WESTERN MEDICINE IN SHOGUNATE
JAPAN
The Tokugawa
shogunate threw up an invisible wall around Japan, limiting contacts with the
western world. The Portuguese had arrived in 1542-3 but, along with the
Spanish, had been forced out by 1638, largely due to anxieties over Catholic
missionary activity. There had been little exchange of medical ideas. Contact
with the Dutch continued, however, since they were Protestant, avoided
missionary work, and traded. In 1641 they were ordered to move their trading
operations to Dejima, a small, fan-
shaped, closely guarded man-made island in Nagasaki Bay.
To care for their own personnel the Dutch East India Company brought physicians
to Dejima.
 |
| Diagrammatic sketch of Dejima, with bridge to mainland (Wikipedia) |
Japanese medicine at
the time was based on traditional Chinese texts, mainly from the T’ang dynasty
(618-907), emphasizing herbal remedies along with acupuncture and moxibustion (application
of smoldering substance from Artemisia leaves over wet skin). Anatomical knowledge was almost non-existent, surgery was seldom
practiced, and diagnosis was based on examination of the pulse, tongue, and
patient demeanor.
The bridge between
Dejima and the mainland was the keyhole through which bits and pieces of Dutch
medicine trickled into Japan. In the 1650s a barber-surgeon named Caspar Schamberger
accompanied the chief of the Dejima station on the obligatory annual journey to
Edo (early name for Tokyo), to report to the shogun. The court physicians
showed great interest in Schamberger’s medical system and published digests of
his teaching. Some of physicians in Dejima were true scholars. Willem Ten
Rhijne, for
example, arrived 1674. He had studied medicine in Leiden under
Franz de la Böe, a promoter of iatrochemistry – a teaching that health and
disease were based on body chemistry. Ten Rhijne imparted the new ideas to the
few able to hear him, though his greatest contribution was a full description
of Japanese medicine, including details of acupuncture. Perhaps the most well known
Dejima physician was Englebert Kämpfer (served 1690-2), an adventurous German physician-scholar,
famous for his collection of Japanese artifacts and a three-volume
history of
Japan – the best description of Japan at the time. Curious students and
physicians began gravitating to Dejima for instruction.
 |
| Willem Ten Rhijne (Wickipedia) |
 |
| Dutch officers and Kämpfer on journey to shogun's court, from Kämpfer's history of Japan (Hathi Trust) |
Japan changed course
under the rule of shogun Tokugawa Yoshimune (ruled 1716-1745). Yoshimune, a
reformer, recognized the
importance of western science. He relaxed censorship of foreign books and ordered
the teaching of Dutch, setting the stage for Dejima’s straightjacket to loosen.
Some years later two Japanese students, Sugita Gempaku and Maeno Ryotaku,
obtained a Dutch version of an anatomy text by the German
professor Johann Adam
Kulmus (pub’d 1734). To see how accurate the book’s illustrations really were
they attended the dissection of an executed criminal, book in hand. In Japan human
dissections were limited to the occasional executed criminal. The few that were
allowed were performed by the eta, a
caste comparable to untouchables in India. Sugita and Maeno saw
that the criminal’s internal organs corresponded well to Kulmus’s illustrations
(unlike Chinese texts) and they, with companions, laboriously translated the
book. The result was the Kaitai Shinso (1774),
considered the most important book in the introduction of western medicine to
Japan.
 |
| Sugita Gempaku (Wikipedia) |
 |
| The Kaitai Shinso, 1774. (Hath trust) |
 |
| Comparable page from Kulmus' anatomy text, latin edition (Hathi Trust) |
The book launched an enthusiasm for the study of western knowledge,
known as the Rangaku (“Dutch study”).
Twelve private medical schools offering instruction in western medicine and
Dutch language opened up in the following years. An illustrated surgical text by Lorenz
Heister, a German surgery professor, was translated into Japanese and
circulated
widely. The first Japanese pathology text was published in 1847.
 |
| Surgical text by Heister (Hathi Trust) |
Dr. Philipp Franz
Balthasar von Siebold, a polymath and collector in Dejima, introduced in the
1820s the new methods of auscultation, percussion, and palpation. He also
taught techniques of paracentesis, thoracentesis, and modern cataract
surgery.
He tried to introduce vaccination but his virus had lost viability.
 |
| von Siebold using telescope (Wikipedia) |
Smallpox vaccination
was finally brought into Japan by Otto Mohnike, a German physician in Dejima. Vaccination
usually traveled to countries far from Europe by sending groups of children on
ships and vaccinating one after the other on the voyage to keep the virus
alive. But Japan would not admit foreign children. Mohnike, in1849, brought
live virus from nearby Batavia (Java), about 50 years after its discovery.
As the shogun’s authority weakened the
pace of change accelerated: a western-oriented medical school opened in
Nagasaki where dissection was permitted (1859), six western-trained doctors
were appointed as physicians to the shogun (1858), and the first two Japanese
students were sent abroad to Holland to study medicine, in 1861. In 1867 the
shogunate was overthrown and the Meiji restoration of the monarchy begun. In
the 1870s, realizing that Germany led the world in medical teaching and
research, medical instruction switched from Dutch to German. German professors
were imported and Japanese students dispatched to Germany. A law was passed
requiring all physicians to study
western medicine, almost putting traditional medicine out of business (though
it could still be practiced).
One more physician, Dr.
James Hepburn, deserves mention. A
Protestant missionary doctor, he set up a
clinic in Yokohama, where he taught students. His reputation was made, though,
when a famous Kabuki actor returned to the stage after Hepburn had amputated a
gangrenous leg and provided him with a prosthesis. Hepburn developed the first
comprehensive Japanese-English dictionary and a romanized system of the
Japanese language that still bears his name.
 |
| Dr. James Hepburn (Wikipedia) |
Modernization of
medicine in Japan continued at a rapid pace, as did modernization in all the
scientific and technical fields. The rest is history.
SOURCES:
Bowers,
John Z. When the Twain Meet: The Rise of
Western Medicine in Japan. 1980; J Hopkins Univ Press.
Bowers,
John Z. Western Medical Pioneers in Japan.
1970; J Hopkins Univ Press.
Bowers,
John Z. Medical Education in Japan: From
Chinese Medicine to Western Medicine. 1965; Harper & Row, N.Y.
Genpaku
Sugita. Dawn of Western Science in Japan.
1969; Hokuseido Press, Tokyo. (Translated by Ryozo Matsumoto)
Historical
Anatomies on the Web: Kulmus, at: https://www.nlm.nih.gov/exhibition/historicalanatomies/kulmus_bio.html
