Young Min - 2025 Mitra Scholar by The Harker School

AConfucianFoundationExemplifiedbyKingSejong

AtthecoreoftraditionalKoreanmedicalphilosophylies insul (“benevolentart”),a Confuciandoctrinethatframesmedicineasanethicaldutyratherthanacommercialenterprise.1

IntheearlyperiodsofKoreanhistory,theresponsibilityforpublichealthrestedprimarilywith themonarch,whowasexpectedtogovernwithpaternalbenevolence.2

KingSejongtheGreatoftheJoseonDynasty,akingmarkedbyhisinnovative advancementsinscienceandgovernance,particularlyexecutedsuchresponsibilitywithhigh qualityinthreefieldsofmedicine:literature,practice,andservice.Hefacilitatedbroaderpublic accesstohealthcarebycommissioningthe Hyangyak Jipseongbang, anextensivecompendium ofKoreanherbalmedicineandtraditionaltherapeuticpractices.3 Thistextstandardized indigenousherbremediesbycompilingscatteredmedicalknowledgeintoonebodyandoutlining comprehensiveproceduresforspecificillnessesusinglocalingredients.4 Bysystematically documentingandprioritizingthetherapeuticpropertiesofKoreanherbs,thispieceofliterature laidthefoundationofaself-sustainingmedicalframeworkrootedinlocallyavailableresources.

Beyondhiscontributionstomedicalliterature,KingSejongalsosoughttoreform medicaleducationbyshiftingitsfocusfromtheoreticalknowledgetopracticalapplication.

The Ministry of Personnel 吏曹 reported to the throne, “Students of medicine only read books on medical prescriptions, and devote themselves to performing

1 Yun-jaePark,"CommercializationofMedicineintheLate19thandEarly20thCenturyinKorea," Korea Journal 55,no.2(2015),41.

2 Park,41

3 Seong-suKim,"HealthPoliciesunderSejong:TheKingWhoSearchedfortheWayofMedicine," The Review of Korean Studies 22,no 1(2019),136

4 Kim,144.

on examinations in order to advance their rank. They do not put their minds on treating illness. From now, considerboththeirexaminationperformanceandtheir recordfortreatingillnessbeforereinstatement.Thisrequestwasfollowed.5

KingSejong’sreformofmedicaleducationservedasanimplicitcritiqueofbureaucratic inertiaandlimitationsoftheexaminationsystem.TheJoseonDynasty’seducationsystemand selectionofgovernmentofficials,includingmedicalpractitioners,revolvedaroundcivilservice examinations.6 Althoughtheseexaminationswereeffectiveinevaluatingacademicproficiency, theyposedlimitationsforprofessionsthatmainlyfocusedonpracticalandphysicalapplications. Recognizingthatmanystudentsofmedicineprioritizedrotememorizationandexaminations overactualpatientcare,KingSejongimplementedpoliciesthatrequiredaspiringphysiciansto demonstratebothscholarlycompetenceandhands-onexperiencebeforereinstatement.He ensuredthatKoreanmedicalpractitionerswerenotjustwell-versedinprescriptionsbutwere alsocapableofeffectivelydiagnosingandtreatingillnesses.Thisrequirementforphysiciansto engagedirectlywithpatientsandapplytheirknowledgeinpracticalsettingsembodiedthe principleof insul byreinforcingtheideathatmedicineremainedamoraldutyrootedinthe well-beingofthepeopleratherthananacademicachievement.

KingSejong’sreformsalsoaddressedthetreatmentofsociety’smostvulnerable populations,includingprisoners.

TheKingtransmittedaroyaldirectivetotheMinistryofPunishments 刑曹, whichstated,“Prisonsareplacesthatshouldbeusedtodisciplinecriminals,and fundamentallytheyarenot[placestobeused]tocausedeath.Whentheprison

5 Sejong sillok, 18thdayof3rdlunarmonth,1421

6 ChristopherPaik,SokChulHong,andYangkeunYun,"TheRoadtoAscension:Exams,LineagesandCivil ServantsoftheJoseonDynasty," SSRN Electronic Journal,2022,1-2

warden 司獄官 isincapableoftakingprecautionstoinspecttheprisonersin [timesof]severecoldorheat,hewillnotbewithout[cases]resultingin [prisoners’]accidentaldeaths,whetherthroughtheircontractingadiseaseor throughtheirbeingshabbilyclothedorstarving.Truly,thisissomething deservingofourpityandcompassion.Governmentofficialsinsideandoutsidethe capitalshouldembodythedepthofmysincerityandshouldpersonallyinspect [theprisoners]atalltimes.[Thewarden]shouldhavetheprisonberepairedand sweptandalwayskeptneatandclean.Aprisonerwithanillnessshouldreceive medicineandmedicaltreatment.Asforthose[prisoners]whodonothave someonesendingthemsupplies,thegovernmentshouldprovidethemwith clothing,food,andaid.Any[official]among[thewardens]whodoesnottake precautionstoupholdthisordershallalsobestrictlyexaminedanddealtwithby theOfficeoftheInspectorGeneral 憲府, forthoseinthecapital,orbya governor 監司,forthoseinareasoutsidethecapital.” 7

AfundamentalpremiseofthisdecreeliesinKingSejong’sdecisionthatprisonsshould serveasinstitutionsofdisciplineratherthanvenuesofsufferingordeath.KingSejongexplicitly statedthatthepurposeofincarcerationwascorrectionratherthanretribution,aligningwith Confucianthought,whichadvocatedforthemoralrehabilitationofwrongdoers.8 Rootedin Confucianidealsofbenevolentgovernanceonceagain,hisdecreetoensurepropermedicalcare withinthepenalsystememphasizedthemoralresponsibilityofthestateinsafeguardingthe healthanddignityofdisadvantagedindividuals.KingSejongrevealshisacuteawarenessofthe

7 Sejong sillok, 1stdayof5thlunarmonth,1425

8 XiuhuaZhangetal.,"CrimeandPunishmentinAncientChinaandItsRelevanceToday," The American Journal of Economics and Sociology 76,no 5(2017),1191

systemicneglectimposedontheprisoners’healthvulnerabilitiesbyacknowledgingthatthe inadequatemedicalattentionandmalnutritioncouldresultinpreventabledeaths.Heelevatesthis senseofaccountabilityevenfurtherthroughorderingthatprisonsbe“repairedandswept”and “keptneatandclean”andtherebydemonstratinganearlyunderstandingofhygiene’srolein diseasepreventionthatalignswithmodernprinciplesofpublichealth.Toestablishtheactive reinforcementofhishumanitarianreforms,KingSejongenforcedstrictaccountabilityforprison wardensandofficialsthroughholdingthemresponsibleformaintainingthehealthand well-beingofthoseintheircustody.Throughensuringcriminals,eventhosewithoutfamily, receivedproperclothingandmedicaltreatmentfromthegovernment,heinstitutionalizeda systemofcarethatprioritizedhumandignityoverpunitiveneglect.Theseeffortscollectively illustrateKingSejong’sand,inturn,Korea’shistoricallyhumanitarianstanceonstate-sponsored healthcare.

Furthermore,KingSejongputimmenseemphasisontheimportanceofequalityin healthcarebyincorporatingdirectmentionsofguidelinesformedicalethicsintheintroduction ofthe Uibang yuchwi,astatedrivenprojectthatcompiled365volumesofmedicaltext.9 It encapsulatesinformationfromtheTangdynasty’sChinesemedicaltextstothefindingsof KoreantraditionalmedicinefromthelateGoryeotoearlyJoseondynasty,andstandsasthemost influentialandcomprehensivestudyofmedicineduringitsera.10

A great physician must compose his thoughts and calm his mind, and must not desire or seek anything. He mustdohisutmosttobemercifulandcompassionate, andhemustpledgetorelievethesufferingofpeoplefarandwide.Ifasickperson

9 Kim,"HealthPolicies,"156

10 Kim,157.

comes and seeks help, he must treat them all equally as if treating an intimate friend regardless of whether that personisofhighorlowlybirth,richorpoor,old oryoung,beautifulorugly,friendorfoe,orChineseorbarbarian.11

Theintegrationofethicalprinciplesintothe Uibang yuchwi reflectsaclearintent toembedmoralresponsibilitywithintheframeworkofstatemedicineastheseprinciples highlightedcompassionandimpartiality.12 Whilesuchidealswereoftenabsentfrom privatelycompiledtextsduetotheirregulatorynature, Uibang yuchwi’spositionasa government-leadinitiativeprovidedaplatformtoformalizeethicalrules.13 Taken togetherwiththe Hyangyak Jipseongbang,thesemedicaltextscharacterizeKing Sejong’sapproachtomedicalreform,onefilledwithdeliberateefforttoenhancethe intellectualandethicalfoundationsofmedicalpracticeinJoseon.Theysignaledashift towardmorestructuredmedicalprofessionalismbyadvocatingforprincipledconduct andadvancedclinicalcompetence.Ultimately,KingSejong’sretroactiveperspectiveand initiativessetthestagefortheproductionoffutureinfluentialmedicaltexts,suchasthe Dongui bogam byHeoJun,affirminghisroleasareform-mindedmonarchwhobreathed lifeintoamoresystematicandelevatedmodelofhealthcarefortheJoseonstate.14

KoreanMedicine’sTransformationThroughouttheCenturies

11 “Lun da yi xi ye ” (On the Practice of the Eminent Physician 論大醫習業) in Qianjin fang, as cited in “Introduction” 總論, Uibang yuchwi, gwon 1 *

12 Kim,"HealthPolicies,"164

13 Kim,165

HumanitarianConfuciusidealscontinuedtoflourishthroughoutthefifteenth,sixteenth, andseventeenthcenturiesasneo-Confucianscholarsheldinfluentialpositions,particularly 14 Kim,166.

withintheHallofWorthies,aninstitutionestablishedbyroyaldecree.15 There,the neo-Confucianofficialstrainedfuturegenerationsofdoctors,researchednewtreatments,and preparedcivilserviceexaminations.16 Kingswouldoftennamemedicalinstitutionsafter Confucianideals,withtheera’smainmedicalinstitution, Hyeminseo, translatingto“aplacefor offeringbenefitstothepeople.”17 Furtheringtheconceptof insul, atraditionalmedicalprivate fundestablishedinGangneung,Gangwon-doprovinceprovidedfreetreatmenttoensureastable supplyofmedicineformembersinitsproximity.18 Althoughthisclinicwaslegallylimitedto servingindividualsinthehigherclass,itrealisticallytransformedintoaserviceforeveryone.19

Despitethebenefitsofreceivingextensiveconsultationsandprescriptions,thislong-standing traditionofaltruisticmedicalpracticeledtoacultureinwhichKoreanpatientsrarelyexpressed gratitudeorpaidfortreatmentastheygrewaccustomedtofreemedicaltreatment.20

BythelateJoseonperiod,growinghealthcaredemandsfromemergingsocialclassesand administrativereformslikethe Daedong law,whichintroducedtaxlawsthatalteredthe distributionofmedicine,initiatedKorea’sshiftawayfromtheneo-Confucianprincipleof winmin, meaning“forthepeople.”21 Whilethestateaimedtoupholdpublichealthcare,andthus royalbenevolence,undertheNationalCodebydedicatingimmensefocustowardsthe Hyeimso,

15 KangYeonseok,"TheCharacteristicsofKoreanMedicineBasedonTimeClassification," China Perspectives, nos 3(87)(2011),37

16 Kang,37

17 Park,"CommercializationofMedicine,”41.

18 Park,42.

19 Park,42.

20 Park,42.

21 Seong-su Kim, "朝鮮後期私的醫療의 성장과 醫業에 대한 인식 전환" [Re-evaluation of the Medical Practice and the Medicine in the Later Half of the Chosun Dynasty], Korean Journal of Medical History 18,no.1(2009),43.

privatehealthcareexpandedintodenselypopulatedareaslike Hanyang,modern-daySeoul,due totheincreaseddemandformedicalservices.22 Publicmedicalinstitutions,including Hyeimso, declinedasprivatepractitionersandpharmaciesbecamemoreprevalent.23 Asaresult,the governmentgraduallyshifteditsfocusfromprovidinguniversalhealthcaretoepidemiccontrol, prioritizingaidforimpoverishedgroupswhocouldnotaffordprivatecare.24

Thispaperaimstoexploretheperseverancedisplayedbythe hanuihak,orKorean traditionalmedicine,communitydespitethegradualwaningofpurelybenevolentpublic healthcareinstitutionsinKoreaduetomanypoliticalandeconomicfactorsthroughoutthe centuries.Graspingfortheretentionoftheirfundamentalhumanitarianvisiongroundedinthe Confucianideologyof insul exemplifiedbyKingSejong,the hanuihak practitionersofthelate nineteenthtoearlytwentiethcenturyemphasizedaccessibilityandpatient-centeredcare, principlesthatremainedintegralnomatterthesubsequenthistoricalchallengesimposedby Japan’scolonizationofKorea.25 Theeffortsof hanuihak practitionerstoresisttheerasureoftheir innatebenevolentfoundationbyadaptingtheirmethodologiestotheever-changingmedical landscapeofKoreaandcultivatingmutuallybeneficialrelationshipswithAmericanmedical missionariesensuredthesurvivalofKorea’smedicalheritage.ThoughJapan’scolonialpolicies introducedWesternmedicalinfrastructureandundoubtedlypropelledtheadvancementof biomedicaltechniqueinKorea,nomattertheirmotivations,theenduringethicalfoundationsof

22 Kim,44.

23 Kim,44.

24 Kim,44

25 Hyo-JinLeespecificallyexpandsfurtherontheprevalenceoftheterm“insul”inherarticletitled,“AStudyon ‘Insul(AnArtofBenevolence)’:FormationofKoreanMedicalEthicsinModernKorea”fromtheKoreanJournal ofMedicalHistory,andanalyzestheevolutionaryjourneyoftheterminthefaceofpoliticalandmedicalshifts startingfromtheJoseonDynastytothemid20thcentury.

hanuihak thatconvergedwiththeAmericanmissionaries’ownhumanitarianapproachtomedical serviceultimatelyallowedKoreatosynthesizetraditionandmodernityintotheunique characterizationofKorea’smodernhealthcaresystem.

Japan’sInfluence

Bythelatenineteenthcentury,thelandscapeofmedicaleducationinKoreaunderwentan immenseshift.In1899,theKoreanempireestablishedthe Gyeongseong Uihakgyo,aninstitution focusedonexpandingWesternmedicine,andshiftedevenfurtherawayfromitsConfucius foundation.26 Theopeningofthefirstgovernment-fundedWesternmedicalinstitutionwasnot merelyadomesticinitiativeforscientificadvancementbutastrategicresponsetoshifting geopoliticalrealities.WhilereformistgroupsliketheIndependenceClubandmedicalexpertJi Seok-YeongmotivatedthisdecisionasameansofstrengtheningKorea’snationalcapacity,the perceptionofmedicalprogressasamarkerofstatelegitimacywasnotsolelyaninternallydriven phenomenon.27 Rather,itwasheavilyinfluencedbyJapan’sownmedicalreformsfollowingthe MeijiRestorationandWesternImperialistnarrativesthatequatedscientificandmedical advancementwithcivilizationalsuperiority.AftergainingcontrolofJapanin1868,theMeiji governmentrapidlysoughttomodernizeitshealthcaresystemaspartofitsbroadernational buildingefforts.28 MuchlikehowKoreaopenedthe Gyeongseong Uihakgyo, theJapanese governmenthadalsoestablishedprivatemedicaluniversitiestotrainphysiciansinWestern techniquesbythe1870s.29 Throughtheseinitiatives,Westernmedicalinfrastructurewasalready

26 In-su Son, "경성의학교 (京城醫學校)" [GyeongseongUihakgyo], Encyclopedia of Korean Culture,last modified1980.

27 Son,“GyeongseongUihakgyo”

28 JayantS JoshiandRajeshTewari,"EarlyExponentsofWesternMedicineinJapan," Proceedings of the Indian History Congress 62(2001),825

29 JoshiandTewari,825.

deeplyintegratedinJapan’spublichealthsystem,reinforcingtheideathatmedical modernizationwasaprerequisitefornationalsovereignty.ThisinitialsuccumbencetoWestern idealsintheJapanesemedicinalfieldessentiallysettheprecedentforotherAsiancountriesto follow Therefore,Korea’sembracementofWesternmedicinethroughthe Gyeongseong Uihakgyo mustbeunderstoodwithinthisbroadercontextofEastAsia.AsJapan’sinfluenceover KoreadeepenedfollowingtheKanghwaTreatyof1876,anagreementthatforcedKoreainto highlyunequaltradewithJapan,Koreanreformerssawcompliancetowardsmedical modernizationasawaytoasserttheircountry’ssovereigntyandresistforeigndomination.30 Japan’sencroachment,whichconstantlyescalatedthrougheconomicfootholdsandmilitary interventionsuntiltheeventualannexationofKoreain1910,signifiedthatKoreahadtorapidly adoptinstitutionsthatwouldsignalitssovereignty 31 Ji,whopioneeredbiomedicineinKorea whileworkingcloselywithJapanesehospitalsandofficials,submittedapetitionin1882calling fortheswiftmodernizationwhereheproposedthecreationofatraininginstitutewhereyouth fromalloverKoreacouldstudyWesternscience.32 Decadeslater,headvocatedforthe standardizeduseof hangul,theKoreanalphabet,inallmedicalliteratureduetothebeliefthat thedominanceofcomplexclassicalChinesecharacterswasslowingKorea’smodernization.33 Thus,theexternalgeopoliticalshiftsinEastAsiamarkedbyJapan’sowntrajectoryandgraspon KoreapressuredinternalKoreanreformiststomobilizethemodernizationofthecountry’s medicallandscape.

30 “Kanghwatreaty,”in Encyclopedia of Asian History (CharlesScribner'sSons,1988),GaleinContext:World History

31 “Korea,HistoricalOverview,”in Gale World History Online Collection (Detroit,MI:Gale,2022),Galein Context:WorldHistory.

32 Sang-yong Song, "지석영 (池錫永)" [Ji Seok-Yeong] Encyclopedia of Korean Culture,lastmodified1979.

33 Song, "지석영 (池錫永)" [Ji Seok-Yeong].

DuringJapan’scolonizationofKoreafrom1910to1945,theJapanesegovernment soughttomarginalize hanuihak throughpromotingWesternbiomedicineasahallmarkof modernity 34 Thissystematicexclusionof hanuihak entrenchedKorea’smedicalsubjugation underJapaneseruleandcreatedstructuralbarriers.Ratherthanabyproductofhealthcarereform, itwasacampaigntosuppresstraditionalmedicineandacalculatedstrategyofcolonial domination,asmedicalinstitutionsbecameinstrumentsofideologicalcontrol.35 Akeyexample ofthisinstitutionalmarginalizationwasthe1907decreetoshutdown Tongje Uihakkyo,the national hanuihak school.36 Throughdismantlingthiscornerstoneof hanuihak education,the colonialadministrationrelegatedtheformofmedicinetoinformalapprenticeships,suchassmall hanuihak schoolsthattaughtaone-yearcourse,thatseverelylimiteditsabilitytomaintain rigorousstandardsofpracticewithoutstate-backedinstitutions.37 Thisinstitutionalerasure workedtodelegitimizetheepistemologicalfoundationsof hanuihak byreinforcingthecolonial narrativethattraditionalKoreanmedicinewasantiquatedandunscientific.Moreover,the absenceofastructurededucationalframeworkcreatedagenerationalknowledgegapthatleft futuretraditionalmedicinepractitionerswithoutaformalizedpathtoaccesscomprehensive training,andthereforecausedthenumberof hanbang practitionerstodecreaseoverthedecades. Thecalculatedrefusaltobuildinstitutionsensuredforthegradualerosionofthesepractitioners

34 Han,“TheRiseofWesternMedicine”,98

35 Han,98

36 Han,101

37 Han,101

rather Figure 1940inKorea.

JapanthenformalizedtheMedicalPractitioner’sRulesin1913underOrdinanceNo.100, replacingtheterm“PermissionforMedicalPractice”with“PhysicianLicense.”39 Thislegislation markedacleardistinctionbetweenWestern-traineddoctors,designatedas“Euisa,”meaning doctors,whiletraditionalpractitionersweredemotedtothestatusof“Euisaeng,”meaning medicalstudents.40 ThisdistinctionbetweenWesternandKoreantraditionaldoctorsbythe JapaneseimposedahierarchythatprioritizedWesternknowledgeanddismissedcenturiesof indigenouswisdomthroughreframingKoreanmedicineasoutdatedandunworthyofofficial acknowledgementfromthegovernment.AlthoughtheMedicalPractitioner’sRuleshadbeen establishedin1900duringtheKoreanEmpireandtheissuanceofmedicalpracticepermissions continuedthroughtheResidency-Generalperiod,theJapanesegovernmentnevertrulylegalized thesepractices.41 Thus,the1913regulationsreflectedtheJapanesegovernment’sdesireto formallyinterveneinKorea’smedicalsystem.Whiletheirinitialgoalfocusedoneradicating

38 Han,101

39 In-sok Yeo et al., “한국

[A History of Medical License in Korea], Korean Journal of Medical History 11,no 2(2002),146-147

40 Kang,“TheCharacteristicsofKoreanMedicine”,40

41 Yeoetal.,147.

traditionalmedicine,ashortageofmedicalpersonnelforcedJapaneseGovernorGeneral Terauchitotemporarilyrecognize uisaeng astrueprofessionalsviatheenactmentoftheUisaeng Regulations.42 However,theJapanesegovernment’smotivationsremainedclearevenafterthey acknowledgedtheprofessionalismoftraditionalpractitioners;Terauchiemphasizedata uisaeng conferenceorganizedbytheAll-KoreanMedicalAssociationthatgrantingthequalificationsto uisaeng wouldonlysustainasatemporarymeasure.43 Thispublicdeclaration’semphasison impermanenceactivelyreassuredJapaneseauthoritiesandWestern-trainedauthoritiesthatthe colonialgovernmentremainedcommittedtophasingouttraditionalmedicine.Italsoreinforced thatJapan’spowerdefinedwhatcountedaslegitimateknowledgeandthequalificationstoheal.

TheseeffortsbytheJapanesetodilutethecharacterizationof hanuihak andtherefore eliminatechancesforautonomy,eveninthesmallerscaleofmedicalpractice,directattention towardsthevalidityandethicalityoftheirmotivationsininterveningwithKorea’smedical system.

Japan’sUnderlyingDesires

DespiteJapan’spersistentattemptstoimposeWesternmedicineonKorea,accessto medicalcareremaineddeeplyinequitableandthegeneralhealthofthepopulationdeteriorated significantlywiththeaveragelifeexpectancyreachingaslowas22.6yearsformenand24.4 yearsforwomen.44 Thecolonialgovernmentrestrictedhigh-qualitymedicalservicestoJapanese residentsandaselectgroupofwealthyKoreans.45 Localpoliceappointedbythecolonial bureaucracyworkedcloselywithhealthauthoritiestoidentifysickindividuals,andwhilesome

42 Yeoetal,150

43 Yeoetal,150

44 Han,“TheRiseofWesternMedicine”,99

45 Han,98.

patientswereadmittedtohospitals,manyKoreansremainedundetectedoruntreatedbyofficials, furtherexacerbatingpublichealthdisparities.46

AfterJapan’sannexationofKorea,DaehanHospitalbecametheGovernment-General HospitalofKorea,andthe hanuihak medicalschoolwasdowngradedtoaMedicalTraining Institute.47 JapanjustifiedthischangebyclaimingKoreawasnotreadyforprofessional education,butinreality,concernsovercompetitionfromKoreandoctorsandfinancialreasons alsoinfluencedthedemotionofthemedicalschool.48 Previously,thegovernmenthadcoveredall medicaleducationexpenses,reinforcingtheirConfuciousbeliefsintheprocess,butJapan graduallyshiftedtoaself-fundedmodel.By1915,allscholarshipswereabolished,making medicaleducationfinanciallyburdensomeforKoreanstudentsandrevealingJapan’sreluctance togenuinelyinvestfundingindevelopingKoreanprofessionals.49

TheJapanesealsoleveragedtheconceptofbenevolencefortheirpolicyoffinancial victimization.50 Undertheinstructionofthegovernment,numerousJapanesehospitalswould purposelynursemoreKoreanpatientsthanJapanesewhilerequiringnofeeinattemptstoappeal totheKoreanpublic.51 Inresponse,Japanesedoctors,suchasonewhoworkedatahospital foundedtomonitortheResidencyGeneral’shealth,opposedsuchmeasureswhenscarcelyany patientsexpressedgratitudefortheirtreatment.52 ThefrustrationexpressedbytheJapanese

46 Han,99

47 Yunjae Park, "일제

[Reformation of the Medical Educational Institutes and Training of General Doctors during the Early Period of Japanese Rule], Korean Journal of Medical History 13,no 1(2004),21

48 Park,21.

49 Park,21-22

50 Park,"CommercializationofMedicine,"47

51 Park,47

52 Park,47

doctorswhenKoreansfailedtoexpressgratitudehighlightsthetransactionalexpectationsbehind theseactsof“charity”astheirverymotivationstosupplysuchbeneficialtreatmentstemmed fromamindsetthatviewedaidnotasarightbutasagifttoberepaidbyloyaltyorsubmission. TheKantoearthquakeof1923cutthesebenevolenteffortsshortduetothescaleoffunding neededtorepairitsdamage.53 TheJapanesegovernmentpushedtheirfinancialneedsonto provincialgovernmentswhichforcedthemtotransformcharitablehospitalsintoprovincial ones.54 Thismodification,inturn,dismantledthefacadeofselflesshealthcareportrayedbythe JapaneseandreducedtheratioofcharitypatientsinKoreafrom60to80percentpriorto1920to 14.3percentby1928.55

UndeniableBoostedEfficacyofWesternBiomedicine

TheimportanceofmaintainingaKoreanidentitytocombatthemaliciousintentofthe Japaneseviapreservingthefundamentals hanuihak doesnottakeawayfromthegeneral superiorityofWesternbiomedicinewhenregardingthepotencyofitsmedicine.ManyKorean medicalpractitionerschosetolearnbiomedicine,whichallowedfornumeroussubstantial discoveriesthatlaidthefoundationsforimportantcomponentsofKorea’shealthcaresystem.Ji Seok-yeongbeganstudyingWesternmedicinebyreadingtranslatedmedicalbooksfromChina andtookparticularinterestinsmallpoxvaccination.56 AftervisitingaJapanesenavyhospitalin Busanwherehestudiedcowpoxvaccinationsfortwomonths,heobtainedmaterialstoperform smallpoxvaccinationsforthegeneralKoreanpopulation.57 Heexecutedthefirstpublicsmallpox

53 Park,50

54 Park,50

55 Park,50

56 Song, "지석영 (池錫永)" [Ji Seok-Yeong]

57 Song, "지석영 (池錫永)" [Ji Seok-Yeong]

vaccinationbyaKoreanin1879whenvisitinghiswife’sfamilyinChungju,andgrewhisefforts byvisitingJapantolearnadvancedvaccinationtechniques.58 Inordertospreadawarenessof vaccinations’efficacy,JipublishedKorea’sfirstpieceofliteraturecompilingtheproceduresof cowpoxvaccination,the Udu Sinsol, whereheemphasizedthathisintroductionofsmallpox vaccinationsavedcountlesslives.59

Furthermore,itiscrucialtonotetheabsenceofsurgeryinKorea’smedicallandscape. Thedoctorswould“usecupping,thecautery,andacupuncturehotorcold,withlongcoarse uncleanlyneedles,withwhichtheypiercetheliver,joints,andstomachforpains,sprains,and rheumatism.” 60 AmericanmedicalmissionaryWilliamJamesHalldescribesKoreanmedicinein asimilarsensethroughmentioningthatKoreanpractitionersexhibitedlimitedknowledgeof surgicalproceduresandanatomicalstructures.61 Instead,theyreliedprimarilyongeneralpractice withsomespecialization,particularlyinacupuncture.62 Acupuncturistsclaimedtotreatvarious ailments,includingrheumatismandhemiplegia,throughrepeatedneedleinsertionsinaffectedor adjacentareas.63 AttemptsatdrainageinvolvedinsertingtwistedKoreanpaper,thoughwith limitedefficacy.64

58 Song, "지석영 (池錫永)" [Ji Seok-Yeong]

59 Kyujin Choi, "우두법 도입으로 수많은 민중의 생명을 구하고 자주적 근대의료의 기틀을 놓은 지석영" [Seok-Young Ji, who saved many people's lives and laid the foundation for independent modern medicine of Korea through the introduction of smallpox vaccination], Journal of Korean Medical Association,May17,2019,244

60 IsabellaBirdBishop, Korea and Her Neighbors (FlemingH RevellCompany,1897),204

61 WilliamJamesHall,Dr, The Life of Reverend William James Hall: Medical Missionary to the Slums of New York; Pioneer Missionary to Pyong Yang, Korea,ed.RosettaSherwoodHall(NewYorkPressofEatonandMains,1923), 184

62 Hall,184

63 Hall,184

64 Hall,184.

In1897,amansufferingfromemphysemasoughttreatmentfromDr.E.Douglass Follwell,amedicalmissionaryinP’yongyangin1895,afterexhaustingtraditionalhealing methods.65 Initially,hehadreliedonalocalsorceress,whoattributedhisillnesstohisparents’ improperburialsiteandadvisedrelocatingtheirremains.66 Despitespendingasignificantsumon theprescribedritual,hisconditionworsened,andwithnoresourcesleft,heturnedtoDr.Follwell forasurgicaloperationthatsuccessfullyrestoredhiswell-being.67

TheinstitutionalizationandadvancementofKoreansurgeryunfoldedunderthe combinedinfluenceofAmericanandGermanmedicaltraditions,introducedrespectivelyby ChristianmissionaryphysiciansandJapanese-traineddoctors.68 Surgicalcareinitially encompassedawiderangeoffields,includingorthopedics,thoracicsurgery,urology,and anesthesia,andgraduallyprogressedincomplexityasappendectomiesbeganaround1915, followedbythesuccessfulperformanceofhepaticabscessdrainagein1917.69 Althoughthemost commonlypracticedsurgicalinterventionsremainedreliantonbasicincisionanddrainage techniques,schoolsintroducedabroaderrangeofsurgicaloperations,suchasintestinal obstruction,mastectomy,gastrectomy,andmoreinsubsequentyears.70 Thus,theevolutionof surgeryinKoreaduringthiserapioneeredthemodernsurgicalsystemthatcontinuedtodevelop afterliberationin1945.71

65 Sung-DeukOak,"HealingandExorcism:ChristianEncounterswithShamanisminEarlyModernKorea," Asian Ethnology 69,no 1(2010),102

66 Oak,102.

67 Oak,102.

68 Se-il Chun and Byun-gil Yeh, "한국 외과학의 지난 100년" [One Hundred Years History of Surgery in Korea], Korean Journal of Medical History 8,no 2(1999), 149

69 ChunandYeh,149

70 ChunandYeh,149

71 ChunandYeh,149

Resilienceof Hanuihak

DespitethegrowinginfluenceofWesternmedicineandtheJapanesegovernment’s narrativethatposedEasternmedicineasamereobstacle,traditionalKoreanmedicine practitioners,includingJangYong-junandKimByeong-gwan,petitionedtheMinistryof Educationin1904toestablishaparallelinstitutiondedicatedto hanuihak. 72 Theirpetition emphasizedtheneedtoacknowledgetheuniquemedicalconditionsofKorea,arguedthathealth concernswereinfluencedbyregionalclimatesandindividualconstitutions,andrendered exclusiverelianceonWesternmedicineimpractical.73 Byarticulatingtheseconcerns,the petitionersnotonlyhypothesizedthelimitationsofamonolithicmedicalframework,butalso soughttopreservedeeplyrootedcultureandintellectualtradition.Theirurgentadvocacyfor thoroughlysupportedtraditionalmedicineinstitutionsrepresentedtheirapprehensiontowardsthe erosionofKorea’smedicalheritageandrecognitionforthepracticalbenefitsofmedical pluralism.However,thestateofKorea’srelationshipwithJapanandtheinitiationofthe Russo-JapanesebarredtheKoreangovernmentfromaddressingthispetition.74

OnMay31,1906,KangPil-ju,LeeEung-se,andJoDong-hoestablishedtheDongje Schoolineffortstoprovidecomprehensiveeducationin hanuihak 75 Itofferedabroad curriculumthatcombinedtraditionalKoreanmedicalknowledgewithWesternmedicalpractices tobothmenandwomen.76 Tofacilitatetheacademicendeavors,theschoolappointedateamof

72 Geon-hyuk Kwon, "동제의학교 (同濟醫學校) [Dongje School]," Encyclopedia of Korean Culture,last modified1987.

73 Kwon, "동제의학교 (同濟醫學校) [Dongje School].

74 편집부, "韓醫學의 역사" [The History of Korean Traditional Medicine], Korean Journal of Medical History 8,no 1(1996),10

75 편집부, 11

76 편집부, 11.

instructors,compromisingLeeKi-young,LeeGyo-gak,SongTae-hwan,JoYong-hwan,and Mrs.Kim,thespouseofKang.77 LeeGeun-sang,theformerviceministerofAgriculture, Commerce,andIndustryandtheformerdirectorof Gwangjaewon,ahospitalestablishedin1899 thattreatedpatientswithbothWesternandtraditionalKoreanmedicine,ledtheschool’s administration.78 InstructionattheschoolcommencedonJune20,andnotablegraduatesofthe medicaldepartmentincludedJeonGwang-okandKimYoung-hoon.79 TheestablishmentofDongjeSchoolsignifiedanimportantsteptowardinstitutionalizing traditionalKoreanmedicine.However,itsclosurein1909duetofinancialdifficultiesreflected thechallengesfacedbysuchinitiatives.80 Despiteitsshort-livedexistence,theschoolseta precedentforfutureeffortstointegratetraditionalKoreanmedicinewithinastructured educationalframework.Moreover,itsapproachtomedicaleducationpresentsastrikingparadox. Unliketherigid,exclusionarystructureofJapanesecolonialmedicalinstitutions,theDongje Schoolembracedanopen,integrativephilosophybyincorporatingclassicalChinesemedicine, Westernscientificconcepts,andindigenousKoreanpracticesintoitscurriculum.81 This progressiveapproach,seeminglyalignedwithmodernidealsofholistichealthcare,contrasts sharplywiththecolonialadministration’sinsistenceonbiomedicaldominance.Theironyliesin thefactthataninstitutionrootedincenturies-oldtraditionsdemonstratedgreateradaptabilityand inclusivitythanthecolonialauthoritieswhopridedthemselvesonmodernization.

77 편집부, 11

78 편집부, 11

79 편집부, 11

80 Woo-yeol Jung, "한의학 100년 약사" [Korean Medicine's 100 Year History], Korean Journal of Medicine History 8,no.2(1999),175.

81 편집부, "韓醫學의 역사," 10.

FoundedonOctober21,1909byagroupofinfluentialmedicalprofessionals,theDaehan MedicalSocietyrevitalizedandintegratedtraditionalKoreanmedicinewithWesternmedical practices.82 Thesocietyheldageneralassemblythreedaysafteritsformation,wheremembers electedYiJun-yongasthepresident.83 ByDecemberof1909,thesocietybeganofferingmedical servicestothepublic,withaparticularfocusonprovidingfreecaretowidows,orphans,andthe poor,whilechargingothersataffordableprices.84 Theycontinuedtoexpandtheirpublichealth initiativesthefollowingyearthroughsettingupacommunalhospitalontheoutskirtsofthecity totreatcontagiousdiseasesusingherbalremediesanddisinfectionmethods.85

Insomecases,traditionalKoreanmedicineworkedevenbetterthanmodernbiomedicine. WhentheSpanishFluhitKorea,over7millionindividualswereinfected,butonly0.82%of thempassedaway 86 WhileWesternmedicinewasstillstrugglingtodiscoveracure,whichwas evidentinEurope’sstruggletocombatthisdisease,traditionalKoreanpractitionersquickly foundherbsanddrugswithextremelyhighefficacyincludingToxin-VanquishingPowder, HarmoniousFlowDecoction,Flesh-ResolvingDecoction,andEphedraDecoction.87 Anaccount bySun-YeongLeein Oriental Medicine alsoservesasacompellingexampleoftheeffectiveness of hanuihak

82 편집부, 11

83 편집부, 11.

84 편집부, 11.

85 편집부, 11.

86 Yong-yuanHuang,"'MedicineoftheGrassroots':KoreanHerbalMedicineIndustryandConsumptionduringthe JapaneseColonialPeriod," Korean Journal of Medical History 29,no 1(2020),250

87 Huang,250.

I was diagnosed with tuberculosis by a provincial hospital on February19,1934. Subsequently, I availedmedicaltreatmentatthehospitalfor40days,butithadno effect. My grandfather advised me to take Korean herbal medicine initially, but I was apprehensive about taking it since I had graduated from the Secondary School (高等普通學校), so Iignoredhisadvice.Nonetheless,Ihadnochoicebut to visittheUisaengrecommendedbymygrandfather.ItoldtheUisaengaboutmy diagnosis, the process of medical treatment, and its effect in the provincial hospital. The Uisaeng examined me for a while and said, “No, they are wrong. Tuberculosis is the name they (Western medicine doctors) created. You are deficient in Yang-qi (陽氣不足). You will recover after taking the medicine to supplement your Yang-qi.” I took 40 doses of the medicine prescribed by the Uisaeng,andIwasmiraculouslycured.”88 Uisaengs commercializedandpreservedtheseKoreanherbaldrugswithhighefficacy throughthemanufacturingofpatentmedicines,whichextendedbeyondlarge-scaleherbal establishments.89 ChoeGeon-hul,wholaterservedasthethirdpresidentoftheKoreanOriental Drugassociation,servesasarepresentative.90 Hisfather,atraditionalpractitioner,ranBochang HospitalinSueun-dong,Kyungsung,andfoundedBochangPharmacytoproduceoverthirty patentmedicinesthatwerebasedonempiricalfamilyformulas.91 Despitethetechnical

88 Lee Sun-yeong, “Pulmonary Tuberculosis and Herbal Medicine the Confession of an Ordinary Person 肺結核과 漢方藥素人으로서의 告白,” Oriental Medicine February 2, 1935, 65–69

89 Huang,"'MedicineoftheGrassroots,'"238

90 Huang,238

91 Huang,238.

limitationsthatprohibitedmassproduction,suchpharmaciesreliedonproprietary“secret formulas”handeddownthroughgenerationstocultivateuniquemedicinalbrands.92 Although WesternandJapanesepatentedmedicineposedpotentialobstaclesthatblockedKorean traditionaldrugsfromreachingcommercialsuccess, uisaengs stillmaintainedafootholdinthe evolvingpharmaceuticalmarketplacebyproducingandmarketingtheirownformulations,often rootedingenerationalknowledge,aspatentmedicines. ByincorporatingWesternmedicaltechniquesandequipment, hanuihak notonly enhanceditstreatmentefficacybutalsoshowcasedadaptabilityinarapidlymodernizingmedical landscape.Theforcedsuppressionof hanuihak paradoxicallystrengtheneditslegitimacybecause thisveryblendingofmethodologiesenabledtraditionalpractitionerstodevelopamoretailored approachtoaddressbothchronicandacuteconditions.

AnExaminationofKimGwang-jin’sMedicalProcedures

KimGwang-jinservesasacompellingexampleofaKoreanmedicalpractitionerwho acknowledgedthebenefitsofahybridmedicalsocietywhilepreservingandadvancing traditionalmedicine.Kim,whoseearlyeducationwasrootedinConfucianclassics,passedthe euisaeng examin1924andestablishedapharmacyinSangyeok-dong.93 Hisinterestinmedicine stemmedfromadesiretocurehisfather’sillness,leadinghimtostudyunderGyu-junLee,a respectedJoseon-eraphysician.GivenhisConfucianbackground,hismedicalknowledge evolvedthroughexposuretotheworksofprominentChinesephysicians,includingLiGaoand ZhangJiebin,andthroughhisengagementwithKorea’smedicaltraditions.94 Astheculmination

92 Huang,238

93 ChaekunOh,"TraditionalMedicineDoctorKimGwangjin'sBattleagainstJaundiceduringtheJapaneseColonial Period," Korean Journal of Medical History 28,no 2(2019)

94 Oh,“TraditionalMedicineDoctorKimGwangjin'sBattle.”

ofallaspectsofhismedicalcareer,Kimsynthesizedhisunderstandingintothe Medical Theory of Ascending and Descending,acomprehensivetextexplaininghumanphysiology,pathology, andherbaltreatmentsbasedontheflowof gi.95 Thistheoryreflectedanuancedintegrationof traditionalKoreanandChinesemedicalprinciplesandtailoredtothepracticalneedsofKorean societyundercolonialrule.LikemanyKoreanpractitioners,helackedformaltraininginWestern medicinebutsupplementedhistraditionalexpertisewithfoundationalWesternconcepts,largely throughtextslike Essentials of Medicine andparticipationinsmallpoxvaccinationtraining.96

Kim’sopennesstobiomedicineallowedhimtoaddressabroadspectrumofmedicalissues withinhiscommunity,makinghealthcaremoreaccessibleduringaperiodwhenbiomedicinewas oftenprohibitivelyexpensive.Furthermore,hisabilitytoreconciletraditionwithinnovation illustratedthe euisang’s pragmaticnatureofprioritizingpatientcareoverideologicalrigidityand effortstomaintainresourcefulnessdespitesystemicoppression.Throughbridgingclassicaland contemporaryknowledge,Kimsafeguardedtraditionalpracticeswhilealsoensuringtheir continuedevolution.

Kim’sclinicalcases,documentedinhis Medical Practice Records,showcasehis methodicalapproachtodiagnosisandtreatment.Forinstance,in1927,hetreateda60-year-old womanwithsummerdiarrheaandbodyachesusing Je-seup-gang-hwal-tang,modifiedto addressherspecificsymptoms.97 Inthiscase,heutilizedhisstrongunderstandingofseasonal influencesonhealthtoadapttraditionalformulaseffectively.98 Whilecolonialpoliciesurgedfor thealienationofKoreanmedicine,practitionerslikeKimsustaineditsrelevancethrough

95 Oh,“TraditionalMedicineDoctorKimGwangjin'sBattle”

96 Oh,“TraditionalMedicineDoctorKimGwangjin'sBattle”

97 Oh,“TraditionalMedicineDoctorKimGwangjin'sBattle”

98 Oh,“TraditionalMedicineDoctorKimGwangjin'sBattle.”

adaptingtochangingcircumstancesandmeetingthepracticalneedsoftheKoreancommunity. Similarly,in1928,Kimtreatedapatientwithtinnitusanddeafnessusing Gagam-gye-gyu-tang anddemonstratedhisskillinaddressingcomplexconditionslinkedtokidneydeficiencies.99 Kim’smeticulousdocumentationofcasestudiesprovidedempiricalevidenceofitsefficacyand thereforereinforcedthelegitimacyof hanuihak.Bycarefullytrackingpatientoutcomes,he provedthatthetheoreticalprinciplesofKoreantraditionalmedicinecouldbetranslatedinto real-worldapplicationswhichcounteredthecolonialnarrativesthatdismissedthefieldas unscientificandexemplifiedthemedicine’spotency.

FoundationofAmericanMedicalMissionariesinKorea

From1884to1941,about280AmericanmedicalmissionariesenteredKorea,andthey eachservedfor13.0yearscomparedtothe7.9yearsofanonmedicalmissionary 100 Theefforts ofAmericanmedicalmissionariesbeganin1882whentheUnitedStatesformedatreatywith Korea,andtheAmericanPresbyterianChurchdispatchedagroupofmissionaries,including medicaldoctorHoraceAllen.101 Allen’ssuccessfultreatmentofthecriticallyinjuredqueen’s nephewin1884markedaturningpointinthetrajectoryofWesternmedicineinKorea.102 In returnforeffectivelyrecoveringhisnephew,KingKo-jongallowedAllentoopen Kwang-hye-won, Korea’sfirstbiomedicinehospitalandevenprovidedfunding.103Duringitsfirst

99 Oh,“TraditionalMedicineDoctorKimGwangjin'sBattle.”

100 Sang-ik Huang and Chang-duck Kee, "朝鮮末과 日帝强占期 동안 來韓한 西洋宣敎醫療人의 활동 분석" [Analysis of Services of Medical Missionaries During the Late Yi-Dynasty and the Era of the Japanese Occupation in Korea], Korean Journal of Medical History 3,no 1 (1994),2-3.

101 Jong-chanLeeandChang-duckKee,"TheRiseofWesternMedicineandtheDeclineofTraditionalMedicinein Korea,1876-1910," Korean Journal of Medical History 5,no 1(1996),5

102 Han,"TheRise,"Page98

103 Han,Page98.

yearofopening,thehospitalserved265inpatientsand10,460outpatientsandpavedthewayfor thethirtymissionary-foundedhospitalsandclinicsthatwouldriseuntiltheendoftheChosun era.104

However,duetoKoreanofficialswhoseizedcontrol,thehospital’sconditionstartedto deteriorate,drivingKingKo-jongtoinitiatereconstructionandleadingDr.O.R.Avison,the thensuperintendentofthe Kwang-hye-won,toleavetheinstitution.105 Dr.Avisoncontinuedto independentlygrowmedicaleducationbycreatingthe Jae-joong-won whichispresentlyknown astheSeveranceHospital,oneofKorea’sbiggesthospitalstothisday.106 Theestablishmentof Jae-joong-won in1904addressedthelimitationsofmissionaryhospitalswithsinglemedical missionariesthroughallowingforamoreconcentratedapproach.107 Avisonrecognizedtheneed foracentralizedsystemwherestudentscouldexclusivelystudymedicinebecauseofthe complexityanddifficultyofthetaughtmaterial.108 ThefirstgraduatesofSeverancenotedthe firstemergenceofdistinctresultsfromthisnewinstitutionwhentheKoreangovernment permittedthefirstofficialWesternmedicallicensestonativeKoreans.109

AmericanMissionarieswithKoreans

Whenproposingtheestablishmentof Kwang-hye-won,Allenemphasizeditsroleasa demonstrationofthemonarch’sbenevolencetowardshissubjects.110 Heexplicitlyframedthe

104 Han,Page98

105 LeeandKee,“TheRise,”6;NorthernPresbyterianReport,1894

106 LeeandKee,6

107 Park, "일제 초 의학교육기관의 [Reformation of the Medical]," 30

108 Park,30

109 Park,30

110 Park,"CommercializationofMedicine,"45.

institutionasameanstoreinforcetheking’simageasacompassionaterulerandarguedthatsuch aninitiativewouldnotonlyprovidepropermedicalcaretoKorea’spopulationbutalsofoster greaterloyaltytotheking.111 Allenalsoadvocatedforthehospitaltooperateasacharitable organizationthatofferedfreemedicalservicestothoseunabletoaffordcare,therebyreinforcing themonarch’spaternalisticrole.112 RatherthansupplantingKoreanmedicine,themissionary presencecreatedahybridmoralecologyinwhichKoreanpractitionerscouldcontinuetoserve theircommunitieswithcompassion,nowinfusedwithnewtechniquesandclinicaltools.

111 Park,45.

112 Park,45.

113 Young Ah Lee, "선교의사 알렌(Horace N. Allen)의 의료 활동과 조선인의 몸에 대한 인식 고찰" [A Study on Horace N. Allen's Medicine and Recognition of Korean Body], Korean Journal of Medical History 20,no 2(2011),296

InadditiontohelpingAllenat Jaejoongwon,MaryScranton,thefirstfemalemissionary senttoKorea,openedaprivatetreatmentfacility,theUniversalReliefHospital,in1885tocarry outmorefreemissionaryactivities.113 Shelaterestablishedahospitaldedicatedtowomen,titled Boguyeogwan,wherefemaledoctorsincludingMetaHoward,RosettaSherwood,andMary Scrantonserved.114 FigureslikeAllenandScrantonframedhealthcareasareflectionofthe state’sorchurch’smoralobligationtothepeople,mirroringtheConfucian-informedexpectations thatphysiciansserveascaretakersofbothphysicalandsocialhealth.Themissionaries’ establishmentofcharitablehospitalsandtheiremphasisonfreeaccesstocarerevivedthe foundationsofmedicalbenevolenceinKoreansocietyduringaperiodwhenJapaneseauthorities persistentlysoughttodelegitimizeit.Thehumanitarianbrandformedicinepresentedby missionariescreatedathirdspace,distinctfrombothimperialJapanesebiopoliticsandstatic 114 Lee,296.

traditionalism,whereKoreanmedicalpractitionerscouldonceagainopenlyoperateasmoral agentsratherthancolonialagents.

UnliketheJapanesewhosoughttocompletelyeradicatetheexistenceof hanuihak,the recordsandmedicalpracticesleftbyWesternmissionarydoctorswhiletreatingKoreans revealedbothpositiveandnegativeviewsaboutKoreancultureandmedicine.115 Sherwood advocatedfortheuseofondol-stylehospitalroomsasthemostsuitableaccommodationfor Koreanpatientsduringthatperiod.116 EliBarrLandis,amedicalmissionaryfromtheAnglican Church,deeplyimmersedhimselfinKoreanculturebygraspingacomprehensiveunderstanding ofthelanguageandpublishingarticlesintroducingvariousaspectsofKoreancultureand customs.117 HeparticularlyshowedanoptimisticattitudetowardsKoreanherbsinhistranslation ofthe Donguibogam intoEnglish,wherehestatedthathefoundtraditionalKoreanmedicinal herbstobeparticularlyimpressive.118 ThisculturalhumilitydisplayedbybothSherwoodand LandispositionedtraditionalKoreanknowledgenotasantitheticaltosciencebutasaculturally embeddedmedicalideologiesworthyofscholarlyengagement.Suchrevalorizationallowedfora selectivepreservationofKoreanmedicalidentity,onethatstrategicallyadoptedWestern practiceswhileresistingfullassimilationintothecolonialmedicalregime.Inthisway, missionarymedicineinadvertentlyarmedKoreanpractitionerswithnewrhetoricaland institutionaltoolstonegotiatetheirprofessionalsurvival.

ReverendandmedicalmissionaryWilliamJamesHallalsosoughttointroduceWestern medicalpracticestoKorea,oftenencounteringtraditionalhealingmethodsthatstarklycontrasted

115 Lee,296

116 Lee,296

117 Lee,296

118 Lee,296.

withhisownbiomedicaltraining.HallplayedacrucialroleinexpandingWesternmedicalcare inthecityofPyongyang,wherehepersonallytreatedoversixtypatientsaday.119 His observationsoflocalmedicalcustomsfirsthandincludedanincidentinwhichhewitnesseda Koreanhealerattemptingtotreatacomatosechildthroughinvasivepuncturingofvariousbody parts.120 Alarmedbytheprocedure,Hallintervenedbywarningthatsuchmethodscouldleadto severeinfectionsandotherlastingcomplicationsincludingsuppurationandjoint inflammation.121 Hiswarningsweremetwithskepticismandindifference,andthechild ultimatelysuccumbedtotheirillness,reinforcingAllen’sbeliefintheurgentneedformodern medicalinterventioninKorea.122

Hall’semphasisonindividualizedcareandpatientdignityfosteredamedicalethosthat counteredtheJapanesemodelofbureaucraticcontrol.WhileJapan’sapproachtotheirownform of“benevolent”healthcareincreasinglytreatedpatientsasobjectstomanipulatetheKorean public’sperceptionoftheirmedicalreforms,missionaryhospitalsmaintainedafocusonthe healingrelationship.Suchahumanistdimensionmadethemissionary’smotivationsmore palatabletoKoreansthanJapanesecolonialmedicineevercould,therebyallowingWestern medicineintroducedbytheAmericanmedicalmissionariestotakerootwithoutdisplacingthe moralterrainof hanuihak Thus,thesemissionariesactedascatalystsforamoralcontinuitythat enabledtheethicalintentofKoreanmedicinetosurvive.

JamesScarthGale’sPerspective

119 Hall, The Life,264

120 Hall,186

121 Hall,186

122 Hall,186.

AccordingtothedocumentationofJamesScarthGale,aCanadianPresbyterian missionary,AmericanmedicalmissionariesinKoreaservedascrucialagentsofhealthcare reformbyconnectingthedividebetweenWesternmedicalscienceandKoreansocietydeeply rootedinConfuciantraditionsandindigenoushealingpractices.Theyintroducedempirical methodologiesforimprovementinprinciplesofcausalitysanitation,andpreventativemedicine tofacilitateashiftintheunderstandingofdisease.123 Boththeirclinicalcontributionsand essentialroleinAmericanmissionaryeffortshelpedlaythefoundationforalasting transformationinKorea’smedicalandpublichealthsystems.124

When the measure of mission work is taken for the wide mission fields of the world, many a medical man will come in for the wreath of laurel. In Korea this will be true. The first missionary to be appointed was medical man, the first to arriveonthefieldwasamedicalman,thefirstgreatlosswasamedicalman.125

TheopeningstatementofthisentrybyGaleassertsthatwithinthevastexpanseofglobal missionaryinitiatives,medicalmissionariesoccupiedaparticularlydistinguishedposition.Gale furtherreinforcesthisheavypraiseofmedicalmissionariesbyreferencingthe“wreathoflaurel” andthereforealludingtoclassicaltraditionsofbestowinglaurelsuponthosewhodisplay exceptionalservice.Inthiscontext,thephrasesuggeststheuniquesignificanceofmedical missionariesinthebroadercontextofmissionwork,wheretheircontributionsextendedbeyond therealmofphysicalhealingandventuredintothedomainofculturalexchangeand humanitarianassistance.ThesubsequentmentionofKoreadirectsthespotlighttothespecific caseofKorea,highlightingthenationasaparticularlysignificantlocusofmedicalmissionary

123 JamesScarthGale, Korea in Translation (1909) (KissingerPublishing,1909)

124 Gale, Korea in Translation

125 Gale, Korea in Translation

activity.ItimpliesthatbothKorea’smissionaryandmedicinalfieldsweredeeplyshapedbythe effortsofAmericanmedicalmissionaries.Bydeliberatelyrepeating“thefirst”throughoutthe lastsentence,Galesuggeststhattheirpresencewasnotincidentalbutratherfoundationaltothe entiremissionaryenterprise.Thefinalclause,“thefirstgreatlosswasamedicalman,”further accentuatesthesacrificesenduredbytheseindividualsastheypioneeredboththeirreligionand formofmedicineinKorea.

The regular laws of cause and effect seem to be out of gear on this side of the 180th meridian. Medical practise is unreasonable. If you have a pain, a long darning needle is stuck into you to relieve it. If you have an inner sickness, the doctor will ask you a question or two, then he will multiply earth by fire and divide by wood, and the result will be a mixture fit for the witch’s caldron, and this you are expected to steep and drink from. To us it seems very unreasonable. Still, we, on our side, tothemareasmuchoutoftouchwiththeirfitnessofthings astheytous.126

Here,GaleraisesgenuineconcernsforthepracticeofmedicineinKorea.Justlikemany Japaneseofficials,hehighlightsflawsthathinderedthepotentialofKorea’smedicallandscape bymentioningtreatmentssuchastheprescriptionofunscientificandborderline-mythic treatmentsforsickpatients.However,Gale’sfinaltwosentencesofthispassagedifferentiatehis andtheAmericanmissionaries’attitudetowardstheireffortstorevampKoreanmedicine.By explicitlystatingthat“tousitseemsveryunreasonable”andthereforeemphasizingthathis documentationreflectsthethoughtsofaWesternman,Galedemonstrateshiscomplex understandingoftheflawsmentionedbeforehand.Heacknowledgesthattheseideasmaypresent themselvesas“unreasonable”duetohisownWesternizedperspectiveandretroactivelyattempts

126 Gale, Korea in Translation

tocomprehendthatthesemedicalpracticesmightseemmorestrangeandineffectivethanthey reallyareduetothatveryperspective.Galecementsthisideathroughthefinalsentence,where hedirectlymentionshisknowledgeofhowculturaldifferencescanalterperspectives.Crucially, heaccountsfortheperspectiveofKoreansbyswitchinghisperspectiveandconsideringhowthe flawsofAmericansmayequallyappear“unreasonable”towardsthoseunfamiliarwithWestern culture.

HomerHulbert’sPerspective

AdiaryentrybyHomerHulbert,anAmericanmissionaryandjournalist,providesa nuancedobservationofthesocio-economicattitudesofteachersandphysiciansinKoreawhich indirectlyhighlightsasystemdeeplyentrenchedintheCofucianideologyof insul Hisaccount revealsthephilosophicalframework’slastingimpactthatrenderedbotheducationandmedicine pursuitsofmoraldutyratherthanavenuesforfinancialgain.

However high may be the esteeminwhichlettersareheld,theordinaryteacheris a very humble member of so-called good society. He is treated politely by everyone, but he is looked upon very much as apensioner.Hereceivesnosalary, but the boys bring him frequent presents, and he ekes out a living in some way

But there is a more dignified side to the question. Teaching seems to be looked upon asathingthatcannotbeestimatedinmoneyvalue.Youcanbuytheservices of a cobbler or a mason, but knowledge is too fine a thing to be bartered. The same holds true of medicine. The physician takes no regular fee, but is the recipient of a gift proportionate to the wealth of the patient and the amount of servicerendered.Nominallytheserviceisagift.127

127 HomerB Hulbert, The Passing of Korea (NewYork,NY:Doubleday,1906),Page337

Inthebeginningofthepassage,Hulbertimmediatelypresentsaparadox:whileeducation wasveneratedinConfucianKoreansociety,thosewhodedicatedtheirlivestodisseminating knowledgeoccupiedamodestsocialposition.Thephrase“so-calledgoodsociety”thatfollows subtlycritiquesthisparadoxicalsocietalstructure.Itsuggeststhatdespitetheculturalreverence forlearning,teachersinKoreadidnotenjoyadequatematerialsecurity,andthereforereflectsthe traditionalKoreanidealsof insul,whichpositionedscholarshipasanoblecallingratherthana meansofpersonalenrichment.Galefurtherelaboratesontheteacher’sstatus,stating,“Heis treatedpolitelybyeveryone,butheislookeduponverymuchasapensioner.”Heusesthis observationtoemphasizethetensionbetweensocialrespectandfinancialdependency;while teacherswereregardedwithcourtesy,theirrelianceonexternalsupportthrustedthemintoa positionofeconomicvulnerability Thisarrangement,adirectoutcomeof insul,onceagain emphasizedthatthepursuitofknowledgeshouldbedivorcedfrommaterialgain.Expandingon thistheme,HulbertcapturesthetraditionalKoreanpracticewhereinstudentscompensatedtheir teachersthroughgifts,reinforcingthebeliefthateducationwastoosacredtobecommercialized. Thephrase“ekesoutaliving”suggeststhatteachersmaintainedamodestexistence,sustained notbyinstitutionalwagesbutbythegenerosityoftheirpupils.

Atthisjuncture,Hulbertintroducesanalternativeperspective:“Butthereisamore dignifiedsidetothequestion.Teachingseemstobelookeduponasathingthatcannotbe estimatedinmoneyvalue.”Again,Hulbertindirectlyreferencestheprinciplesof insul asthis shiftintoneacknowledgestheinherentnobilityofKorea’seducationsystem.Ratherthan devaluingtheprofession,thisstructureupheldtheConfucianprinciplethatvirtueandwisdom wereoffargreaterimportancethanmaterialwealth.Hulbertthenextendsthisparadigmtothe fieldofmedicine.Bydrawingadirectparallelbetweenteachingandmedicine,hehighlightsthe

extenttowhich insul continuedtopermeatemultiplespheresofKoreansociety.Justaseducation wasviewedasahighercalling,thesameappliedtothepracticeofhealing.Physicianswere expectedtoservetheircommunitiesnotoutofdesireforprofitbutasamoralimperative. Hulbertalsorecordsthephysicians’compensationmodel,inwhichpaymentswerealsonot standardizedbutratherofferedvoluntarilybasedonone’smeans,embodyingConfucianidealsof benevolenceandsocialharmony.HeencapsulatestheConfucianperceptionofmedicineasa dutyratherthanaprofessiondictatedbymarketforces.

Conclusion

ThisdeeplyingrainedhumanitarianethosinKoreanmedicine,shapedbybothtraditional KoreanphilosophicalprinciplesandtheinfluenceofAmericanmissionaries,providesathorough frameworkforunderstandingtheevolutionofhealthcareinKorea.The haunuihak practitioner's abilitytoharmonizetraditionwithprogresswhilesimultaneouslypreservingthefoundational Confuciannotionof insul accentuatesKoreamedicine’smostdefiningcharacteristic: benevolence.Overthecenturies,thisverybalancepermittedKorea’shealthcaresystemtomeld itselfaccordingtochangingpolitical,social,andtechnologicalenvironmentswithout diminishingtheessenceofitsethicalroots.TheintegrationofWesternmedicalpracticesthrough theentranceofAmericanmedicalmissionariesfurtherbroadenedthescopeofcare,yetstill maintainedacommitmenttoservingthemarginalizedandimpoverished.Throughthese particularefforts,Koreanmedicineremainedareflectionofthenation’sfoundingvalues.As modernmedicineconfrontsthecomplexethicalchallengessurroundingaccessibility,Korea’s historicalapproachtohealthcareoffersasalientperspectiveontheessentialroleofmedicineasa societaldutyandobligationtoprovidecareirrespectiveofeconomicconsiderations.

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