Studies in Japanese Literature and Culture 7 (March 2024) 25–52© 2024 National Institute of Japanese Literature

Congenital Anomalies in Ancient Japanas Deciphered in the Nihon shoki(Chronicles of Japan)
Tojima Sayaka

The Hakubi Center for Advanced Research, Kyoto University
The Kyoto University Museum, Kyoto University

Yamada Shigehito

Congenital Anomaly Research Center, Graduate School of Medicine,
Kyoto University
Human Health Science, Graduate School of Medicine, Kyoto University

Introduction
Congenital anomalies are structural or functional abnormalities that occur
during prenatal development. According to the World Health Organization(WHO), an estimated 6 percent of newborns have some congenital abnormality,
resulting in hundreds of thousands of related deaths.1 Systematic studies of human congenital anomalies started in the 1960s, triggered by the thalidomide
cases. At that time, as many as 10,000 cases were reported worldwide, and therisk of congenital morphological abnormalities stemming from drugs taken by
the mother during pregnancy became known. This led to research on cases ofcongenital anomalies and their factors. In recent years, with the progress of developmental biology, molecular biology, and genome analysis techniques, a hostof both environmental and genetic factors have now been identified that cancause various congenital abnormalities.
Before congenital anomalies were systematically studied, the epidemiologicalstatus of human congenital anomalies (the kinds of cases and the extent towhich these occurred across a population) could be ascertained only by collecting
case reports published in medical journals. For example, the earliest case of thehuman tail—a congenital anomaly in which a newborn possesses an excess oftail-like structures—was reported in 1884 in the New England Journal of Medicine.2
Similarly, other malformations either characterized by a striking appearance or1
2

See the WHO website: https://www.who.int/health-topics/congenital-anomalies.
Tojima and Yamada, “Classification of the ‘Human Tail.’”

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associated with fatality have also been reported in medical journals. However,the number of cases caused by postnatal disease or by accidents is generally
much larger than those possibly caused by the prenatal situation. Thus, it wasdifficult to grasp the epidemiological status of congenital anomalies even after
the 1800s. For this reason, it has been challenging to elucidate the actual situation of congenital anomalies before the spread of modern medical science. This
study, however, demonstrates the potential of historical documents to help us inunderstanding the epidemiology of congenital anomalies in ancient times, using
Japan as an example.
As in other countries, systematic study of human congenital anomalies in Japan started in the 1960s, and modern medical journals began to be publishedonly in the late 1870s. Consequently, it was challenging to grasp the degree ofincidence or the kinds of congenital abnormalities in pre-modern Japan.
However, numerous ancient historical documents are preserved in Japan.
Careful reading of these historical sources reveals several descriptions suggesting congenital morphological or functional abnormalities. The oldest official
historical chronicle that survives in Japan is the Nihon shoki 日本書紀, which issaid to have been completed in 720. It is a chronological text whose compilation
was ordered by the emperor (tennō 天皇)—the world’s longest-running imperialfamily. The Nihon shoki consists of a mythological part as well as a record of thegenealogy and achievements of forty-one generations of emperors, from thefirst emperor, Jinmu 神武, to Emperor Jitō 持統. It is written in Literary Sinitic
and in annalistic style, with years and dates during each emperor’s reign being
recorded according to the Chinese sexagenary calendrical cycle.
The Nihon shoki is considered to contain more legendary elements than the fivesubsequent official national histories. In particular, post-World War II historiography tended to reject pre-war studies and thought, and several historians proposed theories questioning the historicity of all accounts in the Nihon shoki.
However, recent archaeological excavations of the ancient capital and researchon wooden documents called mokkan 木簡 have shown that the descriptions in
the Nihon shoki (not the entirety but a part of its descriptions at least) accuratelyreflect what actually happened.3 The existence of the emperors mentioned inthis document has been proven by the archaeological record as well. An inscription on an iron sword excavated from the Inariyama 稲荷山 burial mound in
1968, for example, proves the existence of the twenty-first emperor, Yūryaku
雄略,4 which means that the Nihon shoki is not a work of fiction but a chronicleof actual events. Many descriptions in this document, especially those recounting events after the seventh century, have been verified by the findings of sucharchaeological excavations.
3
4

Endō, Rikkokushi.
Hayakawa et al., “Saitama Inariyama kofun.”Congenital Anomalies in Ancient Japan

27

The Nihon shoki is an important historical document that plays a central role inunderstanding Japanese history; and it is also highly valuable from the perspective of East Asian history. Therefore, it has been a subject of study mainly inhistory fields. Noteworthily, it contains many descriptions of natural phenomena, including records of disasters (such as earthquakes, heavy rain, drought, andstorms) and accounts of astronomical events (such as meteors, planetary motions, and solar or lunar eclipses). Recently, some of its astronomical records
have been corroborated by modern science,5 suggesting that these details were
not incorporated as fictional creations but were duly recorded as important matters related to the functioning of the nation. The Nihon shoki also contains numerous descriptions of humans: not only of members of the imperial family
and people subordinate to them, but even of the people opposed to the emperor. Some of these descriptions possibly refer to congenital anomalies.
While the Nihon shoki contains medically valuable descriptions as noted above,it cannot be treated in the same way as ordinary medical records. This is because
it is a historical document based on the social background at that time, and its
contents must be handled with a strict critical awareness. The historical background and intentions of the period in which the text was composed, along withthe degree of truth and exaggeration in its descriptions, must always be considered, instead of simply understanding those descriptions as facts.
Thus, this study attempted to elucidate the epidemiology of congenital anomalies in ancient Japan—which to date has remained largely unexplored—througha cross-disciplinary approach combining medical and historical perspectives.
Materials and Methods
The Nihon shoki Used in This Study
No original copy of the Nihon shoki has survived to the present. Nonetheless,since it has been considered an important record of national history since its
completion, its contents have been repeatedly hand-copied at the imperial court,
and over the years many manuscript copies have been produced; most of theseare designated as National Treasures or Important Cultural Properties of Japan.
In this study, we used the edition of the Nihon koten bungaku taikei 日本古典文学大系 series as the main source text for our reading and data collection.6 Additionally, taking into account the possibility that some characters may have beentranscribed incorrectly in the process of hand-copying or been damaged withage (through deterioration or by insect bite), we have referred also to as many
major extant manuscript copies as possible, to confirm the text of those descriptions we identified as potentially representing congenital anomalies (for a list of
the manuscript copies of the Nihon shoki referenced in this study, see Table 1).
5
6Tanikawa, Sōma, and Qu, “Short-Term Variations.”
Sakamoto et al., Nihon shoki, vols. 1–2.

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Table 1. Copies of the Nihon shoki Referenced in This Study

Jinmu 神武 (1st)Suinin 垂仁 (11th)
Keikō 景行 (12th)
Chūai 仲哀 (14th)
Empress Jingū
神功皇后 (14.5th)Ōjin 応神 (15th)
Nintoku 仁徳 (16th)
Hanzei 反正 (18th)
Yūryaku 雄略 (21st)
Seinei 清寧 (22nd)
Buretsu 武烈 (25th)
Kinmei 欽明 (29th)
Bidatsu 敏達 (30th)
Suiko 推古 (33rd)
Kōgyoku 皇極 (35th)
Seimei 斉明 (37th)
Tenji 天智 (38th)
Tenmu 天武 (40th)
Jitō 持統 (41st)

日本古典文学大系(底本：卜部兼方本)

岩崎本

前田家本

図書寮本

熱田本

北野本

Nihon Koten
Bungaku Taikei(based on Urabe
Kanekata’s copy)

Iwasakibon

Maeda-ke Zushoryōbonbon

Atsutabon

Kitanobon

13c

10–11c14c

14–16c?

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11c

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12c

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Note: For bibliographic information on each of the referenced manuscripts, see the reference list.

Quotations of the Nihon shoki below have been excerpted from the main
source text. In cases where the quoted passage included Chinese characters in
traditional form, we have changed these to their modern equivalents for convenience. This article contains many emperors’ names as well as other Japanesenames and terms. For these, the original characters have been supplied, and theirreadings given as well, for example, Emperor Jinmu 神武. Additionally, in thisarticle, we use the term “Emperor” for any person who is described as having
ascended to the throne as tennō, regardless of his or her biological sex. At thesame time, the term “Empress” is not used to refer to a female emperor, butrather to a woman who is described as the legitimate wife of a male emperor.

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Data Collection from the Nihon shoki
As for the existence of the emperors mentioned in the Nihon shoki, there areseveral theories and it is particularly difficult to verify the existence of the emperors preceding the twenty-first emperor, Yūryaku, from an archaeological perspective. It is therefore also challenging to positively confirm or deny, at thispoint, the historical veracity of the Nihon shoki’s descriptions, and discussions of
the question fall outside the scope of this article. Since the purpose of this study
was to analyze descriptions of human congenital anomalies, the mythologicalsection of the work was excluded. The analysis in this study covered the period
from the first emperor, Jinmu, to the 41st emperor, Jitō, an era whose emperors
are clearly identified as being humans rather than gods in the Nihon shoki.
We collected descriptions of humans possessing abnormal physical and mental
characteristics. Cases clearly describing postnatally-acquired diseases (e.g., the cases
described as 病, meaning “illness”) were excluded from this analysis. Based on theinformation available in each case, the possibility of congenital anomalies was
examined, and a diagnosis of the disease was attempted to the extent possible.
Case Diagnoses: From Medical and Historical Points of View
The Nihon shoki is not a medical text but a historical document recording thenational history of Japan. As background to the compilation of the Nihon shoki,
the threat of the Chinese empire, which at the time exercised a powerful hegemony in the East Asian region, needs to be underlined. In the second year of thereign of the thirty-eighth emperor, Tenji (Tenchi) 天智, Japan suffered a major
defeat in a battle against the combined forces of Tang and Silla in the Korean
peninsula (i.e., the battle of Baekgang 白江, Jp. Hakusukinoe 白村江, 663). Thechanging balance of power, both on the continent and in the Korean peninsula,significantly impacted the formation of the Nihon shoki. All the statements it
contains, in other words, must be carefully examined to assess whether they offer us fact, exaggeration, or metaphor. Accordingly, this study (a) conducted a
medical analysis, to the extent possible, to determine what the names and etiologies of the diseases would be if the statements represented actual symptomsand (b) also undertook a consideration of the historical record to determine
whether these various diseases could, in fact, have actually occurred.
Records of Phenomena Possibly Related to Maternal Nutritional Status
Regarding the relationship between maternal nutritional status and congenital
anomalies, a deficiency in folic acid is well-known to be directly related to neuraltube defects.7 However, most studies to date have focused on the relationshipbetween individual nutrients and disease, and not much research has been focused
Smithells, Sheppard, and Schorah, “Vitamin Deficiencies”; Smithells et al., “Apparent Prevention of Neural Tube Defects.”
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on multiple nutrients, energy levels, and birth defects.8 In the longer term (not interms of birth defects immediately after birth, but in terms of fetal growth retardation [FGR]), “Barker’s Hypothesis,” stating that maternal undernutrition
during pregnancy increases the incidence of future adult diseases in the child, isa plausible effect of undernutrition.9
In ancient societies, epidemics, crop failures, and famines due to climatic irregularities and disasters were considered to be situations directly related to thedeterioration of maternal nutritional status. Since these events were emergencies in the management of the nation, several clear descriptions of them aregiven in the Nihon shoki. Therefore, we examined the possibility of a chronological correlation between the timing of these events and various descriptions ofwhat might be thought to be congenital anomalies. We also collected and summarized data on the occurrence of disasters such as climatic irregularities (extreme temperatures [cold summers, warm winters, hail, etc.], abnormal rainfall[drought, long rains], typhoons, and earthquakes) as possible causes of the deterioration of nutritional status, even if the character 飢 (meaning “starved”) is
not explicitly mentioned.
Results
Among the records for forty-one generations of emperors, a total of thirtythree cases of human abnormalities were found (Table 2). Except during theperiod stretching from the reign of the second emperor, Suizei 綏靖, to the thatof the ninth emperor, Kaika 開化—known as the “generations without history”
for their lack of detailed descriptions—descriptions regarding abnormalities
were found almost universally, and there was no significant chronological bias intheir distribution. These thirty-three cases, the subject of this study, included descriptions of the emperors themselves, of members of their families, and also of
non-imperial people. These cases can be classified into the following five types.
Type 1: Abnormal HeightThis type appeared most frequently in the Nihon shoki. It could be divided into
two patterns: unusually tall and unusually short statures. Descriptions of unusually tall stature were seen only for members of the imperial family (four out often cases). In two of these cases, there were specific descriptions of the person’s
stature. Yamato Takeru no Mikoto日本武尊, who was a son of the twelfth emperor, Keikō 景行, is described as being about 3 meters (1 jō 丈) tall.10 His son,the fourteenth emperor, Chūai 仲哀, is also described as a tall person, 3 meters(10 shaku 尺) in height.11 An indirect description indicates that Emperor Yūryaku
Abu-Saad and Fraser, “Maternal Nutrition and Birth Outcomes.”
Barker,“Fetal Origins of Cardiovascular Disease.”
10
Sakamoto et al., Nihon shoki, vol. 1, pp. 282–283.
11
Ibid., pp. 320–321.
89

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Table 2. Possible Cases of Congenital Anomalies in the Nihon shoki
Number of Cases
Type 1: Abnormal height-Abnormally tall
-Abnormally short
Type 2: Excess tissue or organ formation
Type 3: Speech or behavioral abnormality
Type 4: Different facial or body feature
Type 5: Pigment anomaly
Other

Imperial

Non-imperial

Total

4
4
0
1
4
0
2
0

6
0
6
5
2
6
1
2

10
4
6
6
6
6
3
2

was also tall. In the scene where this emperor encounters a deity named
Katsuragi no Hitokotonushi 葛城一言主, the height of the deity is described as
being tall in a manner similar to that of the emperor.12
Meanwhile, descriptions of unusually short stature were found only in the
non-imperial peoples (six out of ten cases). The earliest description of shortstature is about the people called Tsuchigumo 土蜘蛛, in the chronicle of Emperor Jinmu’s reign. According to this description, the Tsuchigumo had shortbodies and long limbs similar to the Hikihito 侏儒.13 The term Hikihito refers
not to specific individuals but rather to a so-called “dwarf ” people. In the six
descriptions of short stature, four cases related to them. The term 侏儒 also appears in the Chinese historical work Records of the Three Kingdoms (Ch. Sanguozhi
三国志; in the “Book of Wei” (魏書), within the chapter “Encountering the
Dongyi” (烏丸鮮卑東夷伝), “Section on the Wa 倭 people,” commonly known inJapanese as “Gishi wajinden” 魏志倭人伝), to which the original editors of the
Nihon shoki themselves referred.14 According to this Chinese work, the Hikihito
people were about 90–120 centimeters (3–4 shaku) tall. Their occupation canalso be inferred from the descriptions in the Nihon shoki. In the chronicles of thetwenty-fifth emperor, Buretsu 武烈, and the fortieth emperor, Tenmu 天武, onward,
the Hikihito people are described as participating in a number of recreation
activities held by the emperors.15
There was also a description of a such a “dwarf ” person not of the Hikihito
people. During the reign of Emperor Tenji, the chronicle mentions Nakatomibe
no Wakako 中臣部若子 of Hitachi 常陸 Province (present-day Ibaraki Prefecture),
who is said to have been only about 48 centimeters (1 shaku and 6 sun) tall at the
Sakamoto et al., Nihon shoki, vol. 1, pp. 466–467.
Ibid., pp. 210–211.
14
Chen and Pei, Sangokushi, vol. 30; Sakamoto et al., Nihon shoki, vol. 1, pp. 350–353.
15
Sakamoto et al., Nihon shoki, vol. 2, pp. 16–17, 416–417, 460–461.
12
13

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age of sixteen and who was presented to the emperor, perhaps because of his or
her unusual stature.16
Type 2: Excess Tissue or Organ Formation
Among the descriptions of excess tissue or organ formation, only one case related to the emperor himself. This is the fifteenth emperor, Ōjin 応神, who is
described as congenitally having excess tissue as follows: at birth, he had raised
flesh on his arms, shaped like a tomo 鞆—a device worn on the left forearm whenusing a bow and arrow (Figure 1).17 The Nihon shoki also notes that EmperorŌjin had a long reign and a long life18, and these descriptions strongly suggested
a lack of other severe morphological or functional abnormalities.
Other than the one imperial case, there were five descriptions of non-imperial
individuals with various kinds of excess tissue or organs. The earliest such records appeared in the chronicle of Emperor Jinmu’s reign. The emperor is said tohave encountered two people with tails in the Yoshino 吉野 region (in present-day
Nara Prefecture). The first of these was named Ihika 井光 and is described as thefounder of a tribe living in the region. This person is also described as having
emerged from a well (i 井) and as possessing a body that glowed. The second
person with a tail introduced himself to the emperor as Ishioshiwaku no Ko
磐排別之子 and appeared in front of the emperor after pushing his way througha huge rock.19 This tailed person is also described as the founder of a local tribein the Kuzu 国栖 district of the Yoshino region.
In the reign of the eleventh emperor, Suinin 垂仁, there is a description of a manwith a horn (or horns) on his forehead, Tsunuga Arashito 都怒我阿羅斯等.20 He
was the son of the king of the Kara 韓 kingdom on the Korean peninsula, andis said to have come to Japan by ship during the reign of the tenth emperor,
Sujin 崇神, eventually serving two emperors.
While the people in the three cases above were friendly to the court and the emperor, the following two cases describe forces opposed to the imperial court. In
the first year of Empress Jingū’s 神功皇后 regency (after the death of her husband,
Emperor Chūai 仲哀), there was a man named Hashirokumawashi 羽白熊鷲 inpresent-day Kyushu.21 He was robust, had wings, and could fly high. The imperial
court had him subdued because he was a violent robber and disobeyed imperial
orders. A similar case is recorded in the sixty-third year of the reign of the sixteenth emperor, Nintoku 仁徳—the court subdued a person named Sukuna 宿儺in present-day Gifu Prefecture for similarly disobeying imperial commands.
Sakamoto et al., Nihon shoki, vol. 2, pp. 376–377.
Ibid., vol. 1, pp. 362–363.
18
Ibid., pp. 380–381.
19
Ibid., pp. 198–199.
20
Ibid., pp. 258–259.
21
Ibid., pp. 332–333.
16
17

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Figure 1. Depictions of tomo 鞆 (indicated by white arrowheads) worn on the left forearm.
(A) Nenjū gyōji emaki 年中⾏事絵巻, by Fujiwara no Mitsunaga 藤原光長, copied by Tani
Bunchō 谷文晁. National Diet Library Digital Collection. https://doi.org/10.11501/2591106(image 14). (B) Haniwa Keikō no bujin 埴輪 挂甲の武⼈ (terracotta tomb figure of an armoredman). Tokyo National Museum. e-Museum: National Treasures & Important Cultural Properties of National Institutes for Cultural Heritage, Japan. https://emuseum.nich.go.jp/
detail?langId=&content_base_id=100200&content_part_id=001&content_pict_id=033.

Sukuna is described as possessing one body but two faces dorsoventrally. The topof the head was fused and he had no nape, and there were eight limbs (the numberof the limbs was enough for two people); he had knees but no popliteal fossa.22
Type 3: Speech or Behavioral Abnormality
This type was found in six cases: four were about members of the imperialfamily, and two were about non-imperials. All involve functional abnormalities,
but the cases can be divided into those of speech impairment and those of behavioral disability.
Two cases of speech impairment were found in the imperial family. Homutsuwake
no Miko 誉津別王 (命, 皇子) the son of Emperor Suinin, is said to have cried likea baby and been unable to speak even though he was thirty years old with a long
beard. Later, however, he apparently developed the ability to speak when he became interested in a swan.23 Something similar was seen in the case of Takeru no22
23

Sakamoto et al., Nihon shoki, vol. 1, pp. 414–415.
Ibid., pp. 256–257, 267–269.

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Miko 建皇子, the son of Emperor Tenji, of whom it is clearly stated that “hecould not speak and was dumb [sic]”. He died prematurely at the age of eight.24
Descriptions of behavioral abnormality referred specifically to the tendency to
become easily incensed and use violence. Emperor Yūryaku is described as often
killing people based on misunderstandings, and as having once been condemned
as “a very bad emperor” by the people. However, he improved his behavior after
being admonished by the empress.25 In the chronicle of Emperor Buretsu, agrandson of Yūryaku, there are more descriptions of violent tendences, andthose were not for the execution of criminals but rather for pleasure: incidents
such as ripping open the belly of a pregnant woman to see her fetus, or making
people climb trees and then shooting them down.26 Although this emperor had
an empress, he had no sons or daughters. There is no clear statement in the Nihon
shoki about Buretsu’s age at his death, and there are various theories based on descriptions in later history books.27 The Fusō ryakki 扶桑略記 and the Mizukagami
水鏡 from the eleventh to twelfth century state that he died at the age of eighteen,28 while the Teiō hennenki 帝王編年記 and the Kōdaiki 皇代記 from the fourteenth century describe his age at death as fifty-seven.29
Another such description related to an individual who was a royal but nota member of the Japanese imperial family: King Mata 末多 of Paekche on the
Korean peninsula, who was recommended by the aforementioned Emperor
Yūryaku to become a king, is also described as a tyrant who mistreated his people.30
Among this type, only one case was about a non-imperial person. In the fourthyear of the reign of Emperor Tenmu, a certain man is said to have climbed up ahill, uttered something mysterious and thereupon died after beheading himself.31
Type 4: Different Facial or Body Features
Of the thirty-three total cases, six were of type 4. These all concerned non-imperial people living either in remote areas controlled by the imperial court at thetime or even further beyond, whose facial features appeared to be “different.”
This type of description first appears in records of the reign of Emperor Keikō.
There it is described how he launched a large-scale expedition to the Kyushu area
because several tribes there called Kumaso 熊襲 or Tsuchigumo had not paid
tribute. During the expedition, the emperor is said to have killed two Kumaso
Sakamoto et al., Nihon shoki, vol. 2, pp. 331, 368–369.
Ibid., vol. 1, pp. 464–465.
26
Ibid., vol. 2, pp. 14–17.
27
Higo et al., “Kunchū Fusō ryakki 3.”
28
Kuroita, Fusō ryakki, Teiō hennenki; Kuroita, Mizukagami, Ōkagami.
29
Kuroita, Fusō ryakki, Teiō hennenki; Hanawa, Gunsho ruijū 3.
30Sakamoto et al., Nihon shoki, vol. 1, pp. 497–499, vol. 2, pp. 14–15.
31
Ibid., vol. 2, pp. 420–421.
24
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leaders named Hanatari 鼻垂 and Mimitari 耳垂 and a Tsuchigumo leader named
Tsutsura 津頬.32 These were all personal names but also describe physical characteristics: Hanatari and Mimitari respectively mean “large, drooping nose” and“large, drooping ears,” while Tsutsura means “spiky face.”
During the reign of the twenty-ninth emperor, Kinmei 欽明, there is a description of the people from the Mishihase 粛慎 region, an area to the north of ancient Japan’s (i.e., the imperial court’s) sphere of influence at that time, as “demons (oni 鬼魅), not people (hito ni arazu 非人).”33 The following thirtiethemperor, Bidatsu 敏達, summoned a person named Ayakasu 綾粕. The leader ofthe Emishi 蝦夷 people, a tribe inhabiting the region to the north of the area
controlled by the court, he had been brought to court because thousands ofEmishi were ravaging the frontier. Ayakasu is described as an ōemishi 大毛人, theChinese characters for which mean “hairy person.”34 The more definitive description of Emishi as having a face or appearance different from that of thepeople at court can be found in the chronicle of the thirty-seventh emperor,
Saimei 斉明. In the fifth year of this emperor’s reign, Japanese envoys sent to theTang dynasty in China presented two Emishi people (a man and a woman) to theEmperor Gaozong 高宗. The Tang emperor is to have commented that hefound the faces and bodies of the Emishi very strange.35
Type 5: Pigment Anomaly
There were three descriptions of what appear clearly to be pigmentary anomalies. Two of the three cases related to the imperial family. The most obvious
case was that of the twenty-second emperor, Seinei 清寧. It is clearly stated thatthe emperor was born with silver hair.36 He seems not to have an empress orchildren.
Indirect description of hair streaked with gray was found regarding Yamashirono Ōe no Miko 山背大兄王 during the reign of the thirty-fifth emperor, Kōgyoku
皇極. He was the son of a great regent named Umayato no Toyotomimi no Miko
厩戸豊聡耳皇子 and a grandson of the thirty-first emperor, Yōmei 用明. He was
eventually attacked by a minister named Soga no Iruka 蘇我入鹿 in a dispute
over the succession to the throne, and this attack led him to suicide. A satiricalrhyme recorded in the Nihon shoki uses the term kamashishi 山羊 to refer to theprince.37 The word is thought to refer to the Japanese serow, whose fur is
streaked with gray.
Another description of a supposed pigmentary abnormality of non-imperial
Sakamoto et al., Nihon shoki, vol. 1, pp. 288–289, 294–295.
Ibid., vol. 2, pp. 91–93.
34
Ibid., p. 141.
35
Ibid., pp. 340–341.
36
Ibid., vol. 1, pp. 502–503.
37
Ibid., vol. 2, pp. 252–253.
32
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people was found in the twentieth year of the reign of the thirty-third emperor,
Suiko 推古. People who had come to Japan from Paekche were said to have had
vitiligo on their faces and bodies. They were almost marooned on an island in
the sea because of their appearance, but they were allowed to come to Japan after they appealed, citing their special skills in building landscapes.38
Other: Descriptions of Disability Possibly Including Cases of Congenital Anomalies
The expression atsuehito 篤癃 appears twice in the chronicle of Emperor Jitō.39
This term corresponds to tokushitsu 篤疾, a category of disabled people in the
ritsuryō 律令 code, a set of laws enacted around the time the Nihon shoki itself wascompiled (ritsu 律 refers to criminal law, ryō 令 to administrative law). Generally,
the term ritsuryō contains both the Taihō 大宝 Ritsuryō enacted in 701–702 andthe Yōrō 養老 Ritsuryō (a revision of the former Taihō Ritsuryō) enacted in 757.
In the ritsuryō system, there were three categories of disability, based on severity:
zanshichi 残疾, haishichi 癈疾, and tokushitsu 篤疾. Tokushitsu referred to people
with critical illnesses such as leprosy, epilepsy, disability in two of four limbs, orblindness in both eyes, and such people were exempted from all duties and given
one attendant to care for them.40 Although it is impossible to determine the specific symptoms and cause of disease from a description of atsuehito alone, someconditions so categorized may have been due to congenital abnormalities.
Discussion
In the Nihon shoki, we found numerous descriptions that might be attributed tocongenital anomalies. For each of the abovementioned types 1–5, we examined
whether the cases surveyed could have been caused by a congenital abnormality
and tried to diagnose the disease.
Type 1: Abnormal Height
In the Nihon shoki, three emperors were mentioned as being tall. Similarly, in
the Kojiki 古事記, a historical text compiled around the same time as the Nihon
shoki, there are additional descriptions of two further tall emperors: Emperor
Keikō (about 3.6 meters) and Emperor Hanzei 反正, the eighteenth emperor.41
Combining the descriptions in both texts, we might conclude that Emperor
Keikō, Yamato Takeru no Mikoto, and Emperor Chūai represented three generations of tall height, and that such height was thus likely a genetic trait. However,
the heights given for these emperors are too high to be factual. Since the specificfigures themselves are unlikely to be accurate, it is more realistic to consider
Sakamoto et al., Nihon shoki, vol. 2, pp. 197–199.
Ibid., pp. 500–501, 532–533.
40
Kishi, Ryō no shūge.
41
Kurano and Takeda, Kojiki, Norito, pp. 188–189, 288–289.
38
39

Congenital Anomalies in Ancient Japan37

them as exaggerations of the actual height. It is worth noting that descriptionsof the height of an emperor are usually accompanied by expressions praising
their appearance. Furthermore, since the emperors do not appear with the depictions of short stature described below, focus upon their tall stature may be away of expressing prestige, fighting prowess, or esteem. It is also possible thatthe descriptions represent a combination of actual tall stature and exaggeration.
Medically, unusual tallness is sometimes caused by congenital anomalies. For
example, Klinefelter syndrome, a sex chromosome abnormality, is one possible
cause.42 In the emperors’ cases, however, all the tall emperors are described ashaving multiple children. Thus, it is highly likely that their tall height resulted notfrom a congenital abnormality but rather from a genetic trait. The only exception would be Emperor Chūai, who is said to have died suddenly at the age offifty-two.
Such an association of tall stature and sudden death reminded us of anothercausative congenital anomaly: Marfan syndrome.43 This is a genetic disease, andtallness is its characteristic symptom. Additionally, in affected adults, cardiovascular complications and sudden death are highly likely due to aortic dissection.44
Furthermore, this anomaly is also associated with poor eyesight due to myopia
and lens deviation.45 In the chronicle of Emperor Chūai, one account states thatthe emperor could not see and did not recognize the existence of a certain“country on the sea” that a deity wanted to show him.46 The emperor diedshortly after this event, with the chronicle indeed attributing his early death tohis failure to heed the deity’s words. Of course, it is evident that such a narration
contains mythical elements; and it would be practically difficult to see the Korean
peninsula with the naked eye from atop a high hill near Kashii no Miya 橿日宮
Palace (in present-day Fukuoka Prefecture), where the emperor is said to havebeen at the time. However, that another country existed beyond the sea was, setting aside the deity, probably a fact known to the people of that time. It is highly
likely that there were already political, economic, and cultural exchanges between
Japan and the southern Korean peninsula in the third century, when Emperor
Chūai is believed to have reigned. To take one indicative example, a series of excavations since the 1990s47 have uncovered a group of ancient “keyhole-shaped”
burial mounds (zenpō-kōen-fun 前方後円墳) in the southern part of the Korean
peninsula. Burial mounds of such shape were characteristic of ancient Japan atKlinefelter, Reifenstein, and Albright, “Syndrome Characterized by Gynecomastia”; Fordet al., “The Chromosomes in a Patient”; Jacobs and Strong,“A Case of Human Intersexuality. ”
43
Marfan, “Un cas de déformation congénitale.”44
de Beaufort et al., “Aortic Dissection in Patients”; Flynn et al., “Systematic Review andMeta-Analysis”; Pyeritz, “Etiology and Pathogenesis.”
45
Jones, Rodriguez, and Bassnett, “Targeted Deletion of Fibrillin-1.”
46
Sakamoto et al., Nihon shoki, vol. 1, pp. 326–327.
47
Choi, “Kanhantō no Eisankō-ryūiki.”42

38

Tojima and Yamada

the time. In any case, even if the statement that the emperor “could not see” really was an expression of his weak eyesight, it would be consistent with thesymptoms of Marfan syndrome.
Meanwhile, a typical case of short stature was the Hikihito people. Based on
the description of the Tsuchigumo people, who they are said to have resembled,
the Hikihito would seem to have possessed long limbs compared to their trunk.
Two main possible causes of genetic short stature are chondrodysplasia48 andgrowth hormone deficiency.49 However, since the trait of long limbs cannot occur in the case of chondrodysplasia, if there is any truth in such a representation,
the Hikihito possibly suffered from growth hormone deficiency and genetic
short stature.
Type 2: Excess Tissue or Organ Formation
At birth, Emperor Ōjin 応神 is described as having a soft, fleshy mass on his
forearm. Since the emperor had a long life according to the chronicle, we ruledout the possibility that this node of his was malignant. The most likely cause,then, would be vascular malformation.50 Such anomalies often occur in the extremities and are not fatal diseases.51 Vascular malformation can be venous, lymphatic, and a mixture of the two, and it has been reported that venous malformation in the limbs mostly causes pain in the muscles, tendons, and bones.52
According to the Nihon shoki description, however, this emperor enjoyed hunting several times, and these statements suggested that he did not feel much painin the arm with the mass.53 Thus, the mass would more likely be a lymphatic
rather than a venous malformation.
While the descriptions about Emperor Ōjin are highly likely to be caused by acongenital anomaly, the other cases found are not likely to have been factual.
The tailed people recorded during Emperor Jinmu’s reign may have had a congenital anomaly known as a human tail.54 Even if they had this anomaly, it would
be difficult to confirm in an individual wearing clothing unless the tail-like structure itself were exposed. Thus, regarding these tailed people, the descriptions arehighly likely to be metaphors for other facts (e.g. symbols of power, specificforms of clothing or other local customs) rather than representing the symptoms of some congenital anomaly.
In another case, there is a description of a Korean man named Tsunuga
Arashito with a horn on his forehead. The Nihon shoki notes that he was a member
Horton, Hall, and Hecht, “Achondroplasia.”Şıklar and Berberoğlu, “Syndromic Disorders with Short Stature.”
50
Legiehn and Herans, “Venous Malformations.”
51
Maftei et al., “The Surgical Management”; Merouane et al., “Cystic Lymphangioma of the
Elbow.”
52
Rikihisa et al., “Evaluation of Pain Incidence.”
53
Sakamoto et al., Nihon shoki, vol. 1, pp. 370–371, 374–375.
54
Tojima and Yamada, “Classification of the ‘Human Tail’”; Tojima, “A Tale of the Tail.”48
49

Congenital Anomalies in Ancient Japan39of the royal family on the Korean peninsula and that he had made a voyage fromthere to Japan.55 In such a situation, his health condition must have been strong
enough to survive both what would have been an arduous journey during ancient
times, as well as a long stay in Japan. As such, one would not expect him to have
had headaches or other problems in association with the “horn.” Interpreting thisdescription as a case of hard, palpable tissue formation in the frontal region of thehead, the most likely cause would then be a benign skull or subcutaneous tumor,
such as an osteoma or calcifying epithelioma.56 Other anomalies, such as intraosseous meningioma, which causes a mass in the frontal part of the skull, might also
be possible.57 In this particular case, however, several Japanese historical studies
have hypothesized that this does not represent an actual physical description.58
Hashirokumawashi, who revolted against Empress Jingū, is described as having had wings on his body. The closest available realistic interpretation of a“wing-like” structure on the trunk would be a winged scapula.59 This is an anomaly in which the medial border of the scapula rises when the arm is raised, giving
the appearance of angel wings or folded bird wings. However, this condition
does not match the Nihon shoki’s clear depiction of Hashirokumawashi’s highmobility, such as in his “flying high.” Winged scapula can be caused by paralysisof the serratus anterior muscle due to palsy of the long thoracic nerve, or by paralysis of the trapezius muscle due to paranodal nerve injury. In other words,
when a winged scapula occurs, flexion of the shoulder joint to raise the arm forward is restricted, and athletic ability rather reduced.
As for Sukuna, who fought Emperor Nintoku, there are many morphologicaldescriptions, but just as with Hashirokumawashi, comparable cases hardly evenexist. First, the characteristic of having one body, two faces, four arms, and fourlegs in the literal sense can only realistically be true of conjoined twins (craniopagus twins). In the case as described, however, facial orientation of the dorsum
seems to be present, which is rare.60 The descriptions about fused parietals andbeing without any nape suggest that the head also would be fused to a significant
degree. Moreover, the phrase “possessing knees but no popliteal fossa” is challenging to interpret. Additionally, if Sukuna were so severely deformed, it would
be difficult to even survive to adulthood, let alone fight with a sword or bow andarrow. Therefore, it is more likely that this Sukuna, as well as the abovementioned Hashirokumawashi, did not actually have any such deformity, and that thedescriptions thereof are rather merely metaphorical expressions.
Sakamoto et al., Nihon shoki, vol. 1, pp. 258–259.
Farah et al., “Giant Frontal Sinus Osteoma.”
57
Agrawal et al., “Intraosseous Intracranial Meningioma”; Kim et al., “Two Cases of Primary
Osteolytic Intraosseous Meningioma.”
58
Sakamoto et al., Nihon shoki, vol. 1, p. 589.
59
Fiddian and King,“The Winged Scapula”; Kitamura et al., “Tōka ni okeru yokujō kenkō
shōrei no kentō.”
60
Walker and Browd, “Craniopagus Twins.”
55
56

40

Tojima and Yamada

The descriptions of excess tissue or organ formation in non-imperial individuals share several commonalities. First, all five examples were about leaders of
local or frontier-region communities.61 Furthermore, the formation of organs
such as tails, horns, and wings, which humans do not typically possess, and thetwo examples of Hashirokumawashi and Sukuna, who revolted against the imperial court, are accompanied by descriptions suggesting superhuman physicalabilities, such as flight and immense power and agility. These may be expressionsof contempt for the frontier-region people who defied the imperial court, disparaging them as barbarians even while granting the strength of their power.
Type 3: Speech or Behavioral Abnormality
Of the two cases suggesting speech impairment, the cause of the problem
seems to be different in the cases of Homutsuwake, the son of Emperor Suinin,
and Takeru no Miko, the son of Emperor Tenji. The major differences between
the two lie in whether they were adults or infants, and in whether they eventuallybecame able to speak.
Regarding Homutsuwake, the expression “he cries like a baby all the time”
suggests that he had a speech impediment, not a problem with vocalization. Additionally, description of his age (thirty years old), and of his having a long
beard, indicates that he was an adult physically. He also eventually became able
to speak, after he became interested in swans, which he also enjoyed playing
with. Cumulatively, these descriptions suggested that his symptoms were likely
caused by autism.62 If so, this would explain his survival to adulthood, both his
dysphasia as well as his ultimate ability to speak, and even his strong attachment
to a particular object, in this case the swan.
Conversely, in the case of Takeru no Miko, there is only the statement that he
was unable to speak, leaving it unclear whether he had a problem with speech orwith articulation. The major difference between him and Homutsuwake is that
Takeru no Miko died at the age of eight, before he learned to speak. The causeof his death is not mentioned, and it is not difficult to imagine that the infantmortality rate was higher in ancient times than today. Yet while it is also unclear
whether there was a connection between his speech impediment and his premature death, if there was a connection, Takeru may have had some severe intellectual disability (mental retardation). It is known that many childhood diseases cancause both mental disability and premature death.63 Arima syndrome, whichcauses renal failure, is one such example.64
Next, we discuss examples of impulsive murder and the tendency to becomeenraged. Emperor Yūryaku was described as one who summarily executed his
For example, on the Kuzu district, see Haraguchi, “Kuzu no utabue sōjō.”Mody and Belliveau, “Speech and Language Impairments.”
63
Katō, “Seishin chitaijisha no hassei yōin.”64
Arima et al., “Nō keisei ijō”; Kumada et al., “Renal Disease in Arima Syndrome.”6162

Congenital Anomalies in Ancient Japan41

subjects whenever their words or actions deviated from what he expected. Given
the disproportion between the triggering events and the violence expressed by
the emperor on such occasions (quite extreme in degree), together with the frequent occurrence of such descriptions, he might have had an intermittent explosive disorder, a type of impulse control disorder.65
The chronicle of Emperor Buretsu, the grandson of Emperor Yūryaku, also
has many descriptions of abuses against his subjects, but his abuses differ in nature. In contrast to Emperor Yūryaku, who responded to the actions of his subjects with violence, many of Emperor Buretsu’s abuses can only be understoodas having been conducted for his own interest or pleasure, without any apparent
fault on the part of the victim. However, several hypotheses have been proposed
to date by Japanese historians suggesting that descriptions of Emperor Buretsu
as a tyrant are not accurate. Tsuda’s study in 1947 noted that Emperor Buretsu’s
death without a successor severed the male lineage that had existed since thereign of Emperor Nintoku.66 Furthermore, he believed that the Nihon shoki’s editors, based on Confucian ideology, considered Buretsu evil—precisely because
he had severed this lineage—and fabricated such an account accordingly. Another theory suggests that the editors of the Nihon shoki fabricated the story of
Buretsu’s tyranny in order to legitimize the accession of Emperor Keitai 継体 as
his successor.67 Although the authenticity of the descriptions in the Nihon shoki
remains uncertain, from a medical point of view, since impulse control disorders
can be inherited, it is possible to decipher the presence of genetic influencesin these successive descriptions of tyranny from both Emperors Yūryaku andBuretsu, respectively grandfather and grandson.
Finally, regarding the person who committed suicide after uttering something
mysterious during the reign of Emperor Tenmu, from a medical point of view,
the possibility of schizophrenia might be raised.68
Type 4: Different Facial or Body Features
In conclusion, we believe that descriptions of this type are not related to congenital anomalies. We presume that these descriptions result from a combinationof both anthropological morphological differences within Japan at that time andfeelings of contempt for the barbarians outside the area of imperial dominion.
This speculation is based on the statements that the people described as having“different appearances” all lived in areas geographically distant from the Kansai
region where the imperial court was located—for example in the present Kyushu
and Tōhoku regions.
Regarding the facial morphology of the ancient northeastern people called
Schreiber, Odlaug, and Grant, “Impulse Control Disorders.”
Tsuda, Nihon jōdai-shi no kenkyū.
67Inoue, Shinwa kara rekishi e.
68
Hor and Taylor, “Suicide and Schizophrenia”; Sher and Kahn,“Suicide in Schizophrenia.”
65
66

42

Tojima and Yamada

Emishi, Takigawa’s study in 2012 used excavated human skeletal remains andsuggested that there may have been a mix of groups in the region, some withstrong Jōmon-period characteristics and others who were immigrants from theKansai region.69 Several human remains excavated from the Yamoto Tunnel
Burials (from the mid-seventh to the early ninth century)70 and from the Tekiana
Cave (from the eighth to the first half of the tenth century)71—both located in
Miyagi Prefecture—exhibit Jōmon-period facial features, indicating that they
were morphologically different from the Kansai-dwelling population at thattime. The people who strongly retained these Jōmon-period characteristics werelikely the Emishi, who were considered “different in appearance.” However,such descriptions may also have been influenced by the dominant viewpoint of
the time, centered on the imperial court, which regarded remote areas and areas
outside the court’s control as barbaric and primitive.
Thus, descriptions of this type combine both differences in physical forms orlifestyles that actually existed, and also more exaggerated representations rooted
in the court-centrism of the time.
Type 5: Pigment Anomaly
Since this type includes only simple descriptions of pigmentary anomalies
without involving any other superhuman characteristics, for such cases congenital anomalies could well be the most reasonable explanation. Particularly, it isclearly stated that the silver hair of Emperor Seinei was congenital, raising thepossibly that he had albinism, an anomaly caused by reduced melanin pigment
biosynthesis.72
In the chronicle of Emperor Kōgyoku, it is suggested that Yamashiro Ōe no
Miko had gray-streaked hair, similar to that of a Japanese serow. However, since
it is unclear how old he was at the time of this description, and from the fact thathe suffered the serious stress of being attacked, it is difficult to determine
whether his gray hair was congenital, or acquired due to aging or to stress.
The group of Korean people who came to Japan during the reign of Emperor
Suiko was most likely afflicted with vitiligo.73 Its cause is unclear, but according
to the description, they were skilled workers who arrived in Japan together andmay have shared some genetic traits. Since there is also a description of them
being regarded as peculiar because of white patches, they might have been discriminated against for their appearance also in their original homeland, prompting their move to Japan.
Takigawa, Kotsukōkogaku to Emishi, Hayato.
Takigawa and Satō, “Hokuhen no yokoanabo kodaijin.”
71
Yamaguchi and Ishida, “Human Skeletal Remains.”
72
King, “Albinism”; King and Summers, “Albinism”; Oetting and King, “Molecular Basis ofAlbinism.”73
Pande, Suggu, and Bhalla, “Rare Case of Congenital Vitiligo.”
69
70

Congenital Anomalies in Ancient Japan

43

Trends and Factors of Congenital Abnormalities in the Nihon shoki
We found several descriptions of structural or functional abnormalities in the
Nihon shoki that, from the viewpoint of modern medical science, might appear
to result from congenital anomalies. Although there are various causes of suchcongenital anomalies, systematic studies on congenital anomalies since the 1960s
have revealed that they can result from a deteriorated prenatal environment aswell as from genetic factors. Therefore, we also examined whether there are any
descriptions in the Nihon shoki of such possible environmental (i.e., non-genetic)
causes of birth defects, as described below.

Relation to the Occurrence of Epidemics, Famines, and Disasters
The Nihon shoki records four instances of pandemic disease: in the fifth andtwelfth years of Emperor Sujin’s reign74, in the thirteenth year of Emperor Kinmei’s
reign75, and in the fourteenth year of Emperor Bidatsu’s reign.76 The last ofthese pandemics is specifically described as being smallpox.
However, there seemed to be no clear causal relationship between the occurrence of large-scale epidemics and congenital anomalies in Japan. There was noclear description of congenital anomalies in the chronicle of Emperor Sujin (although there is a record in the chronicle of Emperor Suinin about Tsunuga
Arashito having come to Japan during the former Sujin’s reign). There is also
only one case each to be found in the chronicles of Emperors Kinmei and
Bidatsu. Furthermore, as both the Kinmei and Bidatsu descriptions relate to the
Emishi (type 4), the possibility of a congenital anomaly in either case is low.
Other environmental factors that may lead to the deterioration of maternal
nutritional status include the occurrence of famine. Definitive descriptions ofsevere famine were recorded three times: in the twenty-eighth year of Kinmei’s
reign (great flood in the country, many people starving, some resorting to cannibalism)77; in the thirty-third year of Suiko’s reign (prolonged period of rain fromthe third to the seventh month, with all people starving and particularly manyelders, infants, and mothers being said to have starved to death)78; and in theeighth year of the reign of the thirty-fourth emperor, Jomei 舒明 (severe
drought, the whole country starving).79 As can be seen in these cases, poor
weather significantly impacted grain yields.
From our results, it became clear that descriptions of congenital anomalies did
not occur frequently in the Nihon shoki at times when plagues and crop failures
were recorded (Table 3). Therefore, it is difficult to find a clear causal relationship
Sakamoto et al., Nihon shoki, vol. 1, pp. 248–249.
Ibid., vol. 2, pp. 102–103.
76
Ibid., pp. 148–149.
77
Ibid., pp. 126–127.
78
Ibid., pp. 212–213.
79
Ibid., pp. 230–231.
74
75

Tojima and Yamada

44

Table 3. Recorded Disasters That May Have Affected Grain Yields
Total
Famine Climate Earth- Heavy Drought Storm or
number of or crop distur- quake rain orstrongdisasters* failure** bance***floodingwind
Sujin 崇神(10th)
Ingyō 允恭(19th)
Kinmei 欽明(29th)
Sushun 崇峻(32nd)
Suiko 推古(33rd)
Jomei 舒明(34th)
Kōgyoku 皇極(35th)
Kōtoku 孝徳(36th)
Tenji 天智(38th)
Tenmu 天武
(40th)Jitō 持統(41st)

1

1

2

1

1

1

1

1

1

1

6

2

3

2

1

7

1

1

3

1

3

4

2

5

24

11

3

1

1

3
35
12

Ash
fall

2

2

1

1

1

18

2

7

1

2

9

4

2

*Not counting separately those cases where multiple descriptions were thought to represent one continuous disaster, or where the phenomena described were considered to be secondary manifestations of alarger single disaster.
**Number of records clearly describing famine or crop failure.
***Includes temperature extremes, excessive snowfall, and hail.

between the two, and at the very least, the descriptions of congenital anomalies
collected in this study can be considered to have occurred independently of
plague or famine.

Differences in Disease Incidence/Description between Emperors and Non-emperors
Not only some congenital anomalies but also other genetic diseases for which
the causative genes have been identified are familial, as the genes are inheritedfrom one generation to the next. European royal families are known to historically have many consanguineous marriages, in which case the disease genes of
their lineages are assumed to have been passed on at a high rate, causing diseases

Congenital Anomalies in Ancient Japan45

such as hemophilia.80 Additionally, about half of all congenital anomalies are
multifactorial. Even in diseases where the specific causative genes have not been
identified (including cleft or palate lip81 and some congenital heart diseases82 )there are higher recurrence rates among people with a blood relationship to carriers of such diseases than among the general population. It would therefore be
unsurprising if, once found in the Japanese imperial family, such diseases cameto appear repeatedly.
In the long history of Japanese emperors, there have been several generationsof consanguineous marriages to maintain the lineage.83 It would thus be expected if the incidence of congenital anomalies and the expression of associatedsymptoms were more prevalent in the imperial family than among non-imperials. However, no clear trend specific to the imperial families was found. The incidences of congenital anomalies are difficult to estimate accurately in either
imperial or non-imperial people. This is largely because the Nihon shoki was written to record the emperors’ achievements. Given its nature as a national history
compiled by the order of the emperor, there are inevitably many descriptions ofimperial family members. At the same time, even information about imperialchildren is not necessarily recorded correctly in the Nihon shoki: Emperor Keikōis said to have had more than eighty children, yet their names are not recorded.84
It is also difficult to estimate the number of non-imperial citizens at that time,
especially before the family register system had been introduced. Therefore, forboth emperors and non-imperials (whose population size is unknown), the calculation of incidence rates for various congenital anomalies is impossible.
Among descriptions regarding the members of the imperial family, some potential genetic traits were found: the tall stature recorded for Yamato Takeru no
Mikoto and Emperor Chūai, and the descriptions of Yūryaku and Buretsu’s tyrannical behavior. However, these are only potential genetic traits, and there areno cases where incestuous marriage seems to have been the leading cause.
It is only in the case of Emperor Ōjin that the maternal environment, rather
than heredity, could not be ruled out as a possible influence. It is written that
Empress Jingū, Emperor Ōjin’s mother, went to the Korean peninsula to fightin Silla while pregnant, dressed as a man and leading an army.85 If hypotheticallythis were true, it might be imagined that the empress was under severe stressduring her pregnancy. As described above, we have speculated that the fleshy
mass on the emperor’s arm was a lymphatic or vascular malformation. Recent
studies have shown that the incidence of infantile hemangioma is higher when
Stevens, “The History of Haemophilia.”
Mossey and Modell, “Epidemiology of Oral Clefts 2012.”82
van der Bom et al., “The Changing Epidemiology.”
83
Sakamoto et al., Nihon shoki, vols. 1, 2.
84
Ibid., vol. 1, pp. 286–287.
85
Ibid., pp. 334–335.
80
81

Tojima and Yamada46

the mother has allergic conjunctivitis or hay fever.86 Thus, we believe that such ahigh-stress state as in Empress Jingū’s case, during a pregnancy, could well havebeen a factor in producing something like Emperor Ōjin’s condition.
Conclusion
In this study, we attempted to understand the epidemiology of congenital
anomalies in ancient times, which until now have been considered a complete
mystery. This study showed that by reading the Nihon shoki from both medical
and historical perspectives, we were able to catch a glimpse into an aspect of ancient times that until now had remained invisible. In addition to the Nihon shoki,
many other valuable documentary texts exist in Japan. These include manuscripts and anecdotes related to the history of other regions in East Asia, sometimes even records that no longer survive in their countries of origin. As with
the Nihon shoki, it is impossible to interpret all the descriptions in such historical
documents as fact. However, by expanding in scope the application of a method
like ours, we can expect to learn more about ancient congenital anomalies, theirpathologies, and the responses of people to the same long before the spread ofmodern medicine, not only in Japan but also in East Asia as a whole. We believe
this study has shown significant results in demonstrating the potential of these
new methods for deciphering ancient epidemiology from historical documents.
Acknowledgments
This study was financially supported by research funding from the Hakubi
Center for Advanced Research, Kyoto University. The authors also deeply appreciate the many constructive suggestions from Dr. Muguruma Miho 六車美保
of the Kyoto University Museum and Mr. Yamamoto Yoshitaka 山本祥隆 of the
Nara National Research Institute for Cultural Properties in our study of the descriptions of the Nihon shoki. Finally, we salute our Japanese predecessors forleaving us this precious historical document, and express our deepest respect for
the long history of the Japanese emperors.

86

Mizawa et al., “Infantile Hemangioma and the Risk Factors.”

Congenital Anomalies in Ancient Japan

47

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