When healthcare was a royal prerogative

(No.10, Vol.4,Nov-Dec 2014 Vietnam Heritage Magazine)

Tran Tien Hy, middle, an imperial physician during
the Nguyen Dynasty in Hue.
The photo was taken in front of his grandmother’s house in Hue.
Photo from the archive of
researcher Nguyen Dac Xuan

Medical activities under the Nguyen Dynasty were still very rudimentary. Although the Nguyen Dynasty organized many ministries like the Ministry of Personnel, Ministry of Revenue, Ministry of Rites, Ministry of Defence, Ministry of Justice, Ministry of Works, and Ministry of Education, there was still no comprehensive agency for the management of medicine.
In the capital of Hue, there was the Institute of Supreme Medicine (Thai Y Vien), which was only a small medical unit reserved for the Emperor, the Royal Family, and the Imperial Court. Everything else was entrusted to rustic physicians and magicians, who freely worked their trade. Although they were not promoted, they were not bound by any laws.
The selection of doctors for the Institute of Supreme Medicine also did not adhere to any concrete regulations. Anyone who had studied medicine and carried out the trade of a rural physician, despite their background or social origins, could apply for admission into the organization. However, in reality, the majority were the progeny of imperial doctors or those recommended by the Institute of Supreme Medicine.

In 1850, during the reign of Emperor Tu Duc, the first medical university was founded with the goal of training personnel for the Institute of Supreme Medicine managed by an Institute Commissioner. Every year, they held an examination for the recruitment of superb rural doctors from north to south, who were called medical candidates (y sinh).
Whenever the Emperor left the Imperial Palace, one of the imperial physicians from the Institute of Supreme Medicine had to follow along to attend to the emperor. Only doctors from the Institute of Supreme Medicine were permitted to investigate the pulse of the emperor or empress. Whenever the emperor wanted to get his health checked, the two highest-ranking members of the Institute of Supreme Medicine were notified first; these two needed quiet time in order to have the lucid, tranquil, wholesome and unburdened spiritual essence when taking his pulse before making a diagnosis. After checking the pulse, they returned to consult with the doctors of the Institute of Supreme Medicine to carefully discuss complications and arrive at a truly accurate diagnosis. Afterwards, they drafted a prescription complete with the signatures of the doctors on the panel. The prescription would then be assessed by the Privy Council and presented to the Emperor for his consideration and approval.
Whenever the Empress grew ill, the doctor from the Institute of Supreme Medicine was invited to examine her pulse. The empress lay behind a curtain held up by courtesans that left only a small gap, just enough for the hand of the patient to stick through to the outside. The doctor examined the pulse through a thin silk cloth that discreetly covered the Empress’s hand. [To avoid pointing directly at the body of the empress] Sometimes an ivory statue had to be used to point things out, make inquiries, or describe an ailment. Thus, the medical diagnostician could hardly execute his art in accord with the principles of Oriental medicine – view, listen, examine the pulse, and inquire–which speaks to some degree of the confusion involved when diagnosing an illness.
Obstetric and gynaecological issues lay in the hands of midwives who specialized in delivering babies. These people were usually women in the inner palace who were trained to be midwives. Emperor Gia Long had 22 children; Emperor Minh Mang had 126 children; and Emperor Thieu Tri had 37 children. All their midwifery and paediatrics were entrusted to the midwives. The doctors of the Institute of Supreme Medicine were only called during the postnatal period or when obstetric complications arose. Nevertheless, they were only permitted to check the pulse and issue prescriptions.
When imperial concubines grew ill, they had to be taken out of the Imperial Palace for treatment. They convalesced in the Royal Female Sanatorium (Binh An Duong), which was a small tile-roofed building to the northeast of the palace.
The army in general and even the soldiers defending the Imperial City did not have any military medical organization to look after them. When soldiers got sick, they convalesced in the military barracks and found their own doctors for treatment. If they had serious diseases, they were permitted to leave the barracks to seek treatment. If they were afflicted with incurable diseases, then they were relieved of their duties and allowed to return to their hometowns.
Medical provisions for the soldiers and magistrates were only carried out at certain times and in particular regions.
Throughout the 18th century, clergymen held a role as doctors alongside the Hue court. Among them were the French monk Vachet and Polish monk Koffler. They were the first persons to spread the seeds of Western medicine.
Since the 19th century, clergymen who doubled as doctors were replaced by trained physicians.
In 1820, the surgeon Treilard of the French Navy arrived in Danang. He was summoned to the palace by Emperor Gia Long to attend to the health of the Princess. On many occasions, he secretly examined the ailments of the Emperor.
According to ‘Duvigneau in Revue Indochinese’ (1906), the French naval doctor J.M. Despiau became an Imperial doctor during the reign of Emperor Gia Long and served for 20 years up until the reign of Emperor Minh Mang. Despiau was a trusted servant for the Emperor. During the time when smallpox spread among the population, the Emperor sent him to Macao to seek out a vaccine.
After Despiau, it would be over 50 years before another doctor would be invited to the Hue court, so only doctors from the Institute of Supreme Medicine looked after the medical services of the court.
It was not until the early years of the French occupation that Western doctors finally returned to penetrate the court. During this time, Dr. Cotte of the French Mobile Hospital, who was stationed at Thuan An harbour, was repeatedly summoned to the palace to treat the illnesses of Emperor Dong Khanh.
Western medicine became prominent from the day that the Central Hospital of Hue was established in 1896 along with the Laboratory Medical Bio-Chemistry and the Central Pharmaceutical Office.
*Doan Van Quynh is a Hue researcher

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