Pierre-Yves Donzé’s excellent book examines the transformation of medicine into a business from the example of Japan during the first half of the twentieth century. Donzé demonstrates that the construction of a market-based healthcare system began during the 1920s and developed over the following decades. Conducting a multifocal analysis of actors such as the X-ray industry, radiologists, hospitals and patients, he argues that economic and business factors were decisive in the transformation process.
Donzé analyses the metamorphosis of healthcare from the interaction of the medical-device industry, doctors and hospitals in a competitive and fragmented healthcare market. He first looks at the emergence of the X-ray-equipment industry as a major driver of the change. The rise of the Japanese X-ray-equipment industry hinged on the evolution of three players in the business, namely Siemens, Shimadzu and TE, the latter two of which were Japanese domestic companies. The German multinational Siemens dominated the market in the first period (1895–1914), then declined during the First World War until the early 1930s, giving way to the rapid growth of Shimadzu. From the early 1930s to 1945, TE followed Shimadzu into the X-ray-equipment business. Shimadzu and TE developed X-ray equipment together with ‘nameless practitioners’ who enjoyed excellent training and understood local demands. Siemens, by contrast, never adapted its technology and goods to specific local conditions.
Medical doctors played an important role in the X-ray-equipment industry by supporting the establishment of radiology as a medical discipline. Until the 1920s, the central objective was to make medical doctors more aware of the possibilities of radiology as a supporting technology for healthcare. In 1930s and 1940s, radiology shifted from progressive autonomisation to real specialisation and then into a foundational structure for professional claims. A statistical overview of X-ray-device patents illustrates the development of the X-ray-equipment business and the cooperation between firms and radiologists. A company’s capacity for inventing new devices and adapting existing equipment to the specifications of the Japanese market rested on intensive cooperation with doctors. Working with the medical community to offer smaller, lighter and cheaper products, Shimadzu became the leading supplier of the Japanese market in the 1920s.
The adoption of new medical equipment such as X-ray devices revolutionised healthcare management. Donzé lastly discusses how the shift of hospitals to medico-technological platforms was not only a technological and professional metamorphosis but also a managerial and financial one. Since health insurance was underdeveloped in Japan until the Second World War, payments from patients became hospitals’ primary funding source, and hospital management sought out profitable patients. Meanwhile, the Japanese government scarcely intervened in the creation of the healthcare market, leaving it largely unregulated prior to the late 1930s. Thus the emergence of new technologies such as X-ray equipment not only transformed medicine and hospitals but also spurred rising healthcare costs.
As a business historian, Donzé applies industrial financial data to healthcare, and it makes his study unique. Through this rich analysis, the professionalisation of radiologists and the way this process connected to the industry are clearly illustrated. The book opens a field of the history of medicine and business in Japan which has barely been explored and thus reveals several interesting aspects that can be further examined. For instance, this study can be connected to the history of the broader electrical-equipment industry, as the X-ray-equipment industry was one among many industries that grew rapidly in 1920s Japan. The trigger of Japanese industrial growth was the First World War, which dissolved connections with German industry and stimulated independence in domestic industry. The electrical-equipment industry produced or imported devices for electrotherapy for the healthcare market. It is important to note that electrotherapy was the most popular therapy among the private healers and spiritual practitioners when the registration of these practitioners started in 1930, and their number was almost same as that of the medical doctors. As Donzé describes, the healthcare market in Japan was hardly regulated at that time and thus the boundary of legal and illegal healthcare was more blurred than we might now realise. The broader field of the Japanese healthcare market emerges when we pay attention to these private practitioners as well as to linkages between Western medicine and folk remedies.
The industrial history of Japan during the first part of the twentieth century, a period of important conflicts, including the Russo–Japanese war (1904–5), the First World War and the Second World War, is inseparable from the Japanese ambition to become a world power. Within this context, medical equipment travelled and was used in a wide variety of contexts. The industry expanded with general needs and demands but also due to personal ambitions. For example, Genzo Shimadzu, the second-generation president of the Shimadzu company, who played a significant role in developing X-ray equipment, aspired to contribute to the Japanese academy. These ambitions drove the development of new equipment. How each individual who lived in that period thought and how these ideas contributed to the medical industry is another big question that arises from Donzé’s stimulating study.
