Silvered metal, enamel. Note a ball suspension.
#2 Note how different (compare to the Japanese-made medal) is the style of a standard reverse inscription 明治二十一年 - 1888 日本赤十字社 - Japanese Red Cross Society
Note how different (compare to the Japanese-made medal) is the style of a standard reverse inscription 明治二十一年 - 1888 日本赤十字社 - Japanese Red Cross Society