The
Reality of the Human Body
What effects can a medical book,
even in a different language have on a society? They can be enormous depending
on the area of expertise. In this case, it was simple human anatomy. What if it
had been on herbal remedies? The Asian culture uses many herbs to make
concoctions and teas. This breakthrough would have happened eventually by
someone else if not at this time. Social barriers can hamper advancements that
were probably no different than what we have today dealing with stem-cell
research or the intellects did not feel it was a necessary topic of concern to
disclose in detail. Sugita Genpaku (1733-1817) was a Japanese physician that
was fortunate enough to be able to obtain a Dutch copy of an anatomy book
entitled “Tabulae Anatomicae” in 1771. (Genpaku)
Genpaku
was a medical scientist and scholar of Western studies. He was born in a
mansion belonging to the Kohama Clan in Ushigome Yarai, Edo. Genpaku's father
(Hosen Sugita) was the clan doctor who studied Dutch medicine, but Genpaku did
not take it too seriously until he met a Dutch Surgeon Gentetsu Nishi, and at
the age of 17, started his medical training. Gentetsu Nishi was the private
doctor for the shogunate that was living in Nihonenoki in Takanawa. In 1752 at
the age of 19-20, he became the clan doctor.
(Genpaku Sugita)
He was not the only learned
individual of his profession that thought or knew that the Chinese medical
learning information was out of date. He had colleagues that thought the same
way. Hiraga Gennai (1729-1779) was one to whom he discussed this subject with.
He recorded their discussion: “As we have learned
the Dutch method of scholarly investigation through field work and surveys is
truly amazing. If we can directly understand books written by them, we will
benefit greatly. However, it is pitiful that there has been no one who has set
his mind on working in this field. Can we somehow blaze this trail? It is
impossible to do it in Edo. Perhaps it is best to ask translators in Nagasaki
to make some translations. If one book can be completely translated, there will
be an immeasurable benefit to the country.” They both had discovered that a
language barrier existed (Dutch versus Japanese/Chinese) hampering their
ability to learn more about the human anatomy. They both had seen the Dutch
anatomy book and had been trying to understand all of the information contained
in the book. The book had pictorials and written text all in Dutch language.
Discovering this information to be completely or partially different from what
they knew had to be mind boggling to say the least.
There had been other occasions
where existing Chinese medical books that depicted how the human body was
constructed had been proven to be misleading. Kosugi Genteki had an occasion to
witness a post-mortem examination of a body when he had studied under Dr.
Yamwaki Toyo of Kyoto, recorded “what was said by the
people of old was false and simply could not be trusted.” Twelve years
earlier, in
1759, Dr. Toyo published a book entitled “Zoshi (On Internal Organs), to which
Segita read this book and indicted that he could not wait until he had the
opportunity to witness an autopsy. Not all physicians were invited to this
occasion. Only selected few had the opportunity to be present for the
examination. Sugita had compared both books and wanted to observe first-hand
the differences to observe which one accurately described the truth.
Dr. Genpaku was one that wanted to
share the information with his colleagues and not horde the information. He
knew of one that was very diligent in the pursuit of their medicine. His name
was Maeno Ryotaku (1723-1803). Dr. Genpaku was given the opportunity to witness
a post-mortem examination on a body from an executed condemned criminal in the
town of Senjukostukahara on the next day, so he invited Dr. Genpaku. When they
arrived, Dr. Genpaku produced his copy of the same Dutch book Sugita had. The
odds that both individual having the same book, and had brought it with them
clearly indicates both men were in the pursuit of medical accuracy to further
their knowledge of human anatomy and the correct terms for internal organs,
especially to be in the Japanese or Chinese language. They both looked forward
to viewing the human organs to compare against the Chinese medical book versus
the Dutch medical book. They knew of several description inaccuracies in the
Chinese version with the heart.
The individual that performed the
examination was an old man of 90 years of age that indicated he had performed
several post-mortem examinations. It was evident that he knew that the human
body had the same individual organs (other than the difference male to female),
but he just referred to them as “this and that organ.”
This gentleman had no aspirations to identify what the body parts were for
future applications, nor seemed to care either which way. It was clear what
organs was the heart, liver, gall bladder, and stomach, but he had no actual
names, or knew of what others had associated names to many of the other
non-named organs.
After completing the examination,
Dr. Genpaku “consulted
the anatomy chart and clearly identified an arterial tube, a vein, and the
suprarenal gland.” Both physicians had taken the time to make sure that
both books they had in their possession had no variances in the charts between
the two books, even though they were the same edition. They found that there
were none. This is something relevant due to if it were a hand written book
copied or a printing press copy. Either way the copies were the same.
They found that the Chinese Book
of Medicine (Yi Jing) stated that “the lungs are like
the eight petals of the lotus flower, with three petals hanging in front, three
in back, and two petals forming like two ears and that the liver has three
petals to the left and four petals to the right.” It was quite apparent
that the Chinese version of medical anatomy knowledge was very colorful in
language, but lacking in accuracy. They both had observed that this was not the
case at all. As they put it “There were no such
divisions, and the positions and shapes of intestines, and gastric organs were
all different from those taught by the old theories.”
In further investigating, Dr. Genpaku
discovers that the official physicians present during the autopsy, Dr. Okada
Yosen and Dr. Fujimoto Rissen had both witnessed dissections seven or eight
times. They themselves were both perplexed and could not resolve their doubts
when it came to the reality of seen versus medical literature. At least they
wrote down what they thought was strange during each of their previous
observations. They must have wondered why there was such a disconnect between
the reality of as-seen versus taught medical information. It was not a matter
of anatomy, but had to have been a question of who is going to be the one that
wants to inform the proper medical officials that their data on human anatomy
is incorrect. They had just given it up that there was a human difference
between other cultures and the Japanese bodies. The Chinese referred to the
Japanese as “barbarians.” They must not have wanted to add injury to insult. Do
not step on the wrong toes, for it the honorable thing to do. Professional
courtesy to the max! To continue with their investigation to the differences
between the medical technologies, they went to the execution ground to look at
the bones of the previous owners and collected a number of them for further
examinations. What they found there was no different than the other anatomy
inaccuracies they had discovered. This leads us to wonder why the
changes did not get made at an earlier time.
It was next to impossible to learn
about the human internal anatomy as a physician. The Japanese structure did not
allow physicians to perform any type of dissections on human bodies. The
information the physicians had been taught to this point was now in question
for the accuracy and validity of the entire profession. The only group that had
the authority to perform the autopsy was individuals from the eta class. These
were individuals that were an untouchable caste in Japan, being defined by
their restriction to certain occupations associated with death, tanning or
working with hides, cremating the dead, butchering, meat, and thus, doing
autopsies. They could not be physicians.
Upon completing their day
performing the post-mortem examination and collecting bones, the three
physicians (Ryotaku, [Nakagawa] Juana (1739-1786) and Genpaku left together and
conversed about their discoveries. They had opened their eyes to a whole new
level of understanding. They realized that they had been ignorant of the
inaccuracies and realized it was a shame to be of their profession and not
known of the difference. They made the comment “As physicians who
serve their masters through medicine, we performed our duties in complete
ignorance of the true form of the human body. How disgraceful it is.” Honor
in the Asian society is a highly regarded social philosophy and life style.
At that time, they collectively
realized that a major effort must take place to translate the Dutch book into
the Japanese language. They could see that it would take a collective effort to
make it happen. Ryotaku did know some Dutch and had been exposed to it enough
to be able to make some structure from the word phrases and patterns. Both of
them agreed that they would work together to complete the necessary work to
translate the Tabulae Anatomicae. Three years later (1774), the Japanese
version “Kaitai Shinsho (New Book of Anatomy) was published.
One must ask how a society can
elevate individuals to a medical position such as a physician, as they are only
taught by a known and entrusted teacher. The teachers are supposedly learned in
all necessary forms of the medical profession, so they should have known of the
deficiencies that existed for some long period of time. Some professions are
taught and handed down father to son to keep within your specific social class
structure, as was this case. There was a definite breakdown in communication between
the physicians and the eta class. When
this happens, the society/social class structure has to become more
knowledgeable and having individuals strong enough to challenge the norm and
step on new ground. To be able to create a standard for a physician that was
accurate forthwith was an essential advancement necessary for this profession.
It is known that by not keeping within their social occupation class structure,
these physicians opened doors of medical knowledge not known to them before
this time. It is not recorded, but there had to have been additional
opportunities for these medical professionals to witness autopsies to further
their challenging efforts. To stay focused
with attention to detail, all medical charts were verified and accurately drawn,
and named accordingly. So by doing these things, they changed medical and
social history.
