Physicians' Groups and Networks
At the same time, physicians in Tokugawa Japan were also part of local groups of medical professionals. These groups comprised domain and town doctors of all specialties and served as vehicles for both occupational self-government and seigneurial control. They were status groups in the sense that they placed their members within the structure of Tokugawa rule and managed their members' status and public obligations. While the structure of these groups was hierarchical and dominated by the domain doctors, members participated in the tasks of self-government and consensus-building on the basis on shared medical knowledge. Broadly speaking, there were two types of medical professionals in Tokugawa Japan: domain physicians, who directly served the lord and received stipends according to rank, and town and village physicians, who lived among commoners and primarily treated commoner patients. Both types, however, performed certain duties for their lords. In addition to the exercise of self-control, they might have been expected to treat prisoners, for example, or accompany the lord on his travels or pay their respect at the palace at certain times of the year.
In the course of the nineteenth century, many feudal rulers in Japan intensified their oversight of medical practice in their territories. In the castle towns of Fukui and Fuchū, for example, domain and town doctors began to coalesce around newly established medical academies and exercised stricter control over the practices of village doctors and the sale of medicinal herbs to domain subjects. Medical academies issued rules that specified physicians' respective responsibilities within the group. In Fuchū, physicians affiliated with the academy referred to themselves as a shachū (society) [Umihara].
The status groups of physicians were organized by domain. However, when Kasahara Hakuō, a town doctor of Fukui domain, brought the smallpox vaccine to Echizen, he immediately established a regional network connecting vaccinators in many local domains. Because of the exigencies of vaccine transmission, this new network, which the founder called a "society" (shachū), was much more formal than previously existing ties between physicians in adjacent domains. Membership required the signing of an oath and strict adherence to a set of practices and ethical commitments. Within this network, physicians who had sworn the oath and acquired the necessary training created separate chapters (also called shachū) in each domain to collaborate with domain officials while protecting the society's rules. While the vaccinators remained integrated into their local status group of doctors, they also followed a common pattern among occupational groups in Tokugawa Japan. They linked up with similar groups in other territories to form a self-governing transregional organization that could challenge domain authority to a certain extent.
