- The Development of the Japanese Nursing Profession: Adopting and Adapting Western Influences
In this history of the nursing profession in Japan from 1868 to 1938, the eve of the Pacific War, Aya Takahashi focuses on the degree to which Japanese nurses won professional respect in comparison to the status of nurses in Great Britain. She generally finds the Japanese situation wanting. She posits that modern nursing was imported into Japan from the West as a "must-have" for a civilized nation (p. 157). In keeping with her assumption that the Japanese nursing profession was a foreign import, she characterizes the white uniform of the modern nurse as a "western costume" (p. 1) rather than as a symbol of modernity or hygienic cleanliness. She argues that because Japanese nursing developed as a national project, in an atmosphere devoid of feminism, Christianity, and charitable culture, Japanese nurses remained passive and nursing professionalism in Japan was suffocated. Takahashi places much of the blame for the fate of the nursing profession in Japan on the gendered structure of Japanese society. Because the Japanese word for nurse, kangofu, contains a character for woman, nursing was by definition an exclusively female profession. The hierarchical and feudal social and gender structure of Meiji Japan rendered women subordinate to men and nurses to doctors.
In her brief account of the late nineteenth-century origins of modern nursing in Japan, which she draws from a wide variety of secondary sources in both English and Japanese, Takahashi makes passing mention of seminal institutions such as the Sakurai Women's College Nursing School and the Kyoto Nursing School, both founded in 1886. She acknowledges the pioneering roles of figures such as Suzuki Masa (1857-1940) and Ôzeki Chika (1858-1932) in developing domiciliary nursing. By the 1890s, she concludes, there were about five nursing schools, including one run by the Japan Red Cross Society and one at Tokyo Imperial University Hospital, that [End Page 416] operated in accordance with the ideals of Florence Nightingale's nursing system, which emphasized both efficient supervised medical ministrations and safety and respectability for the nurses. Florence Nightingale, whose life story had a prominent place in moral texts in Japan, served, Takahashi holds, as an iconic figure in the definition of nursing as modern work for respectable women.
Although Takahashi explains that many Japanese nurses were engaged in domiciliary work, and she acknowledges that there were a variety of hospital settings, she highlights the central role of the Japan Red Cross Society in the production of the modern nursing profession in Japan. Because of their association with patriotic work, she argues, Red Cross nurses won respect never granted to the nursing profession as a whole. During the Sino-Japanese War, twenty Red Cross nurses worked at the Hiroshima Station Hospital. Because of the Red Cross responsibility for sick and wounded soldiers, service to the Red Cross was work on behalf of the nation in arms. In addition, the prestige Red Cross nurses enjoyed was enhanced by the organization's close association with the imperial family.
During the Sino-Japanese and Russo-Japanese wars, Takahashi asserts, the Japan Red Cross and its nurses were symbols among the Western powers of the rising level of Japanese civilization. Japanese Red Cross nurses won international approval for their effectiveness in military work, but, she points out, what Western observers praised was not the scientific expertise of the nurses but rather their admirable submissiveness to authority, the product of the feudal structure. In drawing this conclusion, Takahashi takes the testimony of foreign observers at face value, without any consideration of Edward W. Said's observation that Western knowledge of the Orient is always constituted by Western power.
The two aspects of twentieth-century nursing history that Takahashi discusses are the relationship of Japan to the International Council of Nurses (ICN) and the status of public-health nursing in Japan. In regard to the ICN, Takahashi emphasizes the leadership of the Japan Red Cross in initiating contact with the international organization and the close ties...