Changes After Peer Review 1st Draft Paper One

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. 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) Social barriers with a government imposed society closed to Western influences can hamper advancements even when changes are necessary.

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. (Prominent People Of Minato City) (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the only learned individual of his profession that thought or knew that the Chinese medical learning information was out of date.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.”(Reilly) 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.”(Reilly) 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 Maeno 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.” (Reilly) 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.” (Reilly) 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.” (Reilly) 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.” (Reilly)

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. This social class was excluded entirely from the hierarchy. (Kallie Szczepanski, Asian History Guide) 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.”(Reilly) 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. This was the first completed translation of a Western medical book. (Tokyo Printing Museum) The Japanese society had closed its doors to outside influences during the shogunate era, so the lack of correct medical knowledge is a product of the society, not the social class.

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 make whatever changes are necessary 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 Japanese 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. New Japanese words created for body parts not yet named. They changed Japanese medical and social history by finding an honorable solution to their own ignorance, and did so in a closed society.