의원의 서사로 본 조선 후기 의료의 사회문화적 풍경

Abstract

Previous studies that explored the medical topography of the late Chosŏn dynasty have primarily focused on such subject matters as royal medical cares, central and local medical systems, familial pedigree of medical officers, knowledge and material exchange with China or Japan, and the medical cultures of Chosŏn Korea from the perspective of the ruling class Yangban elites. What these studies did not involve in their discussions are medical cultures seen from the perspective of medical practitioners, who were commonly recognized as lower than Yangban elites in terms of social status. So, this paper examines the socio-cultural landscape of medical care, life and practice in the late Chosŏn period, through the analysis of medical case histories (and narratives therein) composed by doctors. To this end, this paper primarily investigates medical case histories written in the late Chosŏn period: Rambling Essay on Tested Experiences 歷試漫筆 (1734), Efficacy-Proven Recipes by Yim Chŏng 小白經驗方 (1740), Miscellaneous Writing by Chang Taekyŏng 愚岑雜著 (1856), Efficacy-Proven Recipes by Ŭn Suryong 呑吐經驗方 (1858), and New Compilation as an Easy-to-Carry Treasure 輕寶新編 (c.19th century). Analyzing these historical sources, this paper does not just describe the fragmented aspects of clinical encounters, but also examines the cultural structures, as well as cognitive and sociological dimensions, within which medical practices took place, primarily drawing attention to the major issues revealed in the cognitive yet social processes. What is worth stating here is that the conventional dichotomous world view, such as the “tradition versus modern” narrative, should not be taken for granted. Doctors’ record of medical cases yields significant effects of documenting medical experiences, educating younger scholars, building personal reputations, making a living, and winning over competitors. On this count, doctors (as protagonists of the narratives of medical case histories, and experts in judging the disease patterns to be deficient 虛 or excessive 實) frequently emphasized medical expertise, rather than medical virtue, against the backdrop of the competitive medical markets, whilst pointing out the whimsy or discourtesy of their patients. In the doctor-patient relationship, the doctor's authority was basically situation-dependent and they were in an, as it were, precarious alliance with the patient side (patients and their family members). The patient side was not just in a passive position, but was rather an active actor to the extent that they selected doctors and discussed therapeutic strategies with them, and completed the patient’s story under the guidance of doctors about the patient’s experiences, to participate in the treatment procedure. Medical practice was also a social process in the sense that cultural clashes or negotiations were taking place between doctors, patients and other doctors in the social network of doctors and patients. Medical case histories, in which narratives were conspicuous, often presented diseases as life-threatening bodily episodes that occur under some contingent conditions. This is where ecological conditions, foods and drinks, human interactions and bodily injuries come in as disease-causing factors, and all of these also constitute both the body and the disease. Of these, emotion-induced disease (understood as a hybrid of the social, body and disease) stood out in the narrative of medical case histories. Considering medical tools, not least medicinals, employed in the late Chosŏn period, we can see that, unlike the case of modern people (who are accustomed to the urban life which is away from nature, and to the nicely packaged drugs which are produced in pharmaceutical factories), medical life of those days was much closer to the natural objects, such as nearby plants, animals and minerals, which were in fact part of their lives. All of these observations provide us with an opportunity to become aware of familiar cultural structures in an unfamiliar-looking landscape of the distant past, challenging the conventional description that has portrayed Chosŏn’s medical landscape only in terms of strange, outlandish, or incommensurable pre-modern aspects.