日本という問題系
Japan Problem in Modern
Medicine
☆Now, while “imperial medicine” and “colonial medicine” have come to be frequently cited as analytical concepts, they were once political terms heavily laden with value judgments—specifically, criticism and condemnation of imperial and colonial rule as perpetuated by modern biomedicine. On the other hand, modern medicine is regarded as the time-honored medical tradition of Western Europe and as a cosmopolitan form of medicine accessible to all peoples and races. Tropical medicine, while tainted by the involvement of agents of imperial and colonial rule, has faced relatively little criticism from former colonies because its subject matter and stated goal—the eradication of tropical diseases—easily garnered social consensus. However, even today, one often encounters instances throughout research on tropical medicine and tropical healthcare where diseases of tropical origin and local societies are uncritically linked to colonial discourses—such as “primitive cultural practices,” “backward social systems,” and “lazy inhabitants.”
☆My
view is that the philosophy underlying these projects was carried
forward even as “national state medicine” evolved into “imperial
medicine,” and that this philosophy continued to be upheld consistently
throughout the postwar period, even after the framework of “imperial
medicine” itself had disappeared—that is, even after the Empire of
Japan had effectively ceased to exist.
| さ
て、帝国医療や植民地医療は分析概念としてよく言及されるようになってきたが、かつては近代生物医療（modern
bio-medicine）による帝国支配や植民地支配への非難や罵倒という価値判断をたっぷり含んだ政治用語であった。他方、近代医療は西欧の由緒正し
き医療であり、それを利用する民族や人種を超えて利用可能なコスモポリタンな医療と見なされている。熱帯医療（tropical
medicine）は、帝国や植民地統治のエージェントが関与したという点では手垢にまみれているが、研究対象と達成すべき目標――熱帯病の征圧――が社
会的合意を得られやすかったゆえに、旧植民地からの非難を受けることはこれまで少なかったと言える。しかし、現在においてもなお、熱帯医学／熱帯医療の研
究の随所に、熱帯起源の病気と現地の社会を「未開な文化的慣習」「遅れた社会制度」「怠惰な住民」といった植民地言説に無反省に関連づけることをしばしば
目撃することがある。 |
Now, while “imperial
medicine” and “colonial medicine” have come to be frequently cited as
analytical concepts, they were once political terms heavily laden with
value judgments—specifically, criticism and condemnation of imperial
and colonial rule as perpetuated by modern biomedicine. On the other
hand, modern medicine is regarded as the time-honored medical tradition
of Western Europe and as a cosmopolitan form of medicine accessible to
all peoples and races. Tropical medicine, while tainted by the
involvement of agents of imperial and colonial rule, has faced
relatively little criticism from former colonies because its subject
matter and stated goal—the eradication of tropical diseases—easily
garnered social consensus. However, even today, one often encounters
instances throughout research on tropical medicine and tropical
healthcare where diseases of tropical origin and local societies are
uncritically linked to colonial discourses—such as “primitive cultural
practices,” “backward social systems,” and “lazy inhabitants.” |
| そういう中に、我
々の医療はどのように位置づけられるのであろうか。日本の医療は、独自な文化慣習や行動様式によって今なおその進歩を妨げら
れているのだろうか。日本の旧態依然とした医療制度によって日本人は健康の達成を妨げられたのだろうか。日本の帝国医療における日本人とは、それを実施す
る主体であろうか、それとも帝国医療の対象だったのだろうか。そしてまた、私が日本ないしは日本人という用語を連発する時、それらはどのような空間を指
し、どのような種類の人間のことを言っているのだろうか。 |
In this context, how
should we position our healthcare system? Is the progress of Japanese
healthcare still being hindered by unique cultural customs and
behavioral patterns? Has Japan’s outdated healthcare system prevented
the Japanese people from achieving good health? In Japan’s imperial
healthcare system, were the Japanese the agents who carried it out, or
were they its subjects? Furthermore, when I repeatedly use the terms
“Japan” or “the Japanese,” what kind of space do they refer to, and
what kind of people am I talking about? |
| 私の結論を先に指摘しておこう。 |
Let me state my conclusion first. |
| 後発帝国主義国で
あった日本は、欧米の帝国主義的近代の様々な社会的諸装置をパッチワーク的に導入しながら、同時に強い人種拝外主義によっ
て、独自でユニークな帝国医療システムを作り上げた。その中で医療制度もまた創意工夫され独自の発展を遂げてゆく。しかしながら、制度や理念の変化に社会
の側は追いついていかず、医療はつねに未来に向かう健康達成のプロジェクト（cf.
高橋 1969）であるという幻想を人々に懐かせたまま、第二次大戦の終結を迎える。これが日本の帝国医療が「未完の」プロジェクトであったと私が信ずる
点である。このプロジェクトは、西欧の近代化プログラムの模倣であり、普遍的な方法を現地社会に適合させようとする時におきる、現地側からの反応に基づい
て、独自の展開をとげていった。 |
As a latecomer to
imperialism, Japan created its own unique imperial medical system by
piecing together various social mechanisms of Western imperialist
modernity while simultaneously embracing strong racial xenophobia.
Within this context, the medical system was also ingeniously adapted
and underwent its own distinct development. However, society failed to
keep pace with changes in institutions and ideologies, and the country
reached the end of World War II while people still harbored the
illusion that healthcare was a forward-looking project aimed at
achieving health (cf. Takahashi 1969). This is why I believe that
Japan’s imperial healthcare was an “unfinished” project. This project
was an imitation of Western Europe’s modernization program, and it took
on a unique trajectory based on the reactions of the local population
that arise when attempting to adapt universal methods to a local
society. |
| 西洋近代医療の普及過程にみられる、我が国のユニークな特性を３つ指摘
しておこう。つまり、まず最初に（１）医療の西洋近代化の過程は、かつ
て言われてきたようなシステムの全面入れ替えではなく、試行錯誤を踏まえた漸進的な変化であった。そのため、漢方のような医療システムも完全に駆逐される
ことなく、むしろ医療の多元化をおしすすめることに貢献したということ。つぎに（２）統治技術としての西洋近代医療は最初から成功を収めていたという認識
は、医療者たちの間には、それほどなかったということ。そして（３）医療化を推進させる根拠としては、医療を通して国民および帝国の臣民を壮健にする目的
よりも、医療をより科学化することに強い動機が置かれていたということ。 |
Let me point out three unique
characteristics of Japan observed in the process of the spread of
modern Western medicine. First, (1) the process of modernizing medicine
in the Western style was not a complete overhaul of the system, as has
often been claimed, but rather a gradual change based on trial and
error. Consequently, medical systems such as Kampo were not completely
supplanted; rather, they contributed to the diversification of medical
care. Second, (2) there was not a widespread recognition among medical
professionals that Western modern medicine, as a technique of
governance, had been successful from the very beginning. And third, (3)
the primary motivation for promoting the medicalization of society was
not so much the goal of improving the health of the nation’s citizens
and the empire’s subjects through medicine, but rather a strong drive
to make medicine more scientific. |
| これらのプロジェクトの理念は、国家医療（national
state
medicine）から帝国医療に展開するときにも、それらの展開パターンを引き継ぎ、そして帝国医療そのものの枠組みが消滅しても、つまり大日本帝国が
実質上消滅しても、戦後一貫して継承されていったというのが私の見解である。 |
My view is that the philosophy
underlying these projects was carried forward even as “national state
medicine” evolved into “imperial medicine,” and that this philosophy
continued to be upheld consistently throughout the postwar period, even
after the framework of “imperial medicine” itself had disappeared—that
is, even after the Empire of Japan had effectively ceased to exist. |
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