Japan Decides 2021: The Japanese

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JAPAN
DECIDES
2021
The Japanese
General Election

Edited by
Robert J. Pekkanen
Steven R. Reed
Daniel M. Smith
Japan Decides 2021
Robert J. Pekkanen · Steven R. Reed ·
Daniel M. Smith
Editors

Japan Decides 2021

The Japanese General Election
Editors
Robert J. Pekkanen Steven R. Reed
Jackson School of International Faculty of Policy Studies
Studies, University of Washington Chuo University
Seattle, WA, USA Tokyo, Japan

Daniel M. Smith
Columbia University
New York, NY, USA

ISBN 978-3-031-11323-9 ISBN 978-3-031-11324-6 (eBook)

https://doi.org/10.1007/978-3-031-11324-6

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To my friend Paul, who is always asking me how my book is going.
This one is for you.
—From Robert J. Pekkanen

Steve Reed thanks his coeditors, past and present.

—From Steven R. Reed

To everyone who has lost a friend or loved one in the pandemic.

—From Daniel M. Smith
 Acknowledgments

We are thrilled to produce the fourth in our series of high-quality anal-

yses of general elections for Japan’s House of Representatives, following
Japan Decides 2012, 2014, and 2017. The global coronavirus pandemic
framed Japan’s 2021 election, as we and many authors argue in these
pages. However, it also posed new challenges for the editorial team and
publisher. Through the hard work of our authors, we were able to compile
what we believe will be the definitive volume on the October 31, 2021,
general election in Japan. We wish to also express our thanks to our stal-
wart editor at Palgrave Macmillan, Ambra Finotello. She made every one
of the many steps in this process easier. This is the first Japan Decides
volume not to benefit from the intelligence and creativity of one of the
inaugural editors, Ethan Scheiner, and we want to thank him for his work
in establishing the Japan Decides series. Robert thanks Saadia, Sophia,
Sarah, Lynn, and John Pekkanen for their support. Steve thanks his coed-
itors, past and present. Dan thanks John, and the many friends and family
members who supported him through a challenging two years.

vii
 Contents

1 Introduction: Japan’s Coronavirus Election 1

Robert J. Pekkanen, Steven R. Reed, and Daniel M. Smith
2 Japanese Politics Between 2017 and 2021 13
Robert J. Pekkanen and Steven R. Reed
3 The 2021 Election Results: Continuity and Change 23
Ko Maeda

Part I Party Politics

4 How the Liberal Democratic Party Avoided a Loss
in 2021 43
Kuniaki Nemoto
5 The Opposition in 2021: A Second Party and a Third
Force 59
Robert J. Pekkanen and Steven R. Reed
6 Kōmeitō in 2021: Strategizing Between the LDP
and Sōka Gakkai 71
Axel Klein and Levi McLaughlin
7 Abe’s Legacy 87
Tobias Harris

ix
x CONTENTS

8 Candidate Selection for the 2021 General Election 103

Jochen Rehmert
9 Generational Change or Continuity in Japan’s
Leadership? 115
Charles T. McClean
10 Should I Stay or Should I Go? Party Switching
in Japan 131
Jordan Hamzawi
11 Ministerial Selection Under Abe, Suga, and Kishida 149
Hiroki Kubo

Part II The Campaign

12 Public Opinion and COVID-19 167
Yukio Maeda
13 Social Media in the 2021 Election Campaign 183
Robert A. Fahey
14 Are the Kids Alright? Young People and Turnout
in Japan 201
Gill Steel
15 Did COVID-19 Impact Japan’s 2021 General
Election? 219
Michael F. Thies and Yuki Yanai

Part III The Issues: Domestic and International

16 Japan’s Response to the COVID-19 Pandemic 239
Phillip Y. Lipscy
17 Economic Policy Trilemma: Macroeconomic Politics
in the 2021 Election 255
Kenya Amano and Saori N. Katada
18 Does Income Inequality Matter in Japan? 275
Yeon Ju Lee
 CONTENTS xi

19 Women’s Representation and the Gendered Impact

of COVID-19 in Japan 289
Yesola Kweon
20 Black Lives Matter in Japan: The Specter of Race
and Racism Haunting Japan 305
Michael Orlando Sharpe
21 Constitutional Revision in the 2021 Election 319
Kenneth Mori McElwain
22 COVID-19: The International Dimension 333
Kerstin Lukner
23 Foreign Policy and Defense 347
Michael J. Green
24 China in Japan’s 2021 Elections 361
Kristin Vekasi
25 The Olympics in the 2021 Election 375
David Leheny
26 Conclusion: Voters Choose Competence in Japan’s
Coronavirus Election 387
Daniel M. Smith, Steven R. Reed, and Robert J. Pekkanen

Index 397
 Notes on Contributors

Amano Kenya is a Ph.D. student in the Department of Political Science

at the University of Washington. His research focuses primarily on the
intersections of economic institutions and politics, with an emphasis on
monetary and fiscal policy, and regulation.
Fahey Robert A. is an Assistant Professor at the Waseda Institute for
Advanced Study (WIAS) at Waseda University in Tokyo. His research
work focuses on populism, polarization, and the influence of social media
on political beliefs and behaviors.
Green Michael J. is Director of Asian Studies and Chair in Modern
and Contemporary Japanese Politics and Foreign Policy at Georgetown
University’s School of Foreign Service and Senior Vice President for Asia
and Japan Chair at the Center for Strategic and International Studies.
He previously served as Special Assistant to the President for National
Security and Senior Director for Asian Affairs on the staff of the National
Security Council.
Hamzawi Jordan is a Post-doctoral Research Fellow for the Program
on US-Japan Relations at Harvard University. His research focuses on
electoral institutions, political parties, and voter behavior.
Harris Tobias is a Senior Fellow for Asia at the Center for American
Progress in Washington, D.C. He is the author of The Iconoclast: Shinzo
Abe and the New Japan (Hurst Publishers, 2020).

xiii
xiv NOTES ON CONTRIBUTORS

Katada Saori N. is a Professor of International Relations and the director

of the Center for International Studies at University of Southern Cali-
fornia. Her book Japan’s New Regional Reality: Geoeconomic Strategy
in the Asia-Pacific was published from Columbia University Press in
July 2020. She has co-authored two recent books: The BRICS and
Collective Financial Statecraft (Oxford University Press, 2017), and
Taming Japan’s Deflation: The Debate over Unconventional Monetary
Policy (Cornell University Press, 2018).
Klein Axel is Full Professor at the Institute of Political Science at
Duisburg-Essen University (Germany). He is co-author of Kōmeitō: Poli-
tics and Religion in Japan (IEAS Berkeley, 2014), has produced the
documentary film “Pictures at an Election” (DIJ Tokyo 2008), and has
published widely on Japanese politics.
Kubo Hiroki is an Associate Professor of Political Science at Meiji
Gakuin University. His research interests include comparative politics,
political parties, legislative studies, electoral systems, and political repre-
sentation. His articles have appeared in Party Politics, Electoral Studies,
Public Choice, and Asian Journal of Comparative Politics.
Kweon Yesola is an Assistant Professor of Political Science at
Sungkyunkwan University. Her primary research areas are comparative
political economy, political behavior, and public policy with a focus on
East Asia. Her recent publication includes the co-authored book, Democ-
racy under Siege? Parties, Voters, and Elections after the Great Recession
(Oxford University Press, 2020).
Leheny David is a Professor in the Graduate School of Asia-Pacific
Studies at Waseda University. His most recent book is Empire of Hope: The
Sentimental Politics of Japanese Decline (Cornell University Press, 2018).
Lee Yeon Ju is the Korea Foundation-Song Family Assistant Professor
in Korean Business and Economics at Georgetown University’s Walsh
School of Foreign Service. Her research examines the political origins and
consequences of economic inequality and development with a focus on
Japan and East Asia.
Lipscy Phillip Y. is an Associate Professor in the Department of Political
Science and Munk School of Global Affairs & Public Policy at the Univer-
sity of Toronto, where he is also Chair in Japanese Politics & Global
Affairs and Director of the Centre for the Study of Global Japan. He is the
 NOTES ON CONTRIBUTORS xv

author of Renegotiating the World Order: Institutional Change in Inter-

national Relations (2017) and co-editor of Japan under the DPJ: The
Politics of Transition and Governance (2013) and The Political Economy
of the Abe Government and Abenomics Reforms (2021).
Lukner Kerstin is Managing Director of the Alliance for Research
on East Asia Ruhr (AREA Ruhr), a joint research and teaching insti-
tute of the Universities of Duisburg-Essen and Bochum, Germany. Her
research focuses on Japan’s foreign and security policy. She is co-author of
Reluctant Warriors: Germany, Japan, and Their U.S. Alliance Dilemma
(Brookings Institution Press, 2020).
Maeda Ko is an Associate Professor of Political Science at the University
of North Texas. His research interests center on elections, party compe-
tition, and political institutions. His work has appeared in journals such
as the Journal of Politics, British Journal of Political Science, Compara-
tive Political Studies, and Electoral Studies. He serves as an editor of the
Japanese Journal of Political Science and an associate editor of the Journal
of Elections, Public Opinion, and Parties.
Maeda Yukio is Professor at the Institute of Social Science at the
University of Tokyo. His research focuses on Japanese political behavior
and public opinion. He has served on a Japanese local committee for
major international surveys, including the Comparative Study of Electoral
Systems, the Asian Barometer Survey, and the World Value Survey.
McClean Charles T. is the Japan Foundation CGP Postdoctoral Asso-
ciate at Yale University’s Council on East Asian Studies. Previously, he
was the Toyota Visiting Professor at the University of Michigan’s Center
for Japanese Studies and a Postdoctoral Associate at Harvard University’s
Program on US-Japan Relations. His research focuses on the politics of
age and aging, institutions, representation, social policy, and Japan.
McElwain Kenneth Mori is Professor of Comparative Politics at the
Institute of Social Science, University of Tokyo. His research focuses on
comparative political institutions, most recently on differences in constitu-
tional design across countries. His work has been published in a number
of journals and edited volumes, including American Journal of Political
Science, Journal of East Asian Studies, Social Science Japan, Chuō Kōron,
and the Journal of Japanese Studies. He also serves as Editor-in-Chief of
Social Science Japan Journal, published by Oxford University Press, and
xvi NOTES ON CONTRIBUTORS

is a board member of the UTokyo Center for Contemporary Japanese

Studies.
McLaughlin Levi is an Associate Professor at the Department of Philos-
ophy and Religious Studies, North Carolina State University. He is
co-author of Kōmeitō: Politics and Religion in Japan (IEAS Berkeley,
2014) and author of Soka Gakkai’s Human Revolution: The Rise of a
Mimetic Nation in Modern Japan (University of Hawai’i Press, 2019), as
well as numerous book chapters and articles on religion and politics in
Japan.
Nemoto Kuniaki is a Professor of Political Science at Musashi Univer-
sity, Japan. His research interests cover electoral systems, parties and
party systems, and legislative politics. His articles have appeared in British
Journal of Political Science, Comparative Political Studies, Electoral
Studies, and Party Politics.
Pekkanen Robert J. is Professor at the University of Washington (USA).
He has published twelve earlier books on politics, most recently including
Party Personnel Strategies and The Oxford Handbook of Japanese Poli-
tics. His work has appeared in American Political Science Review, British
Journal of Political Science, Comparative Political Studies, and other
journals.
Reed Steven R. is Professor of Modern Government at Chuo University
(Emeritus). He has recently published Political Corruption and Scandals
in Japan with Matthew M. Calrson (2018). He has published in the
British Journal of Political Science and the American Journal of Political
Science as well as numerous other academic journals.
Rehmert Jochen is a Post-doctoral Research Fellow at the Department
of Political Science at the University of Zurich, Switzerland. His research
revolves around the topics of candidate selection and coalition govern-
ments and has been published in Comparative Political Studies, Political
Behavior, and the Japanese Journal of Political Science.
Sharpe Michael Orlando is an Associate Professor of Political Science at
York College of the City University of New York and an Adjunct Research
Scholar at Columbia University’s Weatherhead East Asian Institute. His
research interests concern the politics of migration, immigrant political
incorporation, and political transnationalism in the Netherlands, Japan,
and around the world. His first book, Postcolonial Citizens and Ethnic
 NOTES ON CONTRIBUTORS xvii

Migration: The Netherlands and Japan in the Age of Globalization, was

published by Palgrave MacMillan in 2014. He is currently completing
his second book manuscript The Politics of Racism and Antiracism in
Japan. His other research investigates Japan as an emerging migration
state as well as the paid voluntary return of migrants and their fami-
lies and implicit boundary making in liberal democracies. He is currently
a member of the Association of Asian Studies Northeast Asia Council
Distinguished Speakers Bureau.
Smith Daniel M. is the Gerald L. Curtis Visiting Associate Professor of
Modern Japanese Politics and Foreign Policy in the Department of Polit-
ical Science and School of International and Public Affairs at Columbia
University. He is the author of Dynasties and Democracy: The Inherited
Incumbency Advantage in Japan (Stanford University Press, 2018).
Steel Gill is Professor in political science at the Institute for the Liberal
Arts, Doshisha University. Her research has mainly focused on public
opinion and political behavior, including research on young people in
Japan and Britain. Her recent publications include What Women Want:
Gender and Voting in Japan, Britain, and the United States (2022) and
the edited volume Beyond the Gender Gap in Japan (2019).
Thies Michael F. is an Associate Professor of Political Science, Univer-
sity of California, Los Angeles (USA). He is co-author (with Frances
Rosenbluth) of Japan Transformed: Political Change and Economic
Restructuring (2010) and his work on elections, parties, coalitions, and
policymaking in Japan, and other advanced democracies has appeared in
top political science journals and edited volumes.
Vekasi Kristin is an Associate Professor in the Department of Political
Science and School of Policy and International Affairs at the Univer-
sity of Maine. Her research focuses on trade and investment strategies
in changing geopolitical environments, economic security, and the polit-
ical risk management of supply chains. She specializes in Northeast
Asia, and her book Risk Management Strategies of Japanese Compa-
nies in China (Routledge 2019) explores how Japanese multinational
corporations mitigate political risk in China.
Yanai Yuki is an Associate Professor in the School of Economics and
Management at the Kochi University of Technology and Research Fellow
in the Graduate School of Law at Kobe University. He conducts research
on the comparative political economy of elections, redistribution, and
political institutions.
 Abbreviations

Political Parties
CDP Constitutional Democratic Party of Japan (Rikken Minshutō)
Daichi New Party Daichi (Shintō Daichi)
DP Democratic Party (Minshintō)
DPJ Democratic Party of Japan (Minshutō)
Hope Party of Hope (Kibō no Tō)
HRP Happiness Realization Party (Kōfuku Jitsugen Tō)
Ishin Japan Ishin no Kai (Nippon Ishin no Kai)
JCP Japanese Communist Party (Nihon Kyōsantō)
Kokoro Party for Japanese Kokoro (Nippon no Kokoro)
Kōmeitō Kōmeitō
LDP Liberal Democratic Party (Jiyū Minshutō)
Reiwa Reiwa Shinsengumi
SDP Social Democratic Party (Shakai Minshutō)
TF Tokyoites First (Tōmin Faasuto no Kai)

Newspapers
Asahi Asahi Shinbun
Mainichi Mainichi Shinbun
Nikkei Nihon Keizai Shinbun
Sankei Sankei Shinbun
Yomiuri Yomiuri Shinbun

xix
xx ABBREVIATIONS

Other Abbreviations
ASEAN Association for Southeast Asian Nations
COVAX COVID-19 Vaccines Global Access
CPTPP Comprehensive and Progressive Agreement for Trans-Pacific
Partnership
DNLW Dually Nominated List Winner
DPRK Democratic People’s Republic of Korea
FOIP Free and Open Indo-Pacific
FPTP First-Past-The-Post Electoral System
HC House of Councillors
HR House of Representatives
KPI Key Performance Indicator
MP Member of Parliament (or Diet Member, DM)
ODA Official Development Assistance
PR Proportional Representation
QUAD Quadrilateral Security Dialogue
SDF Self-Defense Forces
SEA-IP region Southeast Asian/Indo-Pacific region
SMD Single-Member District
TPP Trans-Pacific Partnership
WHO World Health Organization
 List of Figures

Fig. 3.1 Vote share of Ishin SMD candidates 28

Fig. 3.2 Prefecture-level PR vote change, 2017–2021 29
Fig. 3.3 Winning percentage of the LDP’s SMD candidates 30
Fig. 4.1 Number of districts where Hoshu Bunretsu happened
and number of LDI winners where Hoshu Bunretsu
happened, 1996–2001 52
Fig. 5.1 Opposition parties 2017 to 2021 68
Fig. 6.1 2021 Tokyo metropolitan election. Kōmeitō’s 2021
losses as a percentage of 2017 total in all electoral districts 76
Fig. 6.2 Kōmeitō’s PR votes in House of Representatives
Elections (2000–2021) 80
Fig. 6.3 Kōmeitō candidates’ lead in SMDs over their strongest
competitors (2017 and 2021) 81
Fig. 6.4 Overall turnout and Kōmeitō vote and seat share 82
Fig. 9.1 Candidates and Elected MPs Under 40 (1955–2021) 118
Fig. 10.1 Party switching over time 135
Fig. 10.2 Contesting elections over time 137
Fig. 10.3 Predicted probability of run choice (voteshare) 141
Fig. 10.4 Predicted probability of run choice (policy difference) 143
Fig. 10.5 Alluvial plot of party switching for 2021 144
Fig. 11.1 Cabinet Portfolio Allocations under Abe, Suga,
and Kishida 154
Fig. 12.1 Approval ratings of the Abe, Suga, and Kishida cabinets,
November 2017–November 2021 169

xxi
xxii LIST OF FIGURES

Fig. 12.2 Primary reason for cabinet approval, November

2017–November 2021 173
Fig. 12.3 Primary reason for disapproval, November
2017–November 2021 175
Fig. 12.4 Evaluations of government COVID-19 response
and cabinet approval, January 2020–November 2021 177
Fig. 13.1 Social media usage by candidates, per party 187
Fig. 13.2 Demographic correlates of Twitter usage by candidates 190
Fig. 13.3 Correspondence analysis of candidate tweets, by party 192
Fig. 13.4 Distribution of candidate and media positions,
from Twitter network data 196
Fig. 14.1 The Digital Campaign (October 19–30, 2021) 203
Fig. 14.2 Young Adults’ Low Turnout 206
Fig. 15.1 Cabinet Approval and Disapproval Rates, December
2019–January 2022 222
Fig. 15.2 Daily confirmed COVID-19 Deaths per Million People,
January 1, 2021–October 31, 2021 (7-day rolling
average) 222
Fig. 15.3 Share of the population fully vaccinated against
COVID-19, December 15, 2020–October 31, 2021 223
Fig. 15.4 Excess Mortality in G-7 Countries, January
2020–October 2021 224
Fig. 15.5 Low Grades for Government Policy Responses
to COVID-19 225
Fig. 15.6 Changes in Public Opinion about Policy Priorities,
October 2020–October 2021 226
Fig. 15.7 Public Policy Priorities just after the Election, by Party
Identification 227
Fig. 15.8 Impact of COVID-19 Deaths on Party Support,
by Urbanness of Prefecture 230
Fig. 15.9 Is Ishin the Most Credible Party after the LDP? 231
Fig. 16.1 Cumulative COVID-19 Deaths, January 2020–March
2022 241
Fig. 16.2 COVID-19 Vaccine Doses Administered per Capita 243
Fig. 16.3 Unemployment Rate (%), Before and During
the Pandemic 244
Fig. 16.4 COVID-19 Deaths and Change in Leader Approval,
January–June 2020 248
Fig. 16.5 Search Interest in コロナ (Corona) in Japan, Google
Trends 249
 LIST OF FIGURES xxiii

Fig. 17.1 Party positions in the trilemma: supply-side growth,

distribution, and fiscal discipline at the 2021 Lower
House Election 268
Fig. 18.1 Income Inequality in Japan, the United Kingdom,
and the United States 277
Fig. 18.2 GDP and Income Inequality 279
Fig. 18.3 Perceptions of income inequality in Japan: “Income
differences in your country are too large.” 281
Fig. 19.1 Share of Employment and Non-regular Employment
by Gender 292
Fig. 19.2 Effects on Perceptions that One’s Life is Heavily
Influenced by COVID-19 293
Fig. 19.3 Belief in Government Competence, Confidence
in Healthcare Responses, and Trust in Government
by Gender and Those with/without Children 294
Fig. 21.1 Support for constitutional revision among election winners 328
 List of Tables

Table 2.1 Seats in HC 2019 election by party 15

Table 2.2 PR seats and votes by party in the House of Councillors
2019 election 16
Table 2.3 Organization-sponsored candidates in the HC 2019
election 17
Table 3.1 Votes and seats in the 2017 and 2021 general elections 25
Table 3.2 Determinants of SMD vote change 34
Table 4.1 The result of the 2018 presidential selection 46
Table 4.2 The result of the 2020 presidential selection 48
Table 4.3 The result of the 2021 presidential selection 50
Table 4.4 Districts where Hoshu Bunretsu was possible in 2021 53
Table 8.1 Parties and candidates in the 2021 general election 104
Table 9.1 Age of candidates by party 119
Table 9.2 Age of MPs by party 120
Table 9.3 Policy priorities of candidates under 40 124
Table 9.4 Policy preferences of candidates under 40 126
Table 10.1 Multinomial model of run choice 142
Table 11.1 Backgrounds of Cabinet Ministers under Abe, Suga,
and Kishida 153
Table 11.2 Backgrounds of Cabinet Ministers in the First Kishida
Cabinet 157
Table 12.1 What is most important for you in your voting decision
for this election? 180
Table 12.2 Preference for government led by the LDP or major
opposition party in future 181

xxv
xxvi LIST OF TABLES

Table 13.1 Top ten candidates by Twitter followers 186

Table 17.1 Japanese Government’s COVID-19 Fiscal Measures
2020–21 (billion yen) 260
Table 19.1 Womenomics Initiatives (2013–2020) 291
Table 19.2 % of women among candidates and elected MPs
by parties 297
Table 21.1 Yomiuri survey on constitutional amendment: 2017 vs.
2021 324
Table 21.2 Party manifesto positions on constitutional amendment 325
Table 21.3 Voter preferences on constitutional revision 326
Table 24.1 NHK candidate survey by party 365
 CHAPTER 1

Introduction: Japan’s Coronavirus Election

Robert J. Pekkanen , Steven R. Reed, and Daniel M. Smith

This book analyzes the background and results of the October 31, 2021,
general election for Japan’s House of Representatives (HR). This is the
fourth volume of Japan Decides, following our analyses of the general
elections of 2012, 2014, and 2017 (Pekkanen et al. 2013, 2016, 2018).
Each previous volume analyzed an election in which Abe Shinzō led the
Liberal Democratic Party (LDP) to an overwhelming victory, in coali-
tion with Kōmeitō. This volume also follows an LDP-Kōmeitō victory,
but not an overwhelming one and one in which Abe was not the LDP
leader for the first time in a decade. Perhaps more significantly, this is the

R. J. Pekkanen (B)
Jackson School of International Studies, University of Washington, Seattle, WA,
USA
e-mail: pekkanen@uw.edu
S. R. Reed
Faculty of Policy Studies, Chuo University, Tokyo, Japan
D. M. Smith
Columbia University, New York, NY, USA
e-mail: dms2323@columbia.edu

© The Author(s), under exclusive license to Springer Nature 1

Switzerland AG 2023
R. J. Pekkanen et al. (eds.), Japan Decides 2021,
https://doi.org/10.1007/978-3-031-11324-6_1
2 R. J. PEKKANEN ET AL.

first (and we hope only) Japanese HR election held during the coron-
avirus (or COVID-19) pandemic. For that reason, this election will be of
broad comparative interest to scholars trying to make sense of the polit-
ical consequences of the global pandemic. We make our own arguments
about how the coronavirus pandemic affected the 2021 election in Japan
in the conclusion to this volume.
In the chapter that follows this Introduction, Robert J. Pekkanen and
Steven R. Reed provide more background and context to the election.
The chapter touches on several events on which later chapters will focus,
such as the coronavirus pandemic, the reorganization and campaign of the
opposition parties, the transitions in LDP leadership from Abe to Suga
Yoshihide to Kishida Fumio, and the Tokyo Olympics and Paralympics,
but also sets the political stage through a discussion of the 2019 House
of Councillors (HC) election that preceded the fall 2021 HR election.
The third chapter, by Ko Maeda, argues that the results of the 2021
election seem superficially comparable to those of 2012, 2014, and
2017, with the LDP-Kōmeitō coalition maintaining a majority and the
opposition remaining fragmented. However, the chapter also identifies
important differences in this 2021 election. First, the single-member
district (SMD) races are becoming more volatile. Several veteran incum-
bents lost seats they had held for a long time. Second, Nippon Ishin no
Kai (Ishin) more than tripled its seats and further fragmented the opposi-
tion camp. Third, the largest opposition Constitutional Democratic Party
(CDP) and several smaller opposition parties coordinated candidate nomi-
nations in SMDs and gained many districts previously held by the LDP.
Yet, the CDP’s dismal performance in the proportional representation
(PR) tier of the mixed-member electoral system led to its overall loss in
this election. The performance of the opposition parties is also taken up
later in the volume, as the next three chapters consider political parties
more specifically.
The first of these and the fourth chapter in the volume, by Kuniaki
Nemoto, focuses on the LDP’s internal party presidential election and
candidate nomination processes to analyze how the party prepared to
stay in power before the 2021 election. With the new presidential elec-
tion process, the party was able to replace an unpopular leader (Suga)
just before the election, although it did not choose the most popular
contender (instead choosing Kishida). Using various tools at the party’s
disposal, such as internal polls and the PR tier, the LDP tried to mini-
mize the fragmentation of the conservative vote, although ultimately it
 1 INTRODUCTION: JAPAN’S CORONAVIRUS ELECTION 3

took place in 12 districts and the LDP lost to the opposition in five of
them. Overall, the LDP was able to avoid a major loss, even though it
was not able to increase its seats.
In Chapter 5, Robert J. Pekkanen and Steven R. Reed analyze the
opposition. They trace the evolution of the opposition parties from their
situation in late 2017 following the 2017 election. At that time, the major
opposition parties included the Party of Hope as the third largest party
after the collapse of the Democratic Party of Japan (DPJ), but by the
2021 election, that party effectively no longer existed. The creation and
destruction of the persistently fragmented opposition is a major theme in
Japanese politics and of this chapter. The chapter also examines the coor-
dination among four parties on the left––the CDP, Japanese Communist
Party (JCP), Social Democratic Party (SDP), and Reiwa Shinsengumi––
which it argues was successful. Finally, the authors speculate on the future
of the opposition in Japan.
The sixth chapter returns to the governing coalition, this time exam-
ining Kōmeitō. Axel Klein and Levi McLaughlin argue that, in October
2021, Kōmeitō solidified its importance as a coalition partner to the LDP
and its influential place within the national government. The chapter
details how the party navigated its election campaign between contrasting
demands from the LDP and members of Sōka Gakkai, the lay Buddhist
organization that founded Kōmeitō in 1964 and remains the party’s, and
Japan’s, most potent vote-gathering bloc. It highlights the ways through
which Kōmeitō promoted social welfare initiatives in response to the
COVID-19 pandemic, how it mitigated the rise of Ishin in western Japan,
and how its historic links to the People’s Republic of China may grow in
importance as tensions rise in the region. The chapter also considers the
impact of scandals among its members, an overall trajectory of lowered
vote counts, and how changes underway within Sōka Gakkai may shape
Kōmeitō’s future and affect LDP electioneering and policymaking.
Following these three introductory chapters and the three focusing on
the main set of political parties, the volume proceeds with five chapters
that consider contemporary party politics in Japan from different angles:
Abe’s legacy, candidate selection, generational change in leadership, party
switching, and ministerial selection.
The first of these is written by Tobias Harris and focuses on the legacy
of one of Japan’s most dominant political figures, Abe Shinzō. After
resigning as prime minister and leader of the LDP in September 2020,
it was unclear what role Abe would play in Japanese politics. However,
4 R. J. PEKKANEN ET AL.

as the LDP approached another leadership election in 2021––and as the

general election approached––Abe returned to prominence as a king-
maker, using his media presence and his clout within the LDP to influence
first the party’s presidential election and then the policy choices of the
new government of Prime Minister Kishida. This chapter describes the
sources of Abe’s power after leaving the premiership and details the ways
in which he used his power to influence the government’s agenda during
the first months of Kishida’s government.
Chapter 8, authored by Jochen Rehmert, examines candidate selec-
tion. The 2021 general election saw one of the highest levels of legislative
turnover in recent elections. Yet, this was not due to the coordina-
tion of candidates by parties of the progressive opposition, but rather
to the nomination practices and outcomes in the LDP and Kōmeitō.
While the LDP had to replace several resigning incumbents and remove
several others who were tainted by scandals, Kōmeitō’s internal selec-
tion rules forced a partial rejuvenation of its roster. In addition, both
the governing parties and the opposition saw conflicts over nominations
within their own ranks. The LDP was especially plagued by intraparty
conflicts over nominations after several incumbents from other conserva-
tive parties joined the party prior to the election. Socio-demographically,
candidates remain overwhelmingly male and close to retirement age.
In Chapter 9, Charles McClean examines generational change and
continuity in Japan’s political leadership. Young people are underrepre-
sented in most political institutions, and Japan’s House of Representatives
is no exception. While a few young challengers managed to capture
national headlines by defeating much older incumbents, the 2021 elec-
tion otherwise featured the fewest candidates and elected members of
parliament (MPs) under 40 years old in decades. McClean explores the
causes and consequences of this decline in young people running for
office. He finds that candidates under 40 were significantly more likely
than older candidates to say that they would prioritize education, child-
care, and employment if elected; were more supportive of strengthening
Japan’s defense capabilities; and were more positive toward enacting bills
to recognize same-sex marriage and promote LGBT awareness. These
patterns suggest that reforms aimed at increasing the number of young
legislators could have significant consequences for the policies that get
debated and ultimately implemented by the parliament.
In the tenth chapter, Jordan Hamzawi turns his lens on the
phenomenon of party switching in Japan. In the two decades since
 1 INTRODUCTION: JAPAN’S CORONAVIRUS ELECTION 5

electoral reform, Japan’s party system has been in constant flux. After
a slow build toward a predominantly two-party system, politics are
currently dominated by the LDP and its coalition partner Kōmeitō,
with an ever-changing roster of opposition parties vying for the place
of challenger. The 2021 election continued the recent state of political
(non)competition as opposition parties were unable to make a dent in the
LDP’s sizeable majority. While there are numerous contributing factors
that explain Japan’s anemic party competition, Hamzawi focuses on how
candidates navigate their partisan affiliation. He finds that candidates,
particularly candidates from the opposition, follow a pattern of switching
from weak parties to new parties, preferring the potential of a new party
over the issues with existing ones. Instead of slowly building strength
with a roster of seasoned candidates, Japan’s opposition parties constantly
collapse in on themselves because of candidate choices.
In the final chapter on party politics, Hiroki Kubo examines how and
why ministers are selected in Japanese cabinets under the three most
recent prime ministers. Kubo analyzes the outcomes of cabinet port-
folio allocation, comparing LDP faction seat shares and the percentage of
cabinet portfolios each secured in the six cabinets formed since 2017. His
analysis reveals that: First, there is overall proportionality between faction
seat shares andcabinet portfolios; second, there is nevertheless a relative
advantage enjoyed by the prime minister’s faction and the large main
factions; and third, independent LDP members are not disadvantaged
in portfolio allocation. In terms of seniority, relatively young MPs have
been included in the cabinet. In addition, the Kishida cabinet features
three female MPs, accounting for 15% of cabinet members. We return to
the broader issue of women’s representation in Japan later in the volume.
After these chapters on party politics, we turn to the campaign for the
next four chapters—on public opinion with a focus on COVID-19, social
media, youth turnout, and how COVID-19 affected the election results.
Chapter 12 is authored by Yukio Maeda and investigates public
opinion. The 2021 election results surprised journalists and pollsters in
Japan. This chapter explains why the LDP outperformed expectations by
examining media polls and coverage of three prime ministers from 2017
to 2021. Abe struggled to respond to the novel coronavirus while also
dealing with conventional corruption allegations. His successor, Suga,
initially received high approval ratings as people expected him to manage
the pandemic better than Abe. However, these expectations became
a liability when COVID-19 cases surged while Japan was hosting the
6 R. J. PEKKANEN ET AL.

Summer Olympics. When Kishida succeeded Suga, COVID-19 cases were

rapidly declining, and the LDP subsequently won a victory in the 2021
election. Underestimating the impact of the public’s shifting views of
the government’s pandemic response may account for much of the gap
between election predictions and actual results.
Robert A. Fahey in Chapter 13 examines social media and the elec-
tion campaign. Since the use of social media in election campaigns was
made legal in 2013, platforms such as Twitter and Facebook have been
widely adopted by candidates in Japan’s elections. This chapter exam-
ines how social media platforms were used in the 2021 election, looking
at which candidates and parties chose to engage most heavily in online
campaigning, and at the issues, policies, and narratives which the various
parties’ candidates focused on in their social media messaging. LDP candi-
dates focused on the government’s track record and the success of the
COVID-19 vaccination program, while mainstream opposition candi-
dates’ online messaging largely focused on pocketbook and family issues.
The chapter concludes with an analysis of the Twitter follower networks of
both candidates and major media organizations, providing insight into the
extent of affective polarization on social media during the 2021 election
period.
In Chapter 14, Gill Steel looks at youth turnout in the election,
showing that the various mobilization efforts had very little effect on
young people’s participation. She claims that the LDP has depressed
young people’s engagement with politics in the various ways the party
(and through it, the state) depoliticizes politics. As part of this governing
strategy of depoliticization, the state has limited citizens’ opportuni-
ties for participation and has cultivated, or mandated, an atmosphere of
depoliticization that discourages citizen interest and engagement. The
state does so through depoliticizing schools, broadcasting, restricting
youth political activities, campaigning, and curtailing NPOs (nonprofit
organizations). Depoliticization means that young people do not receive
political information and cues from elites that impart a sense of the excite-
ment of politics or the legitimacy of political conflict through mainstream
channels.
Chapter 15 again returns to a theme of this volume, the influence of
the coronavirus pandemic on the election. Here, Michael F. Thies and
Yuki Yanai examine the impact of COVID-19 on voting behavior. When
the pandemic began, Japan’s parliamentary term had passed its halfway
point; the next general election was due before late autumn 2021. An
 1 INTRODUCTION: JAPAN’S CORONAVIRUS ELECTION 7

autumn 2020 election seemed likely, to slipstream in the wake of the

Tokyo Summer Olympics. When COVID-19 forced a year’s postpone-
ment of the Games, the government put off the election as well, gambling
for good news before the term ran out. Voters were largely dissatisfied
with the government’s pandemic response, and many opposed staging
the Olympics at all. In the event, no post-Olympics boost materialized.
But dramatic improvements in COVID-19 outcomes in the few weeks
between the election announcement and voting day led most voters to
focus on the economy instead, just in time for the gamble to pay off.
Nonetheless, the authors do find that urban prefectures with higher death
rates were less likely to support the ruling LDP, and interestingly, more
likely to support upstart Ishin.
After these four chapters on the campaign, we turn to a deeper anal-
ysis of the issues framing the election—from coronavirus policy to foreign
policy to the Olympics. These ten chapters dig into the issues that domi-
nated Japanese politics in the years, months, and weeks leading up to the
vote, in order to provide a rich understanding of the background context
of the 2021 election.
The first of these chapters, by Phillip Y. Lipscy, provides a deep analysis
of Japan’s COVID-19 response policy. What features of Japan’s COVID-
19 response stand out, and how are they best explained? Lipscy argues
that the Abe model of governance critically shaped both the strengths
and weaknesses of the Japan model of COVID-19 response. Japanese
officials have often promoted the Japan model as exemplary of how to
manage the pandemic without sacrificing fundamental democratic values
and civil liberties. However, key features of the model—such as an
emphasis on macroeconomic growth, avoidance of harsh lockdowns, and
making scientific experts the public face of the response––were compat-
ible with how former Prime Minister Abe governed Japan throughout his
tenure. The chapter also places Japan’s COVID-19 response in compara-
tive, cross-national context: Relative to other G7 countries, Japan stands
out for relatively low cases and deaths per capita, but the numbers must
be interpreted with caution and are largely in line with those of regional
peers. The chapter concludes with an early assessment of the COVID-19
response under the first six months of Prime Minister Kishida.
In Chapter 17, Kenya Amano and Saori N. Katada take on the central
questions of macroeconomic policy. Highly accommodative monetary
policy during nine years of Abenomics allowed fiscal expansion to become
the center of the Japanese government’s COVID-19 stimulus and the
8 R. J. PEKKANEN ET AL.

further economic measures were the primary issue facing the 2021 elec-
tion. Under monetary constraints, the economic policy choice among
Japan’s conventional growth strategy, distribution, and fiscal discipline
creates a trilemma, whereby the government can pursue only two of
these three goals. In this election, the LDP-Kōmeitō coalition managed
to straddle between distribution and growth strategy, while exploiting
the policy space for the opposition parties. Although the coalition main-
tained its electoral majority, the inroads made by Ishin, Reiwa, and
the Democratic Party for the People (DPP) whose campaigns neglected
fiscal discipline in favor of both growth and distribution foreshadows the
challenge against the Japanese government’s future fiscal health.
In Chapter 18, Yeon Ju Lee investigates income inequality and the
election. The chapter examines how income inequality began to receive
attention from politicians and voters before the 2021 election. While
income inequality has dominated the political agenda in numerous coun-
tries around the world, it has not been a politically salient issue in
Japan even though it has been increasing since the 1980s. However,
income inequality became politically visible to voters and politicians as
the COVID-19 pandemic further strained the already stagnant economy,
having a direct impact on people, especially those who were less well off.
Both ruling and opposition parties responded to the public dissatisfaction
by introducing measures to address income inequality in their party plat-
forms, including Prime Minister Kishida’s vision of “New Capitalism” to
promote simultaneous growth and distribution.
In Chapter 19, Yesola Kweon furthers the investigation of a critical
topic: women’s representation. This chapter examines women’s represen-
tation in Japanese politics and the Japanese economy. In the economic
realm, Womenomics implemented under the Abe regime made several
meaningful improvements in women’s labor participation, especially for
those who have children. However, little progress was made in terms of
the gender wage gap and gender disparities in high-quality job employ-
ment. The COVID-19 pandemic also had a disproportionate impact on
women, parents, and those with non-regular jobs. This, in turn, led to
lower trust and confidence in the government and its policy responses
to the pandemic. The latter half of the chapter considers gender repre-
sentation in politics. The 2021 election saw a decrease in the number of
women representatives. As with previous elections, the ruling LDP had
the smallest share of female candidates and elected women legislators.
Another random document with
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competition with theirs, and who will prize more highly the pleasure
he receives than that he may be capable of bestowing—such a man
appears to me, in the essentials of character, a brute. The brutes
commonly seek the satisfaction of their propensities with straight-
forward selfishness, and never calculate whether their companions
are gratified or teased by their importunities. Man cannot assimilate
his nature more closely to theirs, than by imitating them in this.
Again. There is no instinct in regard to which strict temperance is
more essential. All our animal desires have hitherto occupied an
undue share of human thoughts; but none more generally than this.
The imaginations of the young and the passions of the adult are
inflamed by mystery or excited by restraint, and a full half of all the
thoughts and intrigues of the world has a direct reference to this
single instinct. Even those, who like the Shakers, ‘crucify the flesh,’
are not the less occupied by it in their secret thoughts; as the Shaker
writings themselves may afford proof. Neither human institutions
nor human prejudices can destroy the instinct. Strange it is, that men
should not be content rationally to control, and wisely to regulate it.
 SEXUAL WEAKNESS

This complaint, commonly called fluor albus, or whites, to which

women are peculiarly subject, must form an important object of
attention, since it is always attended with disagreeable symptoms;
and, when aggravated, soon spoils the beauty of a fine face, weakens
the digestive powers, produces a general bad habit, and occasions
sterility.
 Symptoms.
An irregular discharge from the passage leading to the womb, of a
fluid, which, in different women, varies much in colour, being of a
white, green, yellow, or brown hue. In the beginning it is, however,
most usually white and pellucid, and, in progress of the complaint,
acquires the various discolourations and different degrees of
acrimony, whence proceed a slight smarting on making water.
Besides the discharge, the patient is frequently afflicted with severe
and constant pains in the back and loins, indigestion, paleness of the
face, chilliness, and languor. In process of time, every symptom
becomes highly aggravated, the feet and ankles swell, palpitations,
and a difficulty of respiration are experienced, the menstrual
discharge is rendered irregular, the urine is turbid, the mind is
dejected, and either consumption or dropsy supervenes, and
terminates a miserable existence.
In some languid habits, the fluor albus returns periodically,
instead of the proper menstrual evacuation, until the patient’s
constitution is duly invigorated.
 Causes.
It may be produced by any cause which either weakens or irritates
the womb and its appendages. It may arise from general debility of
the constitution, but it is especially caused by circumstances
impairing the power of the womb itself, as, for instance, a severe
labour, a miscarriage, or profuse menstruation.
In some instances it appears to depend on a full and irritable habit
of body, and, in other cases, of local irritation, such as disorders of
the womb, or of the urinary organs, or a collection in the gut, of the
small thready worms called ascarides.
Upon the high authority of Dr. Hamilton, this disease is most
frequently first brought on by some imprudence in respect to diet
and clothing, or exposure to cold or fatigue, or neglect of the bowels
about the time when menstruation begins.
 Treatment.
In the treatment of this complaint regard must be had to the
apparent cause, and to the state of the patient. The discharge is too
often considered by the sex as the effects of general weakness in their
habit, and, therefore, they are led to the indiscriminate use of heating
medicines, as port wine, balsam copaibæ, &c., without paying
attention to the habit of the body, or cause of the disease.
A milk diet, change of air, and the partial cold bath, as sponging
the loins and thighs with cold water every morning, with attention to
cleanliness and proper exercise, are often sufficient to arrest the
disease, if early adopted.
In addition to this plan of treatment, if the patient be of a full
habit, a disposition to fever from slight causes, attended with a sense
of heat about the passage to the womb, it will be necessary to have
recourse to the lancet, cooling cathartics, and febrifuge medicines,
and to inject, several times a day, flax-seed tea or milk and water,
into the passage of the womb. In the great majority of cases, the
complaint arises from general debility or laxity of the vessels of the
parts, and in such cases the indications of cure are to increase the
vital heat, promote the digestion, and restrain the preternatural
discharge. In order to which, recourse must be had to such of the
tonic medicines as will be found to agree best with the patient. Of
these, the bark and elixir vitriol, the tonic powders or pills, the rust
or tincture of steel, and lime-water have usually been employed, and
often with good effects. In some instances, however, I have known
these medicines to fail, when the nitric acid, diluted, in doses of a
wineglassful, three or four times a day, wonderfully succeeded.
Previously to the exhibition of tonic medicines, it is advisable to
give a dose of ipecacuanha or antimonial wine. Gentle emetics are
supposed to be of singular utility in this complaint, not only by
cleansing the stomach and bowels, and making a revulsion of the
humors from the inferior part of the body, but likewise by their
exciting all the powers of the constitution to a more vigorous action.
 The bowels must be kept in a regular state by conjoining a few
grains of rhubarb with some of the tonic medicines, or by taking
occasionally, at bedtime, one of the aloetic, or aperient or diaphoretic
pills; or, in the morning, a teaspoonful of Epsom salts dissolved in a
tumbler of water.
If there be a fulness of the stomach after eating, the tincture of
rhubarb in small doses will excite digestion. In obstinate cases, it is
often expedient to produce a change in the system, by giving a grain
or two of calomel, or one of the mercurial pills at bedtime, until the
gums become slightly affected, and then the cure may be completed
by strengthening medicines, together with the shower bath.
Besides tonics, stimulating medicines, such as commonly
determine to the urinary passages, have very frequently been
employed with great benefit. Of these, rosin in doses of ten grains in
the yolk of an egg, or a spoonful of molasses, or balsam copaibæ in
doses of a teaspoonful, or tincture of cantharides in doses of twenty
or thirty drops in some mucilaginous drink, and taken three or four
times a day, will be found most salutary.
These means strike at the cause of the complaint; but if it do not
remove the effect very soon, we are not to trust to them alone. For
once a morbid secretion being excited, it is very apt to continue,
although the exciting cause cease to operate.
On this account, we ought, without delay, to have recourse to
astringent injections, such as a strong decoction of red oak bark, with
the addition of a little alum or a solution of alum in water. Half an
ounce of the former to be dissolved in a bottle of water; which should
be thrown into the vagina by means of a female syringe, two or three
times a day. The celebrated Dr. Burns says, after many trials, he
satisfied himself, that although assistance may be derived from
internal medicines and the cold bath, yet the chief dependence is to
be placed on astringent applications to the seat of the discharge; and
these, where there is no fulness of the general system, nor any
affection of the womb itself, are perfectly safe, and seldom fail in
producing a cure.
It will be prudent, when this disease occurs as an early symptom of
pregnancy, not to check the discharge suddenly, lest miscarriage be
the consequence; but it may be moderated by injections of water,
with the addition of a little vinegar, or an infusion of green tea.
Neither should the discharge be suddenly suppressed when it has
been of long standing, and acquired a considerable degree of
acrimony, with an offensive smell. For if it be unseasonably checked,
the belly swells, and a train of the most disagreeable symptoms
occurs. In such cases, soap suds, or an infusion of chamomile flowers
or hops, should be frequently thrown up the vagina; and, as soon as
the blood is freed of its impurities, by suitable medicines, and has
recovered, in some measure, its soft and balmy quality of which it
has been deprived, the astringent injections may be employed with
perfect safety.
The application of a blister to the sacrum, has, in some obstinate
cases, been attended with advantage.
When the fluor albus proceeds from worms, purgatives and bitter
clysters are the proper remedies.
Pain in the back and loins is often mitigated by the application of a
large adhesive or strengthening plaster, and by avoiding a standing
posture of long continuance, much walking, dancing, or any other
violent exertion.
Women should carefully avoid all the remote causes of the disease:
they should pay diligent attention to cleanliness, by washing the
parts frequently with cold water; and when there are excoriations,
milk and water, or lead water, may be employed as a wash.
 Regimen.
The diet should be light, cordial, and nourishing, consisting of
isinglass dissolved in milk by boiling it, jellies, custards, rice, milk,
soft-boiled eggs, gelatinous broths, and light meats, together with a
prudent use of genuine wine, particularly claret or port.
Women, affected with this disease, should by no means indulge in
the use of tea and other warm slops of a relaxing nature; but should
lie on a mattress in preference to a feather bed; and they should rise
early, and take such daily exercise as their strength will admit,
particularly on horseback. When there is much languor, with
chilliness, friction with the flesh-brush, and wearing flannel next the
skin, must not be omitted.
 FALLING DOWN OF THE WOMB.

This is a much more common complaint than the former, and

takes place in women of every age, and every rank. As its name
implies, it consists of change in the situation of the womb, by which
that organ lies much lower than it ought to do. In some cases it
absolutely protrudes entirely without the parts. The slightest degrees
are styled bearing down; and the more violent ones descent or falling
down of the womb.
In general, the first symptom of this complaint is an uneasy
sensation in the lower part of the back while standing or walking,
with now and then a kind of pressure and bearing down.
If these feelings be disregarded, the complaint increases, and the
patient becomes incapable of making water without first lying down,
or pushing up a swelling which seems to stop the discharge of urine;
and if the disease continues to increase, the womb is actually forced
out of the parts, and takes on the form of a bulky substance hanging
down between the thighs. This extreme degree of the complaint can
seldom happen, excepting in women who have had a great many
children, but the less degrees of it occur occasionally in very young
unmarried women.
The causes of descent of the womb ought to be known to every
woman, as many of them may be avoided. Every disease which
induces weakness of the habit in general, or of the passage leading to
the womb, in particular, must lay the foundation for the complaint.
Frequent miscarriages, improper treatment during labour, too early
or violent exercise after delivery, are in married women, the most
frequent circumstances by which falling down of the womb is
produced. In the unmarried, it is apt to take place in consequence of
violent exercise, as in dancing, riding, &c., while out of order, a fact
that ought to be impressed on the mind of every young woman.
 In the treatment of this complaint, the means must be adapted to
the degree of its violence. When the descent is inconsiderable, and
the case is of recent date, the daily use of the cold bath, invigorating
diet, very moderate exercise, and the injection of any mild astringent
liquor into the passage, evening and morning, will probably prove
successful. But should the disease be in a great degree or of long
standing, a course of tonics, with the frequent use of astringent
injections, as a strong solution of alum in water, or decoction of red
oak bark, must be added to the above means.
Dr. Leak advises, that after the parts are reduced, the intention of
contracting the relaxed vagina so as to prevent its future descent,
may be effected by the frequent use of the following astringent
injection. Take of alum, and white vitriol, each, one drachm, boiling
water, one pound, mix and filter through paper. Inject it into the
vagina, milk warm, with a womb syringe. At the same time
endeavour to strengthen the whole bodily system by nourishing diet,
and tonic medicines.
When the complaint resists such remedies, or when, from its
degree, it may appear unnecessary to employ them, the only relief
which can be afforded, unless the womb become pregnant, is to be
obtained by wearing an instrument called a pessary. It is made of
wood or ivory, and if properly adapted to the passage, and of a
proper construction, it can be worn without much inconvenience,
and it never occasions pain. Certain attentions are however
necessary, whenever such an instrument is used. Thus, the pessary
should never be allowed to remain in the passage above a few days at
a time, otherwise it becomes the source of great irritation. It should,
therefore, be occasionally withdrawn on going to bed, well cleaned
and reintroduced in the morning, before the patient rises. In some
instances, after a pessary of a certain size has been worn for several
months, one of a smaller size becomes better adapted to the
passages, and in other cases one of a larger size is required.
Sponges of such a size as, when expanded, fill up the cavity of the
vagina, are very good pessaries. They support the uterus, and, by
putting a string through them, the end of which is to be left hanging
out of the os externum, the woman can take them away and apply
them herself very conveniently.
 To answer this purpose, a fine sponge, wrung out in alum water,
may be dried in a compressed state, and cut into any convenient
form, so as to be introduced as high as possible: this will act by its
astringency, and by its pressure, in a gentle and uniform manner.
During the use of this application, an astringent injection may be
used twice a day; and the sponge tent should be made gradually
smaller as the vagina contracts.
The application of the bandage round the whole belly, with a
moderate degree of firmness, often gives great relief to the uneasy
feelings. The T bandage has also been worn in this case with
considerable advantage.
If a woman liable to falling down of the womb, become pregnant,
there is no occasion for the pessary after the third month, and by
proper treatment after delivery, the return of the complaint may be
prevented.
 MISCARRIAGE OR ABORTION.

We now come to the consideration of a subject, in respect to which

there exists much misapprehension and ignorance, causing useless
and unnecessary alarm and anxiety to those who may be so
unfortunate as to be subject, at particular periods of gestation, to
abortion or miscarriage.
The dangers of abortion or miscarriage are often magnified and
exaggerated. It is dangerous if produced by a fall, a blow, a kick from
a horse, or any other external bodily violence or injury, causing
internal contusion, or rupture of some blood-vessels; and, also, but
not to the same extent, if produced by sudden fright, violent fits of
passion, &c., or from general debility or disease of the uterus; but the
danger arises more from the cause which produces the miscarriage,
than from the miscarriage itself; as it is well known by those versed
in obstetrics that, where it is deemed indispensable to effect a
miscarriage, either because of the existence of a deformed pelvis,
diseased uterus, or other causes, if skilfully effected, it is attended
with no danger, especially in the earlier stages of pregnancy.[43]
 Symptoms.
When miscarriage is about to take place, its first symptoms are
generally occasional stinging pains at the bottom of the belly,
extending across and around the loins and hips; a feeling of fatigue
of the legs, pain in the forehead, burning sensation of the eyes. The
breasts, which before were distended, become soft and flabby, hot
and cold flashes, attended with thirst, fever, and shiverings. In a day
or two after the appearance of these symptoms, a discharge from the
womb takes place of yellow matter, tinctured with red. If not arrested
at this stage, the pains across the loins become more severe and
frequent, attended with a sense of dead weight, and bearing down
about the womb, the water is discharged, and the expulsion of the
contents of the womb takes place. The symptoms of miscarriage,
however, vary with the causes which produce them, or the state of
habit, age, or health of the patient; some recovering immediately,
and rapidly, and with but little inconvenience. Where miscarriage
arises from a serious accident, such as violent falls, bruises, &.c., the
symptoms are somewhat aggravated, and more severe, and are often
preceded and accompanied with violent and profuse floodings and
discharges of coagula, in addition to the other symptoms; although
moderate flowing is not an unfrequent symptom in miscarriages.
It is always accompanied with two circumstances, separation of
the membranous bag, and expulsive efforts or contraction of the
womb itself. The first is productive of discharge, the second of pains
like those of labor. Sometimes the separation or detachment of part
of the conception takes place before any pain is felt; on other
occasions, the pain, or contraction of the womb, takes place first, and
produces a separation. In the first of these cases, the symptoms of
abortion take place suddenly, and are usually occasioned by fatigue,
sudden exertion, or fright. In the second, the pains come on, and
there are particular feelings, and changes, which indicate that a
miscarriage is likely to take place; as, for instance, the cessation of
the morning sickness, the subsidence of the breasts, &c.
 Miscarriage is preceded by floodings, pains in the back, loins, and
lower part of the abdomen, evacuation of the water, shiverings,
palpitation of the heart, nausea, anxiety, fainting, subsiding of the
breasts and belly, pain in the inside of the thighs, opening and
moisture of the womb.
 Causes.
The principal causes of miscarriage are blows or falls; great
exertion or fatigue; sudden frights and other violent emotions of the
mind; a diet too sparing or too nutritious; the abuse of spirituous
liquors; other diseases, particularly fevers and hæmorrhages;
likewise excessive bleeding, profuse diarrhœa or colic, particularly
from accumulated fæces; immoderate venery, &c.
 Treatment.
When a woman is threatened with a miscarriage, there are two
objects to attend to; the first is, to prevent it if we can; the second is
to manage it so that as little blood as possible be lost; and both these
are obtained by the same means. With this view, the patient should
immediately, on the first alarm, undress and go to bed, lightly
covered, with a firm determination not to rise till the process be
either checked or completely over. There should be little fire in the
room, though it be winter; and in summer, the windows must be
opened. Cloths wet with cold water, should instantly be applied to
the lower part of the belly, and back: the drink must be cold, and
everything stimulating should carefully be avoided.
In robust habits, or when the symptoms have been brought on
suddenly by some such cause as a fall or exertion, it is proper to
bleed; and, in cases of sickness or great feebleness, to give a dose of
laudanum; or, what is better, to administer the anodyne clysters.[44]
Opiates are useful in every case where we hope to prevent
abortion, and must be repeated more often or seldom, according to
the effect they produce. They are, however, improper in those cases
where miscarriages must decidedly take place. Their tendency to
occasion costiveness, when employed, must be obviated by clysters,
or some gentle laxative medicine, such as calcined magnesia, Epsom
salts, or a little castor oil. If there be a continued but trifling
discharge, great advantage may be derived from injecting, three or
four times a day, up the vagina, a solution of alum. Indeed, in all
protracted cases, this is of much benefit. The solution ought to be
thrown up pretty high, that it may reach the womb.
When these means produce not the desired effect, and along with
the discharge of blood large clots come off attended with bearing
down or pains in the back and loins, especially if the symptoms
which precede abortion have appeared, there must be every
probability that the threatening event cannot be avoided; then we
must conduct the patient through the process.
 In all cases during the last stage of pregnancy, where our
endeavors to stop or repress the hemorrhage prove abortive, it will
be advisable to deliver her as soon as possible.
When the whole conception come away at once, the pain and
discharge usually go off; but, if only the fœtus come away, all the
symptoms either continue and increase till the placenta come away,
or, if they be for a time suspended, they are sure to return, except in
early miscarriages of ten or twelve weeks pregnancy, when
sometimes the fœtus is expelled separately, and the placenta comes
immediately after, but the latter frequently remains several days. The
most prudent mode in such cases is to leave it to nature, which
sooner or later expels this foreign body.
After the process is over, if the discharge be profuse, and do not
stop on the application of cold water to the lower part of the belly, it
will be proper to plug up the vagina, and this is best done by taking a
piece of soft sponge, dipping it in sweet oil, and then wringing it
gently. This is to be introduced with the finger, portion after portion,
until the lower part of the vagina be well filled. The remainder is then
to be firmly pressed on the orifice; and held there some time for the
effused blood to coagulate. In obstinate cases, previously to the
introduction of the plug, we may insert a little pounded ice, or snow
tied up in a rag, if to be procured,[45] but neither of these should be
continued so long as to produce pain or much shivering. In addition
to this mode of treatment, it will be advisable to have recourse to the
astringent medicines, as advised under the head of Immoderate
Flow of Menses.
 Regimen.
Arrow-root, tapioca, sago, panada, or rice milk, constitute a proper
regimen. If the process be protracted, and the strength much
impaired, the diet may be more liberal. In every case, ripe fruit is safe
and useful. The bowels are to be kept regular, and sleep, if necessary,
is to be procured by an anodyne.
 Prevention.
It requires great attention to prevent abortion in subsequent
pregnancies, whenever it has happened.
In all such cases, it will be highly necessary to attend to the usual
habitudes and constitution of the woman, and to remove that
condition which is found to dispose to abortion.
A woman that is subject to miscarriage, and who is of a full
plethoric habit, ought to take the tincture of foxglove, twice or thrice
a day, for two or three weeks.
She should likewise keep her body perfectly open with gentle
aperient medicines, use a spare diet, and avoid all agitations of the
mind. The sleep should be abridged in quantity, and taken on a
mattress, instead of a feather bed. Regular and moderate exercise
should be taken daily, being cautious, at the same time, not to carry
it to the length of exciting fatigue.
In women of a weak, lax habit, a nutritive and generous diet,
moderate exercise, and tonic medicines, will be required. And, along
with nourishing diet, a moderate use of wine should be allowed, if it
do not heat the patient, or otherwise disagree. The cold bath is of
signal service in every instance where it is not followed by chilliness.
Until gestation be far advanced, it would be advisable for the
woman to sleep alone, and strictly avoid every cause which is
ascertained to be capable of producing abortion.
Women more frequently miscarry in the second or third month
than at any other time; but some have a certain period at which they
usually go wrong, and do not vary a week from it. In such cases, the
woman should confine herself to the house, avoid the least exercise,
and frequently recline on the sofa or bed, till that period be past.
When a female has suffered several abortions, it becomes almost
impossible to prevent a repetition at the same period of gestation in a
subsequent pregnancy. Nothing, however, will be so successful in
preventing a recurrence of a similar misfortune, as in allowing the
uterine vessels to recover their tone; for which purpose tonics must
be given. Attend to particular symptoms as they occur; with proper
diet and exercise. Sea Bathing and the shower bath are both
excellent.[46]
 When necessary to effect Miscarriage or
Artificial Delivery.
During pregnancy, deformities of the pelvis become objects of
solicitude to the accoucheur, when they are of such a character as to
render delivery at full term impossible without the interference of
cutting operations. At this period only can he guard against the
deplorable consequences of these deformities.
 Pelvic Deformities.
The accoucheur may be consulted by a mother anxious to know
whether the pelvis of her daughter is such as to justify marriage. His
opinion may also be desired by a female pregnant for the first time,
in whose mind there may exist fears as to the formation of her pelvis.
In this case, he will have to reply to the following questions:
Is delivery at full term compatible with the safety of the child?
What influence will the deformity have on pregnancy? What
precautions are necessary to guard against accident until the
completion of gestation, and to facilitate delivery?
When the accoucheur states that delivery will not be possible
without the interference of art, he will then be asked whether this
interference will compromise the life of the mother or child; and
whether this operation cannot be avoided by some process during
pregnancy, either saving the life of mother and child, or sacrificing
the child for the benefit of the mother?
In order to answer these questions satisfactorily, and to furnish
himself with a rule of conduct in advance, it will be necessary for the
accoucheur to know precisely the condition of the pelvis, and the
dimensions of the diameters, &c.
However, it must not be supposed that this mensuration can be
made with mathematical accuracy; our means will not enable us to
obtain this precision; but even if we could, the object we have in view
would not be completely accomplished, for, in order to arrive at a
rigorous appreciation of the consequences of the deformity and the
operations it might require, it would be necessary also to know the
exact size of the fœtus, which is not possible.
Happily, in practice, an approximation as to the absolute condition
of the pelvis will suffice, and it is easy to arrive at this result. With
this view, the accoucheur should, in the first place, learn the previous
history of the patient in infancy and youth, and afterward proceed to
an external and internal examination.
 When the accoucheur is called upon to pass an opinion as to the
natural or unnatural conformation of a female, he should, says M. P.
Dubois, inquire minutely into the antecedent condition of this
woman during her infancy and youth. The history of early life will
often, of itself, cause him to suspect the state of the pelvis. He should
address the following questions to the parent:
What diseases was the infant affected with? At what age did they
manifest themselves? At what age did the child walk? After
walking, did it appear weak in the inferior extremities? Was the
erect position possible? Was it easy? Were the articulations large?
If all these phenomena appeared in infancy, it is highly probable
that the pelvis is deformed; and, moreover, it may be affirmed that
the symptoms arose from rickets, a disease peculiar to infancy. It
commences rarely before eighteen or twenty months, and very
seldom after thirteen of fourteen years of age. If there should be
curvatures of the spinal column and extremities, it will be almost
certain that the pelvis is deformed; and if the curvature commenced
in the inferior extremities, we may conclude that it is owing to
rachitis, for this disease exerts its influence first on the tibias, then
on the bones of the thighs, pelvis, and vertebral column. On the
contrary, if the first ten years have been passed without disturbance
of the general health, then curvatures must be attributed to
malacosteon, especially if the curvature of the spine has preceded
that of the lower limbs. Deformity of the spine may exist alone; then
we may legitimately hope that the pelvis is not contracted.
Experience, indeed, proves that the vertebral column may be
considerably curved without the pelvis participating in the deformity,
when the inferior extremities are straight; and that, in general,
curvatures of the extremities alone accompany pelvic malformations.
Indeed, it is not on simple probabilities that the accoucheur is to
interdict the marriage[47] of a young girl, or determine, during
pregnancy, to perform an operation, with the view of protecting the
mother against the dangers of delivery at full term.
 Premature Artificial Delivery.
Thanks to the efforts of MM. Stoltz, Dezeimeris, P. Dubois, and
Velpeau, delivery brought on before the full term is an operation
hereafter recognised in French midwifery. For a long time it proved
useful to our neighbors in England and Germany, while a foolish
prejudice caused it to be rejected by French practitioners, who did
not hesitate even to have recourse to the Cæsarean section and
symphyscotomy.
We have not within the walls of Paris one solitary example of a
woman who had survived the Cæsarean section. She who lived the
longest was one of those on whom I assisted M. P. Dubois to operate.
She died on the seventeenth day of a tetanic affection, when
everything promised a most successful result.—(Bull. of the Acad. of
Med., t. iii., p. 694; t. v., p. 25.)
When the contraction is such that a living fœtus cannot be brought
forth, the accoucheur has then to choose between the Cæsarean
section or miscarriage.
During pregnancy, abortion will present an extreme and last
resource. And it would seem more humane to sacrifice, before the
period of viability, an embryo whose existence is so uncertain, in
order to protect the mother from the perilous chances of
symphyscotomy and the Cæsarean section.
I must confess that, if such an alternative were presented to me,
the diameter of the pelvis being only two inches, I should not hesitate
to propose this means.
The abuse and criminal extension of such a resource is
reprehensible, but not its proper and authorized employment. This
operation should always be undertaken with great care, and all
necessary precaution used to satisfy the public mind of its necessity.
 LABOR, DELIVERY, ETC.

After seven months of pregnancy the fœtus has all the conditions
for breathing and exercising its digestion. It may then be separated
from its mother, and change its mode of existence. Child-birth rarely,
however, happens at this period: most frequently the fœtus remains
two months longer in the uterus, and it does not pass out of this
organ till after the revolution of nine months.
Examples are related of children being born after ten full months
of gestation; but these cases are very doubtful, for it is extremely
difficult to know the exact period of conception. The legislation in
France, however, has fixed the principle, that child-birth may take
place up to the two hundred and ninety-ninth day of pregnancy.
Nothing is more curious than the mechanism by which the fœtus is
expelled; everything happens with wonderful precision; all seems to
have been foreseen, and calculated to favor its passage through the
pelvis and the genital parts.
The physical causes that determine the exit of the fœtus are the
contraction of the uterus and that of the abdominal muscles; by their
force the liquor amnii flows out, the head of the fœtus is engaged in
the pelvis, it goes through it, and soon passes out by the valve, the
folds of which disappear; these different phenomena take place in
succession, and continue a certain time; they are accompanied with
pains more or less severe; with swelling and softening of the soft
parts of the pelvis and external genital parts, and with an abundant
mucous secretion in the cavity of the vagina. All these circumstances,
each in its own way, favor the passage of the fœtus. To facilitate the
study of this action, it may be divided into several periods.
The first period of child-birth.—It is constituted by the precursory
signs. Two or three days before child-birth a flow of mucus takes
place from the vagina, the external genital parts swell and become
softer; it is the same with the ligaments that unite the bones of the
pelvis; the mouth of the womb flattens, its opening is enlarged, its
edges become thinner; slight pains, known under the name of flying
pains, are felt in the loins and abdomen.
Second period.—Pains of a peculiar kind come on; they begin in
the lumbar region, and seem to be propagated towards the womb or
the rectum; and are renewed only after intervals of a quarter or half
an hour each. Each of them is accompanied with an evident
contraction of the body of the uterus, with tension of its neck and
dilatation of the opening; the finger directed into the vagina
discovers that the envelopes of the fœtus are pushed outward, and
that there is a considerable tumor, which is called the waters; the
pains very soon become stronger, and the contraction of the uterus
more powerful; the membranes break, and a part of the liquid
escapes; the uterus contracts on itself, and is applied to the surface of
the fœtus.
Third period.—The pains and contractions of the uterus increase
considerably; they are instinctively accompanied by the contraction
of the abdominal muscles. The woman who is aware of their effect is
inclined to favour them, by making all the muscular efforts of which
she is capable: her pulse then becomes stronger and more frequent;
her face is animated, her eyes shine, her whole body is in extreme
agitation, and perspiration flows in abundance. The head descends
into the lower strait of the pelvis.
Fourth period.—After some moments of repose the pains and
expulsive contractions resume all their activity; the head presents
itself at the vulva, makes an effort to pass, and succeeds when there
happens to be a contraction sufficiently strong to produce this effect.
The head being once disengaged, the remaining parts of the body
easily follow, on account of their smaller volume. The section of the
umbilical cord is then made, and a ligature is put around it at a short
distance from the umbilicus or navel.
Fifth period.—If the midwife has not proceeded immediately to the
extraction of the placenta after the birth of the child, slight pains are
felt in a short time, the uterus contracts freely, but with force enough
to throw off the placenta and the membranes of the ovum; this
expulsion bears the name of delivery. During the twelve or fifteen
days that follow child-birth the uterus contracts by degrees upon
itself, the woman suffers abundant perspirations, her breasts are
extended by the milk that they secrete; a flow of matter, which takes
place from the vagina, called lochia, first sanguiferous, then whitish,
indicates that the organs of the woman resume, by degrees, the
disposition they had before conception.
 MANAGEMENT OF LABOR.

Women in general are ignorant of parturition or delivery. Almost

all of them are under the impression that labor is completed more by
art than nature; hence the most noted accoucheurs are employed to
attend during this interesting period; and professional men, in
general, have no wish to undeceive them on this subject, as their
interest is too much concerned. It is often astonishing to see the
credulity and ignorance manifested on these occasions. Thanks and
blessings have been poured forth, under the idea that he had saved
their lives in labor, when the accoucheur had merely looked on and
admired the perfectly adequate powers of nature, and superintended
the efforts of her work; and it is nature that accomplishes all, while
the accoucheur gets the credit of it. There is not one case in a
thousand in which he can do more than remain a silent spectator,
except to calm the fears of the ignorant and timid attendants. The
mischief and injury that are done by the untimely interference of art
are incalculable.
In pregnancy women are bled till they have not strength enough to
accomplish delivery; and, when it takes place, the forceps or other
instruments are used, which often prove fatal to the mother or child,
or both.
There are various particulars to be avoided, and several things to
be done, in the management of women during labor. We have room
here to state only a few, and shall begin by pointing out the course to
be pursued in
Natural Labor.
When called to a woman supposed to be in labor, ascertain if her
pains are true or false, which may be easily known by a little inquiry.
If the female complains of flying or unsettled pains about the system,
occurring mostly toward evening or during the night, and being
slight or irregular, it may be taken for granted that they are spurious
or false. If these symptoms prove troublesome, an infusion or tea of
hops may be taken; or, if this is not sufficient to relieve them, or
procure sleep, an anodyne may be taken; and it may be necessary
also to give laxative medicines or an injection, with a little laudanum.
True pains may be known by the pain being more concentrated in
the lower part of the belly, through the loins and hips.
The pains now increase in regularity and force, returning every ten
or fifteen minutes, and leaving the woman comparatively easy in the
intervals.
When the pains become regular and severe, there is a discharge of
slimy matter, tinged with blood, known by the name of shows. At
this period of labor it will be proper for the person who attends the
labor to examine, in order to ascertain what part of the child
presents, which may be done by requesting the female to sit in the
chair or on the side of the bed, and to extend the legs, when the
longest finger, dipped in sweet oil, may be passed up the vagina to
the part which presents, and the sense communicated will determine
the nature of the presentation. In nineteen cases out of twenty, or in
almost every case, the head will be felt. Frequent examinations
should be avoided.
Dr. Bard, speaking of examinations, remarks: “What terms shall I
use to condemn, as it deserves, the abominable practice of boring,
scooping, and stretching the soft parts of the mother, under the
preposterous idea of making room for the child to pass. It is
impossible to censure this dangerous practice too severely; it is
always wrong; nor can there be any one period in labor, the most
easy and natural, the most tedious and difficult, the most regular or
preternatural in which it can be of the least use; in which it will not
unavoidably do great mischief: it will render an easy labor painful;
one which would be short, tedious; and one which, if left to nature,
would terminate happily, highly dangerous.”
“All that is proper to be done in a case of natural labor, from its
commencement to its termination,” says Dr. McNair, “will suggest
itself to any person of common understanding; and I have long
labored under the conviction, that the office of attending women in
their confinement should be intrusted to prudent females. There is
not, according to my experience, and the reports of the most eminent
surgeons, more than one case in three thousand that requires the
least assistance. I am aware, however, that there are crafty
physicians who attempt, and often succeed, in causing the distressed
and alarmed female to believe that it would be altogether impossible
for her to get over her troubles without their assistance; and, for the
purpose of making it appear that their services are absolutely
necessary, they will be continually interfering, sometimes with their
instruments, when there is not the least occasion for it. There is no
doubt in my mind but that one-half of the women attended by these
men are delivered before their proper period; and this is the reason
why we see so many deformed children, and meet with so many
females who have incurable complaints.”
It is a very common circumstance for an inexperienced (or he may
be an experienced, but ignorant) practitioner to attempt a rupture of
the membranes, and in doing so, rupture the bladder, which would
render the woman miserable during life. We are acquainted with
twenty-five or thirty females who have met with this sad misfortune,
and many of them have been attended by those who are termed our
most successful, or old experienced physicians.
Dr. Rush, speaking of child-bearing among the Indians, says, “that
nature is their only midwife; their labors are short and accompanied
with little pain; each woman is delivered in a private cabin, without
so much as one of her own sex to attend her: after washing herself in
cold water, she returns in a few days to her usual employment; so
that she knows nothing of those accidents which proceed from the
carelessness or ill management of midwives or doctors, or the
weakness which arises from a month’s confinement in a warm
room.”
Dr. Whitney remarks; “I have had many cases where I found the
attendants alarmed, and some in tears, from supposing that they
should have had help sooner, fearing the worst consequence from
delay; but, admitting that the ‘doctor knew best,’ they would wait
calmly for hours, when in nature’s time all ended well. I pledge
myself as a physician, that all honest doctors will tell you that labor
is the work of nature, and she generally does it best when left to
herself.”[48]
“Among the Araucanian Indians,” says Stevenson in his Twenty
Years’ Residence in South America, “a mother, immediately on her