Paths to Asian Medical Knowledge: 32 (Comparative Studies of Health Systems and Medical Care) - Hardcover

Hardcover

ISBN 10: 0520073177 ISBN 13: 9780520073173

Verlag: University of California Press, 1992

Inhaltsangabe

Like its predecessor "Asian Medical Systems, Paths to Asian Medical Knowledge" expands the study of Asian medecine. These essays ask how patients and practitioners know what they know - what evidence of disease or health they consider convincing and what cultural traditions and symbols guide their thinking. Whether discussing Japanese anatomy texts, Islamic humoralism, Ayurvedic clinical practice, or a variety of other subjects, the authors offer a range of information and suggest new theoretical avenues for medical anthropology. The contributors are Judith Farquhar, Byron Good, Mary-Jo DelVecchio Good; Shigehisa Kuriyama, Carol Laderman, Charles Leslie, Margaret Lock, Mark Nichter, Gananath Obeysekere, Gary Seaman, Margaret Trawick, Paul U. Unschuld and Francis Zimmerman.

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Über die Autorin bzw. den Autor

Charles Leslie is Professor of Anthropology and the Humanities at the Center for Science and Culture, University of Delaware. Allan Young is Professor of Anthropology in the Department of Humanities and Social Studies in Medicine, McGill University.

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Paths to Asian Medical Knowledge

By Charles Leslie and Allan Young, editors

University of California Press

Copyright © 1992 Charles Leslie and Allan Young, editors
All right reserved.
ISBN: 0520073177
One
Between Mind and Eye: Japanese Anatomy in the Eighteenth Century
Shigehisa Kuriyama

It has long been a commonplace of Japanese historiography that the publication of Sugita Gempaku's (1733-1817) Kaitai Shinsho (1774) was a major turning point in Japanese cultural history. As one of the earliest translations of a Western anatomical text, Kaitai Shinsho represented the beginning of two epoch-making developments. First, and most directly, Gempaku's work set in motion the modern transformation of Japanese medicine, revealing not only many anatomical structures hitherto unknown in traditional medicine, but also and more fundamentally introducing the very notion of an anatomical approach to the body—the idea of visual inspection in dissection as the primary and most essential way of understanding the nature of the human body. Second, and more generally, Kaitai Shinsho inspired the rise of Dutch studies (Rangaku ) in Japan, thus giving birth to one of the most decisive influences shaping modern Japanese history, namely, the study of Western languages and science.1

Not surprisingly, Kaitai Shinsho has been the subject of frequent and meticulous study. The tale of how Sugita Gempaku, a physician, with no training in foreign languages, no foreign teachers, no dictionary, and no precedents to rely on, managed through heroic struggles to produce a remarkably sound translation of a Dutch medical text is a story that has fascinated generations. The lives of Sugita Gempaku and his collaborators, the challenges they encountered in this pioneering effort of translation, and the role of Kattai Shinsho in the development of Western studies in Japan have all been repeatedly chronicled in painstaking detail.2

This paper will suggest some new perspectives on this old and familiar material and will raise some questions that have previously not been asked. More specifically, Kaitai Shinsho will be reconsidered in the context of the history of visual perception. My contention is that questions about the rela-

tionship between eye and mind and between looking and seeing constitute the conceptual challenge of Kaitai Shinsho , and that without addressing the relationships framed by these questions we cannot hope to apprehend the deeper implications of the cultural transformation that was taking place in late eighteenth-century Japan.

1

An expression that figures prominently in the writings of Sugita Gempaku, and which defines the leitmotif of his thought, is memboku o aratameru , "changing one's outlook." In its general intent, the meaning of the phrase is clear. It presupposes Gempaku's sense of the profound divide separating the new world, which he is initiating, from the past world of his predecessors; and it expresses his call for a fundamental rethinking of the nature and method of medical knowledge, a radical transformation of habits of mind. In his introduction to Kaitai Shinsho Gempaku urges "all those who read this book to change their outlook."3 He promises a lucidity about the body totally unknown in the past, a new realm of clear and certain perceptions. But, he stipulates, "without a change in outlook, it is impossible to enter this realm.4 In fact, as Gempaku modestly concludes, it was precisely because he himself was able to change his outlook that, despite his natural ineptitude, he was able to achieve insights he could be proud of.5

As Gempaku conceived it, the idea of "changing one's outlook," of membo-ku o aratameru , represented both a prerequisite for, and a consequence of, the transition from Oriental medicine to Dutch medicine, and summarized his conviction that the past and future constituted two entirely different worlds. But this idea naturally gives rise to a number of questions. First, in what ways were the worlds different? That is, what was the precise nature of this "changed outlook"? And how did Gempaku envisage the new realm of medical understanding and experience? Any serious attempt to understand Gempaku and Kaitai Shinsho must address these issues.

To begin, the word "outlook" may be somewhat ambiguous. Generally, "outlook" refers to a conceptual orientation, a set of attitudes. That is, the visual metaphor implicit in "out-look" is usually construed as just that, a metaphor. This common metaphorical interpretation of outlook as conceptual perspective does not, however, capture the full or even primary thrust of Gempaku's call for reform. Rather, "changing one's outlook" must be interpreted literally as well as metaphorically; Gempaku's phrase is as much an expression of a new way of seeing as a call for a new way of thinking. The transformation represented by Kaitai Shinsho was first and foremost perceptual; memboku o aratameru corresponded to a novel mode of visual experience.

Traditionally, the interpretation of Gempaku's changed outlook has focused on the new primacy of anatomy, and this interpretation is certainly

correct—as far as it goes. In one of his late writings, Gempaku first reiterates how he realized the necessity of rejecting long-standing misconceptions and adopting a totally new outlook in medicine. He then goes on to explain: "After that, I understood that true medicine was to be found in the far West, in Holland. The foundation of medicine consists in the detailed investigation of the human body's natural structures, of the appearance of its interior and exterior; and it is when this investigation is accepted as the heart of medicine that medical science in our country will be securely founded."6 What made Dutch medicine true medicine, in other words, and what set it irrevocably apart from the traditional medicine of China and Japan, was its stress on the observations of dissection. The essence of changing one's outlook was learning to conceive of the body anatomically.

This much is straightforward. What is less apparent, however, is exactly what it could mean to conceive of the body anatomically. Here we encounter a critical theoretical lacuna in .the historiography of Japanese medicine. If scholars have unanimously recognized the centrality of the dissector's vision in Gempaku's call for medical reform, none to my knowledge has thought to inquire about what kind of looking this vision involves. Yet it is precisely this question of the particular mode of seeing that we must be most concerned with. To grasp the meaning of Gempaku's call for a changed outlook, common schematic notions of anatomy—of anatomy as simply cutting open the body and peering inside—are inadequate. We need to inquire further and pursue the specific character of anatomical observation.

In his introduction to Kaitai Shinsho , Gempaku stresses that the study of anatomy is in itself neither an unprecedented endeavor nor one unique to the West. Physicians throughout Chinese history had often discussed the internal organs and the skeleton, and some had even pursued dissections. But, he laments,

because their minds were hardened by chronic misconceptions (kyûsen ni kosuru ), even in the case of these physicians, even though they looked at the difference between accepted beliefs and the actual structure of the organs and the skeleton, they wavered haplessly in suspicions and doubts. It is just like the story about the man from Yen who had his native country before his eyes and yet could not recognize it. Even though they dissected they were not thereby suddenly able to see clearly: instead they remained in utter confusion.7

According to Gempaku, then, the failure of traditional medicine ultimately lay in a peculiar failure of vision. Earlier physicians had been interested in the internal organs, and dissections had been performed. Despite this interest, however, and despite cutting open the body and looking inside, they somehow had not seen the body as Gempaku saw it. It is here, in the differing perspicuity of vision, that past and present stood radically opposed, and that Kaitai Shinsho opened up a new world. Gempaku plants himself confidently in

the present, awake and clairvoyant, instead of in the past, where human beings, their minds enslaved by the strange power of old beliefs, could not see what was before their eyes. "Because their eyes and ears were confused by turbid traditions (oshô )," Gempaku eloquently concludes, "they were ultimately unable to sweep away the foggy obscurity and see the clarity of blue skies."

It is difficult in these translations to bring out the full force of Gempaku's language. Expressions such as "hardened by chronic misconceptions" and "turbid traditions" only vaguely hint at the distinct connotations of taint, pollution, and disease implicit in the terms kyûsen ni kosuru and oshô . In the original Japanese, the misapprehensions of traditional medicine appear not simply as mistaken beliefs, but as pathological states of mind, diseases that somehow incapacitated basic powers of discernment and perception. At the same time, the contrast between foggy obscurity and the clarity of blue skies intimates something further; it suggests that Gempaku conceived of this process of "changing one's outlook" as nothing less than a form of spiritual transformation, of quasi-religious enlightenment.

This contrast between a defiled and clouded past, and a present of clear and lucid vision was intended, at least in part, to be taken quite literally. As Gempaku points out, the failure of traditional medicine stemmed neither from a lack of interest in the internal organs nor even from a failure to inspect them. Rather, physicians in the past had been unable to perceive what was before their very eyes because of certain long-standing delusions, owing to certain dispositions of the mind. They had looked but had not seen.

What were these confused precedents that Gempaku was setting himself off against? They were of two sorts. First, there were the early Chinese investigations into anatomy. References to dissection appear in China as early as the Han dynasty (206 B.C.-A.D. 221).8 The sources of this period, however, provide only sketchy, general accounts of what was discerned from dissection at this time, and it is not until the Song dynasty (960-1279) that the first anatomical charts appear. These Song charts were based on the dissection in 1045 of the rebel Ou Xifan as well as on dissections performed at the beginning years of the twelfth century, and they eventually became the basis on which later physicians in China and Japan imagined the body's interior. Copies of the charts appeared thereafter not only in various Chinese medical texts, but by the fourteenth century had made their way into the works of the Japanese monk-physician Kajiwara Shozen.9

By the mid-eighteenth century, however, a number of Japanese physicians had begun to question the conception of human structure represented in this tradition of Song charts. The pioneering efforts of Yamawaki Tôyô (1705-1762), a leading member of the "Ancient Practice" school (kohôha ) of physicians, spearheaded the movement that sought to purify medicine of meta-

physical speculation and return it to the supposedly more empirical and certain foundations of ancient times. In much the same way that contemporary Confucian scholars of the "Ancient Learning" school (kogakuha ) criticized postclassical interpretations of the Confucian canon as distortions of the sage's original teachings, Tôyô and other members of the "Ancient Practice" school rejected the systematic theorizing characteristic of medieval Chinese medicine, and subjected accepted doctrines to searching doubt.

Among other things, Tôyô was skeptical of the account of human structure current in his time. In 1754 he arranged for the first recorded dissection of a human cadaver in Japan, and on the basis of this experience he pointed out many discrepancies between accepted doctrine and what is actually found in the body. This dissection and the subsequent publication, with illustrations, of the anatomical treatise based on it—the Zôshi (1759)—inspired a minor flurry of dissections in Japan, and Gempaku himself acknowledged how Tôyô's discoveries had fired his imagination. 10

In a certain sense, then, Kaitai Shinsho can be seen as the culmination of the surge of anatomical interest that began with Tôyô. Gempaku himself, however, as evidenced by his repeated calls for "changing one's outlook," saw more discontinuity rather than continuity. It was probably Tôyô and his imitators that Gempaku had uppermost in his mind when he made his remarks about the strange failures of vision. Tôyô, in Gempaku's view, despite the heroic and essentially sound character of his intentions, had, when he peered into the cadaver, "merely looked with vague incomprehension," unable to distinguish what was what. And this was also the case with the dissectors after him. Gempaku cites the example of the government physicians Okada Yôsen and Fujimoto Ryôsen who were said to have dissected seven or eight cadavers—a remarkably large number for the time. Yet they, too, in Gempaku's judgment, seemed to have been "unable to break old habits; in any case, they failed to accomplish anything useful."11 All these efforts, no matter how praiseworthy in intent, still belonged to a past era of vague and clouded perceptions. They belonged to a different world.

What was it then about the way in which Gempaku looked at the body that fundamentally differed from his predecessors? How is it that earlier dissectors did not see what he saw? In what sense could Gempaku claim to see "the clarity of blue skies"? These questions define the puzzle of Kaitai Shinsho .

2

In terms of content, in terms of what they saw, the difference between Gempaku and his predecessors is not hard to pinpoint; it is a difference in visual guides. Anyone who has dissected human or animal cadavers knows that anatomical study is far from a straightforward ostensive procedure. It is

messy and complex, and for the most part we are able to distinguish what we distinguish only because we are guided by teachers and texts. In other words, we see what we are taught to look for.

Perhaps the most familiar manifestation of this dependence on guides appears in the universally conservative tendency of anatomical traditions. We may recall for example how even so acute an observer as Leonardo da Vinci "saw" in his dissections pores connecting the two ventricles of the heart—imagined, that is, those pores that had been standard in anatomical teaching since the time of Galen, but which present-day anatomists can no longer see. Nor can we forget Vesalius's scathing critique of his predecessors—of generations of anatomy professors directing dissections without ever noticing the discrepancies between the Galehic texts they read aloud and the realities before their eyes.12

Gempaku's Dawn of Western Science in Japan (Rangaku Kotohajime ) tells of similar failures of vision in traditional Japan. The context is familiar: in Japan as in pre-Vesalian Europe we find the actual dissection left in the hands of nonphysicians, with the outcast eta (who provided the executioners and butchers of traditional Japan) filling the role played by barber-surgeons in Europe; and as in Europe we encounter the same perfunctory attitude toward anatomical inspection, the use of dissection merely to confirm textual knowledge. Consider the account of the first dissection that Gempaku attended—the dissection of a female criminal in 1771:

Toramatsu, an Eta and skillful dissector, was expected to perform the task, but he failed to appear on account of sudden illness. His ninety-year-old grandfather, a sturdy-looking man, took his place. He said that he had performed a number of dissections ever since his youth. In dissecting the human body, the custom till then was to leave everything up to such outcast people. They would cut open the body and point out such organs as the lungs, the liver, and the kidneys, and the observing doctors simply watched them and came away. All they could say then was: "We actually viewed the inside of a human body." With no sign attached to each organ, all they could do was listen to the dissector's words and nod.

On this occasion, too, the old man went on explaining the various organs such as the heart, the liver, the gallbladder and the stomach. Further, he pointed to some other things and said: "I don't know what they are, but they have always been there in all the bodies which I have so far dissected." Checking them with the Dutch charts, we were able to identify them to be the main arteries and veins and suprarenal glands. The old man also said: "In my past experience of dissection, the doctors present never showed puzzlement or asked questions specifically about one thing or another.13

It is not difficult to appreciate how dissections of this sort could contribute little to medical innovation. By glancing at and assenting to what the dissector indicated, physicians merely confirmed what was already common knowl-

edge. We recognize here the psychology of the tourist who visits sites solely for the satisfaction of saying that he has seen them. Gempaku identifies the intriguing feature of human perception that conditions this attitude when he writes, "With no sign attached to each organ, all they could do was listen to the dissector's words and nod." Without pictures, words, or gestures guiding and illuminating our vision we cannot attend to what is before our eyes. Or, to put it positively, such guides enable us to discern the body's articulated structure. In this peculiar indirectness of our senses, this dependence on mediating "signs" to make the world visible, we begin to explore the territory that separates mere looking from seeing.

This is in fact the first reason that Gempaku offers for the "vague incomprehension" of Tôyô's gaze; Tôyô could not clearly distinguish anatomical structures because he had nothing to tell him what was what.14 By contrast, Gempaku had the guidance of the Anatoraische Tabellen of Johann Adam Kulmus,15 and using it he and his companions came to recognize the arteries, veins, and suprarenal glands—to name them, picture them, and thus stabilize their existence. The real contrast, however, is perhaps not so much between "vague incomprehension" and clear perception as between different visions of anatomy. After all, Tôyô did distinguish many important structural features of the body. But the illustrations and descriptions of his Zôshi did not resemble the anatomy of European physicians. The body he saw was not the body that Gempaku saw. Tôyô's anatomical vision was guided by his fundamental suspicion, as a member of the Ancient Practice school, that the medical tradition in his time distorted the insights of the most ancient Chinese physicians. By pointing out the absence of those structures postulated by contemporary teachings, he wished to demonstrate the need for medical reform, and he directed reform toward what he imagined to be the pristine vision of the golden past.

Tôyô regarded his chief anatomical find to be his famous "theory of nine organs" (kyûzô setsu ). This theory was based on his "discovery" that the small intestine, which had long formed part of Chinese medical theory, could not be found when the body is dissected. Tôyô claimed that the small intestine was a myth, a fictional entity postulated by medieval physicians to fit their metaphysical schemes. Thus, there were actually nine organs, rather than the ten of accepted doctrine.16 But the organs Tôyô observed were, as he himself noted, precisely the organs listed in the Zhouli and in the "Pangeng" section of the Book of Documents . That is, the dissection confirmed what he took to be among the oldest Chinese works. Tôyô was guided in dissection by texts he took to be free from the distortions of later Chinese medicine.

Viewed in this way, matters seem simple; the divergence separating Gempaku from his predecessors reduces to a difference in the texts that guided their seeing. They saw different things because they looked for different things. Tôyô looked for and found the organs described in the oldest Chinese

references; Gempaku looked for and found the structures depicted in the texts of Western anatomy. But beyond the idea that observations are theory-laden, the real novelty of Gempaku's visual world consisted not just in what he saw, but more fundamentally in how he saw, in a new perceptual style. The key to this altered style of seeing must be sought in another development in late eighteenth-century Japanese culture, namely, the changing understanding of artistic representation.

3

The illumination provided by Western anatomical labels and illustrations allowed Gempaku to apprehend a whole array of structures that had been previously looked at in Japan but not seen. Nerves, blood vessels, and glands were all suddenly made visible by the selective detail found in Kulmus's Anatornische Tabellen . Now it might be objected that this reverses the order of things, since words and pictures shaped what Gempaku saw, whereas common sense teaches that seeing and other sense experiences constitute the ground in which our words and pictures are rooted. After all, not only does the act of looking at something precede the act of drawing it, but the very term "representation" seems to imply that words and pictures are but secondary schematic substitutes for original perceptions.

Yet how perspicuous are our perceptions? Consider the witness trying to describe to a police artist the criminal he has seen. Almost invariably requests for detail uncover uncertainties: Did the assailant have long or short earlobes? Were his eyelids single or double-fold? As the witness struggles to answer such questions, the mental image that he had assumed to be lucid and complete turns out to be remarkably fragmentary. Based on initial recollections of the witness, the artist makes a preliminary sketch and asks, "Did he look something like this?" "I think he looked older than that," the witness might comment, "and his eyes were more sly, and his lips seemed more fleshy." Through exchanges of this sort an increasingly nuanced and detailed portrait is crafted. In this process the witness also clarifies his vision. The image that seemed to disappear under scrutiny gradually reemerges. By looking at and criticizing successive drawings, the witness discovers more exactly what he saw. Pictures here serve in part as mnemonic aids to an imperfect memory; but the matter also goes deeper. Anyone who has ever tried to sketch a model is familiar with a similar dialectic whereby picturing and seeing go hand in hand: while looking at our model helps us to draw, the drawing in turn helps us to refine our visual grasp of the model. The "seeing" of the model emerges through a dialectical interaction of looking and representing.

This discussion only hints at the complexities joining perception and

representation.17 But it indicates the particular sense of the indirectness of the senses: pictures sharpen, articulate, and illuminate our perception of the world, and vice versa, or, to put it differently, perception, tout court , has its object neither in the world nor in pictures, but in their dynamic interplay in the mind.

Moving back and forth between pictures and the world, between the body depicted and the actual cadaver, was precisely Gempaku's experience of the eye-opening dissection of 1771. By a coincidence, both Gempaku and Macho Ryôtaku, the physician Gempaku invited to accompany him, possessed copies of Kulmus's Tabellen , and both brought their copies to the dissection. Gempaku's description is revealing: "Comparing the things we saw with the pictures in the Dutch books Ryôtaku and I had with us, we were amazed at their perfect agreement."18 We are invited here to imagine a situation in which seeing the body and seeing the pictures of the body were inseparable. The revelation of the striking fidelity of the Western anatomical illustrations went hand in hand with the revelation of the body's articulated structure. One was not possible without the other. Kulmus's anatomical illustrations not only guided what Gempaku saw but also how he saw. By learning a new style of representing the world the Japanese in the eighteenth century learned a new style of perceiving the world; they acquired a new visual style.

The argument is a logical one based on the commonplace observation that style and content are inseparable. If Western anatomical charts allowed Gempaku to see in the body what his predecessors had never seen, then it stands to reason that they also allowed him to see in a way that set him apart. This argument also does not lack historical evidence. Of special interest here is Gempaku's reaction to Lorenz Heister's Surgery , the first Western medical text he saw:

Needless to say, I could not read the book, not a word or a line. But the illustrations of the book looked markedly different from those in Japanese or Chinese books. Just viewing their exquisite precision I felt as though being enlightened (emphasis added). So I borrowed the book for some time as I wanted to copy the pictures at least.19

These remarks must be taken with Gempaku's comment that when he and his companions first examined Kulmus's anatomical charts, "They looked so different from the pictures in the Chinese anatomical books that many of us felt rather dubious of their truth."20 In other words, what so excited Gempaku about Western anatomical drawings was not any sense of their self-evident veracity, or simply the curiosity aroused by their content. It was their striking difference in style, their "exquisite precision." Underlying Gempaku's refrain of memboku o aratameru , of changing one's outlook, then, was the

intense visual experience of an entirely new mode of representation. The quasi-religious revelation of "clear blue skies" was an expression of this eye-opening experience.

4

If Western anatomical charts made Gempaku's experience of enlightenment possible, they did not by themselves make it necessary.21 Pictures may provide fresh ways of looking at the world, but only if one has a way of looking at pictures. The importance of Western illustrations in shaping the way Gempaku and his contemporaries saw the world raises the question of how these illustrations were themselves perceived. What did Japanese in the late eighteenth century see in Western pictures? How are we to understand Gempaku's immediate and enthusiastic response to a foreign mode of representation?

Gempaku provides no direct insight into these issues. Though we have noted the eagerness with which he took in the Western style of representation, he never explicitly theorized about why he was so receptive, or recorded what it was exactly that he found so appealing in Western pictures. We must therefore approach the question obliquely—but only slightly obliquely, for Gempaku was not alone in his enthusiasm for Western illustrations. The years when he and his collaborators were struggling with their translation of Kulmus's anatomy also correspond precisely to the period in which Japanese artists were beginning to study and imitate Western techniques of representation. Historically, this temporal coincidence is significant because the contemporary investigations of Western representational technique helped make Kaitai Shinsho what it was. Adorned by skillful copies of Western anatomical charts, Kaitai Shinsho simply looked strikingly different from Tôyô's Zôshi or any other previous work in Oriental medical history.

However, the pioneers of Western-style art in Japan were self-conscious about the aims and uses of representation in a way that nonartists like Gempaku were not. Two contemporaries of Gempaku, whose attitudes typify those of the Western-style artists in this period, are Satake Shozan (1748-1785), whose Gahô Kôryô is now recognized as the first theoretical treatise on illusionism in Japan, and Shiba Kôkan (1738-1818), the foremost exponent of Western art in his time, and the first Japanese to master the technique of copperplate prints. Both were pupils of Odano Naotake (1749-1780), the artist who executed the masterful copies of Western anatomical illustrations for Kaitai Shinsho .22 Their reflections on art are early and direct sources for understanding the Japanese response to illusionism. The writings of Shozan and Kôkan make plain that they discerned two great virtues in the Western style, two principles that made it incomparably superior to the traditional Chinese and Japanese approach to painting. One was the illusionistic princi-

Image not available.

Fig. 1.1.
The heart and spinal column, depicted m Yamawaki Toyo's
Zoshi.

Image not available.

Fig. 1.2.
Views of the heart in Sugita Gempaku's Kaitai Shinsho.

pie of "resemblance," the notion that pictures should look like what they depict, and the other was the principle of yô , or utility.

Of these principles it is especially the latter that we must come to terms with. Usefulness, for both Shozan and Kôkan, defined the ultimate goal of representation: the realism of a picture, its resemblance to the object represented, was valued because it was the essential means to actualizing the utilitarian end. Thus, when in Gahô Kôryô we read, "In judging the usefulness of a picture one should value resemblance," we must realize (and a consideration of the treatise as a whole makes this unmistakable) that Shozan was not setting up "usefulness" as one possible criterion of judgment as opposed to another, such as beauty. Usefulness was the only real criterion of judgment, the one standard that truly mattered. To judge the utility of a picture was to judge the picture. Since enthusiasm for the Western style of representation focused on the style's "utility," our problem is what utility meant as well as what its connection was to resemblance.

In 1773, Hiraga Gennai—Gempaku's friend, brilliant polymath, and, among other things, an expert on mining—was hired by the domain (han ) of Akita to help develop the domain's copper resources. This represented part of Akita's effort to stave off the economic disaster brought on by a recent series of floods and fires. As it turned out, mining in Akita never developed to the extent that domain leaders had hoped. But Gennai's visit did have an effect of perhaps even greater historical moment. During his stay he introduced local artists to Western representational techniques. This was the origin of the so-called Akita school of Dutch art. The most brilliant of Gennai's disciples was Odano Naotake, the illustrator of Kaitai Shinsho , and the teacher of Satake Shozan and Shiba Kôkan.

These details bring out an essential point; namely, that the study of Western methods of representation originated in the context of an impoverished domain's search for fiscal solvency. Shozan, the author of the first theoretical defense of illusionism, was also and more important the lord of the beleaguered Akita domain. The point is more revealing than one might at first suspect, for the problems in Akita were in fact merely one local manifestation of a more general crisis in mid-Tokugawa society. Throughout the course of the eighteenth century the transition from an agrarian to a commercial economy had steadily eroded the feudal foundations of Tokugawa rule, and produced increasing strains and contradictions in the old social order. The Tanuma era (1760-1786),23 the era in which Sugita Gempaku, Satake Shozan, and Shiba Kôkan first encountered the Western style of depicting the world, was also the era in which these strains and contradictions were beginning to appear in especially grotesque and frightening forms. The Tanuma era was as notorious for the extravagant banquets and outrageous orgies of the urban elite as for the famines and epidemics that devastated the countryside, a period when despite the deepening debt that threatened the very sur-

Image not available.

Fig. 1.3.
Anatomical perspective in Zoshi.

Image not available.

Fig. 1.4.
View of the portal vein in Kaitai Shinsho.

vival of the samurai class, and despite official prohibitions to the contrary, samurai went in droves to the pleasure quarters and whiled away the hours. The period saw the birth of the geisha, and the quest for sensual gratification became a refined art; but it also witnessed widespread infanticide among the peasantry.24

Against this background, we must interpret the insistence of Shozan and Kôkan that art must have "practical utility" (jitsuyô ), and that it must be "an instrument of national utility" (kokuyô no gu ). The call for usefulness was sloganeering that expressed an acute sense of a world gone seriously wrong; it was a call for positive action and reform in a nation perceived to be slipping rapidly toward ruin. Thus for Shozan and Kôkan utility meant first and above all "national utility" (kokuyô ) it referred to whatever might serve the state in its time of crisis. Construed in this broad sense, the preeminence of usefulness in art is not difficult to comprehend. In the minds of reformers— and all proponents of Westernism were by definition reformers—usefulness was the supreme value in representation because it was the supreme value in all things.

Still, we may wonder about how pictures could be useful. It is the specific usefulness of illusionistic pictures that we want to know about. Now, in one sense, there is no great mystery. For Shozan and Kôkan pictures were an unsurpassed tool of communication whose utility to the state lay in their power as instruments of enlightenment, in their ability to convey "what words cannot express." Unlike words, they could be understood by "even children and fools."25 The necessary connection between resemblance and usefulness thus becomes clear. With its capacity to create pictures that resembled the reality they depicted, the Western style of representation created unprecedented possibilities for educating the people and disseminating information. As Shiba Kôkan explained:

The marvel of pictures lies in their ability to allow one to directly see what one has not seen. If, therefore, a picture does not faithfully copy an object as it really is, it loses this marvelous usefulness (myôyô ).

[For example,] Mt. Fuji is a mountain found in no other land. If one wants to see it, one must see it in pictures. If, however, one just concentrates on the expressiveness and technique of the brushwork and the picture does not look like Mt. Fuji, then the marvelous usefulness of pictures is lost.26

In a similar but humorous vein, Shozan wrote, "If a picture of a lion looks like a dog, people will laugh at it."27

Another and perhaps even more fundamental aspect of the demand for usefulness was its negative critique. In large measure the notion of the useful defined itself in opposition to the traditional style. To appreciate the full appeal of Western illusionism for Shozan and Kôkan we must examine their deep dissatisfaction with the artistic culture of their time.

One source of disaffection concerned the contemporary uses of pictures. Gahô Kôryô sets forth the contrast between the practical, informational uses of art made possible by illusionism and the frivolous pastimes then prevalent. His contemporaries, Shozan complains, have landscapes painted on sliding doors so that they might enjoy them in the relaxed leisure of the home; or they hang up paintings just to entertain friends who come to visit; or again people paint as a form of Zen meditation, or even more commonly (and in Shozan's view, worst of all) simply as a diversion, like playing chess or the zither. All of these uses Shozan castigates as making pictures into "playthings which are useless to the state."28 Practicality was defined here by opposition to the aestheticism of a privileged elite; and we can see in Shozan's austere utilitarianism a reaction against an era consumed by the pursuit of pleasure and the cultivation of sensibility, a culture oblivious to the practical problems that so urgently required attention.29

Yet it was not just a problem of the ways in which people used pictures. The question of social application was inseparable from the question of style. As Kôkan explained, the marvelous usefulness of pictures is realized only by pictures that resemble the thing they depict, but in Chinese-style depictions, Mt. Fuji did not look like Mt. Fuji. The failure to look like Mt. Fuji was not an accident. It arose from a highly sophisticated conception of representation that was not concerned with depicting the world but sought instead to evoke the artist's experience. The focus of the Chinese aesthetic was, as Kôkan reminds us, "the expressiveness and technique of the brushwork," the manifestation of the painter's sensibility as he blended his mind into nature and saw it, as it were, from within. This is why in traditional landscapes, depictions of Mt. Fuji might often be indistinguishable from depictions of other mountains. The individuating outer "form" was essentially irrelevant, for what mattered was the inner "spirit," the invisible inner vitality of things as intuited by the sensitive artist and expressed in the nuanced suggestions of his brushwork. From the perspective of reformers, this elitist aestheticism and its worship of sensibility was decadent self-indulgence. At best, the adulation of the suggestive brushstroke was useless, and contributed nothing to resolving the crisis of their time. At worst, a mind-set so preoccupied with the nuances of subjective experience could not clearly see objective and problematic reality and was itself a basic cause of this crisis.

"There is a theory that paintings should present that spirit rather than the form," Shozan wrote in Gahô Kôryô , "but such an approach abandons the practical usefulness of painting."30 Gempaku, Shozan, and Kôkan all saw in Western illusionism an alternative to the decadent subjective orientation of the Tanuma era.31 Thus, for Kôkan, the essence of the Western style was epitomized by the camera obscura, and in his enthusiasm for this foreign device he urged people to look at his pictures through it.32 Instead of a world perceived through the haze of the painter's personal intuition, instead of the

"spiritual" vision of the artist immersed in and harmonizing with nature, the camera obscura presented a world of independent objects, observed from without, mirrored with geometrical fidelity.33 It was especially against the gaze of the traditional aesthete that the early defenders of Westernism in Japan championed Dutch art, which, as Kôkan put it, "Just depicts things as they really are" (tads sono raono o shin ni utsusu ).34

Against the self-indulgent "spiritual" tradition of Chinese-style painting, with which they were so dissatisfied, Shozan and Kôkan championed an art of "forms," an art that depicted the world seen lucidly from without. This was the deepest meaning of usefulness—the clear separation of the human seer from the objects that are seen. For reformers in late eighteenth-century Japan the most compelling attraction of the Western style of representation was the recognition of the world as an independent and objective reality that had to be reckoned with.

5

In the first section of this essay I pointed out the strong language in which Sugita Gempaku set forth his call for reform, how his references to the "chronic misconceptions" and "turbid traditions" of the past hinted at moral failures, and how his conception of memboku o aratameru seemed to carry nuances of spiritual transformation. The preceding discussion of illusionism in the Tanuma era has further underlined the importance of coming to terms with the moral element in the changing outlook of the late eighteenth century. In this concluding section I will examine the way in which Gempaku's experience of a new visual lucidity, was tied in with Confucian conceptions of self-cultivation.

What was the problem with the past? Recall that Gempaku compared the confusion of early dissectors to the confusion of the man from Yen. This is an allusion to a brief story found in the Chinese classic, the Liezi :

There was a man who was born in Yen but grew up in Chu, and in old age returned to his native country. While he was passing through the state of Jin his companions played a joke on him. They pointed out a city and told him: "This is the capital of Yen."

He composed himself and looked solemn.
Inside the city they pointed out a shrine: "This is the shrine of your quarter."
He breathed a deep sigh.
They pointed out a hut: "This is your father's cottage."
His tears welled up.
They pointed out a mound: "This is your father's tomb."
He could not help weeping aloud. His compansions roared with laughter. "We were teasing you. You are still only in Jin."

The man was very embarrassed. When he reached Yen, and really saw the capital of Yen and the shrine of his quarter, really saw his father's cottage and tomb, he did not feel it so deeply.35

The tale is a variation of a favorite Daoist theme: the subjectivity of perception. The source of individual unhappiness and social divisiveness, from the Daoist perspective, is that our perceptions are conditioned by artificial expectations and projections. We always see things as something; that is, we impose an arbitrary value structure on them. The painful confusion of the man from Yen reflects not only the embarrassment of having been gulled, but also the situation of an individual who suddenly confronts the artificiality of his deepest sentiments.

Aside from its piquant Daoist message, the story illustrates a basic assumption common to both the Daoist and Confucian traditions in China, namely that perception is a form of response. Seeing, hearing, smelling, tasting, and touching may or may not have the sentimental overtones of the reactions of the man from Yen, but they all involve, by their very nature, the active participation of the perceiver. The passive reception of images is foreign to the traditional Chinese scheme of experience. One sees in much the same way as one gets angry.

To appreciate how this understanding of perception helps us to interpret Gempaku's criticism of past medicine, I must add that in the Confucian conception of good and evil, particularly as interpreted by the influential Song Confucians, each is a matter of appropriateness of response. Anger, sorrow, and the various other feelings each has its proper place and measure; but only the sage is able to respond with the appropriate feeling in the appropriate degree to each of the countless situations that arises in daily life. It is, of course, not a matter of conscious calculation. Rather, by maintaining a careful watchfulness, the sage achieves a mental balance that allows him to react naturally with a just response. Neglect and carelessness can easily upset this balance and hence skew the ways in which we interact with the world; and thus most of us fall short of the goodness of the sage.

In Keiei Yaws (Conversations with a Nocturnal Shadow ) Gempaku discusses a wide variety of issues in the form of a dialogue with an alter ego, Shadow. At one point the Shadow asks about human possibilities. He notes that great Confucians such as Arai Hakuseki and Ogyû Sorai had achieved the things they achieved because of naturally superior dispositions combined with great effort. But how, asks the Shadow, can the ordinary man hope for sagehood? Gempaku denies any radical divide separating sages and ordinary humans, and appeals to the vision of self-cultivation suggested by a passage in the Confucian classic, The Great Learning (Daxue ). He only alludes to it, citing the phrase, "we look but do not see, listen but do not hear," for most of his readers would have known the text by heart:

What is meant by saying that the cultivation of the personal life depends on the rectification of the mind is that when one is affected by wrath to any extent, his mind will not be correct. When he is affected by fear to any extent, his mind will not be correct. When he is affected by fondness to any extent, his mind will not be correct. When the mind is not present, we look but do not see. listen but do not hear, and eat but do not know the taste of food. This is what is meant by saying that the cultivation of the personal life depends on the rectification of the mind.36

That perception and attention are intimately related is both a commonplace of academic psychology and a fact of daily experience. But in the Confucian perspective inattention represents the fundamental moral flaw. For the eye to see what is before it, and for the ear to hear the sounds around it are the natural responses of being human. But any sort of disturbance of the mind—preoccupations, worries, infatuations—will disturb the mind's natural balance, and hence its capacity to perceive. In extreme cases, Gempaku explains, people will not hear the roaring thunder, or see a sword held menacingly in front of them.37 Such inattention is for Gempaku the root of spiritual failure. The foundation of self-cultivation is actually simple and accessible to all. If one is alert and attentive, then nothing will separate one from the great sages. "The essential thing," Gempaku concludes, "is attentiveness."38

We can now understand the moral taint associated with the oversights of past anatomists. A failure to see reveals a skewed state of mind. Conversely, the bright clarity of Gempaku's new outlook expressed not only his enthusiasm for the new world of illusionistic representation, but a corresponding sense of moral purification. It was the encounter with Western artistic techniques that taught Gempaku a visual style illuminating the world in sharp, vivid detail; but the meaning of this visual illumination was defined by traditional ideas of spirituality. This fusion of two traditions is perhaps the ultimate meaning of "changing one's outlook."

The essential novelty of Gempaku's visual world was a novelty of representation. The traditional historiography that situates Gempaku's anatomical contributions in the history of Japanese empiricism is certainly justified. But the history of empiricism itself needs to be reconsidered from the perspective of the history of visual perception. We need to examine more dosely what it means to observe. I suggest that it is in the visual possibilities revealed by new representational techniques that we must seek the sources of Gempaku's vivid sense of a world suddenly seen clearly and afresh.

Continues...

Excerpted from Paths to Asian Medical Knowledgeby Charles Leslie and Allan Young, editors Copyright © 1992 by Charles Leslie and Allan Young, editors. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Details zur Ausgabe

• Verlag: University of California Press
• Erscheinungsdatum: 1992
• Sprache: Englisch
• ISBN 10: 0520073177
• ISBN 13: 9780520073173
• Einband: Tapa dura
• Anzahl der Seiten: 296
• Herausgeber: Leslie Charles, Young Allan
• Kontakt zum Hersteller: Nicht verfügbar
• Verantwortliche Person: Nicht verfügbar