Reconstructing Bodies

Biomedicine, Health, and Nation-Building in South Korea Since 1945

John DiMoia

• Publisher: Stanford University Press
• Year: 2013
• ISBN:
  9780804786133
• Edition: 1
• Topic: History
• Subtopic: Korean History
• Index: History

South Korea represents one of the world's most enthusiastic markets for plastic surgery. The growth of this market is particularly fascinating as access to medical care and surgery arose only recently with economic growth since the 1980s. Reconstructing Bodies traces the development of a medical infrastructure in the Republic of Korea (ROK) from 1945 to the present, arguing that the plastic surgery craze and the related development of biotech ambitions is deeply rooted in historical experience.

Tracking the ROK's transition and independence from Japan, John P. DiMoia explains how the South Korean government mobilized biomedical resources and technologies to consolidate its desired image of a modern and progressive nation. Offering in-depth accounts of illustrative transformations, DiMoia narrates South Korean biomedical practice, including Seoul National University Hospital's emergence as an international biomedical site, state-directed family planning and anti-parasite campaigns, and the emerging market for aesthetic and plastic surgery, reflecting how South Koreans have appropriated medicine and surgery for themselves as individuals, increasingly prioritizing private forms of health care.

I

From Occupation to Nation

1

Medicine and Its Fragments, 1945–1948

Traditional Practitioners and the USAMGIK

In 1944, Andrew Grajdanzev published Modern Korea, a comprehensive survey of the peninsula and its social conditions following several decades of Japanese colonial rule; the survey offered a deeply critical take on claims made by colonial authorities.¹ While scholars have speculated a great deal on Gradjanzev’s ideological leanings and his personal identity, along with his curious institutional affiliation, the Institute of Pacific Relations (IPR), it is the cumulative statistical portrait presented in his volume that holds the greatest potential for further inquiry: Grajdanzev critiques the very terms on which the colonial apparatus bases its hold, especially the claim of penetrating the Korean countryside, even under difficult wartime conditions. More specifically, questions of land ownership, access to education at all levels, and access to modern forms of medical care represent the major issues to be confronted, with an incisive, almost corrosive skepticism directed at the existing portrait made available through standard sources such as the more optimistic framing offered in Chosen Sotokofu Tokei Nenpo, the series of annual reports issued by the governor-general of Korea (GGK) as evidence of its benevolence toward the colony.

Gradjanzev offers an image of conspicuous lack of medicine and health care, with only a small handful of doctors based in urban areas, offering their care almost exclusively to a Japanese clientele, primarily those associated with the colonial state and its settler population. This is not to say that the colonial medical system had no impact on colonial Korea. In fact, the legacy of Japan’s medical system during the colonial period has recently become the subject of a great deal of emerging scholarly literature, especially with respect to key issues such as gender, reproduction, and mental health. But the issue here will be framed from a slightly different perspective: Assuming Gradjanzev’s terms as a starting point, what were health conditions like for the significant portion of the population not seeking care from a Western-trained physician, regardless of whether Japanese or Korean? What were the available alternatives for this sizable pool of individuals, living outside the major cities and sometimes suspicious of, and seeking to minimize contact with, the colonial state?

Byun Sang-Hun’s Postcolonial Encounter

Issued in March of 1947, the license provided to Byun Sang-Hun (1902–1989)—here identified as “S. H. Byun”—the third generation in a family of Korean traditional medical practitioners, certified his right to continue operating his clinic at Yangsan, a small village located a short distance southeast of Taejŏn in the southern half of the Korean peninsula.² The accompanying photograph, with the left side masked in shadow, offers a sober portrait of a middle-aged Korean male in Western dress, wearing a dark shirt. The individual in question, born in 1902, had continued the practice handed down by his father and grandfather; the licensing procedure likely carried with it a certain degree of anxiety, as it was not yet clear how American military authorities or the USAMGIK would treat Korean medical practitioners.³ Certainly Byun was hardly alone in submitting to this procedure, as the reverse side of the same document assigned him the number 853, thereby placing him among a collection of individuals who had already registered with the USAMGIK Bureau of Public Health and Welfare. Within less than two years, this act of registration was recognized by an independent South Korean state, which later mobilized Byun’s practice as part of its national story by validating his embrace of the “traditional,” even while marginalizing his form of practice.

The location assigned to Mr. Byun’s clinic encompassed the township (myŏn) of “Yang San,” located in the “Yung Dong” (Yŏngdong) district (kun) of the “Chung Puk” (Ch’ungbuk) province of Korea, specifying the area in which he would be permitted to practice.⁴ Comprising a region occupying the south-central portion of the Korean peninsula, the only province lacking access to the sea, Chungbuk (North Chung) was then, as it is now, primarily a rural area, encompassing low-lying mountains as well as agriculture. The town of Yangsan, located in the southeastern portion of the province, was situated toward the center of the peninsula, placing it close to the border with neighboring Chungnam (South Chung). The geographical specificity of Mr. Byun’s site was significant not simply as a matter of administrative record keeping but also because USAMGIK was acutely conscious of the need to account for the geographical distribution of medical personnel—including those trained in Western medicine and Korean traditional medicine—in the aftermath of a series of epidemics the preceding year, including a cholera outbreak.

This spring 1947 survey of “herb medicine” and its associated practitioners was only one in a series of bureaucratic activities conducted over a period of approximately sixty years (1885–1945), devoted to identifying, classifying, and ultimately transforming the practice of Korean traditional medicine, or hanŭihak. The arrival of Western missionaries in the late nineteenth century witnessed initial contact between the different medical traditions, with Dr. Horace Allen (1858–1932) winning influence at the Korean court through his ability to treat a variety of ailments.⁵ Still later, Japanese colonial authorities (1910–1945) attempted to categorize local practices in terms of their own familiarity with German academic medicine adopted during the Meiji period. Byun Sang-hun had previously undergone a similar registration procedure during Japanese colonial rule on more than one occasion, providing a detailed explanation of his training and activities to secure the right to continue his practice as a ŭisaeng, or herb doctor.⁶ This latest intervention by American military authorities therefore must be seen in its context, representing another in a series of challenges to the authority of traditional doctors.

At the same time, this activity also needs to be addressed in terms of USAMGIK’s larger project during the nearly three-year period of its occupation (September 1945–August 1948), a legacy of the unexpected collapse of Japanese forces in August 1945. Caught off guard by Japan’s surrender on August 15, the U.S. Tenth Army did not arrive in Korea until early September, nearly three weeks after the conclusion of combat. Moreover, many of the Civil Affairs personnel accompanying the U.S. Tenth Army had been trained at civil affairs training schools (CATS) designed for the occupation of Japan, meaning that there was a conspicuous lack of expertise regarding the Korean context.⁷ In many cases, the practice was to rely on Japanese personnel and bureaucratic procedures until suitable replacements could be found.⁸ The request that Mr. Byun register his presence with local authorities may be seen not only as part of an exhaustive survey of trained medical personnel but also as an inventory of social resources as a whole. As the American military hoped to hand over its authority to an independent Korean government, a prospect that was looking increasingly likely by spring 1947, there needed to be a thorough accounting of available facilities and personnel.⁹

This effort to survey local resources was framed in terms of public health concerns that had been raised during previous campaigns in Europe and, much closer to the Korean peninsula, the conquest of various island groups held by Japanese forces.¹⁰ In pragmatic terms, this meant that the major concern—even above the welfare of the Korean population—was that of maintaining the health of American occupying forces. The need to survey encompassed those elements that could potentially contribute to the spread of disease—including the availability of clean water and sanitation facilities, contact with animal populations, and the regulation of refugee movements—and required the presence of American personnel trained to handle such contingencies.¹¹ Koreans, on the other hand, had a lengthy tradition of relying on traditional practitioners to satisfy the basic requirements of daily health and were not always certain about the value of Western biomedicine, especially as it had been heavily promoted by Japanese public health personnel in conjunction with a variety of public health campaigns.

Unlike other military occupations taking place at about the same time—those in Germany, Japan, and Austria—the occupation of Korea did not require the removal of a particular ideology or political party, but instead, the removal of members of a specific group, Japanese nationals.¹² More specifically, the Korean case involved the replacement of Japanese medical personnel by local trainees so that members of the former group could be repatriated to their home islands. In the course of undertaking this task, however, American soldiers believed that there were not enough Koreans with the requisite training, meaning that Japanese police, professors, teachers, and doctors maintained their positions well into 1946 and sometimes even beyond.¹³ In those cases where replacements could be found, new staff members tended to be Koreans who had previously found favor with colonial authorities and who were sometimes viewed as compromised by their peers. With respect to medicine specifically, this claim has been made by Korean scholars, arguing that departing Japanese personnel were replaced by a group of similarly minded Korean physicians.¹⁴

Contributing to the sense of urgency from the American perspective was the added contingency of disease control, a problem complicated by the movement of new populations on the peninsula, a subject to be taken up in the next chapter.¹⁵ Horace H. Underwood (1890–1951), a senior figure at USAMGIK and member of a prominent missionary family, was among the American missionaries who had returned to Korea to assist with the task of rebuilding. Taking a position with the Education Bureau, Underwood was ideally situated as an observer and wrote numerous reports regarding the problem of refurbishing an education system that had been largely neglected during colonial rule. In emphasizing a general expansion of access to education, Underwood called for not only an increase in the number of educators but also for the training of “doctors, nurses, [and] veterinarians” willing to work in the outlying areas of Korea.¹⁶ In making this appeal, Underwood reinforced the link between two related perceptions, a shortage of medical doctors to serve the local population, as well as the tendency of medical personnel to be concentrated in urban centers.¹⁷ With this appeal, Underwood backed a proposal that would dominate the USAMGIK approach to the problem of maintaining public health, a desire to rely largely on doctors trained in the Western medical tradition. If practitioners such as Mr. Byun merited attention and were represented in the 1947 survey, their skills and expertise were nonetheless considered only marginally effective. Ultimately, Byun Sang-hun’s career does not represent one of elision but rather the complicated story of a set of skills that began to adapt and transform in the late nineteenth century, facing a succession of challenges to its authority. The issue of increasingly sophisticated forms of surgical intervention and the emerging problem of disease control—particularly enteric disease such as typhus and cholera—were only two of the claims put forward to question the value of traditional practice, which nonetheless succeeded in reinventing itself, both as an independent approach and as a complement to Western medical practice in the newly formed ROK after 1948.

Far from a static set of traditions handed down from time immemorial, hanŭihak underwent numerous changes over a period of more than 300 years—from the late sixteenth century to 1945—selecting diverse elements of Chinese practice and adapting them to meet the needs of the community. To administer this process of knowledge transmission, a set of institutions was established to educate and authorize the training of court physicians, and these sites would continue to function until just prior to the onset of colonial rule. Moreover, many of the elements described in USAMGIK materials—local variations of surgery and inoculation, practices that were perceived as remnants from the past—had actually been introduced in response to the encounter with Western biomedicine in the nineteenth century; thus, hanŭihak already represented a hybrid set of practices by mid-twentieth century. Narrating this series of transformations through the collective story of several (male) generations of the Byun family, this chapter outlines briefly the changes taking place within a sinicized Korean culture that would encounter the transforming effects of Japanese colonial rule, only to be followed by an American occupation.¹⁸

If traditional medicine has not always received its due, moreover, this development needs to be examined not by looking at practitioners in isolation but by looking at the rapid emergence of newer medical institutions that would come to dominate the South Korean scene. Missionary families like the Underwoods provided a means to guide funding and resources from Western donors to local institutions, first during the colonial period and, subsequently, with independence and the Korean War. These resources initially went almost exclusively to promoting the growth of biomedical practice; in particular, Severance Hospital and Seoul National University Hospital would represent two of the most influential institutions in terms of training significant numbers of Korean doctors and nurses, along with subsequently promoting the practice of public health.¹⁹ In choosing to focus on Byun Sang-Hun, this chapter argues specifically that this second story, which has tended to dominate the historiography, remains highly contingent: Biomedicine’s appeal lay precisely in its ability to highlight a perceived contrast with hanŭihak, the dynamic modern posed against the perceived role of the static past. Cast as part of the latter, Byung Sang-hun would be celebrated as a heroic figure near the end of his life, a bearer of traditional practice through difficult times.

Traditional Korean Medicine and the Appeal of Its Practitioners

Scholars focusing on the role of Korean traditional medicine typically select from among three periods, either late Chosŏn (1876 through 1910), colonial rule (1910 thr...