Physicians' Social Bodies and Networks
At the same time, physicians in Tokugawa Japan were also part of localized groups of medical professionals. These groups comprised domain and town doctors of all specialties and served as vehicles for both occupational self-government and seigneurial control. They were status groups in the sense that they situated their members within the structure of Tokugawa rule and managed their members' status and public obligations. While these groups were structured hierarchically and dominated by the domain doctors, all members participated in the tasks of self-government and consensus-building, drawing on their shared medical knowledge.
Broadly speaking, there were two types of medical professionals in Tokugawa Japan: domain physicians, who directly served the lord and received stipends according to rank, and town and village physicians, who lived among commoners and primarily treated commoner patients. Both types, however, performed certain duties for their lords as mediated by their status group. In addition to self-control, they were often expected to treat prisoners, for example, or accompany the lord on his travels or pay their respect at the palace at certain times of the year.
In the course of the nineteenth century, many feudal rulers in Japan intensified their oversight of medical practice in their territories. In the castle towns of Fukui and Fuchū, for example, domain and town doctors began to coalesce around newly established medical academies and exercised stricter control over the practices of village doctors and the sale of medicinal herbs to domain subjects. Medical academies issued rules that defined physicians' respective responsibilities within the group. In Fuchū, physicians affiliated with the academy referred to themselves as a shachū (society) [Umihara].
The status groups of physicians were organized by domain. When Kasahara Hakuō, a town doctor of Fukui domain, brought the smallpox vaccine to Echizen, he established a regional network of vaccinators that rested on top of the local status groups of doctors. To explore this new network, go directly to "A New Regional Network of Vaccinators". Or continue on the pathway "The Networks and Vehicles of Vaccine Transmission."
