Contents

Foreword ···································································· 4
Chapter 1
Nanban-jin Rainichi: The situation of the West and Japan
at the time of the first appearance of Westerners in Japan(16th Century) ···························································· 7
Chapter 2
NanbanIgaku:

MedicinebroughtbytheCatholic

missionaries ······························································ 13
Chapter 3
Kōmō Igaku (“Red-haired medicine”; medicine of the Northern
Europeans): Struggle between the Nanban-jin and Kōmō-jin
and the establishment of Deshima in Nagasaki ················· 30
Chapter 4“Red-haired medicine” introduced by interpreting andimitation ·································································· 39
Chapter 5
The Dawn of Rangaku and the publication of “Kaitai
Shinsho” (The New Treatise on Anatomy) ······················ 50
Chapter 6
Deshima during the time of the French occupation of theNetherlands ······························································ 69
Chapter 7
Von Siebold, as an emissary of
the recovered Netherlands················ 80
Chapter 8
Rangaku in Japan after the Siebold incident ·················· 90

Chapter 9
The “black ships” and the advent of Commodore Perry:
What Japan and Western countries
knew about each other ················ 105
Chapter 10
Commodore Perry brought another shock to the medical
world in Japan ························································· 116
Chapter 11
The first systematic five-year medical education system,
developed by Dr. Pompe ············································ 130
Chapter 12
Pompe’s medical education in the mid-19th century, asJapan transformed from a feudal to a modern society ···· 146
Chapter 13
Bauduin, Mansveldt and the Meiji Restoration ············· 159
Chapter 14
Foreign medical doctors who stayed in Japan through the
Bakumatsu and the Meiji Restoration periods ·············· 169
Afterword ····································································· 181
Bibliography ································································· 184
Chronological table ························································ 192
NAME INDEX
Non-Japanese characters ·········································· 199
For Japanese characters ··········································· 203
SUBJECT INDEX ························································· 207

Foreword

By the term “ancestor of Western Medicine”, most people in both the Eastand West think immediately of Hippocrates, who was active in medicineon the island of Kos in Greece four centuries before Christ. He observed
human health and diseases scientifically as kinds of natural phenomena,and separated medicine from magic. He has been referred to as theoriginator of empirical science. Thereafter, medicine was transmitted to
Egypt, then to Greece, Rome, and the Arab world. The Arab school
responded calmly and rationally to western medicine and added Arabic
refinements such as the number “zero”. However, the Crusades broughtsome medical knowledge back again to Europe. With the Renaissance,
Western medicine started afresh and assumed a new look. Leonardo Da
Vinci painted exquisite diagrammatic structures of human beings.
However, the physiology of the heart and blood circulation was notcompletely known.
Modern medicine can be traced to the research of William Harvey inEngland who clarified the physiology of the circulation of the blood(Exercitato Anatomica de Motu Cordis et Sanguinis in Animalibus). He
went to northern Italy to study at Padova University at the end of the
16th century. Medicine was extremely advanced there at that time.
Foucault commented in his work “Naissance de la Clinique (The birth ofclinical medicine)” that clinical medicine was born with both thedevelopment of percussion by Auenbruger in 1761 and the invention of
the stethoscope by Laennec in 1819.
That is to say, due to the acquisition of the techniques of percussion andauscultation, medical doctors came to understand clinically the diseases
4Foreword

within the body, which were recognized for the first time andanatomically shown by the study of Morgani “De Sedibus et Causis

Morborum per Anatomen Indigatis (The locations and causes of disease
investigated by anatomy)” in 1761.
Hence, modern western medicine was born about 400 years ago, andmodern clinical medicine, about 200 years ago. With the Renaissance and
the Period of the Great Maritime Voyages, the knowledge of Europeans
was enhanced and they used this knowledge practically, accelerating
progression throughout the development of the Industrial Revolution.
How was Western medicine introduced into Japan, and how did it develop
within Japan? The development of medicine in Japan in the last 500
years was somewhat after the historical movement in Europe after the
15th century. Of course, this was affected by the national isolation policy of

the Bakufu ‘government’ in Japan. Through a narrow window, the Dutch
factory in Deshima, which was the only Western outpost in Japan,
gradually but steadily, the Japanese absorbed the information ofEuropean modernization of medicine and this spread throughout Japan.
The story of its growth is fascinating. While being influenced by thehistorical changes of the world, they eventually reached equal status with
the West, despite enduring severe oppression from various domestic
sources.
The main reference books about the history of Japanese medicine include
the following three books: “The History of Japanese Medicine” publishedby Fujikawa Yū (12) in 1941, “The History of Transmission of Western
Medicine” by Koga Jūjiro (26) in 1942, and “The History of Medical Care”
by Sakai Shizu (49) in 1982. Each book is voluminous and all three areespecially helpful for those who wish to know more about the history ofJapanese medicine.
5The first author of the present book (S. K.) was fortunate to be able to use
his position to utilize the National Library, as an Associate of the
Dispensary for the House of Councillors, after serving as the Dean ofJuntendo University, to amass much material.
Through these books, the terms “Nanban Medicine”, “Kōmō Medicine”
and “Rangaku” appear intermittently. The readers may wonder why
different words are used depending on the age for essentially the same
medicine introduced from Europe. Portuguese and Spanish seamen, all
Catholic, who started their travels for oriental countries in accordancewith the Pope’s desire to spread Catholicism, brought Western culture to
Japan for the first time from 1543 onward. A half-century later,
Protestant Dutch and English traders tried to expand their businesses
within Japan.
coexistence

The religious friction among Christians, the difficulty of

between

Catholics

andProtestants,

suppressionofCatholicism by Hideyoshi, and the Tokugawa fears of invasion, resulted
in the Bakufu isolationist policy, which lasted over 200 years. During thattime, the only permitted European contact was via Dutch trading ships,
through their Nagasaki Deshima factory.
Throughout this history, different influences of Western medicine
introduced from Europe were added to traditional medicine in Japan.
Furthermore, accompanying the trickle of Western medicine, scientificinformation flowed increasingly into Japan from the period of theIndustrial Revolution.
We believe that if there is sufficient knowledge and understanding of thehistory of medicine and medical care, especially of people who seek
medical care for themselves or for their families, friendly relations andmutual understanding among various cultures will be further promoted
and we will achieve positive relations in future among health givers andpatients and their families.
6Chapter 1

Nanban-jin Rainichi: The situation of theWest and Japan at the time of the first
appearance of Westerners in Japan (16thCentury)

In August 1543, a Portuguese ship departed the colony of Goa, on the west
coast of the Indian subcontinent, making for China, but encounteredviolent winds in the East China Sea, and landed at Tanegashima, off thecoast of Kagoshima, Kyūshū.

The Portuguese from that ship are said tobe the first Westerners to have set foot on Japanese soil.
This is the period known in Western history as the Navigaciaos Grandes(Great Maritime Voyages) of the Portuguese, from the mid-15th tomid-17th centuries, roughly contemporary with the travels of Marco Polo.
Through the actions of the Portuguese Prince Henry the Navigator, whoestablished the maritime policy of Portugal, there was great interest
regarding Asia among European nations in general, but in particular in
Portugal and Spain. With the support of Isabella, Queen of Spain,
Columbus had travelled to the Americas in 1492, while in 1498 Vasco daGama, under the patronage of Manuel I, discovered the maritime route to
the Indian Ocean, thus strongly promoting the advance towards the Far
East. In 1493, Pope Alexander decided to divide the world into Westernand Eastern hemispheres, giving the rights to evangelize the former toSpain, and similar rights to the latter to Portugal.

He encouraged bothto dispatch talented missionaries to these areas and to convert the
inhabitants to the Catholic faith.

At that time, those who were not

Christian were considered heathen barbarians and it was thoughtessential to convert them to Christianity (Catholicism).

7

At that time, both countries were major naval powers. The Portuguese
had moved southward down along the coast of Africa, establishingcolonies and had discovered the Cape of Good Hope.

In 1510, theyreached Goa, proceeding to Malacca, then in 1516 arrived in Macao.
They sent many fleets to Goa, beginning in 1502, and after much conflictwith Indians in the hinterland and Islamic regions trading with India,
finally established their foothold.
After Spain landed on the American continent, its expeditions crossed
Mexico, defeating the Aztec Empire in 1520, and vanquishing the Incan
Empire in 1533.

In 1519 Magellan set sail from Spain and establishedthe route through the Straits of Magellan at the southern tip of theAmerican continent, and, after continuing to sail westward, arrived in thePhilippines in 1521.

Realizing the huge difficulties involved in reaching

the Orient from Spain, crossing not only the Atlantic but also the Pacific
Ocean, they decided to create a fleet in Mexico for dispatch to the Orient.
The fleet arrived in the Philippines in 1543, after passing through the
Marshall Islands and Palau Islands.

Despite resistance from theinhabitants and protests from the Portuguese, who had come as far as
Macau, the Spaniards tried repeatedly to conquer the archipelago,
eventually succeeding in 1565, deciding on Manila as the capital in 1571,
and giving it the name The Philippines, in honor of the king of Spain atthat time, Philip II (30, 56).
In essence, the Portuguese had reached the Orient traveling eastwards,
while the Spanish had done so traveling westwards, so together theyliterally encircled the globe and were within reach of Japan.

In fact they

seemed ready to swallow the Orient. In 1540 the king of Spain laid claim
to the Pacific Ocean, naming it the Sea of Spain, and forbade vessels ofother nationalities from trespassing in this maritime region without
permission from Spain.

8Chapter1

Nanban-jin Rainichi: The situation of the West and Japan

Coincidentally, 1543, the year in when the Portuguese vessel driftedashore on Tanegashima, is about the time of the flowering of the Italian
Renaissance. It has been pointed out by Prof. Kawakita Yoshio of Chiba
University, that this period was still long before the work describing
circulation in the human body by the Englishman William Harvey, in
1628, which is considered the founding point of modern medicine. In fact,that year (1543) was that in which Vesalius, in Padua, painstakingly
produced “De humani corporis fabrica”, which was the first publishedwork on human anatomy.

Leonardo Da Vinci (1452-1519) had createdmany detailed anatomical diagrams (Fig. 1), while at approximately thesame time Ambroise Parė (1519-1590), the former barber/surgeon who isconsidered to be the father of modern surgery and is famous for hisstatement “Let us bandage him and let the Lord heal him” was at his
most active. Against this background, what was the situation in Japan?
As far as we can judge from the Travels of Marco Polo, the Mongol Yuan
Empire, which had conquered China, was relatively accepting ofEuropeans, yet in the 13th century they twice attempted to invade thenorthern coast of Kyūshū.

On both occasions, the military governmentof Japan (with some help from the natural elements) was fortunately able
to repel the invasions.

This resulted in the construction by the feudallords of Kyūshū in western Japan of ocean-going vessels (known as wako)
to trade with the southern Korean peninsula, the southern coast of theChinese mainland, and even as far as Southeast Asia.
At the end of the 16th and beginning of the 17th centuries, Japan was
unified by Toyotomi Hideyoshi. Later, the Tokugawa regime assumed
power and affixed their red seals of permission to requests by the major
traders in Sakai and Nagasaki to initiate trade with Vietnam, Thailand,
Cambodia, and Java. One of the representative figures was Yamada
Nagamasa, who settled in Thailand with other Japanese, establishing afunctioning Japanese community there. The development of foreign tradecontributed greatly to the improvement of shipbuilding ability and9navigating ability.
Figure 1 From the anatomical drawings of Leonardo Da Vinci

This drawing appears on the inside of the front cover of the “Leonardo Da Vinci
Anatomical Drawings”, the original drawings of which are in the collection of theRoyal Library, Windsor Castle. In it, it seems as if we are looking at the human
circulatory system composed of arteries and veins extending to the extremities of
the arms and legs, including the liver and the kidneys, from the living body surface.
It is quite realistic and fairly accurate. If it were shown without the name Leonardo,
most people would guess it was a modern illustration. There are also records that
he dissected pigs and dogs, so it is quite probable that he had experience in humandissections, judging from his many detailed sketches of anatomical structures,
paying attention to the function of the muscles in the heart and peripheral tissues.
10Chapter1

Nanban-jin Rainichi: The situation of the West and Japan

After he died in 1519, Vesalius in Padua published his own great work “De humani
corporis fabrica” in 1543, the same year that a Portuguese ship from the colony ofGoa, drifted ashore at Tanegashima, driven by violent winds in the East China Sea
off the coast of Kyūshū. It is widely agreed that Vesalius’s book is the first text ofanatomy, but it seems that Leonardo’s drawings would have been quite helpful to
him if he could have had the opportunity to see them.
While these trading activities are small in comparison with the efforts ofthe European powers in penetrating to almost all corners of the maritime
world, there was much trade and exchange between South East Asia andJapan, and there was interest in Japan in previously unknown foreigncultures.
Because of this situation, the feudal lords realized that it wasadvantageous to maintain trade with the Portuguese, who were followedby the Spaniards then the Dutch and the English. The foreign traders
were therefore allowed to travel freely, without hindrance.

The

Portuguese ships traded with Kagoshima, Hirado, Nagasaki, and Sonogi
on the Shimabara Peninsula, navigating as far as the Inland Sea andSakai Harbor, near Ōsaka. There were also no restrictions on
missionaries, who were allowed to proselytize in feudal domains.

In thetowns of Hirado, Nagasaki and Sakai there were no restrictions on
Western dress.

This situation is a far cry from the later period when

only the Dutch were allowed to trade and were restricted to theartificially built island of Deshima, off Nagasaki, and allowed only one
trip per year to pay tribute to the Shōgun in Edo. They spent at least twomonths making that round trip.
Oda Nobunaga, the man who had brought an end to the Warring States
period in 1569, soon invited missionaries to Azuchi Castle, where they
were

astoundedbythecastlefortifications,theseven-storey

entertainment pavilion and the exquisite beauty of the demesne, and they11

realized that it was in no way inferior to the most refined establishments
in Europe. Nobunaga did not give recognition to Christianity as a religion,
but through the missionaries he was trying extremely hard to understandthe culture of Europe. He was also, in his own way, recognizing the effortsof those who had undergone so much to reach the other side of the globe inorder to spread their religion.
The aristocratic and wealthy families of Japan became fascinated withwhat was seen as the symbol of Western culture – the muskets brought
ashore in the distant southwest of Japan, the small island of
Tanegashima. In fact for a time, the Japanese term for a musket was
Tanegashima.

These were looked on as very effective weapons.

Thereafter, while they were also actively imported, their domestic
production was significantly increased by ironwrights such as Kunitomoof Shiga. As a result, their production multiplied.

This shows that theJapanese of that time had the technological means to understand thestructural aspects, and the metallurgical skill to immediately replicate
them, without any particular education.

12

Chapter 2

Nanban Igaku; Medicine brought by Catholic
missionaries

Xavier’s Arrival in Kagoshima
After the Westerners drifted ashore at Tanegashima in 1543, trading
began between the Portuguese and the Japanese, and gradually expanded
due to the welcome extended by the lords in Kyūshū. In 1549, themissionary Francis Xavier, sent by the King of Portugal, arrived at
Kagoshima to promote the spread of Catholicism, accompanied by Father
Come de Torres and the lay brother Joao Fernandes. Xavier, having beenacquainted with Ignatius Loyola during his study at the University ofParis, had initially objected to studying philosophy. However, throughLoyola’s passionate persuasion and invitation and thorough self-training,in 1534 Xavier became acknowledged as a member of the “Company ofJesus”, at age 27.
Because of the Reformation, through the presentation of “Disputatio pro

declaratione virtutis indulgentium” by Martin Luther in 1515 and the

movement initiated by John Calvin in 1541, the Catholics lost many
believers in Europe. The Pope asked Loyola to send some members fromthe “Company of Jesus” to East Asia to increase the number of Christiansin those areas, which is why Xavier was selected (52, 33). It was widely
accepted that the members of his society were simple and sturdy, stoodaloof from worldly things, and devoted themselves to the Church.
Xavier sailed from Lisbon in 1541, arrived in Goa in May 1542 andengaged in missionary work in India for five years. He moved to Malacca
in December 1547, where he met the Japanese refugee Anjiro. There is no13

accurate description in the historical records in Japan of what kind of
person he was, but he had escaped from Kagoshima and learned
Portuguese, becoming converted to Christianity in Malacca. When he met
Xavier, Anjiro enthusiastically explained the significance of the spread ofChristianity in Japan and requested that he go to Kagoshima (Fig. 2).
There was evidence that Japan was receptive not only to foreigners but
also to foreign religions during that part of the 16th century (69).
Figure 2: Xavier’s voyage to India and Japan

Celebrations of the 450th anniversary of Xavier’s landing in Japan were held in
various places in Japan in 1999. Coincidentally, when the Portuguese vessels
drifted ashore on Tanegashima in 1543, the Portuguese held an absolute andundisturbed monopoly of maritime trade from the Cape of Good Hope to the
Moluccas (Spice Islands) eastward of the Celebes. On that vast expanse of water noother European flag was to be seen. This was almost 100 years after the start of themaritime policy of Portugual by Prince Henry the Navigator. However, the voyage
to the east took a year and was not easy or safe, as will be explained later in
14

Chapter 2 Nanban Igaku; Medicine brought by Catholic missionaries

Vignette I.
Xavier set sail from Lisbon on his 31st birthday – April 7, 1541 – and reached Goa
on May 6, 1542 by way of the Cape of Good Hope. He remained in India, with avisit to Ceylon, till the autumn of 1545. He arrived at Malacca on September 25thof that year. During his stay there, he set forth on a missionary expedition to the
Moluccas for 18 months until July 1547.

The timing of his departure from the

Moluccas is not clear. Xavier stepped ashore at Kagoshima in Japan on August 15th,
1549. As shown on the map in Fig. 2, he visited many cities and towns in Kyūshū,around the Inland Sea archipelago and in Ōsaka and Kyōto, chiefly in the westernpart of Japan. Following Xavier’s travels, the Jesuits and Nanban traders carrying
western medicine and culture expanded their sphere of influence to these cities andtowns.
Almeida Introduces Nanban Igaku
After Xavier’s landing, priests from various Catholic countries came to
Japan for missionary purposes. Several of them had some knowledge of
medicine and shared it with the new believers, as did Buddhist priests,
although they were not specially trained in medicine. This was the first
Western medicine to have appeared in Japan, where previously Chinese
medicine had held complete sway.
Padre Luis D’Almeida (1525-1580) was a well-known Portuguese traderin Japanese medical history. He was not particularly proficient in theology,
but he was medically educated and had studied surgery as a youth inPortugal. As a trader he was successful in Macao in 1548, andfurthermore in Kagoshima, Hirado and Yamaguchi in 1549, and he finallybecame a full member of the Society in 1555. With the cooperative supportof the lord of Bungo (modern-day Ōita), he founded Western-stylehospitals there for the care of patients of leprosy, syphilis and common
diseases (Bungo-Funai Hospital), together with an orphanage for the careof destitute children, with his own money. He introduced Western15

methods into the orphanage to rear new-born babies with cow’s milk forthe first time in Japan. Within the hospital, he also designed rooms for
surgical operations and medical teaching. (The present medical society
hospital in Ōita is called the Almeida Hospital). It was reported that thehospital was full of medical and surgical patients until Almeida left thehospital for the sake of his missionary work (39).
This was called “The Era of the Importation of Western Medicine” by
Fujikawa Yū (12) and “The Era of the Introduction of Nanban Igaku” byProfessor Sakai Shizu (49). In the hospital, baptized former Buddhist
priests and baptized Kanpō physicians provided medical care, so it seems
that there were no serious conflicts at that time between Christianity andBuddhism or between Nanban medicine and Kanpō medicine. There werealso quite a few Japanese who were medically educated by Almeida andthe priests who had been medically oriented, and participated as helpers
in medical care after their baptism.
This was actually the first opportunity for Japanese to encounter actualWestern medicine. The medicine they taught was not very specific, suchas giving ointment or applying plasters or oil to burn lesions. According to
the reports from the priests to the center in Macao, at that time in Japan
there was no surgery and they did not specially treat diseases by surgery,because they thought almost all surgical lesions were incurable. In Kanpō,
the knowledge of surgery was originally very limited.
Almeida thereafter actively engaged in missionary activities mainly in
Kyūshū, though he had a few chances to visit Kyōto, Nara and Sakai (39).
He passed away in 1580 at Amakusa.
Mainly due to the suppression of Christianity by the Bakufu in the 17th
century, the records of the Bungo-Funai hospital activities and the actual
situation of their medical education are unclear.
16

Chapter 2 Nanban Igaku; Medicine brought by Catholic missionaries

In the late 16th century, Hideyoshi, the successor to Nobunaga, came torealize that the missionaries denied the divine nature of the Emperor,
Buddha and the Shintoist gods and, in their doctrine, the Jesuits andJapanese converts were willing to destroy Buddhist temples and Shinto
shrine. He reached the conclusion that Christianity could eventually
become a constant source of unrest in the country. Based on this view,
Hideyoshi’s first edict of expulsion was issued in 1587, followed by asecond decree of expulsion and the first martyrs in 1596. When Hideyoshi
went on his Kyūshū expedition, he found the city of Nagasaki
administered by the Church as if it was their own estate, due to a giftfrom a neighboring Kirishitan (Christian) lord.

It is said that Hideyoshi

was very afraid of the possible invasion of Japan, having heard news of
Spanish actions in South America and the Philippines.
Nevertheless, even in the last quarter of the 16th century, many lords ofJapan preferred to continue trade with the Portuguese, because ofinterest in finance and commerce, import of culture and civilization,rather than for the sake of Christianity. Along with the spread of religion
in Japan, conflicts among the Catholics themselves and attacks on
Buddhist temples and Shinto shrines increased. Such antagonistic acts by
missionaries were the reason for Hideyoshi’s decrees.
Until the second expulsion decree and the first martyrs in 1596, contact
betweenfeudallords

andmissionaries

remainedfriendlyandmissionaries were still active. There were many opportunities for Kampō
physicians to watch them and to inquire about their medical activities.
However, it was true their medical care was based only upon theirexperience, not through proper medical education and training, except for
Almeida. Even in the case of Almeida, his major work was missionary
activity and, furthermore, his medical activities were limited to Kyūshū.

17

Contemporary Japanese Medicine
Looking back on Japan at that time, the practice of medicine wasextremely empirical or even considered magical partly because of thegreat influence of Chinese traditional medicine. It is possible to trace
Japanese medicine back to about the 5th century, when it was brought toJapan by doctors from Silla, on the Korean peninsula, who treated theImperial family.
The direct transmission of medicine from China is thought to haveoccurred in the 6th century. Later, embassies were sent from Japan to
China, and some of those stayed more than 15 years to study medicine,
before returning to Japan. In the 7th century, it became increasingly
common to send embassies to China and they imported many documents
concerning Buddhism and medicine. In the 8th century, the eminent
Chinese priest Ganjin was invited to come to Japan by the JapaneseImperial Court, and he gave instructions in the collection of medicinal
herbs, how to combine them, and how to administer them. This isconsidered the origin of Kanpō medicine in Japan.
Chinese doctors at that time used Chinese herbal prescriptions (Kanpō),acupuncture and moxibustion. The origins of acupuncture have been
traced back to the dawn of history in India and China, possibly even backfurther than the beginnings of surgical practice. Acupuncture is based
upon the ancient belief that diseases are caused by evil spirits that are
imprisoned in the body. By inserting sharp-pointed stones or needles into
the skin, openings are made to release them. In cases of very severe
sickness, they placed mokusa (burning mugwort or other herbs) on
multiple points on the skin. Mokusa, rolled up into round pellets, burns
slowly. In two days, the ash would fall off leaving a scar. As for theeffective points on the body surface for these treatments, more than 300
locations were illustrated on a human body figure “Keiketsuzu” from the18

Chapter 2 Nanban Igaku; Medicine brought by Catholic missionaries

late 7th century.
Kanpō medicine was closely related to the introduction of Buddhism.
According to one theory, Kanpō medicine also contained elements of thenatural philosophy of India, and the study of medical treatment was
included in Buddhist ascetic training.
In the 8th century, the Ishitsuryō (Medical and Disease Registration)
controlled education based on the medical system of the Tang dynasty,
and officials were dispatched to various regions, but to what extent thecommon people benefitted from this system is unclear.
In the 12th century, the military came to control most rural areas, and thelegal system of the central government (ritsuryō-seido), including theIshitsuryō, was destroyed. In the 13th century, self-styled physicians andBuddhist priests became the main medical providers, and it became evenmore difficult for commoners to access real medical treatment.
Throughout this period, Kanpō was the main component of the system,
but by the 16th century, uniquely Japanese aspects had also been added.
The Jesuit missionaries who landed in Japan and continued their workthrough the 16th century left records concerning their impressions ofJapanese medicine at that time. “Western treatment of the sick is totallydifferent from theirs. We give Westerners strong medicine and good stew,
and we also give strong soup with meat, but they are given very salty foodthat is difficult to digest in order to stimulate the digestive tract, and they
throw away what the patient does not eat. Of course at a time like that, it
seems that anything at all that the patient wants is good…. Japanese
doctors paid much attention to the pulse due to the Kanpō influence, theyspent about half hour evaluating the pulse to determine the cause of thedisease. In addition there were no pharmacists. However, the acolytes of19the doctors carried wooden boxes which were divided into 44 small
drawers holding different kinds of ingredients. Depending on the
diagnosis, the doctor selected from them, in the home of the sick person,
and mixed the ingredients, boiling or straining them. Depending on thepatient’s condition, the doctor added acupuncture or moxibustion. ”
Furthermore, in the 11th chapter of the late 16th-century “Nihon
Memorandum of Flois” (31), he described Japanese medicine of the timein comparison with European methods.
“At that time, there was no surgery in either Japan or China.

Japanese

disciples who received surgical education and training from Almeida in
Funai Hospital, Ōita, were able to excellently treat gun wounds whichwere still quite rare in Japan, and they showed the excellence of theNanban Igaku surgical education.”
About the difference between the two,
“1. In Europe, scrofula, stones, foot pain (gout?) and plague are extremelycommon diseases. These are almost never seen in Japan.
2. Normally, we let blood from the arm, but in Japan, they use either
leeches or a small knife to let it from the forehead.
3. In Europe, we use irrigation and enema, but they never use suchmethods.
4. In order to examine the condition of the patients, European doctors
carefully examine the urine, but in Japan it is never examined.
5. Europeans have weaker flesh on their bodies and the healing process ofwounds is generally quite slow, but the Japanese bodies are very strong
and so serious injuries, fractures, ulcers, or burns recover extremely
quickly.
6. We have to pass an examination in order to become a doctor. In Japan,
anybody who wishes to become a doctor for economic reasons can do so.”
The method of treatments and the use of medicine were also quite
20Chapter 2 Nanban Igaku; Medicine brought by Catholic missionaries

different from that of Nanban Igaku, but the missionaries were notnegatively disposed to Japanese medicine.

Manase Dosan (1507-1574)

was a well-known person involved with the medical treatment of the most
famous people of his day. There are several records of his having
consulted a Jesuit priest.
The Japanese language ability of the missionaries
It is not possible to recognize how fluently the missionaries spoke
Japanese language in their medical and missionary activities, or also how
clearly any Japanese could understand and speak Portuguese. How
clearly and exactly could the disciples of medical education in Funai
Hospital understand Almeida’s lectures (30). In comparison with theperiod of Kōmō Igaku when persons other than official interpreters wererigidly prevented from coming in contact with the Dutch language, it was
relatively easy in the period of Nanban Igaku. The printing press had
been introduced by the missionaries in the late 16th century in Shimabara,
and a Japanese-Portuguese Dictionary had been compiled in 1590 in
Nagasaki (Fig.3). Due to repeated suppression and expulsion of
Portuguese and Spanish missionaries in the 17th century, the existence of
this dictionary had been kept obscure for a long time. Through the efforts
of many persons, a facsimile edition of the dictionary was reprinted 400
years later in 1975 by the publisher Iwanami, in Japan. It was the
product of the huge effort by many priests to spread Catholicism in Japan
at that time.

As a result, the Saint Anna Hospital in Kyōto, San Lazaro

Hospital in Nagasaki in 1595, in Edo in 1602, in Wakayama in 1608, andin Omura in 1610, many hospitals were established throughout Japan.

21

Figure 3
Japanese-Portuguese Dictionary published in 1603 in Nagasaki by themembers of the Company of Jesus.
①

②

22

Chapter 2 Nanban Igaku; Medicine brought by Catholic missionaries③

In Vocabvlario Da Lingoa De Iapam com adeclaraçáo em Portugues(Vocabularyof Japanese language with explanations in Japanese and Portuguese), Japanesewords were written phonetically in the Roman alphabet and explained in
Portuguese. Figure ① is the frontispiece of the dictionary. Figure ② is the firstpage of entries for the letter A. Because it was not practical to print both Chinesecharacters and Japanese in the original kana for use by missionaries at that time, allJapanese words were written alphabetically. Explanations for these Japanese words
were in Portuguese. Figure ③ is the first page of entries for the letter “A”
23translated into Japanese by T. Doi, T. Morita and M. Chōnan in 1980. The
materials were gathered from conversations’ in daily life between the priests and theaverage Japanese in the latter half of the 16th century. It also contains data toreconstruct colloquial Japanese pronunciation at that time. The priests in Japan atthat time expended much effort to create the Japanese-Portuguese Dictionary for
their missionary activities. It was essential to speak Japanese and to understandspoken Japanese in confession and to preach in their daily activities. They sent thedictionary back to Europe because priests going to Japan wanted to learn Japaneseeven before their departure. The printing machine they introduced to Shimabara in
1590 was delivered only 50 years after the arrival of Xavier in Japan. These efforts
show the extreme dedication for the propagation of Catholicism in Japan. However,
due to the edicts expelling all priests from Japan by Hideyoshi in 1587 and Ieyasu
1613 and the edict of the nationed isolation policy by Iemitsu in 1639, theseimportant data on the Japanese-Portuguese Dictionary became difficult to find inJapan. It was more than 50 years later that Yoshimune ordered Aoki Konyō andNoro Genjō to learn the Dutch alphabet and more than 150 years after the edict of
the nationed isolation policy when Inamura Sanpaku published the dictionary“Haruma Wage” (Dutch-Japanese Dictionary) even though the study of Dutch
language had been strictly forbidden for that period. There was no record from that
period of any attempt to organize a Dutch-Japanese Dictionary by Dutch members
in Deshima unlike the Portuguese priests in Japan in the 16th century. Perhaps thelack of religious enthusiasm played a role.
Nanban-Surgery:

The Kurisaki School and The Sawano School

Even after the middle of the 17th century, Nanban Igaku survived apartfrom any missionary activity. Kurisaki Dōki, son of a landholder ofKurisaki village in Kumamoto, left Japan through Nagasaki to go to
Luzon in the Philippines at the age of 8 years old in 1590, because of his
father’s financial decline. He lived in Luzon for more than 20 years, andlearned Nanban Igaku, probably from the missionaries there, although
there are no records of the names of his teachers or schools. Fortunately,24Chapter 2 Nanban Igaku; Medicine brought by Catholic missionaries

he had kept a lucky charm from a Shinto shrine in the Kurisaki village
and on his return from Luzon he was quickly acknowledged as a native of
Kurisaki, in 1617.
He opened a surgical clinic, and acquired a good reputation as a Nanban
surgeon. All of his four children learned Nanban surgery from him. The
oldest son, Kurisaki Dōki, became official physician of the lord of the
Matsudaira family, relatives of the Tokugawa, in Echizen; the second,
Kurisaki Dōetsu, served lord Matsuura of Hirado. The fourth, Kurisaki
Dōyū, stayed in Nagasaki as the official surgeon of the Nagasaki
magistrate’s office, in spite of invitations from lords in other fiefdoms.
Kurisaki Dōha, a son of Dōyū, was invited to Edo as an official surgeon. In
this typical example of family traditions, all members of the family kept
the family medical secrets and never disclosed them to outsiders. The
negative effect of this is that their contribution to the field of medicine inJapan is not clear and has never been fully acknowledged.
Another example of Nanban surgery at that time was that of the traditiontransmitted originally from Christophe Ferreira. He is the hero of thenovels “Seido no Christ” by Nagayo Zenro (41) and “Chinmoku” by Endō
Shūsaku (7). He is even more clearly described in “Kirishitan

Gidai-Junkyo to Kikyo no Gidai” by Endō Shūsaku (8). Ferreira was apriest who came to Japan specifically for missionary work at the age of 29
during the reign of Tokugawa Hidetada, the second Shōgun. Although theage of suppression and persecution had already begun, he continued topreach in fluent Japanese to Catholic believers in Kyōto in 1608. Becauseof the strict 1613 edict of Ieyasu, the priests and the former Kirishitan(Christian) lords were summoned to Nagasaki and ordered to leave either
Japan or their faith. Of these 37 priests concealed themselves in order tominister to the needs of the faithful. Ferreira was one of them and herealized and accepted the possibility of martyrdom. In hiding, hecontinued to guide and assist believers and to communicate with other25

priests in hiding as the central person of the church and maintained
communications with Portugal.

He was captured in 1633 and after

dreadful torture, finally became an apostate.
He was ordered to be naturalized as a Japanese and was given the name
Sawano Chūan. He was also ordered to make the round trip between Edo
and Nagasaki to act as a translator in the investigations of captured
priests. Though he was not a specialist, he was learned in Nanban
medicine and astronomy and contributed to Japan in both fields. He
translated a book on astronomy and introduced an astronomical telescopethrough the Dutch trading factory in Deshima.
It is very difficult to understand how heavy and horrible the pressures hemust have been feeling regarding his apostasy, and what he considered
was his job as a Bakufu officer.
Aside from these images, he was immortalized in Japanese medical
history as the transmitter of Nanban Igaku by his son-in-law, Sugimoto
Chūan who was a Bakufu official surgeon. The senior translator Nishi
Genpō in Nagasaki learned Nanban Igaku from Sawano Chūan,establishing the Nishi School of Nanban Igaku where he trained many
disciples.
The news concerning Ferreira’s apostasy, was promptly transmitted toEurope through the Dutch trading factory, and he was banished from the“Company of Jesus”.
To atone for Ferreira’s banishment and to offer support to believers inJapan, priests repeatedly infiltrated from Europe and from Luzon. Someof them suffered martyrdom after torture, some of them were imprisoned
permanently in Kirishitan (Christian) residences.

26

Chapter 2 Nanban Igaku; Medicine brought by Catholic missionaries

Arai Hakuseki, the famous Bakufu scholar, edited “Seiyō Kibun” (News of
the West) in Genroku 14 (1701). It was based on his talks with the priest
Giovanni Battista Sidotti, originally from Sicily, who tried to infiltrate
Japan from the far southern island of Yakushima and was captured. Since
this was 70 years after the expulsion of the Portuguese and Spaniards,
there were no official interpreters of these languages. They communicatedwith each other using the peculiar Japanese language which Sidotti had
learned in Luzon and a Dutch interpreter. Topics on this occasion
included the map of the world and countries in Europe. It is recorded thatthey had difficulties understanding each other.
From the viewpoint of Japanese medical history, the period of about acentury, from the landing by the shipwrecked Portuguese merchants on
Tanegashima in 1543 to their expulsion from Japan in 1639 consists of
two stages. The initial half was the period of Nanban Igaku, introducedby the missionaries, including Almeida, which is referred to as the periodof Kirishitan (Christian) medicine. The latter half was maintained by
Kurisaki, Sawano and the schools established by the interpretersspecially interested in medicine, which is called Nanban Igaku.

27

Vignette I Voyage from Europe
Here, let us try to understand the contemporary voyage from Europe toJapan via the Atlantic Ocean, the Indian Ocean and the East China Sea
which all missionaries took. It is said Nobunaga expressed his deep
respect for the missionaries who came to Japan to proselytize theirreligion in spite of such hazards and personal difficulties.
In the middle of the 15th century, Prince Henry the Navigator decided tolaunch the “Navigaciaos Grandes” (Grand Maritime Voyages) after
constructing large wave-resistant 100-200 ton ships with 3 masts andmore than 3 separate decks. With such large boats, they were able to sailfor long periods because they could store sufficient food such as pigs,
chickens and water for 100-200 sailors.
The year of 1549 when Xavier landed in Japan was almost 100 years after
the beginning of the “Navigaciaos Grandes”. E. Kaempfer stayed in the
Dutch factory in Deshima from 1690 to 1692, a quarter of a millenium
from the beginning of the Great Voyages. Nevertheless the voyages from
Europe to Japan were still full of hazards and difficulties, despite new
maritime improvements during these periods.
It is not our intention to introduce their voyage diaries. Because of theexpulsion of the Portuguese and Spaniards from Japan in 1639, suchrecords were not allowed to be kept in Japan. Kaempfer, who sailed from
Batavia to Japan in 1690, was a German physician who stayed until 1692
as a physician in the Dutch factory in Deshima. He left Batavia in May
1690 and enjoyed a smooth voyage under favorable winds and fineweather, and reached Ayutthaya, Siam, within 30 days. In the absence ofwind, even if the weather were fine, the ship would ride at anchor after
furling its sails to prevent being carried into a reef by the ocean current.
The voyage at that time was completely at the mercy of the wind. They
left Bangkok in July of the same year for Japan, when the high pressure28