Social History of Medicine Vol. 26, No. 2 pp.

165181

The Private World of a Meiji-era Japanese Doctor:

Ishii Kendos Diary of 1874
Ellen Nakamura*

Summary. The diary of Ishii Kendo (184082) affords an insight into the world of a Western-style
medical practitioner during a unique time of transition in Japans medical history. This article examines Ishiis life and career with attention to the social networks that supported his medical activities
and the way he constructed his professional identity through cultural participation as well as therapeutic choice. Ishiis peers included prominent members of the civilisation and enlightenment movement, and it is argued here that Ishii was motivated by a belief in the medical version of this cultural
ideal. Yet Ishiis career is also ultimately an example of the way in which doctorseven those who
were themselves part of the Westernisation projectwere subject to new challenges and hierarchies
of knowledge as the transition to Western medicine took effect. His case provides an opportunity to
explore the intersection between medical policy and individual medical practice.
Keywords: Japan; therapeutics; civilisation and enlightenment; social networks; professional identity

Throughout the year of 1874, thirty-three year old physician Ishii Kendo (184082) wrote
in his personal diary faithfully every day, recording with endearing frankness his bodily
condition, his medical and daily activities.1 His one-year chronicle affords an insight into
the private world of a Western-style medical practitioner during a unique time of transition in Japans medical history. In August of the same year the Meiji government promulgated its Medical Regulations (Isei), which required for the first time that all medical
doctors be licensed, and that all new doctors be trained in Western medicine. The Meiji
governments commitment to Western medicine was both a culmination of the
growing interest in Western medicine in the late Tokugawa period, and a part of the
desire to seek knowledge throughout the world that was announced in the Charter
Oath of April 1868.2 With the gradual privileging of Western medical knowledge,
Ishiis skills as a translator and physician trained in Dutch-style (ranpo) medicine put him
in a powerful position. He taught at elite institutions, earned an excellent salary, and at
the peak of his career, was awarded court rank. The recognition and promotion of
*University of Auckland, Private Bag 92019 Auckland 1142, New Zealand. E-mail: e.nakamura@auckland.ac.nz.
Ellen Nakamura is Senior Lecturer in Japanese and History at the University of Auckland, New Zealand. She is the
author of Practical Pursuits: Takano Choei, Takahashi Keisaku, and Western Medicine in Nineteenth-Century Japan
(Cambridge, Mass.: Harvard University Asia Center, 2005), and a number of journal articles. Ellen is interested
broadly in the social and medical history of Tokugawa period Japan. Her current research focuses on the Japanese
physicians of western medicine who lived through the transition from Tokugawa to Meiji.
1

Ishii was also known as Ishii Nobuyoshi. The diary is

available in published form as Ishii Nobuyoshi no
nikki, in Tsukizawa Satoru, Kyodo no rani Ishii
Soken no ashiato o tadoru (Ochiaimachi: Ochiaimachi
Kyoiku Iinkai, 1992), 198302. All quotations from
the diary are translated from this edition.

For an English translation of the oath, see Ryusaku

Tsunoda, William Theodore de Bary and Donald
Keene, Sources of the Japanese Tradition (New York:
Columbia University Press, 1958), 644.

The Author 2012. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
All rights reserved. doi:10.1093/shm/hks083
Advance Access published 28 October 2012

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Ellen Nakamura

Western medicine as orthodox by the Meiji government was in one sense a victory for the
ranpo physicians like Ishii who had long touted its benefits. Yet Ishiis career also provides
an example of the challenges faced by doctorseven those who were themselves part of
the Westernisation projectas new hierarchies of knowledge were created in the transition to modern Western medicine.
This article forms part of a larger project that seeks to understand how ordinary doctors
of Dutch-style medicine lived out the transition to modern western medicine in the late
Tokugawa and early Meiji periods, both as individuals and as interconnected communities
of practitioners. In discussing the contribution of ranpo physicians to medicine in the early
Meiji period, historians have tended to draw attention to the successes of influential men
such as Matsumoto Ryojun (18321907) and Nagayo Sensai (18381904), who are well
known for their contributions to shaping medical policy. By examining the life and social
world of a less famous physician, I hope to present a complementary view from below of
the complex interaction between policy, cultural ideals, and individual medical practice.
Through the study of Ishii, I suggest that Japans medical transformation was not only
a top-down process in which Western medicine was sponsored and progressively institutionalised by the State, but also the result of the collective beliefs and activities of physicians who thought that Western medicine was worth practising in their daily lives. While
legislative changes were important, medical culture was also created by the attitudes and
activities of practitioners, who sometimes challenged and sometimes reinforced State
policies in their daily work.
Alexander Bay has described the adoption of Western medicine in Japan, particularly
after 1880, as internal colonization, whereby the medical community slowly came to
be dominated by the (largely foreign-educated) medical elite of Tokyo Imperial University.3 Bay is concerned with the nationalisation of medicine and the regulation of citizens
bodies through legislation: a centralising process that was still in its infancy at the time
under examination here. In the sense that Ishii was initially on the teaching staff of the
Igakusho, the official medical school which was later to evolve into the medical department of Tokyo Imperial University, he can be seen as closely connected to the
State-sponsored Westernisation project. Indeed, for a short time, he worked as a
medical bureaucrat in the governments translation office. On the other hand, he was
later sidelined from this central position as the knowledge he possessed came to be
less valuable than that which could be obtained through a foreign medical education.
Ishii himself seems to have accepted this (consciously or unconsciously), for he saw
foreign and foreign-trained doctors as a source of authority and medical advice. Thus,
the idea of self-colonisation is illuminating of the way in which ranpo doctors such as
Ishii might take on and internalise State-sanctioned hierarchies of medical knowledge.
Building also upon Michael Browns recent work, which suggests that the medical profession of late eighteenth- and early nineteenth-century England was an imaginative
concept, a point of individual and collective self-identification , I begin by exploring
the importance of medical networks in shaping Ishiis career as a whole and in fuelling
3

Alexander R. Bay, Beriberi, Military Medicine, and

Medical Authority in Prewar Japan, Japan Review,
2008, 20, 11156, 113.

The Private World of a Meiji-era Japanese Doctor

167

his preference for Western medicine.4 It is clear from Ishiis diary that he turned to his
network of friends and colleagues to seek not only companionship but also medical
and professional advice. By engaging with his medical peers, Ishii continually furthered
his knowledge and reinforced his imagined identity as a practitioner of Western medicine.
Secondly, I use the rich source material available in Ishiis diary to shed light on his everyday experience of medical practice in post-Restoration Tokyo. This investigation takes
place through the lens of Ishiis interpretation and treatment of his own ailments
(which he reported in intimate detail) and through descriptions of the treatment of a
small number of patients. Ishiis therapeutic choices demonstrate his enthusiasm for the
new medicine at a time when its practical benefits were questionable. Also significant
is the way in which he used his personal network of medical contacts to seek advice
and obtain drugs. With the support of his colleagues Ishiis commitment to Western medicine remained constant, despite setbacks to his career and deteriorating personal health.
Ishiis preference for Western treatments can be construed as an expression of his identity as a ranpo physician. He was particularly influenced by the civilisation and enlightenment movement: a commitment to the cultural ideals of modernisation in Western style.
In writing of the situation in nineteenth-century America, Warner has observed that physicians used medical therapeutics as a way of expressing their professional identities and
that the unregulated medical environment of nineteenth-century America was conducive
to this kind of identity therapeutics.5 In the environment of early Meiji Japan, when the
medical regulations were only just coming into place, Ishiis extensive use of Western
drugs can similarly be seen as a way of distancing himself from the majority of
Chinese-style physicians. As Rosenberg has suggested in his classic essay on therapeutics
in nineteenth-century America, therapeutics incorporates all those cultural factors which
determine belief, identity, and status, and is not simply a matter of the application of a
cognitive system of medical explanation.6 Ishiis identity as a physician of Western medicine was constructed through the social relations he maintained, the food and clothes he
bought, the books he read and the medical advice he both sought from his peers and dispensed in his own practice.

Western Medicine in Japan

By the time Ishii wrote his diary, Western medicine had already enjoyed a significant presence in Japan for at least a hundred years. Rangaku, or Dutch Learning scholarship was a
small but significant area of intellectual inquiry that came to cover many fields, despite the
maritime prohibitions that restricted access to Western books and limited Japans relationship with the West to an economic arrangement with Dutch traders.7 Medicine was a particularly popular area of scholarly interest, because of the growing interest in anatomy
4

Michael Brown, Performing Medicine: Medical Culture

and Identity in Provincial England, c.17601850 (Manchester: Manchester University Press, 2011), 6.
5
John Harley Warner, The Therapeutic Perspective:
Medical Practice, Knowledge, and Identity in
America 18201885 (Cambridge, MA: Harvard University Press, 1986), 1278.
6
Charles E. Rosenberg, The Therapeutic Revolution:
Medicine, Meaning, and Social Change in Nineteenth-

Century America, in Charles E. Rosenberg and Morris

J. Vogel (eds), The Therapeutic Revolution: Essays in
the Social History of American Medicine (Philadelphia:
University of Pennsylvania Press, 1979), 4.
7
The classic work on Japanese foreign relations in the
Tokugawa era is Ronald Toby, State and Diplomacy
in Early Modern Japan: Asia in the Development of
the Tokugawa Bakufu (Princeton: Princeton University
Press, 1984).

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Ellen Nakamura

among Japanese doctors, as well as the inspirational presence of a number of European

doctors in Nagasaki, including Philipp Franz von Siebold (17961866) from 1823 to 1829,
and Pompe van Meerdervoort (18291908) from 1857 to 1862. Eventually, Western-style
medicine gained enough influence to need its own terminology, and was known as ranpo
medicine, in contrast to the dominant kanpo, or Chinese style medicine. After 1868,
German medicine was thought to be the best model for Japan, and, as a first step, the
German military doctors Leopold Mller (18241893) and Theodor Hoffmann
(18371894) were brought to Japan to teach medicine in 1871.8 Along with these measures to support the education of physicians in Western-style medicine, the government
also moved to establish Western-style hospitals. By 1874, there were fifty-two of these
hospitals throughout the country.9
Historians have been divided on the significance of rangaku for the developments that
followed. An important theme in Japanese scholarship has been understanding the place
of rangaku in the modernisation process and whether such knowledge had a role in challenging the feudal Tokugawa system, or simply became a tool of the Tokugawa establishment.10 More narrowly defined histories of medicine have also pursued the question
of Japans medical modernisation. Many of these have focused on the lives and contributions of individual doctors, and a number of early histories were written by the descendents of ranpo doctors themselves.11 Some general histories also follow this approach, by
combining an examination of historical developments with the contributions of prominent
doctors. Important examples of this genre include Fujikawa Yus canonical Nihon igaku shi
(A History of Japanese Medicine) and Hattori Toshiros Edo jidai igakushi no kenkyu
(Research on the History of Medicine in the Edo Period).12 Biographical studies also
feature. Indeed, some of Ishiis famous contemporaries wrote autobiographies.13
Another focus of Japanese general medical histories has been on institutional history,
namely the establishment of medical schools and hospitals, and their individual histories.14 Some works centre on the development of medical policy and its role in transforming the Japanese medical system, a field of enquiry which continues to attract attention.15

Sakai Shizu, Nihon no iryoshi (Tokyo: Tokyo Shoseki,

1982), 3926.
Koseisho Imukyoku (ed.), appendix to Isei hyakunenshi
(Tokyo: Gyosei, 1976), 54.
10
For a summary of historiographical developments in
English see Numata Jiro, Studies of the History of
Yogaku: A Bibliographical Essay, Acta Asiatica,
1982, 42, 75101.
11
Notably Kure Shuzo, Mitsukuri Genpo (Kyoto: Shibunkaku, 1971); Ogata Tomio, Ogata Koan den
(Tokyo: Iwanami Shoten, 1977); Takano Choun,
Takano Choei den (Tokyo: Iwanami Shoten, 1943).
12
Fujikawa Yu, Nihon igakushi (Tokyo: Keiseisha,
1979); Hattori Toshiro, Edo jidai igakushi no kenkyu
(Tokyo: Yoshikawa Kobunkan, 1978).
13
See for example Ogawa Teizo and Sakai Shizu (eds),
Matsumoto Jun jiden, Nagayo Sensai jiden (Tokyo:
9

Heibonsha, 1980); Ishiguro Tadanori, Kaikyu

kyujunen (Tokyo: Iwanami shoten, 1995).
For example, Juntendo (ed.), Juntendo shi (Tokyo:
Juntendo Daigaku, 1980); Tokyo Daigaku Igakubu
Soritsu Hyakunen Kinenkai and Tokyo Daigaku
Igakubu Hyakunenshi Henshu Iinkai (eds), Tokyo
Daigaku Igakubu hyakunenshi (Tokyo: Tokyo
Daigaku Shuppankai, 1967).
15
Important examples of these include Koseisho Imukyoku (ed.), Isei hyakunenshi (Tokyo: Gyosei, 1976);
Sugaya Akira, Nihon iryo seidoshi (Tokyo: Hara
Shobo, 1978); or more recently, Aoyagi Seiichi,
Kindai iryo no akebono : Bakumatsu, Meiji no iji
seido (Kyoto: Shibunkaku, 2011); Kasahara Hidehiko
and Kojima Kazutaka, Meijiki iryo, eisei gyosei no
kenkyu : Nagayo Sensai kara Goto Shinpei e (Kyoto:
Minerva Shobo, 2011).
14

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169

Historical epidemiology and cultural understandings of disease have been explored in

works by Fujikawa, Tatsukawa and, more recently, Sakai, Shinmura and Yamada.16
Some of the more critical histories have explored the modernisation of Japans medical
system as an attempt to understand the origins of present day problems, seen variously as
relating to capitalism, imperialism or colonialism. One early contribution was made by
Kawakami Takeshi, who, using a Marxist approach, located problems in the contemporary Japanese medical system in the evolution of practising physicians since the Meiji
period, including what he saw as a reliance on commercialism and an incomplete separation of pharmacy and medical practice.17 The overall thrust of Shinmura Takus
edited work Nihon iryoshi (A History of Japanese Medicine) is to understand contemporary problems by examining the past. In looking at the Meiji period, one recent theme
(present in Shinmuras work as in Bays) has been to emphasise the way in which individuals and their bodies came under the control of the Meiji state.18
The particular contributions of the ranpo physicians have been considered in important
works by Aoki, who focuses on local doctors and the spread of Western-style medicine
into the countryside; Achiwa, who emphasises the importance of translation; and
Sugimoto, who has produced a number of detailed but rather eclectic studies. The transition from Tokugawa to Meiji tends to be underrepresented in these studies. On the
whole, Japanese historians award the practitioners of ranpo medicine a limited but very
positive role in preparing the way for the adoption of a modern Western medical
system in the late nineteenth century.19
As will be clear from this brief survey of the literature in Japanese, many studies have
been made of the adoption and institutionalisation of Western medicine in Meiji Japan,
but there have been fewer works which explore how these revolutionary changes manifested themselves in the attitudes and daily work of medical practitioners, particularly
in the early Meiji period. In English, early Western scholarship on the Dutch Studies movement in Japan tended to see it as too unsystematic to form a real basis for the adoption of
Western science. In the view of one scholar, the efforts of Japanese scholars in the Edo
period amounted to little more than a miscellaneous collection of practical data and techniques, and was hence meaningless.20 Recent works, however, have recognised the significance of social networks in spreading technologies such as Jennerian vaccination in
Japan, and argued that hybrid styles of medicine should not simply be viewed as
failed ventures into Western medicine.21 Moreover, valuable preliminary work has
now been published on the medical practices of individual doctors during earlier
16

Fujikawa Yu, Nihon shippeishi (Tokyo: Heibonsha,

1969); Tatsukawa Shoji, Nihonjin no byoreki
(Tokyo: Chuo Koronsha, 1976); Sakai Shizu, Yamai
ga kataru Nihon shi (Tokyo: Kodansha, 2002); Shinmura Taku, Kenko no shakaishi : yojo eisei kara
kenko zoshin e (Tokyo: Hosei Daigaku Shuppankyoku, 2006); Yamada Keiji and Kuriyama Shigehisa,
Rekishi no naka no yamai to igaku (Kyoto: Kokusai
Nihon Bunka Kenkyu Sentaa, 1997).
17
Kawakami Takeshi, Gendai Nihon iryoshi; kaigyoisei
no hensen (Tokyo: Keiso Shobo, 1965).
18
See also essays by Narita Ryuichi, such as Eisei
kankyo no henka no naka no josei to joseikan, in

Joseishi Sogo Kenkyukai (ed.), Nihon josei seikatsushi

(Tokyo: Tokyo Daigaku Shuppankai, 1990), 89124.
Aoki Toshiyuki, Zaison rangaku no kenkyu (Kyoto:
Shibunkaku, 1998); Sugimoto Tsutomu, Edo no
Oranda-ryu ishi (Tokyo: Waseda Daigaku Shuppanbu, 2004); Sugimoto Tsutomu, Edo ranpoi kara
no messeiji (Tokyo: Perikansha, 1992).
20
Grant Goodman, Japan: The Dutch Experience
(London: The Athlone Press, 1986), 22830.
21
Ann Jannetta, The Vaccinators: Smallpox, Medical
Knowledge, and the Opening of Japan (Stanford:
Stanford University Press, 2007); Ellen Nakamura,
Practical Pursuits: Takano Choei, Takahashi Keisaku,
19

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Ellen Nakamura

periods in Japanese history.22 For the Meiji period, Donz has described the hierarchy of
practitioners (established formally in legislation after 1906) that included all kinds of
doctors, both western and traditional, but was led by those who had university qualifications in Western medicine. He has pointed to the significance of the many nameless
practitioners of the Meiji period who paid their own way to study abroad and returned to
Japan to practise privately.23 As I have explained, Ishii Kendo was well connected in the
medical world, but he neither studied abroad, nor succeeded as a medical bureaucrat
or educator in the manner of his more famous contemporaries. I will now turn to a
summary of his life and career before introducing an examination of his diary.

Ishii Kendo, 184082

Ishii Kendo was born in 1840 in Katsuyama domain (now Okayama prefecture), as Hisakichi, the son of Ishii Soken (17961861), a ranpo doctor, and his concubine Muro. Soken
was a low-ranking samurai who had travelled to Nagasaki in 1823 to study with Philipp
Franz von Siebold in his school at Narutaki. This school provided Japanese doctors with
their first opportunity to receive systematic training in Western medicine from a European.24 Soken later served his native Katsuyama domain as an official doctor, spent a
short period studying with Shingu Ryotei (17871854) in Kyoto, and opened a private
practice in Okayama, before eventually being called to Edo to serve the Bakufu government. Soken was well-acquainted with the other men who studied in the Narutaki
school, as well as other prominent rangaku scholars such as Mitsukuri Genpo
(17991863).25 Soken is best known for his connection to Siebolds Japanese daughter
Ine, to whom he was teaching obstetrics in Okayama from 184551. The relationship
turned sour when Soken forced himself upon her and she consequently bore a daughter,
Tada (later Takako) in 1851.26
Ishii Kendo thus grew up surrounded by the influence of Western medicine and with
Siebolds daughter Ine present in the house for a portion of his childhood years. While
Ine fled Okayama and severed her relationship with Soken after her pregnancy, Kendo
enjoyed an amicable and supportive relationship with Ine and his half-sister Takako in
later life, and both of them appear in his diary of 1874. Kendo also had another halfbrother by the name of Umetaro, by a different mother, of whom little is known.27
Kendos early life is sparsely documented. He appears to have attended the domain
school in Okayama before moving to Edo (now Tokyo) with his father when Soken was
appointed an official Bakufu physician in the sixth month of 1853 in the wake of
and Western Medicine in Nineteenth-Century Japan
(Cambridge, Massachusetts: Harvard University Asia
Center, 2005).
22
Susan L. Burns, Nanayama Jundo at Work: A Village
Doctor and Medical Knowledge in Nineteenth
Century Japan, East Asian Science, Technology, and
Medicine, 2008, 29, 6283; Andrew Goble, Rhythms
of Medicine and Community in Late Sixteenth
Century Japan: Yamashina Tokitsune (15431611)
and his Patients, East Asian Science, Technology, and
Medicine, 2008, 29, 1361.
23
Pierre-Yves Donz, Studies Abroad by Japanese
Doctors: A Prosopographic Analysis of the Nameless

Practitioners, 18621912, Social History of Medicine, 2010, 23, 24460.

Harmen Beukers, The Mission of Hippocrates in
Japan (Amsterdam: Four Centuries of NetherlandsJapan Relations, 1998).
25
The most comprehensive biographical study of Ishii
Soken is Tsukizawa, Ishii Soken.
26
Ellen Nakamura, Working the Siebold Network:
Kusumoto Ine and Western Learning in NineteenthCentury Japan, Japanese Studies, 2008, 28,
197211.
27
Tsukizawa, Ishii Soken, 3037.
24

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171

Commodore Perrys arrival.28 In Edo, Kendo studied with (at least in the manner of an
apprentice) some of the most prominent Dutch-studies scholars of his time, including Mitsukuri Genpo (17991863) and Katsuragawa Hoshu (18261881).29 A number of options
were explored regarding his further training. A letter that Soken wrote in 1857 to Dutch
studies scholar and military expert Murata Zoroku (182469) suggests that he was making
arrangements for Kendo to study with him.30 According to domain records, however,
Kendo went to Nagasaki in the seventh month of 1857 to study rangaku with a Nagasaki
interpreter.31 None of these activities were long-lasting, and Kendo moved to Osaka in
the fourth month of 1858, to enter the Tekijuku of Ogata Koan (181063).32
Ogata Koan was a highly trained, charismatic teacher who opened the Tekijuku in
1838, and soon attracted students from all over the country. Here, in this large and flourishing school, Ishii forged relationships with his teacher and fellow students that were to
influence the remainder of his career and social life. Two of these men appear prominently
in the diary and are particularly noteworthy because they became influential members of
Meiji society: Nagayo Sensai (18381902), who became director of the Medical Bureau
and ambassador of the governments Medical Regulations; and Fukuzawa Yukichi
(18341901), founder of Keio University and an outspoken proponent of the civilisation
and enlightenment movement.
While it should not be forgotten that Ogata was also a practising physician, the main
emphasis in the school was the learning of Dutch language and texts. Both Nagayo
and Fukuzawa, who entered the school in 1854 and 1855 respectively, described life at
the school in their autobiographies. In any year, there were around 100 students enrolled
at the school, where they also boarded. Students were divided into eight classes and
placed in a competitive environment whereby those who recited and translated their
portion of text successfully were given marks that formed the basis for promotion to a
higher class, and eventually to class leader. Academic merit was also the criterion for
determining spaces for studying and sleeping, which meant that they were fiercely contested. Students crowded around the one communal copy of a JapaneseDutch dictionary
day and night, quietly looking up vocabulary.33

Katsuyama han nichiroku, cited in ibid., 13145,

137.
29
There is evidence that Kendo was running errands for
the Mitsukuri household in 1856 and his name
appears in the acknowledgements for Katsuragawa
Hoshus Oranda Jii (1858). See Sosogu Nakayama,
Mitsukuri Genpo to Okayama no rangakusha
gunzo, in Rangaku shiryo kenkyukai (ed.), Mitsukuri
Genpo no kenkyu (Kyoto: Shibunkaku, 1978),
387424, 41213.
30
Murata was later known as Omura Masujiro and
became famous as a military tactician in the Choshu
campaigns against the Tokugawa and the Boshin civil
war. Murata had studied Dutch at the Tekijuku and
at this time, he was teaching at the Bakufus military
school in Edo. Sokens letter appears in Nihon Ishi
Gakkai (ed.), Zuroku Nihon iji bunka shiryo shusei, 5
vols (Tokyo: Sanichi Shobo, 1977), V, 161.
28

Katsuyama han nichiroku, 141.

Ogata Tomio, Tekitekisaijuku seimeiroku, appendix
to Ogata Koan den (Tokyo: Iwanami Shoten, 1977),
267.
33
Nagao Sensai, Shokoshishi, in Ogawa Teizo and
Sakai Shizu (eds), Matsumoto Jun jiden, Nagayo
Sensai jiden (Tokyo: Heibonsha, 1980), 10810;
Fukuzawa Yukichi, Fukuojiden, in Matsuzawa
Hiroaki (ed.), Fukuzawa Yukichi shu, Shin Nihon
koten bungaku taikei, Meiji hen (Tokyo: Iwanami
Shoten, 2011), X, 928. In English, see also Fukuzawa Yukichi, The Autobiography of Fukuzawa
Yukichi, Eiichi Kiyooka (trans), (Tokyo: Hokuseido
Press, 1960), 7883; Richard Rubinger, Private Academies of Tokugawa Japan (Princeton: Princeton University Press, 1982), 12651.
31
32

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Ellen Nakamura

At the time Ishii arrived at the Tekijuku in 1858, the head student was Fukuzawa. Following Fukuzawas departure for Edo later that year, Nagayo succeeded his position.34
Thus, these young men were in a position to nurture and influence Ishii upon his
arrival. Ishii thrived within this environment and earned his teachers unqualified praise
for his scholastic abilities. In a letter written in 1860, Ogata told Ishiis father of his
sons excellent progress, writing: There is no one in the school at present who can
outdo him. He is truly a naturally clever scholar.35
Ishii possessed another close friend who was a member of the Tekijuku network,
though their time at the school did not overlap. Physician Shimamura Teiho (183081),
hailed, as Ishii did, from what is now Okayama prefecture, and it is likely that the two
knew each other from childhood. Shimamura entered the Tekijuku in 1852 and passed
through all levels of the curriculum in a single year, before being invited to become
head student of another school in Kyoto. Shimamuras older brother, Tsuge Raikichi,
however, entered the school just a few months after Ishii in 1858, and studied alongside
Ishii, despite their considerable age difference.36 Shimamuras later career mirrored Ishiis
in several significant ways. Their intimacy is reflected in the roughly 120 times that Shimamuras name appears in Ishiis diary over the course of the year.
Ishii completed his studies at the Tekijuku in 1860 and returned to Edo. His father Soken
died the following year, and Ishii inherited his position as official doctor to Katsuyama
domain and remained on duty in Edo. Some secondary sources suggest that Ishii
studied with Pompe in Nagasaki, and indeed there is some evidence that he intended
to do so. Domain records report a request he made in 1862 to study further in Nagasaki,
but it reads as follows: Ishii Kendo said he wanted to study medicine with the Dutch
doctor Pompe in Nagasaki, but since he is already well acquainted with Ninomiya
Keisaku who lives in Doza in Nagasaki, he would like to study with him [instead] and
has submitted a request for leave next year.37 Ninomiya (180462) was another of Siebolds students, who had also played a role in teaching his daughter Ine. He died
shortly after the request was made, however, and Ishiis plans did not eventuate.38
Ishiis fate changed in the eighth month of 1862, when Ogata Koan was called to Edo to
become an official Bakufu doctor and director of the Bakufus School of Western Medicine
(Igakusho). Upon his recommendation, both Ishii and Shimamura became teachers at the
school. They remained at their posts throughout the crisis caused by Ogatas death from
tuberculosis the following year, and the reforms undertaken by the Schools next director,
Matsumoto Ryojun. Matsumoto, influenced by his studies with Pompe, wanted to emphasise medical education rather than the learning of Dutch language. Ishii became responsible
for the teaching of pathology, and Shimamura for physiology. Matsumoto himself took
responsibility for internal medicine. The other teachers included Tsuboi Tameharu

34

Ogawa and Sakai, Matsumoto, 206; Fukuzawa,

Fukuojiden, 110.
35
Ogata Koan, Ogata Tomio, and Umetani Noboru
(eds.), Ogata Koan no tegami, 5 vols (Tokyo: Saine
Shuppan, 1996), IV, 7380.

Tsuge Kenya, Ishii Soken, Nobuyoshi oyako to Tsuge

Seisai, Teiho (Shimamura) kyodai, Itteki, 1998, 6,
18.
37
Katsuyama han nichiroku, 144.
38
On Ninomiya see Kure Shuzo, Shiiboruto Sensei sono
shogai oyobi kogyo, 3 vols (Tokyo: Heibonsha, 1968),
III, 239.
36

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173

(pharmacy) and Kirihara Genkai (anatomy).There were also tutors for Dutch language,
mathematics, chemistry, and physics.39
As the Restoration drew near, Matsumoto tried to prepare the students for their anticipated roles as military doctors, and Shimamura was ordered to give lessons in treating
gunshot wounds. Eventually, as Tokugawa Yoshinobu declared the return of power to
the Emperor and Tokugawa forces were pushed northwards, Matsumoto took a couple
of students and ran off north to join the Tokugawa forces, leaving the school without
a director. Most of the students dispersed.40
The medical school was quickly taken over by the new Meiji government, with caretaker directors appointed in the place of Matsumoto. Eventually, it was amalgamated
with a military hospital, and renamed the Medical School and Hospital in 1869. Ishii,
Shimamura, Tsuboi, and several of the other teaching staff were retained, under the directorship of Ogata Koans son, Koreyoshi.41 Ishii was appointed at the level of daigaku
daijokyo (around the middle of the professorial scale) and received the junior seventh
court rank.42
In the tenth month of 1870, Ishii left Tokyo to take up a position as director of the newly
established Osaka Medical School and Hospital. This institution had been established by
imperial command the previous year, and Ogata Koreyoshi had served as its first director.43 Ishii remained in this appointment for one year, working closely with Christiaan
Jakob Ermerins (184180), who was employed as a lecturer, and his brother-in-law
Mise Shuzo (Takakos husband), who was employed as translator.44 Ine was also in
Osaka at this time. The school employed a punishing schedule, with lectures scheduled
from six in the morning until eight at night.45 Ishii resigned and returned to the
medical school in Tokyo (now the Daigaku Toko) at the end of 1871.46
By 1873, Ishii was unwell with the stomach complaint that was to plague him throughout his 1874 diary. He left teaching to become a member of the newly established
Medical Bureau (Imukyoku) in the Ministry of Education, and worked with his close
friend Shimamura, as well as Tsuboi Tameharu (182486) and Shiba Ryokai (183979)
on translating works on Western medicine into Japanese, under the directorship of
Nagayo Sensai.
At the time Ishiis diary was written, he was living with his wife, three children, and two
apprentices in the Surugadai area of Tokyo. Ishii had married Takahashi Ai in 1866, at the
suggestion of Fukuzawa Yukichi. Ai was the younger sister of another Tekijuku student,
Takahashi Juneki (183265), and the marriage was arranged as a solution to the problem
of her welfare after her brothers death.47
In Ishiis role as a translator of Western medical books for the Medical Bureau of the
Education Ministry, he received an excellent salary of around 142 yen per month.48 He
39

Ishiguro, Kaikyu kyujunen, 1345.

Tokyo Daigaku Igakubu ed., Hyakunenshi, 7993.
41
Ibid., 104.
42
Katsuyama han nichiroku, 145.
43
Ogata Koreyuki, I no keifu : Ogata-ke godai Koan,
Koreyoshi, Keijiro, Junichi, Koreyuki (Osaka: Nenshosha, 2007), 214.
44
Sakai, Nihon no iryoshi, 46771.
45
Ogata, I no keifu, 2223.
40

Ogata Keijiro, Ishii Nobuyoshi Sensei to Osaka, Idan,

1942, 14, 71531, 720.
Letter from Fukuzawa to Nanjo Koken. Keio Gijuku
(ed.), Fukuzawa Yukichi Zenshu, 22 vols (Tokyo:
Iwanami Shoten, 1970), XVII, 223.
48
Ishii Nobuyoshi no nikki, 208 (entry for 5 February).
By comparison, foreign employee Lafcadio Hearn
received 100 yen per month from 1884 to 1903 for
his teaching job in Matsue. See Hazel Jones, The
46

47

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Ellen Nakamura

also practised privately as a medical practitioner and engaged in money-lending activities.

Imaizumi Mine, a daughter of the Katsuragawa family with whom Ishii had studied,
recalled his house as a former daimyos residence complete with an impressive garden,
a hospital wing, and rooms for housing and schooling students.49 It is clear from the
diary that Ishii rented out rooms in the former samurai barracks as a profit-making
venture. A civilised Meiji gentleman, Ishii indulged in Western food and wine, bought
Western-style household items, and was in the process of converting some of his
house to a Western style.
The study of the Dutch and English languages and Western medicine had brought
Ishiis career to great heights, both in terms of material wealth and social prestige. The
year of 1874, however, can be seen as a turning point after which his career and personal
health began to decline. Ishii and Shimamura, along with Tsuboi Tameharu and a number
of others were made redundant from the Medical Bureau in September 1874, as part of
reforms undertaken by Tanaka Fujimaro (18451909) who was made Vice-Minister of
Education that year. Tanaka, like Nagayo Sensai, had travelled to the United States and
Europe on the Iwakura Mission of 187173, and at the same time as his friends lost
their positions, Nagayo found himself appointed head of the Tokyo Medical School. He
later described his gloomy feelings as he worried about his friends and at first tried to
refuse the appointment but was pressed into taking it on.50
Through Nagayo, Ishii ensured his access to Western medical books, and continued his
plans to publish a translation of Thomas Hawkes Tanners The Practice of Medicine, a text
he had used in his teaching at the Igakusho. Ishii achieved a long-cherished dream when
he published a Japanese translation in 1875. It was co-translated by Tsuboi Tameharu of
the Medical Bureau, and Shimamura wrote the preface.51
Ishii spent the remainder of his life in private practice and attending to his own ill health.
According to Imaizumi Mine, who visited Ishii shortly before he died, he had been diagnosed with an incurable illness and refused to see anyone at the end (though he made an
exception for her, with whom he shared a special relationship). He received her in his quiet
room and she described the shock of seeing his gaunt face.52 He died in January, 1882,
aged forty-two. Fukuzawa made the arrangements after his death, explaining how busy
he had been in a letter dated 25 January 1882, because Ishii was an old friend and he
was not in a position to shirk any of these responsibilities.53

Griffis Thesis and Meiji Policy toward Hired Foreigners, in Ardath W. Burks (ed.), The Modernizers: Overseas Students, Foreign Employees, and Meiji Japan
(Boulder and London: Westview Press, 1985),
21953, 234. A superior female textile worker in
the silk industry in Osaka in 1875 received 9 yen
and 22 sen per year, and at the turn of the century,
100 yen was enough to build a two-storey house.
Mikiso Hane, The Textile Factory Workers, in Peter
Kornicki (ed.), Meiji Japan: Political, Economic, and
Social History 18681912 (London and New York:
Routledge, 1998) 14272, 1445.
49
Imaizumi Mine, Nagori no yume (Tokyo: Heibonsha,
1989), 301. Imaizumi Mine (18551937) was the
second daughter of Katsuragawa Hoshu. She knew

Ishii from the time when he had been a student in

her fathers house. When her fathers fortunes
changed after the Restoration and he was forced to
go into business selling medicines, Ishii took Mine
into his own house in the interest of improving her
marriage prospects. Nagori no yume is an oral testimony recorded by her daughter first published in
1940.
50
Nagayo, Shokoshishi, 1423.
51
Ishii Nobuyoshi and Tsuboi Tameharu, Iryo Taisei
(Tanshi) (Tokyo: Ishii Nobuyoshi, 1875).
52
Imaizumi, Nagori, 323.
53
Letter from Fukuzawa to Shoda Heigoro. Fukuzawa
Yukichi Zenshu, XVII, 495.

The Private World of a Meiji-era Japanese Doctor

175

Professional Networks and Prescriptions

I will now turn to Ishiis diary to consider some specific examples of his medical practice in
1874. This section looks at the ways Ishii treated himself and his patients, and how he
employed his medical networks in his practice of medicine. I then consider how his therapeutic choices might have reflected the way in which he constructed his professional identity.
During the course of 1874, Ishii suffered from multiple complaints, the most significant
of which was a stomach illness, mentioned from the very beginning of the diary and
almost daily thereafter. This illness seems to have been a chronic form of indigestion,
to which he did not give a more specific name.54 The most common drug with which
Ishii treated himself was what he called soda, most probably baking soda. He took
this with water on an almost daily basis whenever he was in pain, and generally found
some relief from doing so. Sometimes he took it several times a day, or even two or
three times consecutively until he found relief.
In addition to the treatments that he chose himself, Ishii consulted with a number of
other doctors throughout the course of the year. He most frequently sought advice
from his personal friends: in particular a doctor of Western medicine called Miura Yoshizumi. Very little is known about Miura, apart from the fact that he was later employed as
director of one of Tokyo University Medical Departments affiliated hospitals.55 In any
case, Miura was the man whom Ishii entrusted with his most intimate problems. For
example, Ishii turned to Miura about an infected sore on his penis that he developed in
June.56 Miura suggested an ointment made out of red precipitate of mercury for the
sore, but Ishii observed that it made it worse, and abandoned the treatment in favour
of a simple salve.57 On another occasion, Ishii sought advice from Miura about his
night sweats, and the doctor came to tell him about a method which he had read and
translated. The method involved steeping salvia in hot water and taking it all at once.
Ishii reported a marked improvement.58
Nagayo Sensai lived close by and was a frequent social visitor as well as a source of
medical advice.59 Following his studies at the Tekijuku, Nagayo had travelled to Nagasaki
to learn from Pompe and his successors, Antonius Bauduin (18201885) and Constant
George van Mansvelt (18321912). He became director of the hospital at Nagasaki,
and after being called to Tokyo in 1871, joined the Iwakura Mission and became director
of the Medical Bureau in the Education Ministry.60 He was therefore very well connected
54

Current medical opinion suggests that his symptoms

may have indicated stomach cancer.
55
Miura (dates unknown) was the adoptive father of
Miura Moriharu (18571916) who later studied in
Germany with Rudolph Virchow and became professor of pathology at Tokyo Imperial University Medical
School. In 1881, Yoshizumi was on the faculty of
Tokyo Universitys Medical Department, and he was
involved in the administration of Tokyo University
Hospital from the following year. Little else is
known about him. See Ikeda Monjo Kenkyukai (ed.,
Todai Igakubu shodai sori Ikeda Kensai: Ikeda
monjo no kenkyu, 2 vols (Kyoto: Shibunkaku,
2006), I, 1412.
56
Ishii Nobuyoshi no nikki, 240 (entry for 6 June).

57

Ibid., 244 (entry for 19 June).

Ibid., 204 (entry for 18 January).
59
Ishii lived at Surugadai kita-kogacho 10, and Nagayo
at Surugadai kita-kogacho 17. See Fukuzawa
Yukichi, Biboroku, in Fukuzawa Yukichi Zenshu,
XIX, 334.
60
Nagayo, Shokoshishi. There are also excellent
accounts of Nagayos contributions in Ann Jannetta,
From Physician to Bureaucrat: The Case of Nagayo
Sensai, in Helen Hardacre and Adam L. Kern (eds),
New Directions in the Study of Meiji Japan (Leiden,
New York: Brill, 1997), 15160, and Ruth Rogaski,
Hygienic Modernity: Meanings of Health and
Disease in Treaty-Port China (Berkeley: University of
California Press, 2004), 13664.
58

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Ellen Nakamura

in the medical world and helped Ishii obtain introductions to other doctors as well as
drugs. For example, in June, Ishii was still taking soda as the main drug for his stomach
complaint, but as the pain was keeping him awake at night, he began to experiment
with quantities of morphine and chloral hydrate to ease his insomnia. He tried various
methods about which he had read, including an endermic one which involved removing
the dermis of the skin by applying an ointment of Spanish fly (cantharides). This created
blisters, which were then broken and the morphine powder applied. Ishii obtained his
Spanish fly from Nagayo, and applied the ointment and morphine to his stomach.61
This also, however, led him to experience unpleasant side effects such as headache
and dizziness. Nagayo supplied Ishii with a bottle of aromatic ointment on one occasion,
and on another, examined Ishiis haemorrhoid.62
Ishii also sought consultations further afield, especially with those who had studied
abroad. On a number of occasions, he was examined by Sasaki Toyo (18391918) who
had trained at the Juntendo medical school in Sakura and then with Pompe in Nagasaki.
After Sasaki examined Ishii in his home on 25 January, for example, he tried a remedy
using a pill made from reduced iron and pepsin. After a second social visit from Sasaki
in February, Ishii began to read Felix von Niemeyers (182071) theories on stomach
catarrh, and he experimented with the bismuth soda and bitter cucumber (cucumis colocynthis) that were mentioned therein.63
Ishiis connections to the Tekijuku network gave him access to other highly regarded
doctors. Nagayo Sensai wrote Ishii an introduction to Ito Genpaku (183298), who had
studied with Pompe and travelled to the Netherlands and Germany for further study
before returning to Japan in April 1874. Ishii saw him at the end of July. Ito diagnosed a
nervous disorder and recommended a prescription of bismuth, bicarbonate of soda, and
rhubarb (if constipated) to be taken three times a day.64 He also prescribed pills made from
quinine hydrochloride and reduced iron, to be taken two or three times a day. Finally, he recommended that a poultice smeared with a salve made from tartar emetic be applied to the
stomach area. Ishii had the drugs made up and prepared to follow Itos advice.
Ishii also consulted the German doctor Hoffmann, who arrived as the assistant to Mller
in 1871. At first he attended Hoffmanns consultation hours at the hospital, but later he
used his connections to arrange to see Hoffmann at his home instead. These matters were
arranged through Adachi Hiroshi (18421917), who was also a member of the Tekijuku
network, and a colleague at the Igakusho. With the help of another colleague at the
Medical Bureau, Shiba Ryokai (183979), Ishii successfully asked Hoffmann to write a
medical certificate recommending a thermal springs cure. He consequently requested
eight weeks of sick leave to undertake a cure in a mountainous area and appended
documents supplied by Hoffmann to his request.65
While at the thermal springs in Atami, Ishii engaged in social activities, including many
conversations, walks, theatre performances, and bathing in both the mineral springs and
in the sea. He also drank a daily dose of mineral water. He examined a few medical cases

Ishii Nobuyoshi no nikki, 251 (entry for 20 July).

Ibid., 209, 278 (entries for 10 February and
4 October).
63
Ibid., 210 (entry for 10 February).
61
62

64

Ibid., 253, 254 (entries for 24 July and 27 July). The

).
diagnosis was shinkeitsu (
65
Ibid., 250 (entry for 17 July).

The Private World of a Meiji-era Japanese Doctor

177

in the local area when people approached him for his help. The social life of the resort was
a mixed blessing, for he was often tempted to overindulge in food and drink. For example,
on 24 August, he wrote:
Today I had no pain after breakfast and also after lunch. However, I served rice wine
to Nishioka and ate eel and sweets with tea and also at night ate some udon noodles.
For this reason in the night I had stomach pain and frequent wind and farted
countless times. My abdomen was in agony and I took large quantities of soda
two times.
Ishii can also be seen experimenting with new remedies that were introduced to him by
acquaintances. These included a crystallised form of bicarbonate of soda, and citrate of
magnesia. He also tried various medicines for his sore penis, which he now described
as gonorrhoea.66 These medicines included a mixture of potassium acetate and sweet
spirit of nitre (which he took internally) and a surgical dressing soaked in lead acetate
that he applied externally.
By 10 September he was obviously frustrated by his inability to cure himself, even
though he abstained from sweets, and he began to wonder whether the change of
climate had lost its effect: I am half-way through my stay and it seems that it will have
no particular effect. I am inconsolable.67
Towards the end of his cure, Ishii came down with a cold, and in a rare departure from
Western medicine, he made himself an arrowroot drink to take. He took careful observations of his pulse, however, and after he had diagnosed himself with an intermittent fever,
he took quinine hydrochloride and white sugar.68 He was still unwell when he received
the news that his position had been made redundant and he was forced to return
home on 23 September. Not only was he relieved of his post, but he was also obliged
to return his court rank. Commenting that it was really disagreeable news,69 Ishii took
refuge in his friendship with Shimamura Teiho, who had been made similarly redundant,
and they shared the grievances in their hearts.70
His health continued to deteriorate for the remainder of the year. He began to use
potassium iodide on his penis, as his friend Miura suspected that the sore might be syphilitic. Ishii, however, was still in denial. He wrote on 15 November that having considered
the matter carefully, he was sure it was due to the friction caused by his pubic hair.71
While his stomach continued to trouble him and he took soda, anti-acid tablets, potassium bromide, dandelion, and a number of other drugs for this, his most pressing problem
was a combination of constipation and diarrhoea that eventually resulted in a haemorrhoid and prolapsed anus. For the constipation he took a combination of bitter cucumber,
castor oil, and conducted enemas. For diarrhoea, he took castor oil, colombo, and laudanum. Before he learned how to return his prolapsed anus to its original position using
olive oil (a technique he learned from Miura), he was unable to sit and study for eight
days and spent a great deal of time in bed.72 He tried a number of increasingly drastic

66

Ibid.,
Ibid.,
68
Ibid.,
69
Ibid.,
67

262
270
272
273

(entry
(entry
(entry
(entry

for
for
for
for

15
10
16
18

August).
September).
September).
September).

70

Ibid., 276 (entry for 25 September).

Ibid., 291 (entry for 15 November).
72
Ibid., 289 (entry for 8 November).
71

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Ellen Nakamura

remedies for his sore bottom, including sitz-baths, ointments made from calomel, belladonna and glycerine, laudanum, and silver nitrate. He used some acupuncture needles
around his anus, and eventually resorted to injecting a silver nitrate solution into his
anus. This merely sent him running to the lavatory for the rest of the day.73
An analysis of Ishiis self-treatments in 1874 thus shows that he tried out many different
combinations of drugs. His commitment to Western therapies was not absolute, for he did
use traditional therapies during the course of the year, but these were much smaller in
number. The Western drugs he selected were typical of those being used in nineteenthcentury America and Europe, and some of them, such as chloral hydrate, were still relatively new. On the whole, these drugs seem to have done little to improve his condition,
although the baking soda and morphine did provide some pain relief. Significantly, Ishii
himself appears to have put most faith in the thermal springs cure, and became despondent when the eight week stay did not produce the desired results.
It is clear that Ishii preferred to use Western drugs in the treatment of his private health
complaints, and that he frequently sought advice from the other Western-style doctors
within his network of his acquaintance. His clinical approach appears to have been
largely empirical. He experimented freely with different drug therapies and observed
their effects, recording the doses and results in his diary. It is even possible that he saw
himself as a kind of case study. I will now turn briefly to a discussion of the patients
Ishii treated, to see if he employed a similar approach in his prescriptions for others.
The evidence regarding Ishiis patients is much more limited than the information he
recorded about himself. The small number of cases mentioned certainly does not
suggest a large medical practice, but this may have been because he was only semi-reliant
on private practice at this point, or because he was himself unwell. The medical problems
mentioned include a combination of surgical cases (for example boils and injuries), as well
as eye diseases, lung complaints, fevers, gynaecological problems, and childrens diseases.
He does not mention the treatment of epidemic diseases, apart from the vaccination of his
children against smallpox. He did read on the subject, however, borrowing a book on
warm epidemic diseases from his colleague on 28 January.74
Even a quick glance at Ishiis prescriptions reveals that he used predominantly Western
medicines on his patients. For a woman with a stomach complaint, for example, he prescribed reduction of iron, quinine and pepsin. For a patient with a sore throat he prescribed Dovers powder. For an elderly woman suffering convulsions he prescribed
chloral hydrate. For a girl with an eye complaint, he prescribed atropine eye drops and
a compress of calomel. For a family member with sores on her arms, he prescribed an ointment made from linseed oil and tinctures of iron and quinine to restore her strength.75 As
was the case with the treatment of his own illness, Ishii did not completely reject kanpo
medicine, in spite of his strong preference for Western medicines. He gave his son, for
example, a medicine called shonisan (literally infant powder), which suggests a commercial medicine probably based on Chinese herbs, and Ishii himself used acupuncture,

73
74

Ibid., 296 (entry for 9 December).

Ibid., 206 (entry for 28 January). Notably, the title
suggests a kanpo approach.

75

Ibid., 222, 2256, 234, 260, 299 (entries for 23

March, 7 April, 17 May, 11 August, 21 December).

The Private World of a Meiji-era Japanese Doctor

179

massage, and medicines such as arrowroot drink (for a cold) and aloe pills (for constipation). These treatments, however, were in the minority.
Some evidence regarding Ishiis professional medical practice is obtainable from other
sources. These examples are interesting because they are suggestive not only of the particular medical treatments that were used, but also of the way that the doctors used their
collective knowledge to diagnose and treat their patients. When Fukuzawa Yukichi
became ill with typhus in 1870, he was treated by foreign doctors Duane B. Simmons
and William Willis, as well as the Japanese doctors Ishii Kendo, Ito Genpaku, Shimamura
Teiho, Kumagawa Soetsu, and his friend from Yokohama, Hayashi Yuteki. Fukuzawa
described it in a letter as the best treatment available in Japan:
Had I fallen seriously ill like this even three or four years ago, I could not have hoped
to recover completely, but being here in the city and treated by good doctors and
cared for by good friends, I have made a complete recovery. All thanks to the
doctors and my group of friends.76
A record remains of the treatment, which included remedies such as hydrochloric acid,
quinine, potassium bromide, sugar syrup, and a diet of milk, soup, eggs and whisky.77
Fukuzawa also used his influence with Ishii to obtain Western medical treatment for a
friend. In 1871, he wrote to Ishii in Osaka on behalf of a friend whom country doctors
had been unable to help. He requested that Ishii obtain a consultation with one of the
Western doctors working in Osaka.78
Fukuzawa and Ishii shared a supportive relationship with Hayashi Yuteki (18371901),
a doctor who had studied with Tsuboi Shindo and Fukuzawa and went on to open a
bookshop, the Maruya, in Yokohama in 1868.79 In the diary, Ishii can be seen visiting
Hayashi in Yokohama to discuss his investments, as well as ordering books and on one
occasion, some pills. When on his thermal springs cure in Atami, Ishii arranged his food
supplies through the Maruya, and also obtained finance for the publication of his translation of Tanners Practice of Medicine.
Importantly, the social relationships fostered by these medical networks were not
limited to purely professional activities. There was also a great deal of book lending
and consultation regarding the translation of medical works among members of the
network. Ishii can be seen exchanging English, Dutch and German dictionaries, as well
as books on medicine, chemistry and geography in these languages. Although some of
these exchanges were related to the work of the Medical Bureau, there were private
exchanges of books as well. Members of the network socialised frequently with one
another. The doctors frequently visited and entertained each other with food and
drink, often in Western-style. These gatherings evoke a sense of the way that the
fashion of the civilisation and enlightenment movement and the fascination with
Western style medicines overlapped. To give some examples of the other quotidian
ways in which the doctors depended on one another, Nagayo sought advice about the

76

Letter from Fukuzawa to Kuki Takayoshi. Fukuzawa

Yukichi Zenshu, XVII, 101.
77
Shozaishi in Fukuzawa Yukichi Zenshu, XXI, 2913.

78

Letter from Fukuzawa to Ishii Kendo. Fukuzawa

Yukichi Zenshu, XVII, 11819.
79
This bookshop evolved into the Maruzen, still a
famous bookshop in Tokyo today.

180

Ellen Nakamura

school to which to send his child, and Ishii received Fukuzawas advice about matters such
as installing a Western-style stove, and where to buy rubber boots.80
After 1874, Ishii continued to see patients, and to seek advice for his own medical complaints.
Some evidence of his activities after 1880 comes from a number of letters that Ishii wrote to
Ikeda Kensai (18291918), who became the first director of Tokyo Universitys medical department in 1887. Apart from sending presents and inviting Ikeda to a party at Ueno, Ishii also consulted with him about his health. This time he discussed a fever that he had been treating with
quinine. He also referred one of his own patients who was suffering from a chest complaint. He
had been treating him unsuccessfully for some time, and appended a copy of the prescription
that he had been using. It included drugs such as aromatic spirit of ammonia, pepsin, yellow
cinchona, and quinine, mixed with extract of gentian.81

Conclusions
This article has examined the career and medical practice of a Western-style physician, Ishii
Kendo, who lived through the transition from the Tokugawa era to the Meiji period, a
time in which Western medicine was modernised and made orthodox by the Japanese
State. While this study is limited by the fact that it looks only at a single physician and evidence is taken largely from a single year of the doctors life, it raises a number of questions
for further reflection.
The first point concerns the way in which Ishii constructed his professional identity. Ishii
seems to have identified with his local community of Western-style physicians and their
influence on him extended not only to medical and professional advice but also many
other aspects of his social life. Ishiis medical colleagues were a constant source of information and support, including advice, inspiration, and practical help as well as medical
examination and diagnosis. Ishii was influenced by the civilisation and enlightenment
project not only through his connection with Fukuzawa, who was one of its main proponents, but through his conspicuous consumption of Western books, food, clothes and
other household items. This can be seen as a performance of his Western-style identity.
In his medical practice, Ishii showed himself to be an enthusiastic consumer of new
drugs. He voluntarily adopted and modelled Western medicine in his private practice
and personal life, and received constant feedback and reinforcement of his therapeutic
choices from his peers. This approach can be seen both in his treatment of his patients
and in the medications with which he himself experimented. He tried out the treatments
that he read about in Western books, or learned about from his colleagues, and recorded
his observations in his diary. At a time when Western drugs were still expensive and difficult to obtain, Ishii shows a distinct preference for alkaloids and chemical compounds
which were products of developments in nineteenth-century Western pharmacology
over herbal medicines. When he was unable to purchase the drugs himself, he used connections with his colleagues to obtain them.
In view of the training Ishii received as a ranpo physician, perhaps the tendency to
choose Western drugs over Chinese herbs was only natural. As was characteristic of
the ranpo physicians, he did not completely reject kanpo medicine or other forms of
80

Ishii Nobuyoshi no nikki, 224, 243 (entries for 28

March, 17 June).

81

Letters from Ishii to Ikeda Kensai. Ikeda Monjo Kenkyukai, ed., Todai Igakubu, I, 2002.

The Private World of a Meiji-era Japanese Doctor

181

traditional therapies but rather used them alongside newer drugs. He packed Western
drugs to take with him on his thermal springs cure, for example. Yet the manner in
which he actively sought out the professional advice of foreign-trained doctors and
experimented with new treatments that he had read about in books suggests that he
was going far beyond his own training. Moreover, his willingness to endure potent and
uncomfortable treatments and eat unfamiliar European foods as a part of his treatment
indicates that he was motivated by more than simple curiosity. These were personal
choices that he made as someone who thought that Western methods could offer him
something that traditional therapies could not. Ishii practised Western medicine not
because he was obliged to but because he thought it was worth practising.
The second point concerns Ishiis changing position within the new medical establishment. Ishiis case suggests that as a ranpo physician, he initially enjoyed a period of privilege and wealth, in which he was appointed to influential teaching positions within the
governments official medical institutions, and received an excellent salary. As time went
on, however, the limitations of Ishiis education became apparent. Whereas other
members of the Tekijuku network like Fukuzawa and Nagayo observed the West firsthand and successfully re-invented their careers, Ishii remained in Japan and tried to
make his way mainly as a physician. As his generation was replaced by those who had
studied abroad, or who obtained qualifications in modern Western medicine, Ishii gradually found himself removed from the centre of medical power. This can be observed most
poignantly in his redundancy of September 1874. While the fact that Ishii trained in ranpo
rather than modern medicine was not enough to significantly affect his career as a private
physician, his promotion and subsequent demotion as a teacher and medical bureaucrat
reflects a widening gap between the Western medicine of the Edo and Meiji eras, and the
new hierarchies of knowledge that would see the foreign-trained medical elite of Tokyo
Imperial University come to dominate Japanese medicine. That Ishii himself recognised
and reinforced these developments is suggested in the way that he actively sought the
professional opinions of European doctors and doctors who had studied abroad.
Ishiis diary is fascinating for its evidence of his association with such stars of the civilisation and enlightenment movement as Nagayo and Fukuzawa, but his own quiet rise
and fall suggests that ordinary Western-style doctors of his generation struggled to bridge
the medical worlds of the late Edo and early Meiji periods. It remains to be seen whether
Ishiis career trajectory was unique or whether it was representative of a trend among
other doctors of ranpo medicine. Certainly Ishii was not the only doctor to be made redundant in 1874; his friend Shimamura Teiho consequently made his way as a translator,
whereas Tsuboi Tameharu went to Saitama to direct a regional hospital. Other ranpo
doctors pursued careers as military doctors, as did Matsumoto Ryojun and Adachi
Hiroshi. These are fertile grounds for further research.

Acknowledgements
I am grateful to the editors and anonymous readers for SHM and the friends and colleagues who helped me with the research and writing of this article. Particular thanks
go to Linda Bryder, Jennifer Frost, Ann Jannetta, Jun Nakamura, Jonathan Scott,
Akihito Suzuki, Tsuyama Archives of Western Learning, and the University of Auckland
for its financial and institutional support.

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