For those of us who have grown up in the latter half of the twentieth century, it is difficult to imagine an alternative picture of the body presented in college anatomy textbooks. From our earliest education in science, health, and hygiene, we encounter images of a dissected body with cardiovascular, respiratory, and digestive systems laid out as carefully delineated component parts. Within this modern medical schema, it is the reproductive system, isolated as a set of functional parts, that marks the body’s sex. The reproductive organs show the body to be “male” or “female,” each charged with a specific reproductive function. These images, combined with the authority of science as the ultimate arbiter of reality, have made these sexual categories seem “natural.”

If we look to history, however, we find that this two-sex model is merely one of a variety of ways of envisioning the sexed body. Thomas Laqueur shows that from antiquity through the early modern period, European medicine made no fundamental distinction between male and female bodies. There was only one model: the male. The female body was conceived as a weakened or inferior version of this master template, with the vagina categorized as an inverted penis.¹ Within this frame of reference, it was difficult for women to articulate a feminine experience of the body.

Barbara Duden provides another model of the female body, using a doctor’s notes from eighteenth-century Germany, which reveal how women perceived their own bodies. The doctor who was educated in modern medicine found the bodily experiences of his female patients “strange.” In his mind, women tended to rely on “feelings” rather than visual perception to describe their bodily processes. They tended to talk about their corporeal experiences by relating them to outside occurrences in the form of stories. The body they described was porous and amorphous. Airstreams and fluids passed through the skin, and fluids, such as milk, naturally transmuted themselves into other fluids, such as menstrual blood.²

People in Tokugawa Japan (1603–1868) also understood bodies in ways that seem as strange to modern eyes as those studied by Laqueur and Duden. Before dissection became popular in the mid-eighteenth century, scholars and physicians described a body without the reproductive organs, which distinguish the body’s sex in the modern medical system. Terajima Ryōan, an Osaka-based physician, addressed the question of how to distinguish between a man and a woman in his widely circulated 1712 multi-volume encyclopedia, Wa-kan sansai zue. He listed the “outwardly manifested” characteristics commonly used to distinguish the sexes: yin yang, face up and face down, concave, convex, whether a beard was present, and the length of the hair.³ Ryōan adhered to the dichotomy of yin and yang, roughly female and male qualities derived from long-established Chinese medical traditions. He noted, however, the widespread contemporary belief that a male child was born face up and a female face down. The same principle applied in cases of drowning: a man’s drowned body would be found face up, a woman’s face down. Ryōan’s distinction between concave and convex most likely referred to the genitals, which he saw as one among many signs of sexual difference. He maintained, however, that one could not reliably determine sexual difference from these traits. Rather, the definitive markers of sexual difference were found in skeletal anatomy. In his description, a man’s skull consisted of eight bones, while a woman’s possessed only six, and the female skull lacked the horizontal seam found at the back of the male skull.⁴

These pre-modern depictions of sexed bodies present modern researchers with a series of questions. When and how were modern anatomical depictions of the body introduced into Japan—as scholarly descriptions and as imagery circulating in popular culture? What kinds of cultural, political, and institutional force were behind the ascendancy of the modern anatomical body in Japan? Which individuals and groups appropriated and disseminated this new conception of the body? How did the shift reshape power relations between the state, organized medicine,⁵ unlicensed healers, and medical patients? And, finally, how did this shift in understanding male and female bodies affect gender relations?

Even though this book addresses women’s reproductive bodies from the early modern era to 1945, my starting point for the project is women’s bodies today, where reproductive and maternal health have significance far beyond individual women’s concerns and are vitally important to the interest of the state and medical professionals. As long as we live in this contemporary world, we cannot escape the dominance of modern bio-medical knowledge and government health policies. That is, our bodies have become captive of or colonized by bio-medical knowledge and practices, and government public health measures. While modern bio-medicine is of European origin, its use spread to other parts of the world, and eventually people residing in Japan became subject to the modern power exercised in the field of health and medicine. I clarify how this happened by focusing on the area of midwifery and maternal health.

My approach invokes historical processes of the seventeenth to the mid-twentieth century in which the state and organized medicine exerted an ever-increasing influence over women’s bodies and reproductive lives in Japan. Drawing on insights from Foucault’s writings, I reject theoretical frameworks of the state as a distinct, coherent, oppressive agent, on one hand, and “women” as an undifferentiated, oppressed group, on the other. Instead, I want to focus on midwifery and maternal health policies, discourses, and practices, and to analyze the ways that the engagement of certain groups of women in such practices led to the generation and spread of bio-medical power over those women.

The extensive research into the history of obstetrics and midwifery I have carried out points to two important historical shifts that reshaped the field of health and medicine in Japanese history, radically changing the ideas and practices of obstetrics, midwifery, and maternal health. First, the medical field in mid-eighteenth-century Japan saw the rise of new approaches to analyzing the body, finding causes of diseases, and developing medical remedies, concomitant with what Foucault would call an “epistemic shift” or an overarching change in the criteria for determining what constituted legitimate medical knowledge. These new approaches prepared Japanese physicians to accept Western medical methods and the medical body that developed within this tradition in the mid- to late nineteenth century. In this eighteenth-century field of obstetrics and midwifery, physicians belonging to the new obstetrics school, called the Kagawa School, invented new methods that took advantage of newly introduced perceptions of the human body as a distinct and tangible object. Their school was opposed to the Chinese medical tradition’s age-old perception that the body and larger universe were systemically connected. While Kagawa School obstetricians expanded their practices and client base by developing new methods, the central Tokugawa government and regional (domanial) governments presided over by local feudal lords (the daimyō) rejected collaboration with the Kagawa School or other medical factions. Instead, the central and local government sought to control the biological reproduction of those they governed.

The second shift arose after the 1868 Meiji Restoration with the advent of the modern nation state along with new institutions and disciplinary practices. This institutional restructuring profoundly reshaped the politics of the state, organized medicine, and individual citizens whose bodies became the object of medical surveillance and intervention. The restructuring led to the colonizing of bodies by what Foucault calls “bio-power”—that is, the force that works in conjunction with the circulation of knowledge and the implementation of the practices relating to modern science and medicine. In midwifery and maternal health, much of the efforts of organized medicine and the state toward reforming childbirth and maternal health practices were channeled into the nationwide spread of trained midwives and public health nurses. Modern power also transformed women from being merely objects on which power works into subjects with a will that voluntarily participate in the “improvement” of their own bodies through their exposure to modern health education. I maintain that although there have been changes in government policies on reproductive and maternal health throughout the history of modern Japan, the new institutional landscape that emerged in the late nineteenth century became the basis for the development of modern relations of power, involving the state and individuals, through the twentieth century and beyond. Those relations of power have created oppressive conditions for women, who are divided into different groups according to categories such as class, ethnicity, nationality, occupation, and fitness for reproduction, with each group being subject to a particular type of oppression.

My interest in the emergence of modern power and medical institutions initially led me to single out the 1868 Meiji Restoration as the historical point of rupture. After nearly 700 years of military rule, during which Japan’s interaction with foreign countries—except for countries in East and Southeast Asia—was limited, the internal crisis encompassing the economic, social, and political spheres along with the pressures of Western imperialism led to the breakdown of the Tokugawa shogunate and the establishment of a modern nation state in Japan. To survive the age of imperialism the Meiji ruling elites embarked on a modernization policy that involved a fully fledged Westernization of medicine, among many other fields.

Further research into this topic suggested problems with this initial working hypothesis, however. Although modern medical institutions and practices arose in conjunction with the establishment of the Meiji state, a crucial shift in the system of scholarly and medical knowledge had occurred during the mid-eighteenth century. What prompted this sweeping change in the academic topography were the movements of progressive scholars and physicians who questioned the then more established scholarly and medical systems—namely, the neo-Confucian, Zhu Xi School tradition [Jp Shushi-gaku] whose medical counterpart was called the Goseihō system. Challenging these systems of thought and medicine, progressive and dissident scholars and physicians prioritized empirical and practical knowledge, corroborated by their own experience of seeing and touching the objects of their investigations. It was the eighteenth-century move toward empiricism within Chinese studies and Chinese medical traditions in Tokugawa Japan, not specific medical models imported from Europe, that led to the development of innovations in medicine and a new understanding of the human body.

To understand this overarching shift in the scholarly and scientific method that took place in eighteenth-century Japan, I draw on Foucault’s theory of the “discursive shift.” Basic to understanding this concept is our recognition of the importance of general principles governing a particular cultural and historical moment, which collected together form an “episteme.” This overarching epistemic framework structures the formation of knowledge within various scholarly fields and determines what kinds of knowledge are legitimate. In his important work earlier in his life, The Archaeology of Knowledge, Foucault discusses a decisive epistemic shift during the European Enlightenment that led to the emergence of an academic landscape governed by a new set of conceptual norms.⁶ A similar shift occurred in eighteenth-century Japan in Chinese studies as well as in the fields of science and medicine. The resulting new intellectual framework challenged the neo-Confucian conception of nature, society, the state, and morality that had been widely accepted as the mainstream knowledge of late-seventeenth-century scholars and physicians.

As early as the late seventeenth century and continuing through the eighteenth century, prominent physicians and scholars vigorously criticized neo-Confucian methods, originally developed in Song China (960–1279). To undermine neo-Confucianism, and the scientific and medical models associated with it, they endorsed the study of the most ancient Chinese texts available at the time. They deemed these to be more authoritative because they pre-dated neo-Confucian texts and were presumably uncontaminated by the thinking of later, and thus lesser, scholars, including the advocates of neo-Confucianism. The dissidents’ emphasis on the importance of ancient texts led them to scrutinize their original meanings, which in the medical field prompted physicians to question the efficacy of therapies and medications recommended in more recent Chinese and Japanese texts. It is not that they used remedies discussed in these ancient texts. Rather, they developed drastically new and original therapeutics, legitimizing them by appealing to more ancient texts than those written after the rise of neo-Confucianism in twelfth-century Song China.

These dissident physicians, whom historians later grouped into the Ancient Practice Method factions (Ko-ihō and Ko-hō), developed a new anatomical model of the human body, emphasizing the importance of its visibility, tangibility, and materiality. While the mainstream Goseihō method viewed the human body as a microcosm inseparable from the larger macrocosm, or the universe in which it was situated, innovative physicians perceived the body as a discrete and self-contained entity that lacked a systemic connection with its environment. The growing enthusiasm for the study of tangible body parts and internal organs prompted many physicians to seek a way to perform dissections despite their continuing prohibition for religious and political reasons.

This new focus on the visible and tangible anatomy of the body led to the emergence of new types of sexed bodies, bodies marked with reproductive organs. Instead of defining the body’s sex by grounding it in yin yang theory, and the system of circulation and preservation of ki [Ch qi] and other vital bodily substances, such as the so-called “blood” and “essence,” the body’s physicality emerged as an important criterion for determining its sex. That is, one’s sexual identity became rather confined, circumscribed by the reproductive anatomy of the body as delineated by the new medical theory.

This new approach to the medical body reshaped the field of reproductive medicine. Physician Kagawa Gen’etsu, for instance, established a new set of obstetric methods based on the newly emerging anatomical model of the female body. Competing with established obstetricians versed in Chinese medical classics in an ever more commercialized medical market in the mid-Tokugawa period, Gen’etsu developed procedures using his hands, arms, and eventually a hook to deliver a live child or to extract a dead fetus and afterbirth. Such techniques, based on new representations of the female body, empowered predominantly male obstetricians to the detriment of local midwives.

The growing intervention of medical professionals during the Tokugawa era into women’s reproductive lives, however, was limited compared with the more intrusive methods introduced by organized medicine during the modern period. The pr...