Iraq Banner Desktop

Store Banner Mobile

Japanese illustration of smallpox, dating back to 1720, from a work entitled Toshin seiyo, or The essentials of Smallpox. Source: Wellcome Collection / Public Domain

The Japanese Smallpox Epidemic of the 8th Century: Cause and Effect


Human history has undergone countless epidemics, some which have been nipped in the bud due to sparse populations, some due to prudent medical interventions. Some, like the recent COVID-19 pandemic and the ‘Black Death’, have wreaked almost global havoc, while others have caused devastation locally. One such locally devastating epidemic was the 8th century smallpox epidemic in Japan, during the Nara period, which began in the region of Yamato and quickly spread throughout the country, causing widespread illness and death.

The Wrath of Smallpox

Smallpox was a highly contagious disease, transmitted through close contact or through contaminated objects like clothing and bedding. It is characterized by fever and the development of a distinctive rash of pustules, which can cover the entire body.

It has contributed significantly to the erosion of human mortality throughout history, only eliminated due to a global vaccination campaign in the 1980s, making it the first human disease to be eliminated through human effort. Today, vaccination against smallpox is no longer necessary as the disease has been eradicated completely.

Smallpox was a deadly disease throughout history, that was eventually eradicated through vaccination. (Marina Demidiuk/Adobe Stock)

Smallpox was a deadly disease throughout history, that was eventually eradicated through vaccination. (Marina Demidiuk/Adobe Stock)

Trade and Cultural Contact: Japan and Buddhism

How did smallpox come to Japan? During the sixth century AD, smallpox was introduced to Japan by merchants and Buddhist missionaries from the Korean kingdom of Paekche. Despite periodic manageable outbreaks, the disease continued to emerge in waves with catastrophic consequences. In 735, a second smallpox epidemic swept across Japan, decimating the population by 30 percent, causing labor shortages, and leading to declines in agricultural production and tax revenue for the court.

In response to the epidemic, Emperor Shomu (r. 701-745), a devout Buddhist, turned to his faith as a means to alleviate the suffering of his countrymen. He initiated one of the most ambitious Buddhist patronage projects in Japanese history by building the Todai-ji temple, also known as the Great Eastern Temple, and commissioning the creation of a colossal bronze sculpture of the Vairocana Buddha.

The statue of Vairocana Buddha at the Todaiji (Todai-ji) temple. (Public Domain)

The statue of Vairocana Buddha at the Todaiji (Todai-ji) temple. (Public Domain)

Through this project, the emperor was able to stabilize the economy and social order, as well as offer a spiritual solace to his people during a time of great hardship. In fact, after the passage of the worst parts of the disease, it was Buddhist policies that ensured a return to political stability after the disease ran its natural course.

He consulted with his officials at the Bureau of Medicine to seek remedies and guidelines to help combat the disease. These guidelines included the prohibition of drinking water, the recommendation to eat boiled rhubarb, and the application of powdered silkworm cocoons to boils. However, these measures were not effective in stemming the epidemic.

As a devout Buddhist, Emperor Shomu turned to the power of prayer, and ordered Buddhist monks and nuns to read sutras and offer prayers to kami, the deities believed to be a part of the Buddhist universe, for the recovery of the afflicted. These prayers were believed to have helped alleviate the suffering of the people and bring about some stability during this difficult time.

The Wrath of Onryo: Myth and Custom

In ancient Japan, smallpox was often attributed to the wrath of the "onryo," a mythological spirit capable of returning to the physical world to exact revenge. To protect against these malevolent spirits, Japanese locals developed various customs and traditions.

One belief was that smallpox demons were frightened of the color red and dogs. As a result, people began displaying dolls dressed in red clothing or painted red to ward off the spirits. In Okinawa, an island in southern Japan, locals attempted to appease the demons by using the ‘sanshin’, a musical instrument, and performing lion dances in front of smallpox patients wearing red clothes. During the ritual, they offered flowers and burned incense in an attempt to placate the demons.

Although these beliefs and practices seem unusual and overly superstitious in contemporaneous times, they offer insight into the ways in which people in ancient Japan attempted to understand and cope with the deadly disease of smallpox. Some of these traditions still exist today, including traditional smallpox dances to help avoid the ‘smallpox devil’. Even today, the public places great faith in the color red as its association with the eradication of smallpox.

Minamoto no Tametomo defeats a smallpox devil from Yoshitoshi's 36 drawings of Yokai. (Public Domain)

Minamoto no Tametomo defeats a smallpox devil from Yoshitoshi's 36 drawings of Yokai. (Public Domain)

Smallpox: Public Health and Medical Care in Japan

Smallpox was not endemic to Japan at the time, and caused a major public health crisis. Since the Japanese population was unfamiliar with the disease, it caused widespread havoc across social classes, killings tens of thousands of people. To add to the misery, Japan experienced several more outbreaks of the epidemic, which several impacted its development and identity, including relations with other countries.

Conversely, conversations around public health and improving existing infrastructure also arose, becoming a priority in the centuries to come. Many historians have highlighted how this period was responsible for Japan’s eventual emergence as a global superpower, as public health and medical care rose to the forefront of national conversation, while coalescing a national identity simultaneously.

The smallpox epidemic was significant because it occurred during a period of great change in Japanese history. The Nara period, which lasted from 710 to 794 AD, was a time of cultural and political transformation, as Japan had undergone a heavy period of centralization and nationalization, which had led to the development of some kind of a pan-Japanese identity.

This crisis was exacerbated by the absence of vaccines and other effective treatments (in fact, this was almost a full thousand years before industrial growth propelled modern medicinal science and vaccines). Many members of the imperial family and the aristocracy perished due to the disease. All in all, the epidemic had a significant impact on Japanese society, as it severely weakened the existing political and social structures of the country.

Top image: Japanese illustration of smallpox, dating back to 1720, from a work entitled Toshin seiyo, or The essentials of Smallpox. Source: Wellcome Collection / Public Domain

By Sahir Pandey


Rod-ari, M. 2020. Death, Disease, and Buddhist Patronage in Japan: The Great Smallpox Epidemic of 735. Available at:

Sowards, W. 2018. Japan’s History with the Smallpox Demon. Available at:

Suzuki, A. 2011. Smallpox and the Epidemiological Heritage of Modern Japan: Towards a Total History. Med History, 55(3). Available at: https://doi:10.1017/s0025727300005329.

Watanabe, M. 2020. Evidence found of ‘new normal’ after plague in 8th-century Nara. Available at:

Sahir's picture


I am a graduate of History from the University of Delhi, and a graduate of Law, from Jindal University, Sonepat. During my study of history, I developed a great interest in post-colonial studies, with a focus on Latin America. I... Read More

Next article