S Glance at 
3apaneee flfcebidnc, 
indent anb Hbobern, 
IReprinteb from tbe 
IRortb American Journal ot Ibomoeopatbg. 
Wm. Uob Ibclnuitb, flfc.E)., X2L.W. 
Witb tbe Butbor's Compliments. A 
Glance at Japanese Medicine 
Ancient and Modern. 
By WM. TOD HELMUTH, M.D., LL.D. 
SINCE the year 1853 when, through the intervention of the United 
States by Commodore Perry, Japan opened her ports (which 
had been closed for two centuries) to all nations, the interest 
manifested in ' 'Things Japanese" has developed to such a degree both in 
Europe and America that, at the present, it has almost become a 
uror. This enthusiasm has gradually increased since the late revo- 
lution, and has been further stimulated as the history of the country 
has become more perfectly known through the publication of many 
books and magazine articles, and the establishment in all the large 
cities of this country and Europe of mercantile firms dealing entirely 
in Japanese wares. 
In looking over the English literature of Japan, to gain in- 
formation regarding the medical history of that country, I found 
treatises upon law, commerce, religion, education, arts, agriculture 
and theology, but nothing upon medicine, save a few allusions in 
Chamberlain's book, "Things Japanese," and passing remarks in 
the " Micado's Empire," by Griffis, together with a few lines here and 
there in other works on ancient Japanese rites and ceremonies. 
Upon visiting the American Minister at Tokio, I met Dr. Willis 
Norton Whitney, M. D., a graduate of the University of Pennsylvania, 
who is the interpreter at the Legation, and who also holds an ophthalmic 
clinic at the University. He referred me to an exhaustive contribution 
of his own in the " Transactions of the Asiatic Society of Japan,"* from 
*Notes on the History of Medical Progress in Japan. 2 
which, as well as in the Appendix to a Dictionary of the Roads 
in Japan I am indebted for the main historical portions of 
this paper, The rest I have gleaned from my personal inquiries, 
from conversations with medical men and from my own obser- 
vation. It seems strange indeed when looking over a history 
of medicine to find no mention of the names so familiar to us 
all-Chiron the Centaur, Hippocrates, Galen, Celsus, Rhazes and 
Avicenna-are all absent from the category, and the ancient gods, 
goddesses and great men of Chinese, Korean and Japanese med- 
icine substituted for them, names rather unpronouncable to the 
uncultivated American tongue, and which as much as possible I 
will spare you hear me struggle to articulate. 
Japanese medicine, or indeed "Eastern Medicine, " is probably as 
ancient as any in the world, and abounds with the same mysti- 
cism that enshrouds the early history of Western Medicine. It 
antedates history and up to two centuries before the Christian Era is 
almost completely enshrouded in mysticism. To this age the term 
"Pure Japanese Medicine" has been applied. 
In Japanese mythology Izanagai and Izanami originated the art 
of healing. 
THE THIRTY-SEVEN MEDICINES OF THE DIVINE AGE. 
It is scarcely necessary to enter into any particulars regarding 
this portion of the medical history of the country, because interesting 
as it may be to the antiquarian medical student, the authenticity of the 
records is often questionable, as are also some of the sources from 
which they are obtained, but it is interesting to note that during this 
so-called Divine Age, among the thirty-seven medicines then said to 
be the only ones in use, are several with which we of the present day 
are acquainted. In giving this list Dr. Whitney, in his article, states 
that the names were obtained from " The Nomenclature of Japanese 
Plants," by Professor Matsumura, and from Mr. F. Porter Smith's 
''Notes on the Materia Medica of China." Thus we have Scutellaria, 
Xanthoxylum, Asarum, Plantago, Phytolacca, Artemesia, Zingiber, Al- 
lium and others, which are very often used at the present time. These 
medicines were supposed to be sufficient for the all-prevailing diseases, 
which were believed to originate in disturbances of one of the four 
elements constituting the body and the soul. These were-wind, fire, 
water and earth. It will be remembered that Hippocrates in the 8oth 
Olympiad supposed the body to be composed of four elements and 
that it was the disturbance of the equilibrium of these that constituted 3 
disease. As we approach a little nearer the Christian Era, though still 
uncertain, the records become somewhat more reliable, and within a 
century or two of that epoch Chinese and Korean physicians were 
introduced into Japan, and a more thorough, but even at the best 
imperfect, knowledge of anatomy obtained by the dissection of dogs 
and monkeys. 
EARLY JAPANESE ANATOMY. 
It is very interesting to read the anatomy of those days and to 
observe how nearly some of the descriptions accord with our 
knowledge of to-day, and to find them quite equal, if not more 
accurate, than those of the Western World at the same era. 
The following description I take from Dr. Whitney's article, who 
in turn compiled it from a translation of a history of "Japanese 
Medical Progress" in the original tongue, written by Taken ouchi, 
Prime Minister to the Emperor Jingo. It reads: "The internal organs 
or viscera were eight in number; fugushi, the lungs; hokura, the 
heart; kimo, the liver; i, the gall; ichibuku, the stomach; yogoshi. 
the spleen; murato, the kidneys, and kusowala, the intestines. The 
lungs are in the upper part of the thoracic cavity; they cover the 
heart, are dependant; they also lie adjacent to the gullet and are 
divided into five lobes, and contain within convoluted vessels. The 
color of this viscus is greenish black; and it is the organ of respira- 
tion. The heart lies immediately behind the left mamma; its shape 
is like that of a bottle gourd (Cucurbita lagenaria); it is purple in 
color, and has a cavity within, which contains blood, and is provided 
with a middle wall or partition. It is the root of blood vessels. The 
liver is in the right side of the chest and is divided into two dependant 
lobes; its color is yellowish black. It is flat and hollow and covers 
the gall. There is a hole in it which connects with the heart, and 
also many other holes in it leading outward. The gall lies just 
outside of the liver. It is of a green color, and in form like the root 
of the (cymbidium sp.?) It contains within it a bitter tasting fluid of 
a yellowish color. The stomach lies inwardly at the base of the 
spleen; its figure is like that of a stone jar {kame) and its color is white. 
It receives the food which comes down the gullet, and digests it, 
while below, it reaches to the intestine. In women it creates blood, 
while its water becomes urine (?). The spleen is on the left side of 
the belly ; being above the stomach its color is like that of the for: 
(Paulownia imperialis), and it contains air. The kidneys are 
dependant, one on each side of the vertebral column; they have 
convoluted vessels within, and bind together fibres or tissues ; above 4 
they reach to the liver. The intestine extends from the upper part of 
the navel downward with convolutions ; it is long and bulky, and of 
somewhat greenish white color. It contains food within, and its ex- 
tremity reaches to the anus. The first beginning of the formation of 
the human body is ki ox vital spirit or air, and sui, water. These two 
make first the fibre, or tissues, and blood, then muscles and flesh, 
vessels, bones, internal organs, the four limbs, outer skin, nose, 
mouth, eyes, ears, hairs, fingers and toes, and reproductive organs. 
The air (or vital spirit) enters through the mouth and nose to the 
inner organs, where it mixes with water, then ascends to the head, 
where it enters, minutely divided, into the main trunks of the blood 
vessels, circulates through the extreme parts of the body, and finally 
returns and stops in the inner organs. 
The water enters through the mouth in the food and drink to the 
inner organs, and with the air or vital spirit into the main trunks of 
the blood vessels, where, taking up color, it becomes blood and 
nourishes the bones, while the portion which goes out toward the 
skin is without color and becomes midzusne (lymph?)." 
FIRST POST-MORTEM EXAMINATION. 
I note here also that perhaps the first post-mortem examination 
upon a human body was performed at this early period and perhaps 
is the first one on record anywhere in the world. Whether this be the 
case or not, it is certainly worthy to be chronicled as a historical fact 
in the history of medicine. The Tokio Medical News of 1884, p. 887 
states that the word kaibo (to dissect) was first employed in Reisw\ 
-recording an examination of the body of the Princess Tata-hata, 
A. D 457-479, who had committed suicide because she was accused 
of unchastity. The autopsy, which was commanded to be made by 
the Emperor, revealed a sac filled with water and a stone, thus clear- 
ing the reputation of the princess. 
This may have been a fibro-cystic uterine tumor undergoing cal- 
careous degeneration, several of which tumors have come under my 
own observation. 
During this uncertain and traditional period, some progress was 
made, and many innovations, improvements and retrograde steps 
taken, until about A. D. 669, when the Emperor Teuchi established a 
school of learning and placed over it a Korean priest who had immi- 
grated to the Island and had become naturalized. In this institution 
j- A work on the Treatment of Internal Diseases and Acupuncture which 
students were ordered to read. 5 
was a medical department which was presided over by a superintend- 
ent and an assistant, with about forty medical students in attendance. 
There was also a chair of acupuncture, and one of shampooing or 
massage, together with a professor of diseases of women. Thirty 
physicians were afterwards added, a teacher of Materia Medica ap- 
pointed and also a professor of Botany. The course of instruction in 
this college continued nine years and was graded; one day out of ten 
and fifteen in the fifth and ninth months were the only periods allowed 
for recreation. Here we find that long courses and graded classes 
were considered essential for the training of medical students in these 
very early days. 
The importance attributed to acupuncture, the moxa, and sham- 
pooing by the ancient Japanese can not well be over-estimated, and 
as these practices have continued and are greatly encouraged at the 
present time, more will be said of them further on in this paper. 
Another important and interesting record is found in the fact 
that A. D. 708 J the Empress Gemmei and her successors en- 
couraged women to undergo medical training and allowed them to 
practice medicine. The nuns chiefly after having adopted the faith of 
Buddha could make use of charms, incantations and prescribe 
medicines for the sick. In the sixth year of the same period, women 
were appointed professors to instruct students. This may be the first 
acknowledgment of the ability of women to practice and to teach 
medicine; but the significant proviso attached to the privilege, viz: 
celibacy, would indicate the sagacity of the law-givers. 
WOMEN AS PHYSICIANS. 
INTRODUCTION OF SMALL-POX. 
The introduction of small-pox to the island took place A. D. 670. 
It received the name of Seki-han-so or red pox, and was brought by a 
Japanese fisherman from Shiragi. An epidemic raged throughout the 
country, especially around Kiyoto and well-nigh devastated the em- 
pire. Centuries before this period, even at as remote a time as the 
Christian Era, small-pox had devastated China and inoculation had 
been practised with marked success. The first Chinese monograph 
upon the disease was issued in 1323. 
In A. D. 824-834 a Charity Hospital was established at Fujiwara, 
Fuyutsugu and many medical works published, the authors being in 
J History of Japan by Percy Thorp, London, 1887, p. 45. Dr. Whitney, loc. 
cit., page 270, gives the date as A.D. 7x7. 6 
most instances selected and commanded by the Emperors to perform 
such service. Among such productions was one written by the pro- 
fessor of acupuncture called I-shin-ho, of thirty volumes; a work on 
hygiene in seven volumes, and a compilation from the Chinese, called 
theBiyo-gen-koron of sixty-seven volumes and 1720 discussions on the 
causes of disease alone. 
Physicians and surgeons in these days belonged to certain families 
generally of the upper classes, and the descendants of a great physician 
were supposed to derive from their ancestor not only a predilection 
for, but a peculiar hereditary adaptability to, medical art. 
The admixture of Chinese with Japanese medicine during the next 
centuries vastly improved its general condition and placed it upon an 
eminence which it had not hitherto attained. Many medical men 
flourished and dispensaries and hospitals were founded. Into these 
details it is impossible to enter. But now the frequent and bloody 
civil wars which afflicted Japan, arising from jealousies and misunder- 
standings between the Shoguns were-as are wars always-disastrous 
to the progress of medical science, and the Chinese School, after being 
dominant for centuries, began to decline. || 
A glance at the etiology of disease, as understood and taught 
during these periods, shows it to be a mixture of credulity and super- 
stition, intermingled here and there with an atom of truth, while the 
therapeutics of the period appears to be much more advanced, in some 
cases indeed in accord with the more modern notions. All ailments 
of the body in the early part of this period were supposed to arise 
from two causes-evil spirits, food and drink; a little later wind and 
cold were substituted for these factors, and finally heat and moisture 
were the chief originators of all disorders, the latter coming remarkably 
close to the modern or so-called malarial origin of disease. The devil 
had an important part to play in the afflictions of the body, intermit- 
tent fever (war away ami} small-pox and nervous affections being sup- 
posed to be the work of his emissaries. Sometimes the evil spirits 
were believed to be sent from the dead to torment the living. 
Such being the universal belief it can be readily seen why exorcism 
was necessarily a prominent feature in the treatment of the day, and 
why a professorship of exorcism existed among the faculty of the Im- 
perial Medical College. 
The study of medicinal plants, however, became general; new 
|| Among these civil wars were those of Hogeti, A.D. 1156, Heiji, A. D. 1159; 
then the civil wars between the north (Yoshinaka) and the east (Yoritoma). Onin, 
A.D. 1467, and many others. 7 
drugs were introduced into the pharmacopoeia and discussions between 
the schools then in existence regarding the action of several of the 
then so-called new medicines were common and resulted in a much 
more thorough acquaintance with their virtues. I wish I could give 
the names of these but time will not allow me. Among them, how- 
ever, I find camphor, liquorice, croton tig., rheum, clarified honey, dios- 
corea japonica, chenopodium, magnolia, hartshorn, lime, the skin of the 
white spotted snake, and many others. 
Medical matters went on pretty much in this manner for many years, 
on the whole rather declining for lack of incentive or foreign stimula- 
tion. Examinations for proficiency were abolished for the most part 
and ceased early in the sixteenth century. Gradually the Japanese 
physicians lost their prestige, were removed from court, and priests 
and Chinese called to attend_the principal personages of the empire. 
From time to time, however, spasmodic attempts to elevate the art 
and arouse the dormant spirit of the profession were made until about 
the middle of the sixteenth century (1531 to 1551) certain influential 
and learned men arose, who established seats of learning in the island. 
Among these the most prominent was Manase Shokei, who had been 
reared in a Buddhist temple in the city in which I am now writing 
(Tokyo). He revived the dormant interest in medical art, and de- 
clared the necessity for the examination of excrements and urine in 
all cases of serious disease. He was a zealous upholder of the heat 
and moisture doctrine, as disease producers, and consequently intro- 
duced the general practice of diaphoresis, and that failing, recom- 
mended acupuncture, the toxic moisture being supposed to run through 
the holes made by the needles. 
I'he next step forward was the acknowledgement of the existence 
of the vis medicatrix natures, and its power in protecting the system 
and averting disease, a belief which after centuries of buffeting 
still holds dominant sway in all the medical schools of the world and 
is upheld by the most learned and skilful in the profession. The pro- 
pounder of this doctrine was Nagata Tokuhon. The cures made by 
him were necessarily many, because drug poisoning was abandoned. 
He introduced the practice of allaying thirst with simple water and 
other mild beverages, a custom held even to this day among the 
Chinese and Japanese doctors as reprehensible in the extreme. I am 
acquainted with an American lady now resident near Yokohama, who 
informed me that for a fortnight after her accouchement, she was not 
allowed a single mouthful of water, and her baby, now eight months 8 
old, nursed by an old Chinese Aymah, had never tasted water from 
its birth. I recommended a good drink for it at once. 
DISCOVERY BY THE PORTUGUESE. 
This is a very imperfect sketch (indeed scarcely an outline) of the 
medical history of Japan up to the year 1543, when the discovery of 
the island by the Portuguese§ exerted a tremendous influence upon the 
government and over all the arts, and upon none more powerful than 
that of medicine. 
This discovery of Japan by the Western nations and the introduc- 
tion of Christianity (Roman Catholicism) into the island, the immense 
influence gained by the Jesuits, their non-toleration and persecution 
while in power, and their final expulsion with torture and bloodshed, 
form the most interesting of all the parts of Japanese history. 
Spain and Portugal received the name of Nam Bam-or the land 
of the Southern Barbarians. Among those entering the country about 
this time (1549) were two distinguished Jesuit priests who, it is sup- 
posed, were well versed in medical studies, who landed at 
and obtaining a foothold among the people, began.zealously to pros- 
elyte among the so-called heathen. This was during the reign of 
Philip the Second, King of Spain and Portugal. It has been supposed 
that after due deliberation this method of conversion was adopted as 
a stepping stone to the ultimate subjugation of Japan by that monarch. 
However this may be, there can be no doubt that the works of charity 
and healing practiced by the priests were received with such favor 
and were so generally appreciated, that the Japanese Government was 
asked for a grant of land, whereon might be raised medicinal plants 
and herbs then unknown in the country. This request was granted, 
and 30,000 tan (7,500 acres) were given for the purpose. This persist- 
ent proselyting was so successful that thousands were converted to 
§ There is some discrepancy in dates regarding this discovery of Japan, some 
giving the above year, others 1571; a most excellent authority, however, thus 
writes: 
" The discovery of Japan by Mendez Pinto took place in the year 1542, at the 
time when Martin Alfonso de Sosa was Captain General of Portuguese India and 
when this country, through the discoveries and conquests of the east coast of Asia, 
had reached its greatest extension. With Alfonso de Sosa went to Goa one of 
Loyola's most zealous disciples, Francis Xavier, who was afterwards designated 
the Apostle of Japan." (Japan. Travels and Researches Undertaken at the Cost 
of the Russian Government, by I. I. Rein, Prof, of Geography at Marburg. 
London, 1888, p. 262). 
•(The Micado's Empire, by Wm. Elliot Griffis, A.M., 6th Ed., p. 249. 9 
Roman Catholic faith. Large hospitals for the treatment of the sick 
poor were erected, the entire expense of such institutions being always 
defrayed by the priests and their followers. In the years 1542 and 1580 
we find them in such power that they were enabled to found the first 
great school of Western Medicine, giving it the name of Nam-bam-riu, 
which, being interpreted, means " the school of the Southern Barbar- 
ians." This school flourished for a considerable period enhancing by 
its prominence the strength of the Catholics.* In 1593, at the height 
of the Jesuitic power, the number of Christians was estimated at 
600,000. f 
In the year A. D. 1610J the Dutch entered Japan and were allowed 
to trade at Nagasaki. The circumstances surrounding the introduc- 
tion of Dutch medicine are as follows : In the year 1644 a Dutch 
vessel was wrecked on the shores of the sea of Yamada, on board of 
which was a surgeon named Kaspar, who was sent to Yedo (Tokio) 
and there became so celebrated that a school of medicine, called the 
Kaspar School, was founded. At this time, therefore, there existed in 
Japan, professors of Chinese, Japanese, Korean, Western Medicine as 
expounded by the Jesuits, and the system as taught by the Dutch. 
AN ECLECTIC SCHOOL. 
Human nature is alike the world over, and it is a matter of no sur- 
prise that an endeavor was made to combine all these methods in one. 
A physician of learning, by name Nishi, essayed this and succeeded 
in establishing a Japanese Eclectic School of Medicine. Shortly after 
the foundation of a School of Surgery was laid by one Hanaoka Shin, 
who has left the reputation of being one of the boldest surgeons of his 
time. He recommends laparotomy after this fashion: "When medi- 
cines are ineffectual, as well as acupuncture and the cautery, (moxa) 
the abdomen and back may be opened, the stomach and intestines 
washed and whatever is likely to save the patient may be done."§ 
His anaesthetic was as follows: 
Mandara kuwa Datura alb. 
Souto Aconite. 
Hakushi Agelica anomala. 
Toki Linguisticum Acutilobum. 
Seukiu Conioselinum univittatum. 
* According to Rein, op. cit. p. 271, we find that in the year 1581 there were 
150,000 Jesuits in all classes of society and about two hundred churches. 
f The Micado's Empire, by Wm. Elliott Griffis, A.M., 6th Ed., p. 246. 
J History of Japan by Percy Thorp, London, 1887, p. 145. 
§ From Whitney's article, page 313. 10 
These ingredients were compounded into a fine powder and ad- 
ministered to the patient who, it is said, soon became unconscious 
and the operation was then performed. Among the surgical perform- 
ances were those for carcinoma of the breast, fistulae, necrosis, and a 
variety of tumors. 
During these periods, 1655-1755, also medical controversies were 
carried on regarding the relations of the viscera to each other, the func- 
tions and the circulation in the intestines, I suppose pretty much in the 
same manner as they are to-day and have been since medicine began 
and will be to the end of time, and therefore little mention of them 
is necessary. 
Up to this period the Portuguese and Spanish priests by the means 
heretofore mentioned had acquired a tremendous power in the 
Empire; they even had gone to such extremes in proselyting, that 
natives who would not acknowledge their religion were put to the 
torture; persecutions of the most terrible character were, in some 
sections, carried on against the innocent Japanese. The priests 
looked with distrust upon the entrance of any foreigner into the 
Island and were even loth to help any shipwrecked mariners cast 
away upon the coast. || The power thus gained caused growing 
apprehension of the Government. Those in power began to see that 
ultimately Japan would be subjected to foreign yoke, until finally, in 
the year 1587, Taiko Sami issued an edict that all Jesuits quit the 
country in twenty-four days and in the year 1614 the Emperor 
Lyeyase expelled them from the country. Great bloodshed ensued ; 
the Buddhists and Shintoists rose en masse, and the tortures inflicted 
upon the Catholics in this attempt of ejectment were of the most 
appalling and disgusting character. 
JAPAN CLOSES HER PORTS FOR TWO CENTURIES. 
Then Japan drove out all foreigners, closed her ports and main- 
tained that unique isolation which distinguished her for two centuries 
among the nations of the world. It took, however, many years to 
accomplish the complete expulsion of the Catholics, for we read that 
|| An English pilot, Wm. Adams, wrecked upon the coast of Japan, thus writes : 
"After wee had beene there five or sixe dayes, came a Portugal lesuite, with 
other Portugals who reported of vs, that we were pirates and were not in the way 
of marchandizing, whiche report caused the Governours and common peeple to 
think evil of us." 
(The original letters of the English pilot, Wm. Adams, between A.D. 1611 and 
1617. Reprinted from the papers of the Hakluyt Society, 1878.) 
•JRein, Travel and Research in Japan, p. 290, 11 
in 1637 another Roman Catholic Rebellion raged and was only 
quelled after many months. These facts are mentioned in this place 
because with the closure of the country, all foreign medical importa- 
tions were cut off and Japanese medical science-if the conglomera- 
tions of the different systems can be called a science-having no 
impetus from without began gradually to lose the vigor that trans- 
plantation of the foreign element had engendered. But the seed of 
Western Medicine had been sown and thought on medical subjects 
had been directed into more legitimate channels. The native Japanese 
still bent on discovering the cause of disease advanced many 
etiological theories to explain it. 
Between the years 1751 and 1763, an entirely new doctrine- 
certainly to Eastern Medicine-was taught by one Todo of Kiyoto. 
He believed that all diseases arose from the presence of one poison 
in the system, and that to eliminate disease therefrom an equally 
powerful poison was necessary. Rather a foreshadowing in the 
East of the law similia similibus emanating in the West. His school 
received the name of Ichi-doku-ka. 
Thus for a time the history of medicine ran only in the groove of 
Japanese thought and experience, but in the last quarter of the last 
century two distinguished physicians, seeing the tendency to declina- 
tion in all things medical, labored zealously for the elevation of 
medical science. One was Taki-Genko, the other Sugita Gempaku. 
The former founded a medical school on the Chinese system, the 
buildings of which were burned, but were re-builded by his son in 
1773. By order of the Shogun, all physicians were ordered to sub- 
scribe toward the support of this school. The term of studentship 
was one hundred days in the spring and summer of two years.* The 
second (Sugita Gempaku) began to study the Dutch language in 1771, 
and after having witnessed the dissection of the body of a notorious 
woman, Awocha Baba (old Mother Green Tea), was so struck with the 
imperfectness of anatomy, as then understood, that finally, with the 
aid of some medical friends, he translated, after many interruptions. 
The Tafel Anatomica, by John Adams Kurumanns. 
This was the first great step towards solid improvement in 
medical science in Japan. Dr. Whitney in his article expresses the 
surmise that this great man had embraced Christianity, in other 
words, had become one of "the forbidden sect." "It is said," 
* Vide outlines of Japanese Education, prepared for the Philadelphia Inter- 
National Exhibition in 1876. 12 
writes Dr. Whitney, "that it was his custom when meeting with 
words which it was impossible to understand in the translation of his 
work on anatomy, to make opposite each a cross within a circle, and 
it is related of him that he always accompanied the sign with a prayer 
to God that the meaning might be shown him." 
VACCINATION. 
Vaccination was introduced into Japan by the Russians in 1824, 
and twenty-five years later by the Dutch at Nagasaki, to which 
settlers the honor has been generally attributed. The truth is that the 
art was brought by a fisherman of Yezo named Nakagawa Goroji, who 
was by a storm driven on the coast of Siberia. He there learned the 
methods of vaccination, and returning to his home, soon began to 
vaccinate the people. In an epidemic of variola which, a few years 
after, visited the place, the beneficial effects of the art were fully 
established in Japan. In this year Dr. Von Seibold arrived from 
Holland and gave some instructions in medicine and surgery, his 
chief study, however, being botany ; he vastly increased the 
knowledge of Japanese plants, flowers and herbs, and wrote the 
history of these in a valuable work now in the Museum at Leyden. 
In the year 1848 an edict from the reigning Shogun prohibited the 
practice of Western Medicine, while that of Surgery was still allowed. 
It would seem that not much attention was paid to the pronuncio, 
for very shortly after its issue we read of colleges being established 
and hospitals founded for the advancement of medical science. 
The first public lecture on Medicine and Surgery after the opening 
of the ports of Japan, was delivered on the 15th of November, 1857, 
by Dr. Pompe van Meerdervoort; and shortly afterward the first 
foreign hospital under the Government was founded. 
In the year 1870 a memorial from the college was presented to the 
Government asking that Professors of Western Medicine be imported 
to teach in the University, and that the bodies of criminals be allowed 
for dissection. These requests were granted, and a dozen medical 
students were dispatched to Germany to be educated, and professors 
of the varied branches of medical science were brought to Japan. In 
April, 1877, the University of Tokio was organized with four depart- 
ments, viz.: Law, Medicine, Science and Literature, and in 1878 a 
library for the institution was founded. 
During the years i860 to 1870, several English and American 
physicians gave great impetus to Western Medicine, among whom 
we may name : 13 
First, Dr. J. C. Hepburn, who was the pioneer of the Protestant 
Church; he came to Japan in 1859, and sedulously labored for the 
moral and physical condition of the people for over a quarter of a cen- 
tury. He was held in high esteem by all who knew him. Dr. Eldridge, 
who delivered a course of lectures in Hakodate and successfully 
edited a medical journal. Dr. Henry Lanning, of the Episcopal 
church, who opened the first dispensary at Osaka, where a medical 
school had been in existence for some years. The Rev. Wallace Tay- 
lor was also much interested in the work. Dr. Vedder, of the U. S. 
Steamer "Stonewall," was surgeon of the hospital at Kobe, estab- 
lished in 1868, together with Dr. Clary, Dr. Anderson, Dr. Simmons, 
Dr. Berry and many others. Of course, in this paper many names 
and incidents must be omitted, because it is merely presented as a pre- 
face to those who in the midst of professional duties at home have 
scarcely time to look at other than the medical literature of our own 
country and of Europe ; it may perhaps excite further interest in the 
medical progress of Japan, which, as in the case of all the other 
sciences and arts, has been marvelously rapid. 
THE MOXA, SHAMPOOING AND ACUPUNCTURE. 
Having now hastily described what I have gleaned from the writ- 
ings of others, I come to consider what particularly interested me, an 
ignorant medical foreigner, when 1 entered Japan. I had the vaguest 
possible notions regarding its medical status,but my general idea was 
that it was very much below any American standard, and that medical 
knowledge was chiefly confined to the Buddhists and Shintoists, with 
here and there the foreign element intermingled. 
As I stood upon the deck of the steamer as she came up the Bay of 
Tokyo, the numbers of naked men-save only what might be called 
suspensory bandage, minus the hole in the centre-propelling their pic- 
turesque looking boats around the ship, was a novelty, but one to 
which one becomes accustomed in a very short time. The muscu- 
larity of these men, especially of their lower limbs, was noticeable. 
When I was enabled to more closely inspect their persons, I found 
that few of them had not round white cicatrices upon various portions 
of their bodies, bearing witness to the use of the moxa. This method 
of cauterization has been in existence in Japan for many hundreds of 
years; mention is made of it in the i ith century.f The cone to be 
burned, which is composed of the dried leaves of the artemisia vulgaris 
kalefolia (mugwort), is placed upon different portions of the body for 
fMicado's Empire, by William Elliott Griffis, 6th ed., page 207. 14 
different affections, and then lighted. Works upon the subject of the 
moxa were published and explicit directions given for its use. Kaemp- 
fer in his History of Japan, J has been very explicit in his manner of 
using this cautery. A specimen or two may suffice. "In a difficult de- 
livery you must burn three cones on the extremity of the little toe of 
the right foot. This will give instant relief and promote recovery." 
"In obstruction of the menses and in fluxes, in whites, piles and the 
ulceration of haemorrhoids,you must burn the place called Kiso on both 
sides with five cones. To find out this place, you must measure from 
the navel straight down five inches, then sidewise at right angles five 
inches, so that there be ten inches between the two places to be burnt.'' 
Pages of these directions can be found and volumes have been written 
upon the subject, evincing the great reliance of the Japanese on this 
method of cauterization; indeed, this, with acupuncture and shampoo- 
ing, or as we term it, massage, are three most ancient methods of cure, 
and are at this time largely practiced all over Japan. The latter, mas- 
sage, as has been already mentioned, had its professor in the seventh 
century, and has been regularly practiced ever since. It formerly was 
only practiced by the blind men (Amma) who became very proficient, 
the increased delicacy of touch of these unfortunates, rendering them 
especially adapted for it. At the present time, however, the adminis- 
tration of massage is not limited to the blind or to the male sex. 
Women are allowed to practice it, and very deft and gentle they are. I 
have seen them as they kneel upon the bed-in a way peculiarly 
Japanese-and thoroughly do their work. In all the cities, towns and 
moderate sized villages, these masseurs and masseuses wander slowly 
along the streets, often in front of the hotels, many of them dressed 
in a white or figured Kimonas and holding a staff. They use a rude 
flute or pipe from which three very melancholy sounding notes are pro- 
duced, and one hears all night long at intervals two and even three of 
these "professors" notifying the public that they are ready to be called at 
any moment. 
While mentioning the moxa and shampooing, it may be as well in 
this place to add a word concerning the third ancient practice already 
mentioned, which has descended to this day, viz: acupuncture. This 
branch of medical art originated centuries ago in Korea, and from 
thence was imported into Japan. Many schools for instruction in the 
various methods of its application flourished successively and from age 
by Whitney in his Notes on the History of Medical Progress in 
Japan, p. 289. 
Transactions of the Asiatic Society of Japan, Vol. XII., pt. IV. 15 
to age to the present day. The needles are about the size of the 
acupuncture needles that we use, and the hollow ones resemble those 
of our aspirating needles. They are made of steel, silver or gold, and 
are driven into the integument with a small mallet with force sufficient 
to pierce the skin and enter the connective tissue; they are then twisted 
sharply round several times and withdrawn. Ten, fifteen or twenty 
insertions are required, according to the nature of the disease for which 
they are applied. When the point is withdrawn the spot is rubbed 
with the finger in the same manner as we do after the use of the hypo- 
dermic needle. 
JAPANESE HOSPITALS. 
Upon my arrival at Tokyo I presented the letters which I had 
obtained at the Legation of Japan at Washington, one to Dr. Kanehiro 
Takaki, who, by the way, is a F. R. C. S. (Eng.) and Director-General 
of the Medical Department of H. I. M.'s Navy, and the other to Dr. 
Kensai Ikeda, physician to H. I. M., the Emperor. The latter was 
unfortunately absent at the Palace, but I was received kindly and 
graciously by Dr. Takaki, who speaks English fluently. I was not 
obliged to take off my shoes at the door, although the many sandals at 
the threshold indicated a large number of patients in the waiting-room. 
I was ushered upstairs to an apartment furnished in full English style, 
and filled with beautiful bronzes and other works of Japanese art. Tea 
was brought, and the Japanese smoke box, which you find everywhere, 
in all the shops, in the temples and in the houses. Still more to my 
surprise, the Sei-i kwai Medical Journal was brought to me, a periodical 
printed one-half in English and the other half in Japanese. In the for- 
mer I found among the original articles, one upon the "Toxicology of 
Male Fern with special reference to Visual Disturbance," and "A Re- 
view of the Preventive Measures taken against Kak'ke in the Im- 
perial Navy." In the latter "Clinical Observation on Poplyteal 
Aneurysm," a most aggravated case of which I saw in the Red Cross 
Hospital in the afternoon and from observations upon which the ar- 
ticle was taken, and "Clinical and Post-Mortem Notes on General 
Tuberculosis." Besides this, there was any quantity of ordinary 
journalistic matter, society proceedings, sanitary gleanings, condens- 
ations, etc. I note these facts, as they seem peculiarly interesting to 
me as indicating the rapid progress in all medical matters within the 
past thirty years. At the present there are ten or a dozen medical 
journals in Japan, and as appropriate in this place I might say that I 
saw afterwards at the Legation, through the kindness of Dr. Whitney, a 16 
copy of the new Japanese Pharmacopoeia published in Latin, and I 
think also in the Japanese tongue. In the afternoon I visited with 
Dr. Takaki the Red Cross Hospital, and was surprised beyond meas- 
ure at its modern completeness. It occupies, I should say, a space 
equal to two full-sized blocks in New York; has a front built of brick 
and stone, containing the usual offices, all of which are handsomely 
furnished in American style. The surgeons, staff and nurses are all 
wearing the so-called European costume. The first thing that strikes 
one is the extravagance of space occupied. The rooms are all 
spacious, with high ceilings, and commanding a beautiful prospect of 
the surrounding country. The entire construction is upon the pavilion 
plan, each pavilion being one story high and entered from a corridor, 
which opening upon a well-kept garden runs entirely around the 
buildings. I may be better understood if I say, that behind the build- 
ing devoted to offices, museum, library, etc., is a large, oblong, hex- 
agonal garden; entirely around this garden extends a corridor, and 
opening off this corridor at right angles and at a distance of about 
fifty feet apart are built the pavilions, fopr on each side and two at the 
further extremity. After the usual amount of bowing, tea was brought 
and the smoke-box. After patronizing both of these we went through 
the institution. Two things struck me while passing through the 
main building; one was the beauty of the pathological specimens; the 
second, the rare coloring of the pathological plates. These are all water 
color drawings, executed in the most realistic colors, true to nature, or 
rather to disease, and very carefully done. I inquired the cost of 
these paintings and found it to be about two yen each, equivalent in 
our currency to about $1.44. The surgical department is very com- 
plete, especially that devoted to operations. The floors can be flushed 
with water at a moment's notice, and every appliance for complete 
antisepsis is at hand. I was particularly pleased to see all the ap- 
proved apparatus for plaster bandaging and casts. The instruments 
were numerous and very much after our own patterns. I was also 
shown a number of leather cases all marked with the red cross, which 
were held in readiness for the field in case of war or insurrection, and 
which contained all the apparatus (instruments, splints, bandages) for 
surgical operations and surgical dressings. These at a moment's notice 
can be placed in the ambulances and sent to the seat of war or tumult. 
This hospital is under the patronage of the Imperial Household, and 
the management of the Red Cross Association, according to its recent 
circular,* which was kindly translated for me by Prof. Mazo Nitobe. 
§The History of the Red Cross Hospital. Tokio, July, 1892. 17 
The objects of the hospital are as follows : 
1. In times of peace for the reception of those injured by accidents 
or wounds of any kind. 
2. In times of war it is to be converted into a military institu- 
tion. 
3. In times of peace, according to the merciful power of the 
Imperial Household to be open for the good of the general 
public. 
There is a department of Internal Diseases, Surgery, Diseases of 
Women, Ophthalmology and Otology. Very poor persons may be 
attended free of charge but, as a rule, remuneration is required from 
patients. The following table will show the number of rooms, the 
charges and the cubic feet of air given to each patient. 
Classes. 
No. of 
Rooms. 
No. of 
Beds. 
No. of 
Persons 
in Room. 
Cubic 
Metres 
for Each. 
Daily Charge. 
American 
Currency. 
ist 
13 
13 
1 
75 
3.00 Yen 
$2.10 
2nd 
12 
12 
1 
60 
Y 1.50 s 
$1.05 
3rd 
16 
32 
2 
45 
Y 1.00 
$0.70 
4th and 5th. 
8 
28 
2 - 5 
30 
.30 - 60 
$0.21 - .42 
Cottages 
4 
6 
1 or 2 
3i 
1.50 
$1.05 
Charity 
4 
20 
5 
28 
The expense of carrying on this hospital is defrayed by an annual 
contribution of 5,000 yen a year, to be continued for ten years after 
1891, and by 5,000 yen contributed by the Red Cross Association ; 
the balance of the income being derived from the " pay patients." 
At present the number of charity patients is only ten, but the private 
rooms appeared quite well filled. There is a good training school 
for nurses here. The nurse must be over twenty and under thirty 
years of age, must remain in the hospital for two years after 
her graduation, and she is obligated to hold herself in readiness to be 
called at any time within twenty years. 
CHARITY HOSPITAL, TOKYO. 
After having gone thoroughly over this institution we drove to the 
Charity Hospital, founded and under the immediate supervision of Dr. 18 
Takaki. This institution is purely charitable and is dependent upon 
voluntary contributions for its support. It was founded in 1882, by 
Dr. Takaki, who takes the greatest interest in its welfare. Its last report, 
which I had also translated for me, || shows that since its opening 
in 1891, there have been treated, in patients, 2,542 ; recovered, 1,072; 
improved, 842; died, 569; remaining, 59. The number of out patients 
-that is, those treated in their private residences-was 28,255; of 
these there are 14,482, who are called " one-day patients," by which 
I suppose is meant those requiring one visit only ; thus making the 
number of those more seriously affected 13,773. Of these 8,419 
recovered, 4,689 improved;^- died, 434 ; remaining, 231. In 
passing through the wards of both these hospitals, I was struck by 
the position of the patients lying in bed, especially that of the women. 
They seemed to rest on their left side, with the knees slightly drawn 
up, and the feet always in a state of flexion. This must be attributed 
to constant habit of the Japanese of kneeling. By the term "sitting 
down," the Japanese mean kneeling with the foot flexed upon the 
floor almost in a line with the leg. The facility with which they 
assume and rise from this position is remarkable. They must find 
comfort in it, for where there is plenty of opportunity for them to sit 
as the Europeans, they draw their legs up under them whenever it is 
possible. 
KAK-KE (beri-beri). 
The most highly interesting portion of this visit was the opportu- 
nity afforded me of seeing several cases of kak'ke (beri-beri), a 
disease peculiar to Japan, China and Korea, and one which has 
caused a great deal of discussion among the Faculty in Japan. As 
Dr. Kakaki had made an especial study of this affection, and through 
his especial treatment it had been stamped out of the Japanese Navy, 
I was very glad to see these cases and to hear what he had to say 
concerning it. 
I think perhaps that this is the very latest information concerning 
the disease that comes from Japan. Kak-ke is classed, I believe, as 
an endemic neuritis, which I suppose should be one of the forms 
of multiple neuritis. The symptoms, as detailed to me by Dr. 
Takaki, are various and there are several degrees of severity. There 
are both sensory and motor disturbances. The disease may begin 
|| The Fifth Report of the Tokyo Charity Hospital, 1891. 
the translation, this number is said to have "lightly recovered"-which 
I take to mean "improved." 19 
with a patch of numbness on the leg, circumscribed and varying in 
size. This may be accompanied with fever or not. In the first case 
I saw the tendon reflexes were lost and there were two areas of 
anaesthesia. After a time general anasarca sets in, often accompanied 
by violent palpitation of the heart, and sometimes general and local 
paralysis. There is always more or less anaemia, sometimes to a 
great degree, and muscular atrophy. In another case I observed 
paralysis of only certain sets of muscles, which I understand 
frequently is present, and in some instances proves fatal. CEdema of 
the lungs also is in some cases a prominent symptom. I was so 
much interested in this to me entirely new disease, that upon my 
return to the hotel I wrote to Dr. Takaki, asking the following ques- 
tions : 
1. Does the disease attack others than soldiers and sailors ? 
2. Is it found much outside of Japan ? 
3. What were the actual articles of food eaten by the sailors befor 
you inaugurated your new diet list ? 
4. Are the symptoms always those of neurosis, viz. numbness 
hyperaesthesia, followed by cardiac palpitation ? 
5. Are there ever convulsions? 
To the 1st question the Doctor replied : That the disease may 
attack any person without regard to occupation. That he has seen it 
among scholars, boys, officers, carpenters, men, etc. 
To the 2nd: The answer was in the affirmative, with the specific 
words "where people take rice much as an article of diet." 
To the 3rd: "Too much rice with comparatively small quanti- 
ties of meat, fish, etc. (albuminates)." 
To the 4th : "Chief symptoms: CEdema, numbness, motor 
paralysis of limbs, loss of reflexes, indigestion and heart affections 
(palpitation). CEdema is almost always the first symptom." 
To the 5th : The simple word "never" is affixed. 
By a perusal of these answers the symptomatology of the disease 
may be made out. 
It may be well to state here that other ideas have been promulgated 
regarding the etiology of the disease, some declaring it to be caused 
by an intestinal parasite; others to a micro-organism. From the re- 
sults of the dietetic treatment already mentioned as adopted by Dr. 
Takaki, there can be no doubt that the disease arises from the super- 
abundance of carbohydrates and the lack of albuminous food. It is a 
well-known fact that for centuries rice has been the staple of food in 
Japan; that meat and milk were unknown until a few years ago. 20 
The following quotation will give some idea of the methods by 
which the doctor succeeded in discovering the cause and of eradicat- 
ing the disease:* 
"From the end of 1880, when Director-General Kanehiro Takaki- 
then Deputy Inspector General-was the director of the Tokyo Naval 
Hospital, he determined to inquire into the cause of Kak'ke. He 
noticed the great difference between the number of Kak'ke cases on 
board ships and in barracks, and also the same difference in the ships 
which went on long voyages, and began to think that such difference 
must be due to the difference between the articles of food given on 
board ships and in barracks, as other things being the same. Obtain- 
ing permission from the Minister of the Navy Department, he made 
an examination of food by visiting ships and barracks within the limits 
of the district of Uraga. He obtained a report showing the articles 
and quantities of food given in each ship or barrack during a week, 
and found on examination, that the amount of albuminates contained 
in the food given was not sufficient, and that the amount of carbo- 
hydrates was too great for the due preservation of health." 
He then concluded that the occurence of a large number of cases 
of Kak'ke, whether in men on long voyages or amongst ordinary 
students and shop assistants on shore, must be due to the food used, 
this being the cause of the great number of Kak'ke cases occuring in 
the ships and barracks within the limits of the Uraga district, and he 
inferred that the cause of Kak'ke must be in the improper proportions 
of carbon and nitrogen contained in the food. The immediate effect 
of supplying the men with a properly regulated diet is forcibly illus- 
trated by the facts, that in six years prior to the introduction of the 
proper diet, out of 29,321 men in the navy there were no less than 
9,516 cases of Kak'ke; in the six years immediately following the adop- 
tion of the improved diet, out of 48,275 men the number of cases was 
765, making an average of about one-third in the first period and one- 
sixty-third in the second. Since that period the disease is practically 
eradicated. Since my return from Japan, even as late as January of 
this year, I find a most interesting article by Albert S. Ashmead, of 
New York, on the Kak'ke Heart, which is noteworthy in this place.f 
After giving an account of the observation of many Japanese physi- 
cians on this subject, beginningas early asA.D. 640, he says: "They 
show that a prolonged first sound has been found in all stages of the 
* Review of the Preventive Measures taken against Kak'ke in the Imperial 
Navy, Tokyo, Twenty-third year of Meiji (1890), p. 5. 
f The International Medical Magazine, Phila., Jany., 1893, p. 1277. 21 
disease," which confirms the statement made by Dr. William A. Thom, 
Jr., Physician to the British Vice-Consulate at Norfolk, Va., who re- 
cognized this condition in the cases lately treated at St. Vincent's 
Hospital. This paper is well worthy of attention by those desiring 
further information upon the subject. 
I am told by a professor of the University that, up to the times of 
the revolution, physicians were not permitted by royal edict to enter 
society, and were compelled to lead secluded lives. As with the 
priests, commingling with the world distracted their attention from the 
proper pursuit of their profession, it was thought that the entire life of a 
medical man should be concentrated upon the healing of the body. In 
order, therefore, that there should be no extra temptations and that the 
people should be able to distinguish physicians from other professions, 
all the doctors were obliged to have their heads cleanly shaved. 
Upon the same authority, I must state, sorry'as I am to say it, 
that American medicine does not hold a high position at the pres- 
ent time in Japan, the decided preference of all the people inclin- 
ing to the German practice. This, I am told, can be, in a meas- 
ure, accounted for, by smallness of the fees, and to the lack of attain- 
ments possessed by many who, perhaps, after other unsuccessful 
trials in America, choose Japan as a last resort wherein to practice 
the healing art. The fees of the Japanese are, indeed, small, and 
are not regulated by the number of visits made, but upon the quan- 
tity of medicine given. I think, about eighteen cents a day is 
allowed for the drugs used. The doctors, to increase their fees, 
supply medicine for a week or a fortnight. 
To make this paper a little more complete, I will add here a letter 
that 1 received from Dr. Whitney in answer to some questions I asked 
him regarding medical practitioners, and one also from Miss Richards 
in reference to training schools for nurses. 
United States Legation, Tokio, 
August 2, 1892. 
Dear Dr. Helmuth : 
There are several women practicing medicine, two of whom I am 
personally acquainted with, Dr. Okami, a graduate of the Women's 
Medical College of Philadelphia, and another whose name I have for- 
gotten, who is now located on the Negestei road, Yokohama, in 
a neat little hospital. There are no homceopathists, hydropathists, 
or Western eclectics in Japan, although there are a very numerous 
class of eclectics, who practice Chinese and Western Medicine. 22 
I should have said that the above-mentioned lady doctors, and one 
or two more I have heard of, are fairly well received. The New 
Charity Hospital Medical School will admit ladies from next term . 
(Signed) W. N. Whitney. 
Sincerely yours, 
M. E. Hospital, 
Broad and Wolfe Streets, 
Dear Dr. Helmuth : 
Phila., September 22, 1892. 
I, as you may know, went out under the American Board of Mis- 
sions, and organized a training school for Japanese women in Kyoto, 
Japan. I found that the nurses who graduated were treated with a 
great deal of respect, and with more consideration than nurses are 
here in America. Training schools where nurses receive excellent 
instruction have been organized; and I am told nurses graduating 
from these schools receive very large wages for women in Japan. The 
nurses who have graduated from the Mission School have, many of 
them, been invited to go into hospitals in charge of the nursing de- 
partments, and have been treated with respect. 
Training schools have elevated the nurses who have been trained. 
Of medical women and their standing I know less than I do of nurses. 
I have been away from Japan nearly two years. During that time 
some medical women who had been in America in medical 
colleges have returned to Japan. One, I think, has a hospital appoint- 
ment in Tokio. Training schools are popular. Several Japanese 
women have been sent to Europe into training schools to suffi- 
ciently perfect themselves to take charge of training schools in 
Japan. 
Very sincerely. 
Linda Richards. 
February 25.-Since this lecture was delivered before the Homoeo- 
pathic Medical Society of the County of New York, on Feb. 9, the 
author has received a letter from Yokohama, bearing date of Jan. 27, 
1893, stating that Dr. Mary A. Gault, a graduate of the Cleveland 
Homoeopathic College, Class of 1883, has been successfully practising 
homoeopathy in Japan for two years. This fact has been mentioned 
that the reader may know that the seed has been sown, and that the 
prediction is made, that as certain as the sun shines it will in good 
time bear fruit in abundance.