The state-running medical institutions which had been instituted in the earlier period of the Chosun dynasty substantially downsized during the reconstructing process after the major wars with Japan and Qing dynasty. The downsizing was mainly due to the malfunctioning public financial system; but it was also due to the growth of the private medical market. The growth of the private medical market reoriented the focus of the public health system of the Chosun dynasty from providing treatment for every minor disease to providing the more efficient policy against epidemic. Hwal-in Seo (a temporary local public health center established for epidemic) became a new core of the dynasty's health policy under the phrase of "Ae Rye (saving the rituals)." As the changes of the dynasty's public health policy, the growing private medical market had been admitted into the public domain. Chosun government once had declared Sa Yak Gye (a private mutual-aid group for medicine) illegal and prohibited the private groups to be organized. Instead, with the policy change mentioned above, the government tried to support the private mutual-aid group for medicine while forbidding sales of fake medicine, restraining rise of price of medicine. Especially the Do go merchants often caused the sudden rise of price of medicine by bulk purchasing. Medical practice was reassessed as the period when it was considered as one of the lowest professions had been over. Although the Yangban class still refused to be a professional medical practitioner themselves, they also well understood the value of medicine as a field of study to save human and dismissed negative perception on medicine. Medicine as a field of study and medical practice, which had been underestimated under the ruling system influenced by the Song Confucianism and the status system of the Chosun dynasty, faced a new era. The whole society guaranteed more free practices of the medical practitioners and they were recognized for their works. With the change of social environment, the government officials gradually realized needs to discuss how they could educate and recruit medical practitioners to provide advanced medical treatment and what provisions they had to legislate to ensure the stable supply of the medicine. It is certain that the transformation developed in the medical environment and the changes of the public health policy up to 18th century Chosun dynasty accompanied the emergence of the commercial society. However, the overall social urge was still not enough to induce the actual law-making process. The change of the public health policy and the growth of the private medical market were surely the evidence of the transforming Chosun society; at the same time, they also revealed the immaturity of the medical environment which was not able to lead new health policies.
Health Policy/history ; History, 16th Century ; History, 17th Century ; History, 18th Century ; Humans ; Korea ; Medicine, Korean Traditional/*history ; Private Sector/*history ; Public Health/*history ; State Medicine/history

In the 1950s and 1960s, Korea overcame the aftermath of the war and laid the foundations for modernization of economy and professionalization of medicine. The National Medical Services Law, enacted in 1951 was the first medical law to be legislated since the establishment of the Republic of Korea. The law provided a medical system for the traditional Korean medical practitioners, activated opening of hospitals through report-only system and prohibition of interference in medical practice, and facilitated mobilization of the doctors by the government. The Medical Law, legislated in 1962 by the Park Jong-Hee administration contained practice license system, regular practice reporting system and practice designation, thereby strengthening the government control on the medical practitioners, inducing professionalism and high-quality of medical practitioners and abolished unlicensed medical practitioners such as acupuncturists, moxa cauterists and bone setters. The Medical Assistant Law of 1963 was introduced so that medical examination and assistance could be carried out under supervision of professional doctors. To reduce areas without healthcare system, region-specified medical practitioners got licensure and a community doctor system was organized. However, due to expensive medical fees in comparison to economic status and medical needs of patients, shortage of doctors, low accessibility to hospitals led to the prevalence of illegal medical practice by unlicensed practitioners. Absence of national budget or policy on the health care system and the American-style noninterference medical system were other factors causing the situation. Government, Korean Medical Associations and Korean Dental Association tried, without success, to exercise control over the unlicensed medical practice. President Park Jong-Hee had to introduce a special law concerning the health-care related crimes with life sentence as the highest penalty. While the government put modernization before social welfare, operated on a policy of state-controlled medical care system, and doctors achieved specialization system similar to that of the United States, the public had to suffer, being treated by unlicensed medical practitioners. Inevitably, the need for a national medical practitioner supply plan and a policy to support health service was raised.
Health Policy/history ; History, 20th Century ; Humans ; Legislation, Medical/*history ; Licensure/*history ; Private Sector/history ; Public Health/history ; Republic of Korea ; State Medicine/*history

BACKGROUND: The natural history of bacillary tuberculosis was studied in India and results showed that at the end of the 5-year period, 49% of the patients were dead, 33% were cured and 18% remained sputum-positive. The aim of this survey is to observe the natural course of the patients with intractable tuberculosis disease who were incurable with all drug regimens of the national tuberculosis programme(NTP). METHOD: Of the patients who have been found as intractable cases in Kang-Weon Province by the supervisory medical officer during the period from January 1,1987 to December 31,1992, 179 were eligible for this study. Sputum examination was done for those who were survived until October in 1993 at the Kang-Weon provincial laboratory of KNTA. 49 out of 179 patients were transferred to the private sectors and retreated with the combination of prothionamide, cycloserine, ofloxacin, enviomycin, etc. They seemed to have been bacteriologically cured, and so they were excluded from the study. Finally 130 patients were analyzed by modified life table method to calculate the fatality rate and the survival rate during the period of 7 years. RESULTS: 1) 80.8% of intractable cases were male and 19.2%,female. 2) More than 94% of intractable cases showed moderately or far advanced Tb findings on their X-rays at the time of registration at health centres. 3) The cumulative case-fatality rate was 19.74% at the end of 1-year period and has risen to 34.55% by the end of 4-year period(increasing by 4.9% a year on an average). The case-fatality rate has shown no appreciable rise since then until the end of 7-year period. 4) The case-survival rate was 80.26% at the end of 1-year period and has decreased to 65.45% by the end of 4-year period. And then there was no appreciable change in the survival rate until the end of 7-year observation. CONCLUSION: The case-survival rate of intractable cases was higher than that of untreated pulmonary tuberculosis patients and they may have risk of spreading multidrug resistant organisms. It is time we made an effort to improve case-management qualitatively.
Cycloserine ; Enviomycin ; Humans ; India ; Life Tables ; Male ; Natural History ; Ofloxacin ; Private Sector ; Prothionamide ; Sputum ; Survival Rate ; Tuberculosis* ; Tuberculosis, Pulmonary

The purpose of this study is to understand the reality of imperial medicine by exploring the strategic attitude of the Japanese authority targeting the public who were not patients of Hansen's disease. For this purpose, this study examines the mass media data related to Hansen's disease published in Korea and Japan during the Japanese colonial rule. Research on Hansen's disease can be divided into medical, sociohistorical, social welfare, and human rights approach. There are medical studies and statistics on the dissemination of medical information about Hansen's disease and management measures, the history of the management of the disease, guarantee of the rights of the patients and the welfare environment, and studies on the autobiographical, literary writings and oral statements on the life and psychological conflicts of the patients. Among existing research, the topics of the study on Hansen's disease under the Japanese colonial rule include the history of the Sorokdo Island Sanatorium, investigation on the forced labor of the patients in the island, human rights violations against the patients, oral memoirs of the patients and doctors who practiced at that time. All of these studies are important achievements regarding the research on the patients. An important study of Hansen's disease in modern Japan is the work of Hujino Utaka, which introduces the isolation of and discrimination against the patients of Hansen's disease. Hujino Utaka's study examines the annihilation of people with infectious diseases in Japan and its colonies by the imperial government, which was the consequence of the imperial medical policies, and reports on the isolation of Hansen's disease patients during the war. Although these researches are important achievements in the study of Hansen's disease in modernity, their focus has mainly been on the history of isolation and exploitation in the Sorokdo Island Sanatorium and discrimination against the patients within the sanatorium, which was controlled by the director of the sanatorium. Consequently, the research tends to perceive the problem within the frame of antagonism between the agent of imperialism and the victims of exploitation by the hands of imperialism. Hence, it has limitations in that it has not fully addressed the problem of the people who were not Hansen's disease patients and as such, existed somewhere in between the two extremes in the process of administering medicine under the imperial rule. The purpose of this study is to identify the direction of imperial medicine in the history of Hansen's disease in Japan and to comprehend the characteristics of policy on Hansen's disease developed by Mitsuda Kensuke, who was behind the policy of imperial medicine, and examine the process of imperial medicine reaching out to the people (of Japan and its colonies). To achieve the goal, this study explores how the agent of imperial medicine gain the favor the public, who are not Hansen's disease patients, by means of the mass media. Specifically, this paper examines data in the Japanese language related to Korean patients of Hansen's disease including the mass media data on Hansen's disease in the source book titled The Collection of Data on Hansen's Disease in Joseon under the Colonial Rule(8 volumes) compiled by Takio Eiji, which has not been studied until now. It also reviews the cultural and popular magazines published in Japan and Joseon at that time.
Asian Continental Ancestry Group* ; Communicable Diseases ; Discrimination (Psychology) ; Hand ; History, Modern 1601-* ; Human Rights ; Humans ; Japan ; Korea ; Leprosy* ; Mass Media ; Periodicals as Topic ; Public Opinion* ; Public-Private Sector Partnerships ; Social Welfare