Gender of Profession: The Nurse and The Medical Practitioner at the Tokyo Imperial University Hospital

Abstract

This article explores the shaping of gender hierarchy between the nurse and the doctor in modern Japan, through the lens of the Tokyo Imperial University Hospital. I understand gender hierarchy of these two medical professions not just in terms of ranks in hospital bureaucracies, salaries, or educational credentials, but also the ways their work was defined, their skill levels were evaluated, as well as the probability of their united actions as members of a single profession to advocate their shared interests. Tokyo Imperial University is Japan’s oldest university, which is the birthplace of modern medical education. The hospital of this university was a symbolic locus for the making of gender hierarchy of the doctor and the nurse, which often transpired in other institutions and articulated in state regulations such as the Nurse Regulations prepared by Home Ministry officials in 1915. In this hospital, doctors who were male, while designing nursing education and labor practices, defined nursing primarily as women’s supplementary labor for doctors. While doctors had an exclusive professional territory, such as diagnosis, surgery, and medication, what nurses’ exclusive professional territory was undefined and how their skill levels could be evaluated remained unclear. In other words, probationary nurses often worked together with trained nurses, which allowed managers of the hospital to exploit their cheap labor, as well as attenuating the professional authority of the trained nurses.</br>But, this process did not go unchallenged. Leaders of nurses at this hospital, such as Suzuki Masa and Ōzeki Chika did not think that nurses should be subordinated to the doctor. As managers of the Tokyo Imperial University Hospital hired unmarried women to have them endure intense labor with low wages, Ōzeki publicly protested a doctor at Tokyo Imperial University to improve nurses’ working environment, and these two soon resigned.</br>After the resignation, Suzuki organized a visiting nurse service company called The Charity Visiting Nurse Corps (jizen kangofukai), and dispatched a group of its member nurses to the clients. Unlike when they worked in the Tokyo Imperial University Hospital, they became an independent service provider, deciding their work schedules, and the fees for their service for themselves. Compared to their wages in the Tokyo Imperial University Hospital, the service fees were two to three times higher in this new company. As nurses came to claim a high pay, visiting nurse service companies of this kind blossomed in Tokyo and other big cities,</br>However, they eventually failed to gain a clear legal definition of what nurses could exclusively do as professionals and how their skills were assessed, and private nurses lost their high demand during the Great Depression. By looking at this process, this article reconfirms the conventional wisdom that the gender hierarchy of doctors and nurses were not biologically given but socially constructed through the interplay of education, employment, state policies, and the market, and considers why nurses’ efforts alone could not challenge the entirety of this hierarchy, without institional supports from the state.