History of Medicine

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-

Diagrammatic sketch of Dejima, with bridge to mainland (Wikipedia)

shaped, closely guarded man-made island in Nagasaki Bay. To care for their own personnel the Dutch East India Company brought physicians to Dejima.

     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

Willem Ten Rhijne (Wickipedia)

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

Dutch officers and Kämpfer on journey to shogun's court, from
Kämpfer's history of Japan (Hathi Trust)

history of Japan – the best description of Japan at the time. Curious students and physicians began gravitating to Dejima for instruction.

     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

Sugita Gempaku (Wikipedia)

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. 

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

Surgical text by Heister (Hathi Trust)

widely. The first Japanese pathology text was published in 1847.

     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

von Siebold using telescope (Wikipedia)

surgery. He tried to introduce vaccination but his virus had lost viability.

     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

Dr. James Hepburn (Wikipedia)

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.

     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