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468medicine.In light of the success of the cowpox vaccine and the reputation of Pompe van Meerdervoort, Japa-nese medicine proceeded to retreat from Eastern medicine and introduce standardized Western medicine. In 1858, the shogunate publicly recog-nized the cowpox vaccine introduced by the Western physicians. In 1860, the Otamagaike Insti-tution for Vaccination, established by interested physicians, came under the direct management of the government. In 1861, it was renamed the School of Western Medicine, and the shogunate govern-ment directly ran facilities for treatment and educa-tion in Western medicine.As Western medicine was publicly recognized, plans for the introduction of Western medicine were prepared throughout Japan. In Sakura and other locations, Western-style hospitals were built. In Saga han, all physicians were retrained in Western medicine, and a measure was introduced outlawing traditional Chinese medicine. In terms of education, some hans, including Satsuma han, taught Western medicine at educational institutions, and Western medical education spread across Japan.The end of isolationism and the establishment of formal diplomatic relations with foreign countries stimulated domestic discussion regarding how Japan should approach relationships with Western countries. Among physicians who had studied Dutch and Western medicine in private medical schools, some quickly noticed the need to respond to changes in international relations and became active in fields other than medicine. In 1868, 14 years after the end of isolationism, the Edo shogu-nate was defeated during the Meiji Restoration. The new governing body aimed for a centralized government based around the emperor, and the administrative, legislative, and judicial systems considerably changed. In terms of medical treat-ment and education, in contrast to the Edo period in which the system differed among each han, the new government set its sights on a unified, coun-try-wide approach.It was decided to modernize practices, particu-larly by incorporating Western medicine from Germany. However, many physicians at the time were practitioners of Japan’s traditional medicine, meaning there was an urgent need for educating physicians who learned Western medicine, while previous physicians were also continuing to prac-tice. The “Medical Code,” published in 1874, served as the guiding principle regarding medical treat-ment, and several laws and regulations were regu-lated based on it. To train Japanese physicians in Western medicine, plans were made for instructors to be invited from Germany and for the Japanese physicians trained under their tutelage to become instructors and train other Japanese physicians. Further, there were many Japanese physicians studying abroad in Western countries, particularly in Germany.［Takanaka Sato］Medical trainingThe second head of Juntendo, Takanaka Sato (1827–1882), was the son of a physician of Omigawa han, which lay about 90 km east of Tokyo, and raised in Edo. First named Jo Shunkai, he studied under a Western medicine-practicing physician. Already skilled for treating wounds at the age of 16, by his mentor’s advice he entered Wadajuku, the school of the prominent surgeon Taizen Sato. Immediately after entering the school, Shunkai moved in response to Taizen’s move to Sakura. Shunkai studied Western medicine at Juntendo and gained considerable surgical skills. Taizen recog-nized his potential and skill, and in 1853, Taizen adopted Shunkai and selected him as his successor for the management of Juntendo. In the Edo period, many professions were hereditary, and an inheritor was often the eldest son, but a talented child also would be welcomed from another family as an heir. One of Taizen’s children, Ryojun Matsumoto, was a physician, but he had been adopted by another family, and Taizen affiliated Shunkai as his successor. Subsequently, Shunkai took the name, Takanaka Sato.We can get a glimpse of Takanaka’s undertaking from “Juntendo Surgical Experiments.” In that book, other than records of Taizen’s treatments, five cases relating to Takanaka were recorded. Although it was difficult in Japan at the time, Takanaka performed a successful inguinal hernia surgery, ligation for an arterial injury, etc. with Taizen by followed the procedure described in a Dutch medical journal. Furthermore, similar to Taizen, Takanaka dedicated himself to translating Dutch medical texts into Japanese and constantly