9   Diseases, doctors, and medicines

1. Among us, it is commonplace to suffer from swollen glands,¹ kidney stones, gout, and plague; in Japan all of these ailments are rare.

Swollen lymph nodes (they are not actually glands), particularly in the neck, are a common symptom at the outset of a variety of illnesses. Sixteenth-century Europe was repeatedly subjected to acute and chronic infectious diseases, including bubonic plague, which refused to go away after devastating Europe in the fourteenth century.² Frois might also have mentioned typhus and syphilis, two diseases previously unknown in Europe that ravaged the continent during Frois’ lifetime.³ Most of us are familiar with kidney stones and gout. The Portuguese term used by Frois for the latter (podagra) is still used by doctors and often refers to gout that manifests as pain in the joint at the base of the big toe. Kidney stones and gout were a particular problem for European elites, who consumed large amounts of meat and not enough diuretics (e.g. beets, peas, artichokes, cabbage).

Japan in the sixteenth century appears to have been relatively free of acute and chronic infectious diseases, despite its large and urbanized population.⁴ The Japanese penchant for cleanliness and Japan’s physical separation from the rest of Asia and the world might help explain why Japan went unscathed (relatively speaking) by diseases that elsewhere changed the course of history.⁵

2. We use bloodletting; the Japanese use a cauterizing iron with herbs.

Bloodletting as “preventative maintenance”⁶ or to restore the body’s humeral balance was common medical practice in Europe. Burning moxa—a wool-like material ideally taken from the leaves of a species of Chrysanthemum (Artemesia vulgaris)—and acupuncture, were the Chinese and Japanese way of restoring or insuring bodily health. Both were similar to European practices in that they were predicated on the idea that health presupposed a balance of vital force (ki in Japanese, from the Chinese qi).⁷ Maintaining or restoring ki entailed engaging bodily energy through acupuncture (strategic placement of very thin silver or gold needles) and/or burning very small, cone-shaped moxa at particular sites on the body (the heat generated by the moxa was thought to “unblock” or accelerate the flow of ki). As Kaempfer wrote in his thorough chapter on moxibustion,⁸ the moxa burned so slowly that “… the pain is not very considerable, and falls short of that which is occasion’d by other Causticks.” Although Japanese and Chinese physicians did not agree (and still disagree) about where to burn for various complaints, Kaempfer observed that the backs of the Japanese “… of both sexes are so full of scars and marks of former exulcerations, that one would imagine they had undergone a most severe whipping.”⁹

Much like bloodletting, moxibustion was used to treat specific ailments (e.g. headaches, toothaches), as well as to maintain bodily health. Again, Kaempfer: “Here, these little mugwort cones [moxa] are to be found in most houses, and people are burned in the spring, just as in England blood-letting was formerly customary at the same season.”¹⁰

Today, few Japanese, particularly among the younger generations, practice moxibustion, just as few Europeans embrace phlebotomy. Note, however, that there have been some impressive studies of the physiological equivalent of blood-letting, i.e. blood donation, that suggest significant increases in life expectancy. Reading about disfiguring scars caused by moxa and the unnecessary deaths caused by overzealous bloodletting, we laugh at our ancestors, yet our ancestors may well have the last laugh.

3. Among us, men ordinarily are bled from their arms; the Japanese use leeches or a knife to the forehead, and they bleed horses using a lancet.¹¹

The ordinary procedure for bloodletting in Europe was to open a vein with a lancet or fleam and to then collect and measure the blood flowing or spurting from the patient’s arm (the goal was to remove “excess” blood and restore the body’s humeral balance and health). Europeans also used leeches and cupping devices to remove smaller amounts of blood from severed capillaries. (Perhaps because leeches are so painless, their frequent use led to their extinction in some parts of Europe.)

The forehead bleeding mentioned here by Frois refers to a Chinese practice carried out with a “three-corner-needle” or fleam on the crown and occipital part of the head (because the crown usually was shaven, Frois speaks of the forehead). This bleeding to remove “bad blood” was not so common a practice as venesection and probably was used for certain maladies. Thus, Valignano (and others) wrote “They never bleed a person, …”¹²

4. We make use of enemas or syringes; under no circumstance do the Japanese use such remedies.

For at least two-thousand years before Frois wrote this, the West made use of enemas to treat constipation and flush parasitic worms from the colon and lower intestine. Syringes of wood or carved from ivory frequently were used to propel an anti-worm drug, or vermifuge, up into the small intestine. During the sixteenth century tobacco from the New World became a popular key ingredient in vermifuges used to treat worms.

Frois’ Jesuit superior, Valignano, contradicted Frois in a rare contrast not found in the Tratado: “… their purges are sweet-smelling and gentle—in this they certainly have an advantage over us for our purges are evil-smelling and harsh.”¹³ Marcelo de Ribadeniera, a Franciscan who came to Japan in 1594, wrote that, aside from the various “… simple medicines and potions made by boiling roots” (taken from books written in Chinese, i.e. kanpoyaku), “… they also administer purges in candied pills so that they may be taken more easily.”¹⁴

5. Among us, doctors write prescriptions to be filled by pharmacists; doctors in Japan dispense medicines from their own homes.

By the fourteenth century the professions of physician and apothecary were distinct and proto-pharmacies could be found in many European cities, often in monasteries and religious houses (the Church of Santa Maria Novella in Florence, Italy claims to have the oldest pharmacy, dating to 1221). In sixteenth-century Portugal druggists were licensed and apothecary shops were required to have a small and specialized reference library, appropriate weights and measures, and both simple and compound medicines.¹⁵

Doctors in sixteenth-century Japan usually were called kuzushi or “medicine-masters,” and true to their name, they filled their own prescriptions whenever they could (sometimes ingredients had to be ordered from a specialist). This does not mean they grew, gathered, and made it all. When Luis de Almeida (1525–1584), a merchant and surgeon turned Jesuit, took over a clinic in Bungo (Kyushu) in 1559, he quickly set up a pharmacy and put a former Buddhist monk in charge who could read Chinese and order Chinese medicines from abroad.

6. Our doctors take the pulse of both men and women first from the right arm and then from the left; the Japanese take a man’s pulse first from the left, and a woman’s first from the right.

This difference, writes Okada, stems from Oriental yin-yang philosophy. The pattern was not restricted to medicine; male-left, female-right also applied to “signing” documents or making oaths using a bloody fingerprint.

7. Our doctors examine one’s urine to gain greater information regarding the illness; under no circumstance do the Japanese examine this.

It is hard to overestimate the importance of urine as a diagnostic tool for medieval and early modern Western medicine (the mantula, or urine flask, was the symbol of the medical profession during the Middle Ages).¹⁶ Medical practitioners in sixteenth century Europe analyzed and described urine much as sommeliers today discuss wine. Urine was swirled and sniffed and visually examined to determine bouquet, color, sediments, thickness and other qualities that were thought to reflect bodily health. Okada notes that de Almeida checked the urine of the fief lord of the Goto islands (this according to de Almeida’s letter of October 20, 1566¹⁷). Around this time, Japanese medical practitioners, led by Mansae Dosan (1507–94), re-worked Chinese neo-Confucian ideas (i.e. that disease was a consequence of an undisciplined, poor lifestyle) and popularized a four-fold approach to clinical care that emphasized visual observation of a patient’s skin color, hair, feces and urine.¹⁸ Frois apparently was unaware of this development. Today, Japanese hospitals seemingly collect urine samples for almost anything under the sun (perhaps because it occupies the patient during his/her long wait to see a doctor; there is insurance money for it; and the test is relatively innocuous).

8. Because the flesh of Europeans is so delicate, it heals very slowly; Japanese flesh is robust and recovers much better and faster from serious injury, burns, abscesses, and accidents.

Recall Frois’ very first contrast in Chapter 1, which cast Europeans as “well built” or robust as compared with the Japanese. A contemporary of Frois’, Mexia (1540–1599), likewise wrote: “When they [the Japanese] fall sick, they recover in a very short time without taking hardly any medicine.”¹⁹ This, together with statements by many European visitors about the light diet of the Japanese, may well be the first elaboration of the stereotypical oriental that is frugal, long-lived, and can survive on less than the Westerner.

9. Among us, wounds are sutured; the Japanese cover them with a little bit of paste-coated paper.

The Japanese did not suture wounds, perhaps because sword wounds healed quickly owing to the sharpness of Japanese swords. A good adhesive band-aid apparently worked perfectly well. Okada wonders if the “paste” was ointment that also functioned as an adhesive.

10. All the dressings that we make using cloth, they make with paper.

As Frois points out in the following chapter (see #10), the Japanese had many varieties of paper, compared to a handful in Europe. The Japanese could use paper and not cloth for treating wounds because some of their paper was as soft as gauze. It would not be surprising to learn that the paper also had the advantage of breaking down in time, i.e. that it was the equivalent of today’s dissolvable stitches.

11. Among us, abscesses are treated using intense heat; the Japanese would rather die than use our harsh surgical methods.

The European practice of using a red-hot iron to burn an abscess, or pouring scalding oil into a gun-shot wound, were sometimes effective, but always horrifying ways to treat a localized infection or trauma. Of course, the treatment also was likely to scar someone for life. It is perhaps no surprise that the Japanese referred to Europeans as “southern barbarians.”

12. When our sick have no appetite, we work hard to make them eat; the Japanese think this cruel, and a sick person who does not want to eat is allowed to die.

Okada points out that eating, especially rich food, was thought to reduce the efficacy of Chinese medicine. Arguably, what is eaten without an appetite or even in the presence of nausea may exhaust an already stressed gastro-intestinal system, increasing putrefaction and flatulence and perhaps hastening death. Fasting may allow organs to recoup enough to make eating beneficial.

13. Our sick lie on beds or cots with mattresses, linens, and pillows; the sick among the Japanese lie on mats on the floor using a wooden pillow,²⁰ with their kimono over them.

This is simply the ordinary sleeping arrangement described elsewhere in separate contrasts regarding beds, bedspreads, and pillows (see Chapter 11). Perhaps Frois felt repetition was worthwhile, for the soft versus hard contrast might be more poignant in the context of the sickbed.

14. In Europe, chickens and young cocks are considered medicine for the sick; the Japanese consider them poison, and they instead feed fish and pickled radish to the sick.

It is tempting to think that Frois is referring in the first half of this distich to a light chicken broth (ironically not unlike Japanese miso shiru). Although Europeans at least as far back as the Middle Ages considered chicken broth healthful, Frois does not explicitly refer to soup or broth. As we saw in Chapter 6 (#7, #24), Europeans were apt to boil a fat and succulent chicken and then add rice flour, sugar, rose water, almonds, and goat’s milk, producing a dish that had the consistency of melted white cheese. Serving such a dish to somebody who was sick is suggested by Valignano’s comment that, “… they regard hens, chickens, sweet things and practically all the foods we would give patients as unwholesome for them; on their part they prescribe fresh and salted fish, sea snails and other bitter, salty things, and they find from experience that they do patients good.”²¹

One reason the Japanese rejected domestic birds, as Alvarez noted, was because they were considered a taboo food (“… they never eat anything they breed”²²), and for a sick person to eat their meat would be to tempt fate. As Valignano acknowledged, the Japanese found from experience that fish and slightly fermented pickles worked quite well.

15. We pull teeth using dental pincers, dental forceps, the parrot’s beak, etc.; the Japanese use a chisel and mallet, or a bow and arrow tied to the tooth, or a blacksmith’s tongs.

Dentistry in sixteenth-century Europe was practiced mostly by barbers and by itinerant tooth-pullers who extracted dental roots and broken or rotten teeth using various pliers-like tools such as the “duck bill,” “goat’s foot,” and “pelican.” Tooth-pullers advertised their experience and expertise by wearing strings of extracted teeth.²³ Although dentistry in sixteenth-century Europe bordered on torture,²⁴ some of the tools mentioned by Frois (or modern variants of the same), such as the parrot’s beak, are still in use by dentists, albeit with anesthesia.

It is fun to imagine a tooth tied to a ten-foot string, which in turn is attached to an arrow, shot from a bow. However, as Okada suggests, Frois’ mention of a bow and arrow probably is a reference to Japanese use of a bow drill.

16. Our spices and medicines are ground in a pounder or mortar; in Japan they are ground in a small copper vessel with an iron disk that is held between both [hands].

In medieval and early modern Europe, spices such as saffron, basil, and pepper were considered powerful medicine (not just seasoning), and thus Frois’ mention of spices along with [other] medicines that were ground with a mortar and pestle (e.g. bezoars, relics, coral, salts).²⁵

The Japanese variant of the pestle and mortar seemingly entailed an iron disk of some thickness that was rolled alternately left to right in a copper vessel.

17. Among us, pearls and seed pearls are used for personal ornamentation; in Japan they serve no other purpose than to be ground for the making of medicines.

Europeans may not have used pearls as medicine, but they did use various “stones” (i.e. bezoars) found in the stomachs of animals, not to mention ground-up relics and mummies from Egypt!²⁶ In Chinese-style medicine, pearl dust served to relax the spirit, settle the soul, brighten the eyes, and cure deafness.²⁷ That is to say, it was considered good for the nerves (pearls contain zinc, selenium, and calcium; inferior pearls are used today by pharmaceutical companies to make high-quality calcium).

18. Among us, a doctor who is not certified is punished and cannot treat patients; in Japan, anyone who wants to may take up practicing medicine as a way to make a living.

The thirteenth and later centuries in Europe witnessed the growth of cities and the establishment of hospitals and universities that awarded medical degrees. A medical degree, in the case of physicians, and practical knowledge and experience, in the case of surgeons and apothecaries, were generally required before an individual could legally practice medicine in a given locale, especially in cities.²⁸ Because a medical degree entailed years of study, there were relatively few university-trained physicians in sixteenth century Europe and most were employed by the rich and powerful.²⁹ In Frois’ Portugal, a shortage of university-trained physicians led to an influx of doctors from Spain.³⁰ Finding a doctor was one thing; paying for it was another. At the time Frois wrote, the cost of seeing a university-trained doctor in England was a gold coin or ten shillings; in today’s money this would be close to 100 pounds or 150 US dollars.³¹ Professionalization was costly in another sense: while it may have reduced the number of “quacks” practicing medicine, it also drove experienced and knowledgeable midwives and other lay practitioners from the field, leaving the vast majority of Europeans to fend for themselves.

In Japan, there is an old saying that “a hundred men must die to make a good doctor.” The Japanese were keenly aware of the presence of quacks, which they called yabu-isha or “bush-doctors.”

19. Among us, it is always a dirty and shameful thing for a man to suffer from venereal disease³²; Japanese men and women see this as a common occurrence and are not at all ashamed of it.

In 1493 syphilis appeared for the first time in Europe (gonorrhea, buboes, and genital ulceration had been a problem for centuries) and within two years raged throughout Europe, infecting one in five people.³³ However shameful the “French disease”³⁴ may have been, it became a chronic endemic disease of Europe during Frois’ lifetime.

Syphilis may have reached Japan as early as 1512 and spread rapidly owing in part to the “casual” Japanese attitude toward prostitution.³⁵ Writing in 1576, the Jesuit Vice-Provincial of Japan, Francisco Cabral, noted that the Jesuits had treated Japanese with the “French evil” at their hospital in Funai.³⁶

In this distich, Frois reveals an unspoken bias to the effect that only Christians were moral enough to feel shame (not that shame stopped many from having sex with strangers). Actually, while the Japanese may not have picked out sexually transmitted diseases for approbation, they long have been very ashamed of all incurable and visually distressing diseases. They were, until very recently, unrelenting in their attitude about leprosy, preserving a far more stringent segregation than found in the West.

1  Alporcas (referred to in English as scrofula) is a swelling or tuberculosis of the lymph nodes of the neck.

2  Brian Pullan, “The Counter-Reformation, Medical Care and Poor Relief.” In Health Care and Poor Relief in Counter-Reformation Europe, eds. Ole P. Grell, Andrew Cunningham, and Jon Arrizabalaga, pp. 18–40 (London: Routledge, 1999), 21–22; Laurence Brockliss and Colin Jones, The Medical World of Early Modern France (Oxford: Clarendon Press, 1997), 37–80.

3  J.D. Oriel, The Scars of Venus (London: Springer-Verlag, 1994), 11–23; Daniel T. Reff, Disease, Depopulation, and Culture Change in Northwestern New Spain, 1518–1764 (Salt Lake City: University of Utah Press, 1991), 170–172.

4  William E. Deal, Handbook to Life in Medieval and Early Modern Japan (Oxford: Oxford University Press, 2006), 63.

5  Ann Bowman Jannetta, Epidemics and Mortality in Early Modern Japan (Princeton: Princeton University Press, 1987), 281; Linda Newsom, Conquest and Pestilence in the Early Spanish Philippines (Honolulu: University of Hawai’i Press, 2009), 17; William H. McNeill, Plagues and Peoples (Garden City: Anchor-Doubleday, 1976):124–127, 201.

6  Constitutions from late medieval monasteries in Portugal prescribed preventative bleeding every two to six months. A.H. De Oliveira Marques, Daily Life in Portugal in the Late Middle Ages (Madison: University of Wisconsin Press, 1971), 149.

7  Cheng Xinnong, Chinese Acupuncture and Moxibustion (Beijing: Foreign Language Press, 1999), 361.

8  Engelbert Kaempfer, The History of Japan, Together with a Description of the Kingdom of Siam, 1690–92. 3 Vols. (Glasgow: James MacLehose and Sons, 1906[1690–92]), II, 282.

9  Kaempfer, The History of Japan, II, 282.

10  Ibid.

11  Com sanbixugas ou c [om] faca na testa, e aos cavalos com lanceta.

12  Michael Cooper, They Came to Japan (Ann Arbor: University of Michigan Press, 1999), 240.

13  Ibid.

14  Ibid.

15  Marques, Daily Life in Portugal, 151.

16  Ibid., 150.

17  See Cartas que os Padres e Irmãos da Companhia de Iesus Escreuerão dos Reynos de Iapão & China aos da Mesma Companhia da India & Europa, des do Anno de 1549 Até o de 1580. 2 Vols. Facsimile edition by José Manuel Garcia (Maia: Castoliva Editora, 1997), I, 213–224.

18  Deal, Handbook to Life in Medieval and Early Modern Japan, 234.

19  Cooper, They Came to Japan, 241.

20  Makura.

21  Cooper, They Came to Japan, 240.

22  Ibid., 191.

23  Andrès Pérez de Ribas, History of the Triumphs of Our Holy Faith Amongst the Most Fierce and Barbarous Peoples of the New World, trans. Daniel T. Reff, Maureen Ahern, and Richard Danford (Tucson: University of Arizona Press, 1999[1645]), 97.

24  James Wynbrandt, The Excruciating History of Dentistry (New York: St. Martin’s Press, 1998).

25  Jack Turner, “Spices and Christians.” In Encompassing the Globe, Portugal and the World in the 16th & 17th Centuries, ed. Jay Levenson (Washington, D.C.: Sackler Gallery, Smithsonian Institution, 2007), 48.

26  “Mummy,” or ground up corpses preserved with bitumen, was in great demand in Europe ever since the days of the Crusades. When French physician Guy de la Fonteine investigated the mummy trade in Alexandria in 1564, he found that fresh corpses were being dug up to satisfy Europe’s demand for this “medicine.” Brian Fagan, “Mummies, Or the Restless Dead,” Horizon XVII (1975):64–82.

27  Okada, Yoroppa-Bunka to Nihon-Bunka.

28  Brockliss and Jones, The Medical World of Early Modern France, 188–195.

29  Charles Webster, Health, Medicine, and Mortality in the Sixteenth Century (Cambridge: Cambridge University Press, 1979).

30  Isabel Mendes Drumond Braga, “Poor Relief in Counter-Reformation Portugal: The Case of Misericôrdias.” In Health Care and Poor Relief in Counter-Reformation Europe, eds. Ole P. Grell, A. Cunningham, and J. Arrizabalaga, pp. 201–215 (London, Routledge, 1999), 206.

31  See Andrew Wear, Knowledge and Practice in English Medicine, 1550–1680 (Cambridge: Cambridge University Press, 2000).

32  Mula, a colloquial expression in Portuguese for venereal disease

33  Oriel, The Scars of Venus, 11.

34  The epidemic of 1493 seemingly began among the army of the French King Charles VIII. The epidemic was understood as punishment from God for the French armies’ wanton destruction of Naples. Mary Elizabeth Perry, “Magdalens and Jezebels in Counter-Reformation Spain.” In Culture and Control in Counter-Reformation Spain, eds. A.J. Cruz and M.E. Perry, pp. 124–145 (Minneapolis: University of Minnesota Press, 1992), 131.

35  Brett Walker, “Epidemic Disease, Medicine, and the Shifting Ecology of Ezo.” In Race, Ethnicity and Migration in Modern Japan, Michel Weiner ed., pp. 397–424 (London: Routledge, 2004), 405.

36  James Murdoch, A History of Japan. 3 Vols. (New York: Ungar Publishing, 1964), II, Pt. I, 77. Note that there is no mention of syphilis or the “French evil”—perhaps edited out!—in the version of Cabral’s letter that appears in Cartas … de Iapão & China, I, 357.