고문서로 본 조선 후기 환자의 질병과 치료 - 『고문서집성(古文書集成)』에 수록된 병록(病錄)을 중심으로

Abstract

A byeongnok (病錄) is a document in which a patient recorded the state of their illness in order to request treatment from a physician. Unlike royalcentered chronological records, these documents allow us to examine the circumstances of illness and treatment among the literate class who were capable of leaving such records. Whereas ui-an (醫案), which have typically been the focus of previous research, are written from the physician’s perspective, the byeongnok stands out as a primary record from the patient’s point of view, conveying the patient’s voice directly. Through the examination of over 30 byeongnok included in the Collection of Historical Documents (古文書集成), we can observe various characteristics of disease and treatment among people, mostly living in rural areas, during the late Joseon period. One notable feature is the detailed documentation of both personal and familial medical histories. These records not only include past illnesses, but also reveal patterns in the patient’s behavior, their relationships with physicians, and their level of understanding regarding their own diseases. In order to provide as much information as possible to the physician, patients sometimes described illnesses they had suffered since childhood or symptoms experienced at different stages of life. To describe symptoms more precisely, they occasionally used hangul (Korean script), and some records appear to have been updated with new symptoms appended to earlier entries. However, possibly due to the practice of sending these documents to multiple physicians via intermediaries, the names of patients and physicians are often omitted. Due to family structures at the time, mens’ byeongnok tend to be more detailed and cover longer periods, whereas womens’ records usually focus briefly on present symptoms. In some cases, if the patient had medical knowledge or if the illness resembled a past experience, they would attempt initial self-treatment. If that failed, they might consult a knowledgeable acquaintance or finally send a byeongnok to a physician for a prescription. When a physician’s treatment was deemed ineffective, patients often stopped the medication on their own and sought another practitioner. For many living in rural areas, if no satisfactory treatment could be found locally, they eventually looked to Hanyang (the capital). In a time when transporting patients for treatment was difficult and physicians could not always make house calls, byeongnok became a vital tool for seeking medical care. The authors of these records tried to include every possible helpful detail within their own understanding of medical knowledge. Many show a clear grasp of the basic medical framework that attributed disease to either external afflictions (oe-gam) or internal damage (nae-sang), and they often recorded their conditions with remarkable precision. While it cannot be said that everyone in the late Joseon period possessed comprehensive medical knowledge, the literate class appears to have held at least a basic understanding sufficient to care for themselves and their families.