German-Japanese relationship in pathology and forensic medicine during the late 19th and early 20th centuries
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Since the last decades of the 19th century there has been intensive academic contact between German and Japanese pathologists and forensic physicians. In the late 1880 s the Japanese physician Moriharu Miura worked on behalf of the Japanese Government with Rudolf Virchow for several years. Close connections existed between the Freiburg Institute of Pathology and several Japanese scholars; very well known is the collaboration between Ludwig Aschoff and the Japanese pathologist Sunao Tawara. According to some forensic doctors, the first forensic physician in Japan was Wilhelm Doenitz who held the chair of anatomy in Tokyo and first practised forensic medicine part-time and an additional way, later as a full time forensic pathologist. In order to improve the education of Japanese forensic pathologists, K. Katayama was sent to Europe where he worked for 2 years with Liman in Berlin and for another 2 years with Hofmann in Vienna. Back in Japan he founded the Institute of forensic medicine at the university of Tokyo and in 1889 became head of Japanese forensic medicine. The paper examines the contact and the cooperation between German and Japanese physicians related to the development and establishment of forensic medicine in Germany and Japan.
KeywordsHistory of pathology History of legal medicine German-Japanese collaboration
Deutsch-japanische Beziehungen zwischen Pathologen und Rechtsmedizinern während des späten 19. und frühen 20. Jahrhunderts
Seit den letzten Jahrzehnten des 19. Jahrhunderts gab es intensive Beziehungen zwischen deutschen und japanischen Pathologen und Rechtsmedizinern. Moriharu Miura arbeitete einige Jahre mit Rudolf Virchow zusammen. Auch zwischen dem Freiburger pathologischen Institut und verschiedenen japanischen Ärzten existierten enge Beziehungen; gut bekannt ist die Zusammenarbeit zwischen Ludwig Aschoff und dem japanischen Pathologen Sunao Tawara. Der erste Rechtsmediziner in Japan war Wilhelm Dönitz, der den Lehrstuhl für Anatomie in Tokyo innehatte und die forensische Medizin zunächst nebenamtlich, später im Hauptberuf praktizierte. Um die Ausbildung der japanischen Rechtsmediziner zu verbessern wurde K. Katayama nach Europa gesandt; hier arbeitete er zwei Jahre mit Liman in Berlin und zwei weitere in Wien mit Hofmann. Nach Japan zurückgekommen, gründete er das rechtsmedizinische Institut in Tokyo. Im Jahr 1889 wurde er Leiter der Rechtsmedizin in Japan. Der Aufsatz untersucht Beziehungen und Kooperationen zwischen deutschen und japanischen Ärzten im Hinblick auf die Entwicklung der Rechtsmedizin in Deutschland und Japan.
SchlüsselwörterGeschichte der Pathologie Geschichte der Rechtsmedizin Deutsch-japanische Beziehungen
In 1901, on the occasion of his 80th birthday, the German pathologist Rudolf Virchow stressed in his speech the newly established contact between Germany and Japan. He referred to the rich friendship which both countries had achieved in recent years and underlined the large number of medical disciples from Japan who remained true to their German education and who were of great help in the investigation of difficult scientific problems . Indeed, around 1900 there were some outstanding Japanese researchers who made important contributions to contemporary medicine, mainly in the fields of bacteriology, hygiene and pathology. To mention only two of these scholars, I refer to Shibasaturo Kitasato who had been working at the Institute of Hygiene with Robert Koch since 1885 [18, 21]. In 1889 he isolated Clostridium tetani and in 1894 he discovered the pathogen responsible for the plague [14, 24]. Another famous Japanese scholar was Sunao Tawara who worked together with the pathologist Aschoff and discovered the conduction system of the heart about which he published a monograph in 1906 .
The close collaboration between Germany and Japan started in the second half of the 19th century and involved a mutual exchange. German doctors were appointed to Japanese medical schools and universities but this lasted only for a few decades, from 1871 to 1905. However, Japanese scholars visited Germany where they received an academic and scientific training which they used to introduce modern medical faculties after returning to Japan. Despite the disturbed political relationship between Germany and Japan during World War I , these visiting activities lasted much longer  and in the 1920 s and 1930 s there were numerous Japanese scholars working at German university institutes  and even in the decades after World War II some of these contacts still existed.
Since the early contacts between the Japanese culture and European civilization, European medicine was part of the cultural transfer from the west to the east. In 1542 a Portugese ship first visited the Empire of Mikado  and in 1597 Dutch traders found their way to this far-eastern country. They gradually formed a colony in Nagasaki, which was for a long time the most important point of contact between Japan and Europe. Surgeons and physicians from all European countries, usually from the Dutch East India Company, were the intermediaries for western medicine, which found its way into Japan in the middle of the 16th century [1, 4, 13, 19].
Thus a foreign complex of medical knowledge supervened the system of Chinese medicine [16, 26] which was gradually adopted by the Japanese when they conquered southern Korea in the 4th century A.D. An understanding of western medicine was impossible without a knowledge of the anatomical structures of the body but, as in China, the laws forbidding dissection were based primarily upon reverence for the human body. Moreover, death was seen as a continuous process and dead people accompanied those still living in many ways and for a long time . Therefore the family of the dead individual had to arrange for an untainted body and this cultural tradition was not compatible with the implementation of modern medicine based on anatomy, physiology and pathology.
Despite this tradition some Japanese doctors, influenced by western thought, performed anatomical dissections in the 18th century. The first Japanese who tried to record an accurate description of the anatomy of the human body was Yamawaki Toyo. He was an adherent of medical thought which forcefully advocated the renaissance of ancient Chinese medicine based on sweating, vomiting and purging but he was also interested in anatomical studies. He had the opportunity to observe a dissection of a beheaded criminal on February 7, 1754 and a few years later in 1759, he published his observations. This was the beginning of experimental anatomy in Japan. Yamawaki Toyo’s major contribution was to stimulate a spirit of investigation at a time when there was a mounting interest in foreign learning .
Prior to the Meiji period [13, 25], which started in 1868 and allowed the official appointment of German university teachers, some steps were made which fostered the dissemination of western medicine in spite of constant attempts by the government to ban western studies. After the middle of the 18th century several medical schools were established under the sponsorship of feudal lords in Edo, Kyoto and Osaka, where the students became familiar with western medicine. The first was opened in 1786 and Franz von Siebold from Würzburg who joined the Dutch army as a military surgeon in 1822 and came to Japan in 1823 played an important role. He was allowed to travel through the country but had to leave Japan in 1829. In the Netherlands he worked on his famous work “Archive for the description of Japan” and between 1859 and 1863 he stayed in Japan for a second time and taught medicine in Nagasaki [2, 7, 10, 12, 23, 28].
The leading role of western medicine was enhanced in 1840 when the government outlawed all western studies except medicine. As a result, the expanding body of students dedicated to all fields of western learning turned to the schools of medicine and surgery. In 1849 the government issued a special order forbidding the practice of western medicine , however, surgery and ophthalmology were not barred, because these fields were so popular and the results of treatment were so readily observable that there could be no hidden adverse effects. The order was never strictly enforced.
Ogata Koan, a teacher at the medical school in Osaka and from 1862 director of the Institute of western medicine in Edo, wrote the first Japanese text on general pathology and internal medicine, published between 1847 and 1849 in 12 volumes . It consisted primarily of abstracts that had been translated from the writings of European physicians. In 1848 there were 71 medical and scientific books translated from Dutch into Japanese. All this happened before the old system had to be abandoned in 1868 and the more open-minded Meiji period began.
The period of the official adoption of the German medical teaching system began in 1870 when 2 German army physicians were invited to become professors at the medical college of the newly organised University of Tokyo [17, 22]. Even during this period, teachers of medicine came from various western countries, especially from England, France and America, yet the German influence and the German model remained predominant . The decision for the German model was due to at least three reasons: first, several of the translated books of the past centuries were written by Germans, despite the fact that they had come in a Dutch version to Japan. Second, the influence of von Siebold, who had visited Japan a second time between 1859 and 1863, was considerable and third the reputation of German medicine in the second half of the 19th century was high.
The first physician who was selected to lead the German medical mission was Benjamin Carl Leopold Müller [2, 25] who had studied medicine in Bonn and Berlin. His doctorate in medicine was based on studies in surgery, with gynaecology and as a minor subject also forensic medicine. Thus the first German professor in Japan was also familiar with some aspects of forensic medicine although this academic discipline was not yet fully established in German universities. The curriculum Müller established consisted of a 3-year period designated for premedical courses followed by a 4-year clinical education but at the outset the clinical courses did not contain lectures in forensic medicine.
From the beginning of the German era one goal was to train Japanese scholars to take over from the visiting teachers. A period of studies in Germany was considered to be of high importance. Thus in 1870, when the German model was adopted officially, 12 Japanese students were sent to Germany to study medicine . The field of pathology was one of the most important areas to establish and enlarge German-Japanese relationship in medicine. The German pathologist Rudolf Virchow who had worked out the concept of cellular pathology was one of the most important German professors with whom Japanese researchers were working. By order of the Imperial Government Moriharu Miura worked with Virchow for several years until 1887. After his return home in 1887 he founded the first Japanese pathology institute in Tokyo according to the German model and became head of a “school” of pathology . Two of the most prominent members of his school were K. Yamagiwa, later the successor of Miura and who also visited Virchow in Berlin and worked with him between 1888 and 1891. The other was A. Sata, director of the medical school in Osaka from1894. He established the long-lasting tradition of contacts to the pathology Institute in Freiburg where he stayed from 1897 to 1900 and collaborated with the pathologist Ernst Ziegler. Up to1905, 6 other Japanese physicians stayed as visiting scholars with Ziegler: Fujiro Katsurada (director of the pathology institute in Okayama), A. Fujinami (he became head of the pathology institute at Kyoto university in 1901), O. Kimura (he became director of the pathology institute in Sendai in 1915), T. Sumikawa, Y. Tashiro and T. Hayami . The Freiburg Institute was eager to build up and maintain these contacts. In 1905/1906 when Ludwig Aschoff was appointed to the Freiburg medical faculty as professor of pathology, he continued the collaboration with Tawara who had already worked with him in Marburg. Aschoff tied the bonds of collaboration with Japan even more firmly and up to the outbreak of the World War I there were another five Japanese scholars who received their qualification in pathology.
Not only the Freiburg Institute was engaged in the German-Japanese cooperation and the successor of Virchow in Berlin, Johannes Orth, also undertook similar activities . Freiburg and Berlin were the two important centres for this academic and scientific collaboration, but almost all other institutes of university departments and some important hospitals were visited by Japanese scholars.
World War I led to an interruption of these close contacts and even in the years prior to the war, the relationship between Germany and Japan had reached a low. However, in 1921 a revival could be noted, again with the two universities Freiburg and Berlin at the centre. In Freiburg there were sometimes five Japanese colleagues working at the same time on pathological problems. In 1933 and 1934 Matazo Masugi, who already had an international reputation as a nephropathologist, published his famous work on the experimentally evoked glomerolonephritis which became known as Masugi nephritis and contributed much to our understanding of inflammable diseases of the kidney . Aschoff enjoyed a high reputation in Japan and when he visited Japan in 1924 he was granted many honours . S. Hatano, who was the last Japanese scholar in 1939 prior to World War II, worked with Aschoff’s successor Franz Büchner and was later the director of the pathology institute in Kobe.
With the appointment of Wilhelm Dönitz as professor for anatomy at the Tokyo University in 1873 the first steps for the establishment of forensic medicine in Japan were taken.
Dönitz who had been educated at the Charité Hospital in Berlin, was at this time the only physician who worked in forensic medicine. At first he only practised forensic medicine as a sideline, but later became a full time forensic pathologist . He took part in every autopsy together with his disciples. In 1875 he made the acquaintance of the Scottish doctor Henry Faulds who had discovered the method of using fingerprints to identify perpetrators and Dönitz soon introduced this method into Japanese legal medicine. Moreover, he was engaged in hygiene and epidemiological studies. In 1876 he left Tokyo and worked for some years at the medical school in Saga to combat cholera and typhus. After his return home in 1886 he dealt primarily with infectious diseases.
As in the field of pathology, some Japanese doctors went to Germany by order of the Imperial Government. Kuniyoshi Katayama stayed in Berlin for 1 year from October 1884 with Liman at the institute for forensic medicine. After the first year in Berlin he went to Vienna for 2 years, then he returned to Berlin where he stayed for another year with Liman. After his return home he founded the first department of legal medicine in 1888 and became head of the Japanese forensic medicine in 1889 . Compared to Germany the establishment of this department had been effected very early. Despite the fact that in Germany important books on legal medicine had been published and several professors had already taught this discipline since the beginning of the 19th century, sometimes as extraordinary professors for “Staatsarzneikunde” or as professor for “medicina forensis et publica”, the establishment of a full professorship occurred mostly in the first two decades of the 20th century. Berlin had been appointed such a chair since 1864.
As in Germany forensic medicine had been taught in Japan without having its own institutes for this discipline at the universities. Between 1877 and 1883 Johann Ernst Tiegel worked as professor for physiology at the medical school in Tokyo. He gave lectures not only in physiology but also in pathology, hygiene and forensic medicine. When Julius Karl Scriba was appointed as surgeon to the Tokyo university in 1881 he taught legal medicine as well as surgery, dermatology and ophthalmology. At the beginning of the 1870 s in Nagoya a medical school and hospital became associated with an already existing school for interpreters. The Austrian physician Albrecht von Roretz started his teaching activities in 1876, which offered all medical disciplines including legal medicine . He also gave lectures in forensic medicine not only for students but also for physicians and police officers. Thus, legal medicine was taught before the discipline had been fully established at the medical faculties in Japan. With the beginning of the 20th century the era of the German teachers came to an end and Japanese physicians trained in Germany or Austria were able to take over from their foreign teachers.
However, around 1900 there was no generally accepted single system of postmortem examination of unnatural death or sudden unexpected death in Japan.
If at all, in most areas the causes of death were estimated by external examination without an autopsy. Large cities like Tokyo, Yokohama, Osaka, or Kobe soon introduced a medical examiner system with autopsies performed for unknown causes of death. Because an error in the postmortem diagnosis infringes on the right of a dead person and his family and sheds a doubtful light on public health and social security and other related matters, Katayama had already asserted the need for a medical examiner system throughout Japan in 1889. He was particularly engaged in forensic psychiatry and organised courses for forensic doctors and community doctors. Up to 1921 he was the director of the Tokyo institute. His successor was S. Mita who had also received an education in Berlin at the Charité Hospital with an emphasis on immunology under Professor Friedberger. T. Furuhata followed as the third director and he had been educated in pathology at the Berlin pathology institute and later became founder of human genetics in Japan. He was the director of the department of legal medicine from 1936 to 1952 .
After World War II the intense relationship between German and Japanese physicians became weaker. This was due to the world wide political situation and to the increasing scientific power of the United States of America which had already started at the beginning of the 20th century. As a result of this development a new orientation towards America emerged in almost all countries which did not fall under the sphere of influence of the USSR. Despite this reorientation the contacts between Japanese and German universities and persons never came to an end. During the last 50 years there have been many contacts and much collaboration in all areas of medical research. Successful collaboration with Japanese colleagues was performed by Professor Staak (Cologne) and Professor Prokop (Humboldt-University, Berlin). In Hamburg Professor Janssen collaborated with Professor Roy Nanikawa from the institute of legal medicine of Kanazawa University . Thus, the old tradition which had its origins in the second half of the 19th century is still alive and this provides convincing evidence that collaboration in this tradition yields fruitful results.
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