Assistant Professor, Department of History, Sungkyunkwan University.
Uisahak. 2020 Dec;29(3):1101-1132. doi: 10.13081/kjmh.2020.29.1101.
How did the Japanese establish a medical welfare system? In answering this question, historians of modern Japan have accentuated the assertive role of state bureaucrats, especially from those of the Home Ministry (naimushō). Historians of Japanese medicine also emphasized the role of the state. William Johnston, in his pioneering work on tuberculosis in Japan, explored the rise of a hygiene administration on this disease as a state enterprise. In the medical history of Japan, scholars highlighted the significance of the wartime period in the birth of this system. The emphasis on the Japanese wartime state is justified. The Japanese government managed to establish a national health insurance in 1935, while the United States government has not been able to establish a medical insurance for every citizen to this day. However, these scholars have not explored how welfare benefits were distributed to members of Japanese society. This article seeks to fill this historiographical gap by looking at the Student Health Center of Tokyo Imperial University (Tōdai), Japan's first state-established university founded in 1886. This university, I contend, was a critical locus in the birth of medical welfare in Japan. At this university were the most privileged medical facilities and practitioners who could provide medical services, as well as students without stable incomes of their own, thus in need of welfare support. The demand of staff of Tōdai's Student Association to establish a Student Health Center was accepted and realized in 1926, and Tōdai students became the beneficiaries of state-managed medical support. The Tōdai Student Health Center was different from other medicare facilities in that its role was not limited to save students from poverty. Student Health Center practitioners helped students check health for university admission, campus life, and job placement to be white-collar elites. Student Health Center practitioners evaluated students' health when they tried to enter Tōdai and get jobs and inculcated students in how to manage living as mental-worker "gentlemen," in coping with tuberculosis, venereal diseases, and neurotic breakdown. Also, they produced statistics about the health condition of Tōdai students, which immediately stimulated further investment in the facilities of Tōdai authorities for the center. Based on statistical data, Tōdai authorities developed a hygiene campaign against tuberculosis so that students could take advantage the of state-of-the-art treatments inexpensively. As such, Tōdai students became among the biggest beneficiaries of this process. In other words, the Student Health Center had a dual significance at Tōdai: a medicare institution as well as part of privileged campus culture. Tōdai was a symbolic locus that reveals the uneven diffusion of medical welfare benefits in Japanese society. Through the lens of this facility, this article seeks to explore the paradox of welfare in meritocracy that contributed to the formation of the elite class in modern Japan.
日本是如何建立医疗福利制度的？在回答这个问题时，现代日本历史学家强调了国家官僚，尤其是内务省（naimushō）官僚的积极作用。日本医学史学家也强调了国家的作用。在其关于日本结核病的开创性研究中，威廉·约翰斯顿（William Johnston）探讨了将卫生管理作为国家企业来应对这种疾病的兴起。在日本医学史中，学者们强调了战争时期在该体系诞生中的重要性。强调日本战时国家的作用是合理的。日本政府设法在 1935 年建立了国家健康保险制度，而美国政府至今仍未能为每个公民建立医疗保险。然而，这些学者并没有探讨福利利益是如何分配给日本社会成员的。本文通过研究日本第一所国立大学东京帝国大学（Tōdai）的学生健康中心，试图填补这一历史空白。我认为，这所大学是日本医疗福利诞生的关键场所。在这所大学，拥有最优质的医疗设施和从业者，可以提供医疗服务，还有那些没有稳定收入的学生，因此需要福利支持。1926 年，Tōdai 学生协会的工作人员要求建立学生健康中心的请求得到了接受和实现，Tōdai 学生成为国家管理医疗支持的受益者。Tōdai 学生健康中心与其他医疗保险机构不同，其作用不仅限于使学生摆脱贫困。学生健康中心的从业者帮助学生在入学、校园生活和就业安置时检查健康状况，使他们成为白领精英。学生健康中心的从业者在学生试图进入 Tōdai 并找到工作时评估他们的健康状况，并教导学生作为脑力劳动者“绅士”如何管理生活，应对结核病、性病和神经崩溃。此外，他们还制作了有关 Tōdai 学生健康状况的统计数据，这立即刺激了 Tōdai 当局对中心设施的进一步投资。基于统计数据，Tōdai 当局开展了结核病卫生运动，以便学生能够以低廉的价格享受最先进的治疗方法。因此，Tōdai 学生成为这一过程的最大受益者之一。换句话说，学生健康中心在 Tōdai 具有双重意义：既是医疗保险机构，也是特权校园文化的一部分。Tōdai 是一个象征性的场所，揭示了日本社会医疗福利利益不均的现象。通过这个设施的视角，本文试图探讨精英主义福利中的悖论，这有助于形成现代日本的精英阶层。
