- Hiro Fujimoto, “Kinsei iryō-shi kenkyū no genzai: minshū, kō-kenryoku to iryō [Social History of Medicine in Early Modern Japan: Commoners, Public Authorities, and Medicine],” Yōgaku, Vol. 21, 2014, pp. 91–125.
This article surveys current trends in the history of medicine in the Edo period, focusing on research since the 1980s, when the social history of medicine emerged and began to flourish in Japan. Interest in the social history of medicine in Tokugawa Japan began among historians of Western learning (yogaku, or rangaku) and then attracted historians of Tokugawa Japan. In his 1985 book, Zaison no rangaku (Dutch-learning in Villages), Tasaki Tetsuro criticized the traditional ‘Great Doctors’ approach and shed light on anonymous practitioners of Western medicine in rural villages. Tasaki’s perspective urged historians of early modern Japan to investigate the medico-social structure in villages (conceptualized as iryo-kankyo by Umihara Ryo), including various medical practitioners (Dutch-learning or Chinese-learning physicians, charlatans, and pharmacies), patients and their family, medical market, medical culture and religion.
However, historians of Tokugawa medicine overlooked the relationship between medicine and public authorities. This is because they emphasized the local history of medicine, thus avoiding medical policy stemming from the central government. On the other hand, this relationship has been thoroughly discussed by medical historians of modern Japan. Although most of them dealt with governmental policy after the Meiji period (1868–1912), a few paid careful attention to the Bakumatsu period (1853–1867). For example, Kozai Toyoko and Brett Walker argue that the Tokugawa Bakufu tried to subordinate and colonize the Ainu people through compulsory vaccinations. Here, vaccination, which had been regarded as an index of modernization among historians of Tokugawa medicine, was reframed as a medical technology by the public authorities.
This perspective can be applied to the whole of the Edo period. Thus, this article will reconfigure the previous works in terms of the relationship between the central and local governments and medical policy. In the early days of the Shogunate (the 17th century), the Bakufu attempted to monopolize medicine and doctors, providing them to lords (daimyo). Under Yoshimune (1716–1745), however, the Bakufu started to give commoners drugs as an act of mercy. The shogun Yoshimune also tried to domesticate foreign medications in order to restrain the exportation of gold, silver and copper which had been exchanged for imported drugs. The Kansei Reforms (1787–1793), resulting from the Great Tenmei famine, meant a change of governmental attitude toward medicine and discouraged expenditures on medical services. Although the Bakufu still gave the commoners medication, this was not an act of benevolence, but an attempt to prevent insurgency. Around the turn of the 19th century, national and local governments rearranged their institutions according to coastal defense and took measures regarding territorial disputes. Physicians were expected to take part in military service and medical technologies, such as vaccinations, functioned as tools of governance. These perspectives will lead historians of medicine in early modern Japan to collaborate with the historians of politics, and promote comparative research on Japan and other countries.