Practical Pursuits by Ellen Gardner Nakamura

During the Tokugawa period, Western medicine filtered into Japan. Ellen Nakamura argues in her book Practical Pursuits: Takano Chōei, Takahashi Keisuku, and Western Medicine in Nineteenth Century Japan (Harvard University Press, 2005) that western medicine was dispersed throughout Japan by Japanese physicians who believed that the practical benefits of Western medicine could improve the quality of their patients’ lives. While these physicians did not completely adopt Western medical practices, they incorporated some Western medical ideas into their own treatments. Through the writings of Takano Chōei (1804-1850), a rangaku scholar and ranpō physician, and Takahashi Keisaku (1799-1875), a rural internal medicine doctor from the province of Kōzuke, Nakamura argues that Western medicine was spread by extensive social networks to physicians throughout the country. Practicing physicians were interested in examining Western medical methods, and Nakamura shows that Western medicine spread to rural Japan even as the Bakufu increasingly limited the flow of Western ideas into Japan.

The book is presented as an account of the dispersion of Western medicine to rural Japanese physicians through social networks, but it ultimately is an analysis of a specific relationship between Chōei and group of Kōzuke physicians, including Keisaku. While at times this may prevent from Nakamura from successfully arguing her wider thesis, it is a valuable look at this specific relationship. Whether or not this relationship is a typical arrangement in the Japanese medical society is not entirely clear, but there is no doubt that these individuals’ interactions influenced each other in meaningful ways. Whether or not any broader social trends can be extrapolated from this network is difficult to say. Nakamura clearly hopes to demonstrate that the previous scholarship in this area focused too heavily on physicians in Nagasaki and in the Bakufu without examining the expanding role of Western medicine in Japanese society. Ultimately, the author succeeds in demonstrating that Western medicine was not limited to those select physicians.

The social network that developed between Chōei and the Kōzuke physicians was based on his work as a scholar. As a rangaku scholar and ranpō physician, Chōei studied European medicine and translated Dutch books into Japanese. While the term rangaku literally translates to “Dutch learning,” rangaku scholars studied other European works as well. (p. 6.) Because of the Dutch foothold in Nagasaki, rangaku scholars focused primarily on Dutch texts. Scholars such as Chōei were primarily limited to translating European texts which were considered practical by the Bakufu. It was not unusual for rangaku scholars to focus their attention on medical works. As a ranpō physician, Chōei practiced a more Western style of medicine, but in general, ranpō doctors practiced an amalgamation of Western and Chinese methods. Nakamura argues that previous historians have not directly addressed the importance of Western medicine to rural or local physicians.

Instead they focused on the impact of Western medicine on Nagasaki and Bakufu physicians. Nakamura’s work is part of a growing field of Japanese scholarship called zaison no rangaku or “study of Western learning in the countryside.” (p. 2.) By shifting the perspective to rural life and examining the impact of Western learning, Nakamura demonstrates that physicians sought to employ Western techniques to solve Japanese medical problems in pastoral Japan. While the spread of this information was haphazard and unsystematic, it reached remote areas such as Kōzuke. Nakamura tries to show that physicians throughout Japan actively networked and studied with ranpō physicians and rangaku scholars because they believed that Western medical knowledge could be put to some practical use. Like their western colleagues, Japanese physicians were becoming concerned that their methods were less effective at treating people than they would like. Keisaku and other physicians applied those Western concepts especially for fighting problems such as epidemics and famine after traditional medicine had failed.

Takano Chōei was a prominent scholar, physician and political figure in the late Tokugawa period. Chōei has been primarily studied by historians because he wrote The Tale for the Dream (1838) which criticized the Bakufu’s hostile policy towards foreign ships. The Bakufu imprisoned Chōei for this work. Chōei later escaped from prison, but he eventually committed suicide to avoid capture. This tragic story has overshadowed his role as a leading rankagu scholar in Japan. Nakamura instead has focused on his medical scholarship and put aside his political writing.

While Chōei never achieved financial security or fame during his lifetime, he was well known for translating Dutch medical texts to Japanese. Chōei was born into a middle ranking samurai family, but he ultimately rejected his samurai heritage to focus on his rangaku scholarship and medical practice. As a result, he struggled for money throughout his life. Chōei studied medicine with Phillip Franz van Siebold (1796-1866), a well-known European physician in Nagasaki. The Bakufu briefly allowed Japanese students to study medicine with Siebold, because they believed that Western medicine might be useful. Even before Chōei studied with Siebold, he could translate Dutch.

After the Siebold School was closed after a scandal involving its founder, Chōei slowly severed ties with his family and focused on his rangaku studies. It was Chōei’s translation work that interested Fukuda Sōtei, a prominent Kōzuke physician. Chōei adapted the Dutch medical texts to help Japanese physicians develop solutions for local problems. Chōei did not provide literal translations of the Dutch source materials; he interpreted the work to best serve the social needs of his physician audience. Sōtei was learning Dutch and he sought out Chōei for additional guidance because he saw the potential for practical applications of Western medicine. Sōtei and Chōei began a relationship that allowed Chōei to network with a number of rural physicians from Kōzuke. Nakamura believes that this interchange of ideas between urban and rural intellectuals created an impetus for social change in Japan that extended beyond the Tokugawa period.

Three of these physicians, Sōtei, Yanagida Teizō, and Takahashi Keisaku developed long-term relationships with Chōei. They would be his students, patrons and collaborators on future works. Unlike American or European physicians, the Japanese doctors were not limited by any codes which provided limitations on physicians consulting with members from other sects or traditions. This permitted physicians to employ various methods to serve their patients. Chōei’s book Fundamentals of Western Medicine was funded by Sōtei, while Treatise on Two Things for the Relief of Famine and Methods of Avoiding Epidemic Diseases were collaborations with these rural physicians.

It is unsurprising that these physicians would collaborate on books dealing with public health problems. Rural physicians were interested in famine and epidemic diseases because they often oversaw public health in their small communities. Treatise on Two Things for the Relief of Famine and Methods of Avoiding Epidemic Diseases were essentially public health tracts. While famine may appear to be a primarily economic or agricultural issue, rural physicians ultimately had the responsibility for treating the victims of famine. These physicians also knew that it was not uncommon for epidemics and famines to spread together. Chōei emphasized this symbiotic relationship in Methods of Avoiding Epidemic Diseases. Not surprisingly, Japanese physicians viewed famine as a medical problem.

Chōei believed that Western texts included helpful solutions for fighting famine in Japan because it was often the result of cold weather which reduced rice crops. Chōei believed that Europe had a far more inhospitable and colder climate than Japan. In order to survive he assumed that the Europeans must have possessed crops that could withstand cold summers and harsh winters. In his work on famine, Chōei focused on the potential usefulness of such crops as buckwheat and potatoes for limiting the effects of famine. The Kōzuke physicians had introduced potatoes and buckwheat to Chōei. The rural physicians understood that these crops could potentially limit the effects of famine. Unlike rice, buckwheat allowed Japanese farmers to have two or three harvests even in cold summers. Chōei advocated planting potatoes because they were incredibly hardy and could withstand cold, wet summers. While these efforts did not necessarily swell the production of buckwheat and potatoes, their efforts set the stage for the eventual expansion of these crops after the Meiji Restoration.

In addition to combating famine, rural physicians developed networks to deliver the smallpox vaccinations to local villages. Nakamura argues that the efforts by ranpō physicians to bring these vaccinations to Japan encouraged “the wider acceptance of Western medicine, not only among private physicians but eventually the shogunate itself.” (p. 151.) For the most part these networks were local networks, organized by physicians for physicians to both deliver and preserve the smallpox vaccinations. Because these networks were somewhat informal, the smallpox vaccines were not distributed throughout the country at the same time. In fact, Keisaku, an advocate of Western medicine, had difficulty securing a smallpox vaccination for his village.

Nakamura does an excellent job throughout this book demonstrating that social networks developed between local physicians and proponents of Western medicine. Nakamura’s underlying thesis in this work is that these social networks allowed for the “exchange of ideas between urban and rural intellectuals, and, eventually, for social change in the late Tokugawa period and beyond.” (p. 180.) Nakamura successfully demonstrates that these networks did exist, but she fails to show how extensive they truly were. At the end of the book, it is not clear whether or not the relationship between Chōei had with the Kōzuke physicians was a typical arrangement. Nakamura’s work would benefit from additional examples of consulting arrangements between proponents of Western medicine and Japanese physicians. Despite this minor complaint, Nakamura’s book does an excellent job elucidating the growing influence of Western medicine during the Tokugawa period.