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Figure 2　Letter from Ryojun Matumoto to Taizen(1860). Ryojun explains to Taizen that learning in Nagasaki is beneficial for Takanaka. (Image courtesy of Juntendo)improving his knowledge and skills.To further improve his skills and knowledge, Takanaka traveled to study under Pompe van Meerdervoort in Nagasaki. It was not easy to travel to Nagasaki while following Taizen’s tracks and managing Juntendo; however, Takanaka was advised by his brother-in-law Ryojun Matsumoto to go, and in 1860, Takanaka left for Nagasaki (Figure 2).Physicians from different areas had come to study under Pompe van Meerdervoort; however, many were graduates of private schools of medi-cine and Dutch studies. Each of these individuals would assume essential roles in the medical field of the shogunate and early Meiji era; however, Pompe van Meerdervoort’s evaluation of the skills and knowledge of these Japanese physicians was harsh.Pompe van Meerdervoort taught medicine that comprised basic and clinical medicine that was recently introduced in Europe. In comparison, Western medicine taught in Japan was not system-atic, and even excellent students who had studied Dutch had to re-learn from basic medicine. It was under these circumstances that Pompe van Meerd-ervoort recorded uncharacteristically high approval of Takanaka’s surgical skill in his memoirs.Medical activities at SakuraTakanaka returned to Sakura from Nagasaki in 1862 and worked as both the head of Juntendo and a Sakura han physician. As a han physician, he revolutionized the Sakura han medical system. In 1866, he abolished education in traditional Chinese medicine in han’s medical school, and while allowing local physicians to continue practicing traditional Chinese medicine, he forbade its implementation by han physicians. He also proposed the establish-ment of a han-managed, Western-style hospital: Sakura Youjousho that was founded in 1867. In terms of medical education and hospital treatments, he emulated the actions of Pompe van Meerder-voort in Nagasaki. He planned to modernize and Westernize medicine and medical education of the Sakura han.Takanaka’s duty as a han physician was not a full-time responsibility, and he was able to continue examining and teaching at Juntendo. He standard-ized a Pompe van Meerdervoort-style of medical education in Juntendo. A time-table of 1865 lectures tells us that Takanaka and the other instructors used records of Pompe van Meerdervoort’s lectures and taught basic and clinical medicine from Dutch texts. Many students gathered at Juntendo, and an 1865 register of names has records of 110 people not only from Sakura han but from across Japan.The shogunate became aware of Takanaka’s successes and requested that the Sakura han transfer him to the shogunate. The Sakura han refused, stating that he was a pivotal figure in the revolution of the medical system currently underway in the han. In this way, Takanaka became known throughout the country during the end of the shogunate as an exceptional figure in medical treat-ment, education, and administration.Activities in TokyoThe Meiji government, founded in 1868, also noticed Takanaka Sato’s accomplishments and abil-ities, and in 1869 appointed him to the highest teaching position, daihakase, in the nationally-run university Daigaku Toko. The origin of Daigaku Toko, the predecessor of The University of Tokyo Faculty of Medicine, was the Otamagaike Institu-tion for Vaccination established at the end of the shogunate. It became the shogunate’s Western medical clinic that was then requisitioned by the Meiji government, becoming Daigaku Toko in 1869. Daigaku Toko was both an institution of medical education and a core institution of national medi-cine and public health administration, supervising the management of vaccination affairs and patenting 469