Family Matters: Managing Illness in Late Tokugawa Japan, 1750-1868

Abstract

This dissertation explores how people living in the city of Edo (present-day Tokyo) in the latter half of the Tokugawa period (1603–1868) dealt with illness. Doctor-based care has most often captured the attention of historians, but the proportion of time doctors physically spent with patients was dwarfed by that provided by domestic caregivers. To elucidate the medical landscape of Edo and describe how urban residents cared for sick family members, I draw from a rich body of family records. These include more than a dozen diaries and over fifty family records written between 1750 and 1868, composed by men and women of diverse social status and occupation such as samurai, commoners, popular authors, and doctors.

Chapter One illustrates how day-to-day management of illness was implemented by family members rather than by medical practitioners, demonstrating the key role of women as mobile caregivers and the ways in which illness bound families together. Chapter Two examines what sufferers consumed when they fell ill, revealing the importance of adjusting diet, self-medicating, and record keeping within the home. Chapter Three depicts the role of religious sites and therapies in the lives of Edo residents, showing the importance of family members’ prayer by proxy.

Against this backdrop of therapeutic options, Chapter Four explores how families interacted with medical practitioners by using the records of three Edo physicians to trace their daily routines. Diaries of families who hired physicians show that they often saw several doctors over the course of a single illness. Seeing a doctor was not a binary relationship between patient and practitioner but an enterprise that mobilized multiple family members. Chapter Five argues that illness in late Tokugawa Japan was a social event on the scale of weddings or births—one that could bring dozens of visitors to the home, all bringing gifts. In total, this dissertation contends that health care in early modern Japan was rooted in the family, and that the patterns of therapeutic practice seen in early modern diaries were fundamentally shaped by familial participation in illness management.