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15 chapter one Biomedicalization and Globalization Biomedicine in Japan The first time I visited a doctor in Japan, I wondered at the aesthetic differences from my American experiences. I was uneasy in the ill-­ fitting brown plastic slippers I was asked to exchange for my own shoes before even entering the small primary care clinic’s lobby. ­Were they clean? How was I supposed to walk in them? As I shuffled along ­ behind the nurse on our way to the exam room, one flew off ­ every few steps. I was clumsy and uncomfortable . I was sure that I would rather walk around the clinic barefoot than in slippers that countless patients before me had worn. I was also perplexed by the nurse’s crisp pink uniform and bobby-­pinned hat. Compared to the nurses in scrubs that I had grown up with, the clinic nurse looked like she had walked out of another era. I caught myself feeling annoyed. Was it practical for a nurse to wear a dress? Did it have to be pink? The physician turned out to be a gregarious older man who nodded reassuringly as I described my symptoms and history of upper respiratory infections . ­ After the consultation, I was handed a series of mystifying white packets containing two types of powders, two types of pills, and a small plastic ­ bottle filled with a clear liquid. ­ There was no pharmacy visit; the prescriptions ­were written and filled in the same room. I was cautioned to wear a mask if I left the ­ house and given instructions to gargle regularly in the­future to prevent myself from getting sick again. The last instruction was so foreign that I assumed I had misunderstood, though I would ­later learn from colleagues that in Japan gargling is widely practiced to prevent colds and influenza. When I got home, I inspected the packets and their printed dosage instructions . Still a ­ little unnerved by the old-­ fashioned ambience of the clinic, I looked up each medi­ cation on the internet before deciding to follow his instructions. When the search failed to turn up any surprises (and certainly no exotic ingredients), I felt silly for having checked. Biomedicine was biomedicine ­after all, even in rural Japan. Japan’s relationship with biomedicine goes back centuries. Even before the island nation opened its doors to relatively unfettered trade with the rest of the world, rangaku scholars studied Dutch and Rus­sian medical texts and 16 Chapter One achieved a sophisticated understanding of nascent Eu­ ro­ pean medical theory (Jansen 2000, 2002; Jannetta 2007). Despite living in a famously “closed country” ­under the shogunate, early Japa­nese physicians studied Chinese and Western medical theory and imported key medical technologies into Japan. Jennerian vaccination, the technique for vaccinating against smallpox using cowpox,wassuccessfullycarriedoutinJapanwithinapproximatelyfiftyyears of its discovery half a world away despite the absence of natu­ ral cowpox on theJapa­nesearchipelagoandthepracticaldifficultiesofimportingspecimens from Eu­rope (Jannetta 2007). By the time Perry “opened” Japan in 1853, Japa­ nese physicians had already carried out sophisticated, large-­ scale vaccinationcampaignsusingatechniqueandbiologicalagentimportedfromEu ­rope. One reason for this remarkable accomplishment is that physicians ­ were one of the only groups in Tokugawa society permitted by the shogunate to look beyond Japan for practical and theoretical knowledge. Chinese medicine had been practiced in Japan for centuries, but Japa­nese physicians ­were pragmatic and ecumenical in their approach to healing. They had access to alternative medical theories and technologies through the work of the rangaku scholars. While the esteemed Tokugawa Medical College taught traditional Chinese theory and practice, by the 1600s many Japa­ nese physicians also studied Western medical techniques (Beukers et al. 1991). Doctors who practiced Western style medicine during this period ­ were called ranpo (Dutch-­ method prac­ ti­ tion­ ers), gleaning what they could from Dutch or Rus­sian medical texts and anatomical ­tables (Jannetta 2007: 3). Consequently, early Japa­nese physicians developed their own pragmatic, evidence-­based approach to medical knowledge distinct from Chinese medicine . Historian Marius B. Jansen describes the first anatomical dissection in Japan, which took place in 1771, writing that “on their way home Sugita and his friends reflected on how shameful it was that they had tried to serve their lords as doctors without first having a true knowledge of the ­ human body” (Jansen 2000: 213). ­Because Chinese medicine is based on holistic theory , doctors trained in it never opened a body to perform surgery or make anatomical observations. This, combined with social custom that limited contact with the dead to lower...


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