[Epilepsy and Japanese History] Episode 4 | The Light from Nagasaki
The day Western medicine brought the term "brain disease"
November 1857, Nagasaki.
Twelve Japanese doctors gathered in a room at the magistrate's office.
Standing opposite them was a 28-year-old Dutch naval surgeon, Johannes Lydius Catharinus Pompe van Meerdervoort. The theme he chose for his first lecture was not medicine.
It was physics.
This was not merely the order of the curriculum. Pompe had a conviction: all natural phenomena can be explained through observation and experimentation—and the human body is no exception.
The moment this conviction landed in Nagasaki, the explanatory system built over a millennium by "spirits," "karma," and "convulsion-causing insects" began to waver, quietly but decisively.
The long run-up that began with "Kaitai Shinsho" (New Book of Anatomy)
The influx of Rangaku (Dutch studies) did not happen overnight.
In 1774, Sugita Genpaku, Maeno Ryotaku, and others published "Kaitai Shinsho," a translation of a Dutch anatomical text. It was the first book to systematically demonstrate in Japanese that the brain is the center of thought and sensation.
However, at this stage, the "functions" of the nervous system had not yet been conveyed. Knowledge of anatomy—the shape and position of organs—had arrived, but there was a vast gap in understanding the pathophysiology of "why the brain causes seizures."
The next door was opened by "Seisetsu Naika Senyo," which began to be translated around 1793. This was Japan's first full-scale Western internal medicine book, marking a turning point where Rangaku, previously centered on surgery, stepped into the realms of internal pathology, diagnosis, and prescription. Here, for the first time, the foundation was laid for discussing internal symptoms like seizures as problems of the brain.
And then, Pompe arrived.
"There are only patients"
What Pompe brought to Japan was not just medical knowledge.
During his five-year stay, he awarded diplomas to 61 students and examined over 14,500 patients. His practice was governed by one principle: he made no distinctions based on wealth, social status, or whether one was Japanese or Western.
There is a quote by Pompe that has become the school motto of the Nagasaki University School of Medicine.
“A physician must be well aware of their calling. Once this profession is chosen, the physician no longer belongs to themselves, but to the sick.”
The perspective that “there are only patients” also holds revolutionary significance in the history of epilepsy.
Stripping away all labels—those possessed by spirits, those carrying the karma of a past life, or the shame of a family—and facing them as “patients with a brain disease.” That perspective did not exist in feudal Japan.
In September 1861, a clinic opened on the hills of Kojima-go, overlooking Nagasaki Harbor. It was Japan’s first modern Western-style hospital, equipped with 124 beds and four operating rooms. For the first time, medical care based on symptoms and pathology, rather than status, lineage, or spiritual background, began to be practiced as a system.
What is happening inside the brain—the birth of a new question
The physiology and pathology conveyed in Pompe’s lectures were directly related to the understanding of epilepsy.
What is the nervous system? How does the brain function? And what happens when brain function is disrupted—these were explained for the first time in scientific terms.
The concept of “kan no mushi” (the worm of convulsions) attempted to explain the outside of the phenomenon of seizures. However, Western neurophysiology asked about the inside of the seizure—what is happening inside the brain.
This shift in the direction of the question was decisive.
In Europe during the same era, the neurological understanding of epilepsy was advancing rapidly. In 1873, British neurologist John Hughlings Jackson proposed the theory that epileptic seizures are caused by “excessive or disorderly discharges of nerve tissue in the brain.” This is almost identical to the modern definition—the “excessive electrical excitation of cerebral neurons.”
For a thousand years, seizures had been explained as “something coming from the outside” or “having a cause within oneself,” but for the first time, they were grasped as an “electrical phenomenon of the brain.”
The Meiji Restoration and the institutionalization of medicine
In 1868, the Meiji Restoration occurred. The new government decided to adopt Western medicine as “medicine.”
In 1883, medical licenses were granted only to those who had studied Western medicine, and while Kampo (traditional Japanese) medicine was not banned, it began to decline. Thanks to the efforts of people like Matsumoto Ryojun, who studied under Pompe, German medicine became the foundation of medical education in Japan.
Regarding epilepsy, two changes occurred simultaneously during this era.
One was a change in diagnosis. Terms like “kan no mushi” and “possession by spirits” were replaced by terms like “disease of the nervous system” and “brain disease.” Seizures came to be positioned not as spiritual phenomena or moral issues, but as symptoms explainable through neuroscience.
The other was a change in treatment. In 1857, potassium bromide began to be used as an anti-epileptic drug in Europe, and in 1912, phenobarbital appeared. The concept of “suppressing seizures with medication” became a reality for the first time.
If Kampo remedies like Uncaria hook or dragon bone were empirical treatments that “might work,” this was the first true “treatment” designed based on mechanism.
However, the light was refracted
Medicine changed. But society did not.
Rather, in a sense, the prejudice became more complex. The situation where "seizures continue even though it should be treatable" was easily interpreted as a personal problem. With the establishment of medical explanations, the responsibility for being "unmanageable" was placed more strongly on the individual concerned.
Furthermore, in the context of modern state formation after the Meiji era, "national ability" and "body management" became strongly linked. Epilepsy began to face institutional restrictions in military service, employment, and marriage.
The language of science does not erase prejudice. It sometimes updates prejudice into a more sophisticated form.
From "possessed by a spirit" to "a person with a neurological disorder that requires management"—the label changed. However, the result of being "distanced from society" continued in a different form.
What the door called Nagasaki opened
Nagasaki was the only window Japan had open during the era of national isolation.
One of the most important things that came through that window was the idea that "human suffering has observable causes, not mystical ones."
The realization that a person having a seizure is not possessed by a spirit, nor deeply sinful, nor a family shame, but is a patient with an abnormality in their nervous system, spread gradually throughout Japan through the modern medical education that began with Pompe.
However, it took a long time for that light to reach every corner of society. And even now, there are places it has not fully reached.
About myself
When I first received the explanation of "electrical abnormalities in the brain," I felt a strange sense of relief.
It is not a spirit, nor karma, nor a family problem. Electrical signals are firing excessively in the brain—that is all it is.
But at the same time, I realized that this explanation solved nothing. Even after obtaining neuroscientifically accurate terms, the questions of "why not tell them?" and "what will happen if I do?" did not disappear.
The light that Pompe brought to Nagasaki was the recognition that "seizures are a brain disease." Compared to the darkness of a thousand years ago, that is a definite step forward.
However, that light continues to be refracted even now, hitting another wall: the prejudice of society.
Even if medicine advances, if society does not change, an explanation will not lead to liberation.
I know this through my own body.
[Series: Epilepsy and Japanese History]
Episode 1: The True Identity of Spirits—The Heian Period and Lady Aoi
Episode 2: Fox Possession and Karma—Konjaku Monogatarishu and Buddhist Interpretations
Episode 3: Infantile Convulsions and the Family System—Until the Edo Period, When a "Culture of Hiding" Was Completed
Episode 4: The Light from Nagasaki—The Day Western Medicine Brought the Term "Brain Disease"
Episode 5: Reach, Waves—Modern Japan, Where Are We a Thousand Years Later?
Episode 6: Hearing the Word "Cannabis"—Our Story of Redefining the Weight of Life
References: Sugita Genpaku, "Kaitai Shinsho" (1774); Pompe van Meerdervoort, "Five Years in Japan" (1868); John Hughlings Jackson, "On the Anatomical and Physiological Localisation of Movements in the Brain" (1873); Nagasaki Yojosho related historical materials; Japan Epilepsy Society historical materials