Taipei: Taida chuban zhongxin, 2012.
Reviewed by Luwei Yang, MA candidate, History, Nankai University; HYI Archival Research Training Program Visiting Fellow
After his study on the rules of medical practice in Japan-ruled Taiwan, Liu Shiyung expanded his research by tracing the roots of colonial medicine in his new book, Samurai Sword and Lancet (Wu shi dao yu liu ye dao), providing us with a vivid and deep history of the framing of “Western” medicine in Japan, as well as its spread throughout East Asia. Liu offers a physician-centric history of modern medicine in Japan; furthermore, within the context of East Asia, his book dialogues with previous research on European colonial medicine.
Through its unusual title, this book juxtaposes two seemingly irrelevant objects: the samurai sword, symbolic of the spirit of bushido in Japan and, the lancet, which represents modern biomedicine, reminding us that we should never neglect the local cultural background when studying the history of Western medicine in East Asia. Liu contends that the development and spread of “Western” medicine in Japan was unavoidably stamped by the culture of Bakufu Society, even though Japan is usually seen as a pioneer in studying the West and became the center of “Western” medicine in East Asia. Physicians, though wielding lancets, were remarkably similar to the sword-wielding samurais of the Bakufu. Moreover, we can find the deep influence of Bakufu society in both the importation and development of “Western” medicine in Japan and the process of its spread over East Asia. The history presented in this book, a Japan-centered narrative of modern medicine, explicitly interprets the tension between the passage to modernity and the resistance to and dynamic of traditional culture in colonial regions.
The first chapter explores Japanese society before its medical westernization and summarizes the basic characteristics of the late-Bakufu period, depicting the process of how the samurai class turned to Confucianism and medical careers due to the political transition. By analyzing three schools of Confucianism at that time, Liu shows how the spirit of bushido as well as Confucian tradition affected and framed the process of medical westernization in Japan. The different schools of “Western” medicine that arose later on, Liu indicates, simply followed the trajectory of different schools in Confucian studies. Similar to the Confucian turn in medicine in China, Japanese physicians also adhered closely to Confucian studies; however, due to the absence of an imperial examination system in Japan, Japanese physicians paid even more attention to Confucian studies than their Chinese colleagues, for the mastery of Confucian works directly guaranteed their reputation. According to Liu, this unique political and social environment framed Japan’s medical westernization in a totally different way compared to Europe.
The second chapter focuses on the process of medical westernization. Dr. Liu starts with the history of samurai surgery before the introduction of modern biomedicine. Then by depicting the interaction between local medicine and medicine imported from the Netherlands before the Meiji reform, Liu argues that “Western” medicine developed into a Japanese style during this time: first, “Western” medical education adopted the same system as local medicine; secondly, physicians of “Western” medicine could be absorbed into the ruling class like their colleagues in local medicine; lastly, the development of “Western” medicine in Japan was deeply influenced by Japan’s political environment so that it seems to have become one kind of Japanese medicine instead of being seen as “Western”. The author argues that the so-called Meiji reform should be seen as a “transition” in the medical domain in that all kinds of medicine—traditional medicine, foreign surgery—as well as social tradition, all contributed to the framing and development of modern Japanese medicine.
The third chapter investigates the landscape of modern Japanese medicine in the late 19th century through an examination of the education and practices of different schools. By analyzing the pyramid structure of modern physicians at that time, the author finds that graduates from the medical school of the University of Tokyo remained at the top of the hierarchy and were trained to teach medicine; graduates from small medical schools were trained to practice medicine and were the second level; and physicians who did not receive medical training but passed national physician examination remained at the bottom. Liu asserts that modern Japanese medicine, though operating with totally new medical knowledge, was not new in terms of its education and practices but rather reflected traditional Japanese society in the late Bakufu period.
The fourth chapter discusses the conflict between schools and physicians in the late 19th century and argues for the existence of a Japanese style of modern medicine. The author focused on scholarly debates concerning the origin of kakke and the plague between two schools: the medical school of the University of Tokyo, represented by Mori Ōgai and the school of the Private Institute of Contagion, led by Kitasato Shibasaburō, showing that the history of “Western” medicine in Japan was to some extent at the mercy of physicians instead of medicine itself. Famous physicians and their students developed a family-like system that asked its members to fight only for their teacher’s reputation instead of the scientific truth. Liu draws our attention beyond the “pure” medical science itself to the complex power relationship between individuals as well as organizations, reminding us that the history of medical westernization should be seen as a continuation of physicians’ transition from late Bakufu society.
The conflicts depicted in the fourth chapter pose a question: where did the losers go after they failed in their debates with another school? The fifth chapter, “Transition and Departure” answers this question by tracing the development of colonial medicine in Taiwan, Korea and China. Instead of simply providing different national narratives, Liu chooses to focus on individual physicians. He tracks students of Kitasato Shibasaburō in Taiwan, China and Korea: who had to escape Japan to avoid pressure from the University of Tokyo after they lost the debate on the origins of plague. While narrating their contributions in different countries, Liu is sensitive to differences in space and time. He compares China and Korea with Taiwan, indicating that Taiwan benefited the most from those Japanese doctors because Taiwan was their first destination after leaving Japan and because they encountered less resistance there than in China and Korea. Meanwhile, the author does not follow the popular view in the study of colonial medicine in Europe that modern biomedicine contributed to colony building while also benefiting the lives of the local people. Instead, Liu argues that, unlike Europe, there were actually not enough modern physicians in Japan; moreover, because elite physicians who lost debates were forced to leave Japan, there was a better research environment in the colonies. Therefore, explanations of the development of colonial medicine in Africa, America and India do not suit East Asia. Unlike historians like Daniel Headrick who uses an imperial-oriented approach to study the spread of medicinal knowledge in the early 20th century, Liu has a good sense of the complexity and locality of medical development, and he criticizes the mechanistic trend in the development of biomedicine that emphasizes the scientific nature of medicine to the neglect of the role of individuals.
Samurai Sword and Lancet discusses the unique story of colonial medicine in East Asia. Instead of just copying models developed by Western historians, Liu Shiyung has a keen sense of the unique characteristics of Japanese society, as well as China and Korea, and offers a convincing history on how physicians were affected by their backgrounds and how they contributed to the history of colonial medicine in the early 20th century. Just as the book title indicates, the author presents a fascinating narrative involving external and internal factors with a focus on individuals.
However, the author is also limited by his title, for he often tries to use the metaphors of the samurai sword and the lancet by labeling historical periods of medicine with samurai terms. For example, he uses “Niten Ichi-ryū”, a term used to describe swordsmanship to characterize the origin of modern medicine in Japan, which was framed by different schools of medicine. But the term “Niten Ichi-ryū” means a combination of opposite subjects, like Yin and Yang, whereas these schools were not opposed to each other at all; in fact, they seemed to coexist quite well according to the book.
Liu takes the complexity of medicine in late 19th century Japan into account; however, he seems to neglect the complexity of biomedicine itself. He relies on a comparison of Japanese and “Western” medicine, but he fails to stress the differences within “Western” medicine itself, especially the difference between the surgeon and the physician. Instead, he tends to treat them as one class.
Samurai Sword and Lancet is an outstanding book on the history of medicine in East Asia, and Liu Shiyung provides an alternative to the study of colonial medicine that does not simply copy European or post-colonial style analyses. The book is a worthwhile read for historians, and a valuable reference for scholars of the history of medicine in particular.