clinical thermometry through such enlightenment projects as pubic exhibitions. Behind this was Japan’s strong desire for modernization and Westernization, which made social, economic, and cultural resources available to be exploited more than in Britain. This desire was reflected in the experiences of Japanese thermometer users, as this paper has shown.
This comparison implies that modern technologies do not become popular necessarily in the place where they were invented and improved technically. In developing countries, like Japan in the early twentieth century, political rulers, economic entrepreneurs, and the public would demand modern devices ardently and strived to popularize, sophisticate, and diversify them. It tells us how important the medical technology stood among various sociocultural forces.
Beyond this understanding, one may refer to a modern desire for the correct understanding of their own bodies. Benjamin Franklin kept a daily ledger to chart his progress toward “moral perfection,” including his health conditions. In modern times, his followers do so by number. The “Quantified Self,” a new health movement in the United States, has promoted “self-knowledge through numbers,” particularly through such machines as smartwatches and digital health checkers. Such self-trackers measure and monitor their pulse, temperature, blood pressure, brain waves, fat and sleep cycles; send such “self-surveillance” data to a web server; and share it through Social Network Service in order to archive better health collectively. The history of clinical thermometry, a basic anthropometry, and a pioneering medical technology may be a hint to us to think of the self-surveillance for health. It depends not only on medical technology but also on the sociocultural trajectories surrounding human beings.
In the late nineteenth century, there was only one advertisement for a clinical thermometer, which appeared in the Chemist and Druggist in the 1860s. However, the number rose to 12 in the 1870s, 89 in the 1880s, 91 in the 1890s, 70 in the 1900s, 271 in the 1910s, and 214 in the 1920s, peaking around the Great War.
Jo Watanabe was a director of the National Metrology Institute and official of the Ministry of Commerce and Industry in 1935.
The Tsumura’s advertisement stated that its clinical thermometer “prevents imports.”
The imported clinical thermometers were basically expensive, between one and two yen each (Morishita Jintan 1974: 66).
This firm contracted the following four wholesale agents: 藤本商店 (Fujimoto Firm) and 山口医療器 (Yamaguchi Medical Instruments) in Osaka and 松吉医科器械 (Matsuyoshi Medical Instruments) and 藤本医療産業 (Fujimoto Medical Industry) in Tokyo.
In searching for cases in which the clinical thermometer was used, this paper relied significantly on Akira Hayami’s book on the 1918–19 influenza, which includes the records of the epidemic in personal diaries (Hayami 2015: 173–76).