John P. DiMoia is Assistant Professor in the Department of History at the National University of Singapore.

Reconstructing Bodies

Biomedicine, Health, and Nation Building in South Korea since 1945

By John P. DiMoia

Stanford University Press

Copyright © 2013 Board of Trustees of the Leland Stanford Junior University
All rights reserved.
ISBN: 978-0-8047-8411-5

Contents

Introduction: Medicine as a Form of “Ordinary Shopping”………………..1Part I From Occupation to Nation…………………………………….Chapter 1 Medicine and Its Fragments, 1945–1948……………………….19Chapter 2 Mobilizing New Models of Public Health and Medicine, 1945–1948…46Chapter 3 From Minneapolis to Seoul: Transforming Surgery, Clinical
Practice, and Professional Identity at Seoul National University Hospital,
1954–1968…………………………………………………………72Part II Meet the State……………………………………………..Chapter 4 Family Planning and Nation Building in South Korea, 1961 through
the mid-1970s……………………………………………………..109Chapter 5 Taking Samples for the Nation: Historicizing the Biological
Sample in the South Korean Antiparasite Campaigns, 1969–1995……………145Chapter 6 Reconstructing the Face: “Asian Blepharoplasty,” Professional
Expertise, and the Development of a Plastic Surgery Market, 1954 to the
present…………………………………………………………..177Conclusion: Challenging Developmental Expectations…………………….213Notes…………………………………………………………….229Bibliography………………………………………………………255Index…………………………………………………………….271

Excerpt

CHAPTER 1

Medicine and Its Fragments,1945–1948

Traditional Practitioners and the USAMGIK

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

Gradjanzev offers an image of conspicuous lack of medicine and healthcare, with only a small handful of doctors based in urban areas, offering theircare almost exclusively to a Japanese clientele, primarily those associated withthe colonial state and its settler population. This is not to say that the colonialmedical system had no impact on colonial Korea. In fact, the legacy of Japan’smedical system during the colonial period has recently become the subject ofa great deal of emerging scholarly literature, especially with respect to key issuessuch as gender, reproduction, and mental health. But the issue here willbe framed from a slightly different perspective: Assuming Gradjanzev’s termsas a starting point, what were health conditions like for the significant portionof the population not seeking care from a Western-trained physician, regardlessof whether Japanese or Korean? What were the available alternatives forthis sizable pool of individuals, living outside the major cities and sometimessuspicious 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)—hereidentified as “S. H. Byun”—the third generation in a family of Koreantraditional medical practitioners, certified his right to continue operating hisclinic at Yangsan, a small village located a short distance southeast of Taejonin the southern half of the Korean peninsula. The accompanying photograph,with the left side masked in shadow, offers a sober portrait of a middleagedKorean male in Western dress, wearing a dark shirt. The individual in question,born in 1902, had continued the practice handed down by his father andgrandfather; the licensing procedure likely carried with it a certain degreeof anxiety, as it was not yet clear how American military authorities or theUSAMGIK would treat Korean medical practitioners. Certainly Byun washardly alone in submitting to this procedure, as the reverse side of the samedocument assigned him the number 853, thereby placing him among a collectionof individuals who had already registered with the USAMGIK Bureau ofPublic Health and Welfare. Within less than two years, this act of registrationwas recognized by an independent South Korean state, which later mobilizedByun’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(myon) of “Yang San,” located in the “Yung Dong” (Yongdong) district (kun)of the “Chung Puk” (Ch’ungbuk) province of Korea, specifying the area inwhich he would be permitted to practice. Comprising a region occupyingthe south-central portion of the Korean peninsula, the only province lackingaccess to the sea, Chungbuk (North Chung) was then, as it is now, primarily arural area, encompassing low-lying mountains as well as agriculture. The townof Yangsan, located in the southeastern portion of the province, was situatedtoward the center of the peninsula, placing it close to the border with neighboringChungnam (South Chung). The geographical specificity of Mr. Byun’ssite was significant not simply as a matter of administrative record keepingbut also because USAMGIK was acutely conscious of the need to account forthe geographical distribution of medical personnel—including those trainedin Western medicine and Korean traditional medicine—in the aftermath of aseries of epidemics the preceding year, including a cholera outbreak.

This spring 1947 survey of “herb medicine” and its associated practitionerswas only one in a series of bureaucratic activities conducted over a periodof approximately sixty years (1885–1945), devoted to identifying, classifying,and ultimately transforming the practice of Korean traditional medicine, orhanuihak. The arrival of Western missionaries in the late nineteenth centurywitnessed initial contact between the different medical traditions, with Dr.Horace Allen (1858–1932) winning influence at the Korean court through hisability to treat a variety of ailments. Still later, Japanese colonial authorities(1910–1945) attempted to categorize local practices in terms of their own familiaritywith German academic medicine adopted during the Meiji period.Byun Sang-hun had previously undergone a similar registration procedureduring Japanese colonial rule on more than one occasion, providing a detailedexplanation of his training and activities to secure the right to continuehis practice as a uisaeng, or herb doctor. This latest intervention by Americanmilitary authorities therefore must be seen in its context, representing anotherin 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’slarger project during the nearly three-year period of its occupation(September 1945–August 1948), a legacy of the unexpected collapseof Japanese forces in August 1945. Caught off guard by Japan’s surrender onAugust 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 theCivil Affairs personnel accompanying the U.S. Tenth Army had been trainedat civil affairs training schools (CATS) designed for the occupation of Japan,meaning that there was a conspicuous lack of expertise regarding the Koreancontext. In many cases, the practice was to rely on Japanese personnel andbureaucratic procedures until suitable replacements could be found. The requestthat Mr. Byun register his presence with local authorities may be seennot only as part of an exhaustive survey of trained medical personnel butalso as an inventory of social resources as a whole. As the American militaryhoped to hand over its authority to an independent Korean government, aprospect that was looking increasingly likely by spring 1947, there needed tobe a thorough accounting of available facilities and personnel.

This effort to survey local resources was framed in terms of public healthconcerns that had been raised during previous campaigns in Europe and, muchcloser to the Korean peninsula, the conquest of various island groups held byJapanese forces. In pragmatic terms, this meant that the major concern—evenabove the welfare of the Korean population—was that of maintaining thehealth of American occupying forces. The need to survey encompassed thoseelements that could potentially contribute to the spread of disease—includingthe availability of clean water and sanitation facilities, contact with animalpopulations, and the regulation of refugee movements—and required the presenceof American personnel trained to handle such contingencies. Koreans,on the other hand, had a lengthy tradition of relying on traditional practitionersto satisfy the basic requirements of daily health and were not always certainabout the value of Western biomedicine, especially as it had been heavilypromoted by Japanese public health personnel in conjunction with a variety ofpublic health campaigns.

Unlike other military occupations taking place at about the same time—thosein Germany, Japan, and Austria—the occupation of Korea did not requirethe removal of a particular ideology or political party, but instead, theremoval of members of a specific group, Japanese nationals. More specifically,the Korean case involved the replacement of Japanese medical personnelby local trainees so that members of the former group could be repatriatedto their home islands. In the course of undertaking this task, however, Americansoldiers believed that there were not enough Koreans with the requisitetraining, meaning that Japanese police, professors, teachers, and doctorsmaintained their positions well into 1946 and sometimes even beyond. Inthose cases where replacements could be found, new staff members tended tobe Koreans who had previously found favor with colonial authorities and whowere sometimes viewed as compromised by their peers. With respect to medicinespecifically, this claim has been made by Korean scholars, arguing thatdeparting Japanese personnel were replaced by a group of similarly mindedKorean physicians.

Contributing to the sense of urgency from the American perspective wasthe added contingency of disease control, a problem complicated by the movementof new populations on the peninsula, a subject to be taken up in the nextchapter. Horace H. Underwood (1890–1951), a senior figure at USAMGIKand member of a prominent missionary family, was among the American missionarieswho had returned to Korea to assist with the task of rebuilding. Takinga position with the Education Bureau, Underwood was ideally situated asan observer and wrote numerous reports regarding the problem of refurbishingan education system that had been largely neglected during colonial rule.In emphasizing a general expansion of access to education, Underwood calledfor 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 ofKorea. In making this appeal, Underwood reinforced the link between tworelated perceptions, a shortage of medical doctors to serve the local population,as well as the tendency of medical personnel to be concentrated in urbancenters. With this appeal, Underwood backed a proposal that would dominatethe USAMGIK approach to the problem of maintaining public health, adesire to rely largely on doctors trained in the Western medical tradition. Ifpractitioners such as Mr. Byun merited attention and were represented in the1947 survey, their skills and expertise were nonetheless considered only marginallyeffective. Ultimately, Byun Sang-hun’s career does not represent oneof elision but rather the complicated story of a set of skills that began to adaptand transform in the late nineteenth century, facing a succession of challengesto its authority. The issue of increasingly sophisticated forms of surgical interventionand the emerging problem of disease control—particularly entericdisease such as typhus and cholera—were only two of the claims put forwardto question the value of traditional practice, which nonetheless succeeded inreinventing itself, both as an independent approach and as a complement toWestern medical practice in the newly formed ROK after 1948.

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

If traditional medicine has not always received its due, moreover, thisdevelopment needs to be examined not by looking at practitioners in isolationbut by looking at the rapid emergence of newer medical institutions thatwould come to dominate the South Korean scene. Missionary families like theUnderwoods provided a means to guide funding and resources from Westerndonors to local institutions, first during the colonial period and, subsequently,with independence and the Korean War. These resources initially went almostexclusively to promoting the growth of biomedical practice; in particular, SeveranceHospital and Seoul National University Hospital would represent twoof the most influential institutions in terms of training significant numbersof Korean doctors and nurses, along with subsequently promoting the practiceof public health. In choosing to focus on Byun Sang-Hun, this chapterargues specifically that this second story, which has tended to dominate thehistoriography, remains highly contingent: Biomedicine’s appeal lay preciselyin its ability to highlight a perceived contrast with hanuihak, the dynamicmodern posed against the perceived role of the static past. Cast as part of thelatter, Byung Sang-hun would be celebrated as a heroic figure near the end ofhis life, a bearer of traditional practice through difficult times.

Traditional Korean Medicine and the Appealof Its Practitioners

Scholars focusing on the role of Korean traditional medicine typically selectfrom among three periods, either late Choson (1876 through 1910), colonial rule(1910 through 1945), or the period of independence following the occupation(from 1948 to the present), marking the beginning of the ROK. While this approachhas produced a growing body of literature, especially for the complexnegotiation between the first two periods, it has often treated the post-1945 storyas one marked primarily by the emergence of large-scale Western biomedicineand assuming traditional practice as a given. In fact, Korean traditional medicinealso underwent enormous changes during this period (1945–1965), particularlyfollowing the Korean War, when it began to be taught in university degreeprograms for the first time. This process of accommodation therefore representsan extremely valuable activity in itself, especially as it took place at a timewhen the ROK was in the process of refashioning its own independent institutionsand practices. In this refurbished form, traditional Korean medicine (orTKM) forms a critical component of the South Korean national story.

In arguing for the adoption of this terminology, I am following the practiceof recent scholars of China, many of whom have argued that traditional medicalpractices reorganized under the PRC have to be treated as a distinct field,comprising a set of practices designated under the rubric of traditional Chinesemedicine or TCM. For the comparable Korean case, I propose to adoptthe label TKM, aiming to encompass the revised forms of practice emergingin late Choson and colonial rule (1876 through 1945) as well as the new universitydegree programs that appeared in an independent South Korea beginningin about 1965. Moreover, the analogy between the Korean and Chinesecases is a useful one, as the transformation of medical practice was commonto the nations of East Asia. Once an elite set of practices catering almostexclusively to the court, TKM, in contrast, became associated with the ruralcountryside, thereby making it available to a much wider demographic. Incontemporary South Korea, the use of herbal remedies and TKM now standsalongside Western biomedicine as a legitimate form of practice, with manyKoreans choosing according to their particular ailment.
(Continues…)Excerpted from Reconstructing Bodies by John P. DiMoia. Copyright © 2013 by Board of Trustees of the Leland Stanford Junior University. Excerpted by permission of STANFORD UNIVERSITY PRESS.
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