近世日本産科史の研究―産婆と女性産科医を中心に―

Abstract

生產作為人類歷史中恆久不變的根源性課題，與女性的身體密不可分。女性史研究在探討女性生殖機能的同時，也關注生產在歷史進程中逐漸醫療化的轉變，即是從迷信、咒術等傳統實踐行為，轉為以科學與醫學知識為基礎的產科醫療體系。在日本產科史的研究脈絡中，先行研究聚焦於近世時期產科知識與技術的發展，並藉此分析女性身體觀與胎兒觀的變化。然而，相較之下，對於實際參與產科醫療的女性醫療從事者，亦即產婆與女性產科醫師，她們所擔當的角色、實際所為，以及歷史意義的探討，相對上較顯不足。 本稿旨在釐清近世日本產科史中，女性醫療從事者的角色變化及其發展脈絡，並為其在產科醫療形成過程中的歷史位置予以定位。第一章概觀日本產科史，整理產科醫療中知識與技術層面的演進，其中，賀川流產科的出現被視為日本產科學邁向近代化的重要轉捩點。賀川玄悅提出正常胎位說，創案難產手術「回生術」，並批判既有的「產椅」與「腹帶」等慣習。其門弟更進一步以母子雙全為目標，推動難產手術的改良。 第二章以產婆為主要分析對象，透過賀川流門人在產科書中對產婆的論述，探討近世產婆的實際樣貌。賀川玄悅的弟子山邊文伯批判產婆缺乏師承體系與專門書籍，過度依賴自身經驗。而平野重誠的《坐婆必研》則系統性地整理產婆所需之知識與技術，具有產婆職業教育先驅性的意義。 第三章則聚焦於近世末期至明治初期活躍的兩名女性產科醫師，楠本稻（イネ）與光後玉江。透過楠本稻的〈履歷明細書〉追溯其學醫歷程與醫療活動，並藉由光後玉江的診療紀錄與患者書信等一手史料，考察其作為女性醫師的日常實踐，以及其在地方社會所獲得的信賴。 綜上所述，本文透過產婆醫療化、近代化的進程，以及女性產科醫師的具體實踐，闡明女性醫療從事者在產科領域中的歷史意義。

Childbirth is a fundamental issue in human history and an activity inseparable from the female body. In the field of women’s history, alongside discussions of female reproductive functions, childbirth has been examined through the process of the medicalization of obstetrics, in which practices once grounded in superstition and ritual gradually shifted toward scientific and medical knowledge. While previous studies of Japanese obstetrical history have clarified the development of obstetrical knowledge and techniques, as well as changes in perceptions of the body and the fetus, research centering on the practices and roles of female medical practitioners, such as midwives and female obstetricians, remains comparatively limited. This study aims to elucidate the historical process of the roles played by female medical practitioners within Japanese obstetrical history. Chapter One provides an overview of Japanese obstetrical history and outlines the development of obstetrical knowledge and techniques, positioning the emergence of the Kagawa school of obstetrics as a critical turning point in the modernization of Japanese obstetrics. Kagawa Gen'etsu advocated the theory of cephalic presentation, devised the difficult-delivery procedure known as the “回生術”, and criticized customary practices such as the use of birthing stools and abdominal binders. His disciples further advanced surgical techniques for difficult deliveries, aiming not only at maternal survival but at the preservation of both mother and child. Chapter Two focuses on midwives, examining their actual conditions in the early modern period through discussions of midwifery found in obstetrical texts written by members of the Kagawa school. Yamabe Bunpaku criticized midwives for lacking systematic education and relying excessively on experience, whereas Hirano Shigemasa’s “坐婆必研” presented the knowledge and skills required of midwives and played a pioneering role in the development of vocational education for midwives in Japan. Chapter Three examines two female obstetricians active from the late early modern period to the early Meiji era: Kusumoto Ine and Kougo Tamae. By analyzing Kusumoto Ine’s curriculum vitae, the chapter traces her educational background and medical activities. In the case of Kougo Tamae, primary sources such as clinical records and letters from patients are used to shed light on her medical practice and the trust she earned within local communities. Through an examination of the medicalization and modernization of midwifery and the concrete practices of female obstetricians, this study seeks to clarify the historical significance of female medical practitioners in the field of obstetrics.