Episode 80 – Dr. Ellen Nakamura (Auckland)

Originally published on November 23, 2018
[This transcript has been edited for clarity.]

Tristan Grunow: This is the Meiji at 150 Podcast. I’m Tristan Grunow. On this episode, I’m talking with Dr. Ellen Nakamura, Senior Lecturer in Japanese and History at the University of Auckland. Dr. Nakamura is the author of Practical Pursuits: Takano Chōei, Takahashi Keisaku, and Western medicine in nineteenth-century Japan, published by Harvard University Asia Center in 2005 as well as, more recently, “Working the Siebold Network: Kusumoto Ine and Western learning in nineteenth-century Japan,” published in Hapa Japan in 2017. Dr. Nakamura, thank you so much for talking with me today.

Ellen Nakamura: Thank you very much for inviting me.

TG: In your research, you’ve looked at Western medical practice in Japan in the 19th century, and more recently, you gave this presentation on battlefield medicine during the Bōshin War. So, could we start by talking about that, and then go more broadly into your work on Western medical practice?

EN: Certainly. The paper I gave most recently was about doctors who were treating people in the Bōshin War, and this is very new work for me, but I also found it really interesting. It came out of looking at a diary of a doctor who was involved in the campaign in Tōhoku in the Bōshin War, and he wrote in great detail about his experiences there; a wonderful diary keeper with all sorts of detail about what he purchased in order to go there, the names of the domains the people that he treated came from, the equipment that he asked for and the equipment that he received, and just wonderful detail in this diary.

I became interested in the doctors who were participating in the war, and as I suggested at the beginning of the paper that I gave, we tend to gloss over the violence of the Meiji Restoration, the Bōshin War. Comparatively speaking, scholars have noted that the Meiji Restoration was fairly bloodless in terms of the numbers of casualties and so on. I have some figures here for you if you’re interested. Compared to the French Revolution, or possibly tens of millions in the Russian or Chinese Revolutions, it’s estimated that in the Bōshin Civil War, even a high estimate might be around 30,000 deaths. So comparatively, perhaps we are looking at a smaller number of casualties, but for the people who are on the ground (and certainly from reading this diary), there’s people coming in all the time, they’ve all got horrendous injuries, and these were new kinds of injuries caused by new weapons of war. So, they needed new kinds of treatments and systems to cope with those kinds of injuries.

TG: That’s a great point about looking at battlefield medicine as a reminder that there was quite a bit of violence in the Bōshin War, and you mentioned that it’s mainly about doctors, but there was also some discussion, then, about the battlefield nurses, right?

EN: That’s right, and it’s not really clear from what I’ve read so far who exactly those nurses were. There seems to have been both men and women. Actually, recruitment seems to have been a major problem throughout the diary, and there’s a number of possible reasons for that: one might have been rivalry between the domains, or not really having proper systems for working out who was going to pay them and how much they were going to be paid, and this kind of thing.

So, it seems that there were a number of doctors. The doctor I’m talking about… his name is Seki Kansai, and he went to the Tōhoku area, and he took a number of his own disciples with them. They went there, and they recruited locally as well. It’s not really clear whether these people were paid or whether they were expected to volunteer their services, and then there were local nurses as well (some male and some female). They seem to have done mostly menial tasks, but I’m sure that they must have received some kind of education as well when they were learning how to treat these wounds.

TG: I’m curious: what kind of battlefield medicine was being practiced? I mean, when we think of that time, the American Civil War comes to mind, where the mindset was “just amputate everything.” So, what was the level of medical knowledge and medical practice on the battlefields of the Bōshin War?

EN: Yes, that’s an interesting question, and perhaps my first impression of this came from reading the diaries of people like William Willis who was also involved in treating the wounded in the Bōshin War. He was a European doctor. He wrote about this, and said that the Japanese doctors were not very prepared to treat gunshot wounds and certainly, that doesn’t seem to have been the case for the doctors that I’ve been looking at: they were removing bullets, and they were also doing a certain amount of amputation as well.

Willis suggests that he was doing a bit of amputation and that he was teaching people to use splints to immobilize injuries, and this also seems to have been something new. I haven’t come across it in the diary that I’ve been looking at, so it’s possible that was a new technique that was being taught. Yes, certainly, there was quite a lot of amputation going on, and that seems to have been successful in many cases but often, the approach was to try to send people away from the battlefield back to the major hospitals in Edo and Yokohama, where they would have access to doctors and more equipment there.

TG: In your research more broadly, you’ve looked at the introduction of Western medical practice to Japan in the 19th century. Can you put the Bōshin War and the battlefield medicine during the Bōshin War into that context?

EN: Well, I’ve been working on a number of doctors. I started out my career with looking at the first half of the 19th century, and I was interested in doctors who were learning about Western medicine even in the countryside. Rural areas of Japan studied Dutch, and I found this a fascinating thing, and so I suppose that as the years have gone by, I’ve expanded my horizons to look closer at the end of the 19th century.

What I’m currently working on is a collective biography of a number of doctors who lived through the transition to the Meiji period, and in the historiography so far (particularly in the Japanese historiography), I’ve noted that the doctors who were studying Western medicine (or rangakusha as some might call them) are often seen as the heroes of this process who, despite quite severe restrictions on their activities, managed to learn Dutch. They also managed to recognize the value of this, and then they implemented the modern Japanese medical system, as based on the Western model, and therefore, they led the way for this wonderful modernization of Japanese society.

So, there is a certain glorification of these doctors, and yes, they’re seen as medical heroes. In thinking about this, the doctors that I’ve been interested in have been not so much heroes, but more ordinary kinds of doctors. In thinking about this, it’s interesting to think about the continuities; it’s not like these doctors woke up one morning after the Restoration and found themselves modern. They actually lived through this experience, so I’m trying to think about: Well, what did this mean in terms of their daily practice? What did it mean to require them to get licenses in Western medicine, and did the fact that they had learned this prior to the Restoration actually help them in this process?Or was the medicine that was introduced after the Restoration something new?

Several people have thought about this gap between the rangaku of the late Edo period and the modern, more biological version of Western medicine, which was just coming in at the same time as the Restoration was taking place. They’ve noted this gap and perhaps, the people that I’m looking at were representative of that gap, but many of them seem to have experienced difficulty in making this transition to the Meiji period perhaps because they were trained in an earlier version of it. Some of them seem to have personal reasons for having difficulties. I’ll just give you one example: there was a doctor by the name of Ishii Kendō who was a rangaku scholar and initially, he gained an appointment in the Ministry of Internal Affairs, where they developed a medical bureau, and he had a position in that, but after a few years, he and a number of doctors actually lost their positions. This was a time when a number of reforms were being taken up and so, he received a demotion at this moment, and then continued to practice as a private medical practitioner for the rest of his life. So yes, we found these interesting examples of people who didn’t quite become these heroes of modernization.

TG: You were saying that this battlefield medicine is a good reminder of the violence of the Meiji Restoration and the violence of the Bōshin War. As you were saying as well, it’s also a reminder that there was quite a bit of innovation in medical knowledge in Japan during the Tokugawa period, even before the Meiji Restoration. Could you talk about what does change in medicine after the Restoration, or what impact does the Meiji Restoration have on medical practice in Japan then?

EN: Well, it has a huge impact really, but it has an impact, I think, because of the decision taken at a high level to reject Chinese-based medicine going forward, and so, there was a decision made to license all new practitioners of medicine. The Chinese doctors were allowed to continue practicing medicine on an ongoing basis, but all new doctors had to be trained in Western medicine, not Chinese, and so there was a phasing out of the traditional kanpō style medicine, (this is a huge change).

Now, whether this was actually a practical change in terms of what got better about medicine is a difficult question because at this time, the things which perhaps you might suggest were most advanced in Western medicine were surgery, which might have been a reason why the Western surgeons were so highly regarded during the Bōshin War, and the other one was the vaccination (genarian vaccination) which proved to be very effective against smallpox. So, these two things were highly influential, and they influenced these decisions to adopt Western medicine, but in terms of other forms of practical therapeutics, it’s debatable whether there actually was a difference between the two at this time. What came later was more of a systemization and then later on, bacteriology and public health, hygiene. These things made more of a difference, perhaps, than what you might see in terms of daily practice.

TG: And speaking of public health and hygiene, my students always think it’s funny when I read these documents from the late 1500s. You know, the Jesuits come in, and they recognize: “Oh my gosh, these people bathe everyday! They’re so clean!” (Laughter) Even a city as big as Edo – compared to London during the 17th and 18th centuries, or as late as the 19th century – was actually much more hygenic. So, where does Japan fall in terms of medical practice? Is Japan that far behind, or are they right abreast with developments in the rest of the world?

EN: Well, that’s one of the interesting things too because developments in understanding bacteriology and germs and germ theory and these kinds of things were taking place just at the moment when the Meiji transformation was taking place. So then when doctors went overseas after the Meiji Restoration took place, many of them studied in Germany, and they were able to actually participate in these new medical transformations in quite a dramatic kind of way. They brought this knowledge back with them, and then they became very proactive in introducing the germ theory and bacteriology into research institutes at Tokyo University and so on.

So yes, I mean if you want to think about it in terms of “catching up” (and I’m not sure that’s the best way to think about it), yes they participated in this very quickly, and I’m pretty certain they were on equal level to anyone else in the European world.

TG: You were talking about how these Japanese physicians go study overseas. Mori Ōgai, for example, goes to Germany, but there’s also a tie, not only to Germany, but also to the Netherlands. I understand you’ve written about this, particularly regarding psychiatric practice.

EN: That’s right, yes. I mean, it’s not really a huge area of expertise for me, but I was looking at one of Japan’s first journals of medicine, and in this, the doctors were making translations of quite recent, actually, journals, which had been published in the Netherlands. They were choosing practical kinds of essays which interested them, and one of them was on psychiatric health. It was a translation of a case study of a particular woman who had become deranged, and the treatment that was offered her was a combination of gentle drugs and psychiatric therapy.

I thought this was really interesting that Japanese doctors were interested in this at the time. And you know, one of the suggestions has been, previously, that Japanese doctors actually didn’t have such a good understanding of the Dutch language, but certainly, by the time we get to the mid-19th century, they were translating quite difficult materials into Japanese. They had quite a good understanding of these journal articles that were written.

TG: Speaking of, also, these German ties, you’ve also written quite a bit about Philipp Franz von Siebold and the network that he establishes, and his role as being instrumental in introducing Western medicine to Japan.

EN: Yes, Siebold was a German doctor. He became a naturalized Dutch citizen, and he came to Japan in the early 19th century. In Japan, he’s still very much a hero, and there’s a Siebold museum in Nagasaki, where his story’s told and many of his artifacts are still there. I think that perhaps one of his greatest legacies was a network of students, and these students seem to have been attracted to Siebold.

He was still quite a young man when he came to Japan, but he was the first Dutch physician at Nagasaki who had a full medical degree rather than a military kind of training, and so he was quite highly regarded. The students flocked from all over Japan to study with him, and there was this network created of students created who were extremely loyal to him. One of his other legacies who I’ve written about was his daughter. Her name was Kusumoto Ine, and she herself also studied medicine, and became one of Japan’s (perhaps we might argue) first obstetrician trained in Western medicine.

TG: On the topic of female practitioners of medicine, you’ve also written about women doctors in Japan, and one in particular: Ogino Ginko.

EN: Yes, so Kusumoto Ine worked in the Edo period, and I see her as a rangakusha, someone of the late Edo period who made an important first step as a woman in the medical world. Ogino Ginko, on the other hand, came a little later, and she trained in the Meiji period. She became the first licensed female medical practitioner. Ine, I would argue, was a doctor, although there are some who suggest that she was only ever a midwife, but I think she was far more than that. You can see that she was treating a number of different ailments, and treating both men and women.

Ogino Ginko on the other hand, battled the Meiji bureaucracy to be allowed to sit medical examinations, and she became the first licensed practitioner. She wrote a very interesting paper about why Japan needed to have female doctors, and her own personal experience was a major factor in her becoming a doctor because she had suffered a sexually transmitted disease, which she obtained from her husband. She felt extremely embarrassed to have to undergo treatment for this by male doctors, and so she herself decided to become one.

TG: And she wrote this in 1893, is that correct?

EN: Yes, 1893.

TG: That’s remarkable considering that there’s other kinds of petition activities in the People’s and Popular Rights Movements going on. You mentioned that she was the first female physician. How common was it for women to become practitioners of medicine at this time?

EN: Well, it certainly wasn’t common, but thanks to Ogino Ginko, it did become possible, and there was a stream of women who did become medical practitioners. Yes, later there was a physician whose name was Yoshioka Yayoi, and she actually set up a school for women doctors, so for a while, they were able to study alongside men. However, according to some of them, they found this quite difficult because they were poorly treated by the male physicians, and so Yoshioka Yayoi decided to set up her own school of medicine. That became, I think, Tōkyō Joshi Ika Daigaku today (Tokyo Women’s Medical University).

TG: I mean, I was wondering where the female physicians were getting trained because at this time, women weren’t even allowed into the imperial universities, right?

EN: That’s right, yes. So, I think Ogino Ginko had quite a struggle, and she herself was the daughter of a physician, and so, she must have had that kind of influence as well. She used a combination of private study and then she was able to enter one particular school, which had a sympathetic principal. She was then able to study alongside the male students for a while.

At that time, there were two ways to become a physician: one was to graduate from a recognized medical school, and the other was to sit the medical examinations, and so, the path that she had to take was to sit the medical examination. There was an interesting story about this: she went to seek the support of Ishii Taranori, and she went to him and argued that well, actually, there is nothing in the regulations to say that women can’t sit the medical examinations. So with that, she was able to push it through with his support.

TG: You mentioned some question about whether or not this one woman was a doctor or a midwife, and in the Meiji period, you can imagine that there were women who, especially in local areas, were performing as midwives, maybe as types of Shamanist healers. So, with the adoption of Western-style medicine, was there any kind of conflict between Western medicine and more traditional practices of medicine?

EN: Yes, there was, and certainly, one of the unexplored areas (I think) in all of this is to look at women in medical families, and I think that they were probably doing all kinds of work behind the scenes, but we don’t know exactly what it was they were doing in medical families in preparing medicines and these kinds of things.

As far as the midwives go, yes, there was quite a conflict between women who trained in the new systems; they became new midwives, and they had bicycles and shiny sets of equipment. Many of them were actually young women as well, whereas traditional midwives tended to be older women who had lots of experience. And so, yes, for a little while, there was quite a lot of rivalry between the two groups and a certain reluctance on the part of women who were giving birth to put themselves in the hands of a young woman who might have a certificate and equipment, but wasn’t really seen as having the sort of experience that you would expect to have from a midwife.

TG: Going back to the Bōshin War and the battlefield medicine on the Bōshin War, you were saying that it’s indicative of how there were already understandings of Western medical practices. Do we see that the Bōshin War and that experience are advancing medicine in Japan in some ways?

EN: I think it was certainly a factor in the decision to adopt Western medicine, and certainly, Willis, who participated so enthusiastically in the treating of patients, was one of those who was invited to take a teaching position in the medical schools of the Meiji period. But again, there were some interesting rivalries happening there.

Some of the Japanese doctors had decided (taking advice from Dutch doctors in Japan and from their own understanding) that many of the works which they had been reading were German works rather than English ones. So, there was a rivalry among doctors in Japan: those who supported Willis because he made such a wonderful contribution to saving people in the war, and those who thought that actually, Germany had the most advanced form of medicine and so, this should be the way for Japan to go forward. In the end, it was the German model that was used and well, this was offered a sort of compromised position, but for a while, it was touch and go.

TG: That’s a great point. So often, when we think of the Meiji period, it’s always about these oyatoi gaikokujin who are coming in, and these foreign advisors coming in, getting hired at the imperial universities to teach these new technologies. But as you were saying, Western medicine had already been trickling in and being practiced. Maybe just after the Meiji Restoration, it’s accelerated in some ways?

EN: Yes, it was accelerating in many ways, and as I mentioned before, Chinese-style medicine was really sidelined despite the fact that most of the practicing physicians were practicing traditional Chinese-style medicine. Many of those who were practicing what they called “Dutch medicine” were including many elements of traditional Chinese medicine as well, so we also have to recognize that.

TG: When we talk about these foreign advisors who come over to Japan, and particularly, those advisors who come over for architecture, they almost get fascinated by Japanese styles of architecture, or the Japanese aesthetics. Do we see the same with these Western physicians who come over? Do they start researching Chinese medicine, for example, and becoming more fascinated with those things?

EN: There was an element of that, particularly with some of the earlier doctors such as Siebold. He actually had his students prepare essays in Dutch about all kinds of topics: the growing of tea, whaling and all kinds of topics. So, he was certainly interested in Japanese practices. In the Meiji period, of course, they became very interested in thermal springs, which were a huge part of healing in the Edo period, and they went around measuring the mineral content of hot springs and these kind of things, and writing about this in their writings. Yes, so there was an element of that, but I’m not sure that Chinese medical thought as such became of such interest. It might have been among those interested in acupuncture.

TG: They didn’t come over and say: “Oh, these Asians have it all figured out.”

EN: No, I’m afraid not.

TG: (Laughter)

EN: Yes, they tended to be rather dismissive of Japanese medical practices on the whole.

TG: And the diaries that you were mentioning before about the doctors in the Bōshin War dismissing the practices of these doctors might be indicative of that.

EN: Yes, I think so, and you know, comparing the two accounts, I’ve found that what this suggested didn’t really hold true for the doctors that I was looking at, but at the same time, as Seki was doing in Tōhoku, he was recruiting local people to take part because they didn’t have enough people on hand. You can then imagine that they might well recruit people who didn’t have a terribly good understanding of Western surgical techniques even though the people leading those military hospitals might have had quite a good understanding. So, Willis wrote about how he was teaching these doctors what to do, and that they certainly caught onto it very well, but you know, he was the one who had to teach them.

TG: So, these people who are recruited to perform battlefield medicine…what happens to them afterwards? Do they go back to their villages and become local physicians, for example?

EN: Some of them were local physicians in the first place, and we actually find one interesting example in the diary I was looking at of a local physician who wrote to Seki, and said: “Hey, can I come and study with you at the military hospital?” I think that was only for a short period of time, and then he would have gone back to his regular duties. I don’t have any figures about the number of doctors who might have gone on to continue in this area, unfortunately, but it would be an interesting thing to look into.

TG: The Meiji at 150 Podcast is hosted by Tristan Grunow at the University of British Columbia in Vancouver, Canada. This podcast would not be possible without the cooperation of the UBC Centre for Japanese Research and the technical assistance of the UBC Faculty of Arts ISIT. Find out more about the Meiji at 150 Project, including the Meiji at 150 Lecture Series, Digital Teaching Resource and Workshop Series by visiting our website: meijiat150.arts.ubc.ca. Thank you for listening.


*Citation for this episode: 

Ellen Nakamura, interview with Tristan Grunow, The Meiji at 150 Podcast, podcast audio, November 23, 2018. https://meijiat150.podbean.com/e/episode-80-dr-ellen-nakamura-auckland/.

The Meiji at 150 Podcast is hosted, produced, and edited by Tristan Grunow, with editorial assistance from Joshua Linkous. Transcripts by Kelly Chan.