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After centuries of hegemonic wars. the new sociopolitical order successively established by the Tokugawa rulers during the first decades of the l7th century deeply influenced the world of medicine and... medical care. The destruction of Buddhist temples had already accelerated the secularization of medicine. Now. local rulers sought physicians co strengthen the fabric of their young domains. For lack of local candidates. many first-generation physicians in regional fiefdoms. such as Na katsu. were recruited from elsewhere. As the genealogical tables and registers of families such as Murakami. Oe. or Karashima show. specific skills or an exceptional educational background were helpful in gaining employment as a clan physician. From the second generation on. prospective successors. preferably the firstborn sou. received their basic education in the private homes of local samurais or priests (terakoya). Thereupon. they became disciples of a more or less renowned physician. depending on available financial resources. The licenses provided at the end of this professional training used to oblige the young physicians co keep the acquired knowledge secret For a while. this hampered the spread of medical knowledge and the development of a homogeneous medical care system even at the level of domains. From the second half of the 17th century on, we observe more and more aspiring young men on pilgrimages through the country to old and new centers of knowledge exchange, such as Nagasaki and Kyoto and. later. Osaka and Edo. Nagasaki. in particular. attracted visitors and sojourners from all over the country as the interpreters of the Dutch and Chinese trading posts provided medical books. instruments. maren:1 medic.1. and instructions at their private schools. While absorbing foreign know-how. interaction between Japanese visitors and students raised the awareness of regional differences and the nationwide situation. At the end of the 17th century. people living in the castle cities or domain rulers could access health ca re provided by specialists in internal medicine. surgery. acupuncture. pediatrics. obstetrics. and so on. In contrast. the vast majority of villages remained without professional help, depending on folk medicine. homespun remedies. and magic rituals. However, this was starting to change. Heavy losses among the rural workforce due to epidemics. combined with rising levels of literacy and income. induced local headmen and domain administrators to seek suitable solutions. Sometimes they managed to attract itinerant physicians to settle down and make a living by providing medical care and basic education to village children. In other cases, members of the local communities became interested in medicine and received a more or less intensive medical educatiou. Among the latter group. we find Yakata Moromichi. whose ancestors were Shinto priests at the famous Usa Shrine over many generations before the family moved to the Yabakei a rea. Moromichi was bor11 in Yakaia. a hamlet in a narrow valley about 17 km away from the domain center and Nakatsu castle. His father served as village headman and Moromichi seems to have received a thorough education during his childhood. There is no source material indicating the circumstances of his decision to study medicine, but he could not have pursued his studies over several years without the permission of the authorities, not to mention several journeys and a long stay at Nagasaki. Fortunately, we are able to trace the course of his studies through 18 manuscripts preserved in the Yakata collection. Most of them show one of his pen names, sometimes place names and dates, and a few texts have been identified by the characteristic features of his handwriting. The first two manuscripts relating to medicine were written in 1767. One shows teachings about traditional medicine given by an unknown physician, Morimura Genryū, from a village in the neighboring province of Bungo. The second one deals with Chinese-style divination. Three years later, Moromichi compiled an untitled booklet that again shows a variety of diseases and Chinesestyle treatments together with several prescriptions given to him by individuals, such as a “Takaya Sōbē” or “Mr. Munakata from Nakatsu.” During that same year, he studied pediatrics using a book published by the 11th-century Chinese pediatrician Yi Qian and prescriptions collected in the Japanese Suō Province. For the first time, he mentions a “Dutch-style” treatment. Further manuscripts on pediatrics written in 1769 indicate the importance of this discipline, especially for a prospective rural physician who had to cope with the then high child mortality rate. In 1769, Moromichi turned to pulse diagnosis. The related manuscript draws from the famous Song pulse book, Mài Jué, together with Manase Dōsan's writings on that matter. Furthermore, it contains Zhao Jizong's thoughts about the appropriate “Medical Way” of a Confucian physician. At this stage, Moromichi seems to have been primarily interested in the Chinese teachings of the Jin–Yuan era and their adaptation to Japanese conditions by Manase Dōsan, the leading scholar of what is nowadays called the “School of Later Prescriptions” (Goseihō-ha). In 1771, Moromichi compiled a manuscript on moxibustion based on a book by Ajioka Sanpaku, who was strongly influenced by Manase's school. Perhaps for that reason, Moromichi traveled to Kyoto in 1773. When he returned to Nakatsu, the Confucian Kuranari Ryūshō had returned from extensive studies and was employed as an official Confucian scholar of the Nakatsu Clan. Until the establishment of the clan school in 1796, Kuranari was teaching in his residence and, for a while, Moromichi became his disciple. During the early 1770s, Maeno Ryōtaku, Sugita Gempaku, and other physicians in Edo had written a translation of the Dutch edition of J. A. Kulmus’ “Anatomic Tables” (Ontleedkundige Tafelen). Maeno, an ardent scholar of the Dutch language, served as a physician in the Edo residence of the Nakatsu domain. He had undertaken most of this pioneering endeavor and enjoyed the support of Lord Okudaira Masaka. Printed in 1774 under the title “New Book on Anatomy” (Kaitai Shinsho), this translation became a milestone in the history of “Dutch studies” (Rangaku). More than ever before, physicians in the Nakatsu domain were aware of Western medicine. In 1775, Moromichi went to Nagasaki, the mecca of “Dutch studies”, where he stayed until the following year. Maeno Ryōtaku was on good terms with Yoshio Kōgyū, a senior interpreter at the Dutch trading post and a renowned scholar who stood at the forefront of Dutch studies and attracted visitors and disciples from all over the country. This might have facilitated Moromichi's access to Yoshio. During his stay in Nagasaki, Moromichi studied Yoshio's vast collection of books, manuscripts, and instruments. His excerpts and notes reflect important 17th-century texts related to Western medicine and pharmaceutics. Several manuscripts written in Nagasaki deal with ulcers, all kinds of wounds, fractures, and basic surgical operations, such as harelips. They describe a great number of plasters, ointments, and tinctures, as well as the distillation of pharmaceutical oils. In that very same year, 1775, the Swedish physician and naturalist Karl Peter Thunberg arrived in Nagasaki. His later publications about Japan and Japanese plants elevated him to the ranks of Engelbert Kaempfer and Philipp Franz von Siebold. This eminent scholar had mercury(II) chloride in his luggage and attempted to introduce "Van Swieten's liqueur" as an effective and palatable mercury treatment for syphilis. Thunberg's name can be found in Morornichi's notes, but none of his teachings became known to this rural physician. After roughly two years in Nagasaki, Moromichi returned to his native village. In contrast to the majority of high-ranking domain physicians, he did not try to gain a reputation by connecting himself to one of the dominant teaching t raditions. His manuscripts reveal that he had received an excellent education and was well-versed in classic Chinese and Confucian studies. Nevertheless, he developed only a limited interest in theoretical deliberations about illnesses and their causes. Most of his excerpts and notes deal with practical aspects of medicine. Being less bound by medical doctrines than many of his colleagues in castle cities, he seems to have applied Song- and Mingera Chinese prescriptions for internal problems and Western-style treatments in surgical cases. This was more than the villagers of Yabakei could have hoped for.続きを見る
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Mendeley出力
Michel-Nakatsu-Sosho19-DisseminationMedicalKnowledge